Toward the Development of an Intervention to Improve Hearing Aid Access for Older People With Dementia

Abstract

Over-the-counter (OTC) hearing aids were recently introduced to improve the affordability and accessibility of hearing aids; however, these devices are designed for self-directed hearing aid fittings which may not be feasible for all older adults. Notably, older people with co-occurring dementia and hearing loss are likely to face significant barriers when using OTC hearing aids. This creates an urgent health inequity: if people with dementia cannot successfully use OTC hearing aids, they may be left without an affordable and accessible option for their hearing healthcare. This dissertation includes three studies that establish necessary scientific groundwork for developing a behavioral intervention program to facilitate successful OTC hearing aid use in community-dwelling people with dementia and their family caregivers. The first study is a proof-of-concept trial which shows that OTC hearing aids are effective for well-selected older adult hearing aid candidates with mild-to-moderate hearing loss and normal cognition. The second study is a large secondary data analysis which reveals significant unmet hearing aid need in people with dementia—and shows that this need is disproportionately concentrated among people with dementia living at home in the community versus other institutional or congregate care settings. These data suggest an intervention for OTC hearing aid use might be most successful when targeted to community-dwelling people with dementia. Finally, the third study is a qualitative exploration of dementia care stakeholder views on the feasibility and acceptability of OTC hearing aids for community-dwelling people with dementia and their family caregivers. Results reveal key advantages of OTC hearing aids for people with dementia—but also indicate a host of stakeholder-perceived barriers which need to be addressed to promote successful OTC hearing aid use in this population.