Factors correlated with hearing aids adherence in older adults: a prospective controlled study

Abstract

Objective

To investigate which factors influence the adherence to hearing aid (HA) use in elderly patients with moderate-to-severe hearing loss.

Methods

This observational, prospective, single-centre study enrolled patients with moderate-to-severe hearing loss. They were evaluated before and 1 year after having either one or two HAs fitted.

Results

A total of 86 patients were enrolled in the study and of these 69.8% (60 of 86; USER group) continued to use their HA at 1 year after fitting; six patients had not continued their use (NON-USERS). The USER group was younger than the NON-USER group, but the difference was not significant. The USER group had a significantly better unaided auditory threshold at baseline than the NON-USER group. HA use resulted in improvements in speech audiometry and auditory threshold. There was also a maintenance of cognitive function in the USER group.

Conclusion

Use of HA for 1 year resulted in improved auditory performance and an absence of a deterioration of cognitive function.

Trial registration: This research was retrospectively registered under no. NCT04333043 at ClinicalTrials.gov (http://www.clinicaltrials.gov/) on the 26 March 2020. This research has been registered with the Ethics Committee of the Area Vasta Emilia Nord under number 104, date of approval 17/07/2017.

Keywords

Hearing loss cognitive functions quality of life daily life impairment.

Introduction

Population ageing is a global phenomenon that particularly affects developed countries.¹ Different factors contribute to increased life expectancy in these high-income countries, including improvements in healthcare and medical technologies as well as social and economic developments. The most recent estimate reports that the mean life expectancy of Europeans will increase by 4.5 years during the next 30 years.² This change in age distribution is impacting both the economy and society, especially healthcare systems because high numbers of older people suffer from physical or sensory functional deficits affecting mobility, communication, memory, vision and hearing.³ The prevalence of hearing loss (HL) increases with age;³ and according to the World Health Organization’s ‘World report on hearing’, the global prevalence of moderate or higher grades of HL increases from 12.7% at 60 years to over 58% at 90 years of age.¹ This demographic shift due to population ageing and population growth will influence the epidemiology of HL.⁴

The main type of HL in older adults, known as bilateral age-related HL (presbycusis), is characterized by deteriorating hearing abilities (such as sound detection, localization and speech discrimination), especially in noisy situations, and the subsequent negative effects on cognition, sociality, sensitivity and more generally quality of life.⁵ There is an association between HL and age-related cognitive decline, which has a negative impact on auditory skills and the execution of psychoacoustic tasks.⁶ Untreated HL, particularly in elderly subjects, leads to consequences in several domains. For example, there is a correlation with an increased risk of dementia,⁷ Alzheimer’s disease,⁸ greater physical inactivity,⁹ mental health problems (such as depression),¹⁰ frailty¹¹ and their level of psychosocial well-being.¹²

The most common strategy to correct presbycusis is sound amplification using hearing aids (HAs). Different studies reported that these devices have a positive effect on the cognitive outcome,^13–17 but most of these studies did not compare the cognitive performance before and after having the HA fitted.

The Italian National Health System partially or totally funds the cost of HAs. In order to obtain the funds for an HA, the patient must be affected by at least moderate HL in their best ear. Due to the increasing number of older adults, the demand for HAs is expected to grow, with a subsequent economic impact on the Italian National Health System. It is therefore essential to understand the efficacy and use of HAs over time in elderly adults. This current prospective study aimed to investigate the factors that influence the adherence to HA use in elderly adults.

Patients and methods

Study aims and participants

This observational, prospective, single-centre study enrolled consecutive patients with at least moderate HL in their best ear at the outpatient service of the ENT Department, Guglielmo da Saliceto Hospital in Piacenza, Italy between February 2018 and February 2021. The inclusion criteria were as follows: (i) ≥65 years; (ii) presence of hearing impairment with at least moderate HL in the best ear; (iii) use of unilateral or bilateral HA for the first time. Patients with previous application of HA, severe cognitive deficits or severe psychosis were excluded from the study.

The primary aim of this study was to investigate the adherence to HA use in a group of elderly adults 1 year after their first fitting. The study analysed which factors among different domains including auditory outcomes, subjective perception of the hearing impairment, quality of life and the cognitive status influenced the adherence to HA use. The secondary aim was to determine the evolution of the different factors analysed after 1 year of HA use.

This research was retrospectively registered under no. NCT04333043 at ClinicalTrials.gov (http://www.clinicaltrials.gov/) on the 26 March 2020 and it is registered with the Ethics Committee of the ‘Area Vasta’- Emilia Nord under number 104 (date of approval 17/07/2017). All study participants provided written informed consent before the first assessment (baseline).

Study design and assessments

The study included two assessments: one before the first use of HA (Pre) and one after 1 year of HA experience (Post). Audiometric measures, questionnaires and a cognitive test were performed at each assessment. More details about the study design, instruments, timing of assessments and inclusion/exclusion criteria are reported in a previously published study protocol.¹⁸

In order to investigate the factors influencing the use of HA, the patients were classified in two groups: the USER and NON-USER groups. The USER group was composed of patients who attended the 1-year follow-up visit or those who reported HA use via a structured telephone interview. Adherence to the treatment was investigated by asking questions concerning to their HA use (during a structured telephone interview) and through the administration of the International Outcome Inventory for Hearing Aids (IOI-HA) questionnaire (in particular the first question) for in-person visits. The NON-USER group was composed of patients who did not attend the 1-year follow-up visit and reported that they had abandoned their use of the HA during the structured telephone interview.

Structured telephone interviews were performed for patients who were unable to attend the 1-year follow-up visit due to the SARS-COVID19 pandemic or other health problems. The interviews were conducted 1 year after the first HA use. Specific questions concerning the use of the HA and the benefits in subjective terms were asked during the telephone call by an expert ear specialist via a structured questionnaire.

Different factors were analysed during the medical appointments, including: (i) monolateral or bilateral HA use; (ii) auditory performances: pure tone audiometry, speech audiometry, Italian version of the Oldenburg Satz (OLSA) test;¹⁹ (iii) cognitive functions: Montreal Cognitive Assessment (MOCA) test;²⁰ (iv) quality of life: Assessment of Quality of Life (AQoL-8D) (with a particular focus on the ‘senses’ subscale evaluating hearing, visual and energy);²¹ (v) daily life impairment: Hearing Handicap Inventory in the Elderly (HHIE) screening test;²² (vi) HA satisfaction: IOI-HA (only during the Post assessment).²³

With regard to auditory performance, the study evaluated Pure Tone Average (PTA) by the pure tone audiometry and Speech Reception Threshold (SRT) by the speech audiometry. PTA is the mean air-tonal threshold at 500, 1000, 2000 and 4000 Hz frequencies. Speech Reception Threshold (SRT) is defined as the level of speech corresponding to 50% of correct answers. PTA and SRT were evaluated in free-field unaided condition before the first fitting of the HA and in free-field aided condition during the Post assessment.

Statistical analyses

All statistical analyses were performed using R Statistical Software (R Core Team [2020], R: A language and environment for statistical computing. R Foundation for Statistical Computing, Vienna, Austria). As this was a prospective study carried out over a limited time period, it was not possible to perform a sample size calculation. The USER and NON-USER groups were compared using Student’s t-test for independent samples whenever the assumption of normality was not rejected (based on the Shapiro–Wilk test). If normality failed, Wilcoxon rank-sum test was used instead. The null hypothesis in this procedure was the equality of the two distributions (and not only their means) but reduces to the equality of the two means of the Student’s t-test in the case of normality. Similarly, when comparing Pre and Post evaluations Student’s t-test was used for paired samples if normality was not rejected and its non-parametric equivalent (Wilcoxon signed rank test) when normality failed. A P-value <0.05 was considered statistically significant.

Results

This observational, prospective study enrolled 116 consecutive patients. Of these, 30 provided written informed consent but did not attend the first appointment. Therefore, 86 patients with a mean ± SD age of 82.1 ± 6.9 years (range, 67–95 years; 48 females and 38 males) were included in the study. All of them were affected by moderate-to-severe HL with a mean ± SD unaided PTA of 72.2 ± 12.6 dB (range, 51.2–115 dB) and a mean ± SD unaided SRT of 72.3 ± 21.1 dB (range, 45–110 dB). Patients showed hearing difficulties in a noisy environment with a mean ± SD OLSA score of 8.6 ± 5.4 dB signal-to-noise ratio (SNR) (range, −0.6–22.7).

A total of 39 of 86 patients attended both the Pre and Post evaluations and all of them were classified as HA users. The remaining 47 patients only completed the first evaluation (Pre) and did not attend the follow-up visit. All of these patients were contacted for a telephone interview: 21 were actually HA users, six were non-users of HAs, 10 were dead and 10 did not answer the interview. No statistically significant difference was observed when comparing the mean age of the patients who completed (n = 39) and those who did not complete (n = 47) the protocol evaluation schedule (80.8 versus 83.1 years, respectively).

The USER group consisted of 60 patients: 39 patients who attended the 1-year follow-up visit and 21 who reported HA use during a telephone interview. The NON-USER group consisted of six patients. The mean age, the presence of comorbidities, PTA, speech audiometry and questionnaire results at the first evaluation (Pre) were compared between these two groups to better understand the potential impact of these factors on HA usage. The mean age of the USER group (80.7 years) was lower than that of the NON-USER group (86.0 years), but the difference was not significant. A total of 53 of 60 patients (88.3%) in the USER group and five of six patients (83.3%) in the NON-USER group presented with at least one comorbidity. Among these, six of 60 patients (10.0%) in the USER group and none of the patients in the NON-USER group were affected by either mild cognitive disorder, dementia or depression. The mean number of comorbidities per patient was 1.6 in the USER group and 1.1 in NON-USER group.

At the Pre evaluation, there was a significant difference in the mean PTA between the two groups (NON-USER group, 87.5 dB; USER group, 70.8 dB; P = 0.017; Wilcoxon rank-sum test). Wilcoxon rank-sum test did not show significance when comparing the median SRT of the two groups (USER group, 65 dB; NON-USER group, 70 dB).

The responses to the questionnaires were compared using Student’s t-test and the results are presented in Table 1. The mean HHIE score in the USER group was 0.2 points higher than that in the NON-USER group but the difference was not significant. These findings were indicative of the equal effects of hearing impairment on the emotional and social adjustment in everyday life in the two groups. There were no significant differences between the two groups in terms of the HHIE emotional and social subscales. There was no significant difference between the two groups in terms of the mean AQoL-8D scores. In contrast, analysis of the ‘senses’ subscale demonstrated a mild, but not significant, difference at baseline (8.2 points in the USER group versus 9.3 points in the NON-USER group). The USER group had a higher MOCA score than the NON-USER group at baseline, which was suggestive of a better cognitive status, but the difference was not significant.

Table 1.

Questionnaire scores at the first evaluation of elderly patients fitted with hearing aids (HA) who were included in a prospective study to investigate the factors that influence the adherence to HA use stratified according to adherence at 1 year (USER and NON-USER groups).

Questionnaire	USER groupn = 60	NON-USER groupn = 6	Between-group difference
HHIE	23.5	23.3	0.2
AQoL-8D	78.6	85.5	6.9
MOCA	19.0	15.0	4.0

Data are presented as mean score.

There were no significant between-group differences (P ≥ 0.05); Student’s t-test.

HHIE, Hearing Handicap Inventory in the Elderly; AQoL-8D, Assessment of Quality of Life; MOCA, Montreal Cognitive Assessment.

In terms of the characteristics of the HA USER group, different domains were evaluated in order to investigate the benefits of the 1 year of HA use in elderly adults. Although all of the patients were affected by at least moderate HL in their best ear, some of them decided to use just one HA in the ear that had a better hearing threshold because they had uncomfortable hearing when the HA was in the worst hearing ear. The same domains were analysed after stratifying the patients into monolateral (n = 24) and bilateral (n = 36) HA USER groups to verify the efficacy of one- or two-device use.

The PTA and SRT were evaluated in the free-field unaided condition before the first fitting of the device (Pre assessment) and in the free-field aided condition during the Post assessment in 38 patients. Comparison between the unaided auditory results during the Pre evaluation and the aided results during the Post evaluation was performed to investigate the audiometrical benefit of the HA use. The study also verified that the mean auditory threshold (PTA) and mean speech auditory performance (SRT) in the unaided condition had not changed for the duration of the study.

The mean unaided PTA during the Pre evaluation was 71.6 dB in the HA USER group (n = 38) (71.9 dB in the bilateral HA USER group and 73.6 dB in the monolateral HA USER group), whereas the mean aided PTA during the Post evaluation was 48.3 dB in the HA USER group (n = 38) (48.4 dB in the bilateral HA USER group and 48.3 dB in the monolateral HA USER group). The PTA difference between the two time-points was 23.3 dB (P < 0.001) (23.5 in the bilateral HA USER group and 25.3 dB in the monolateral HA USER group; P < 0.001). The median SRT was 65 dB during the Pre evaluation compared with 55 dB during the Post evaluation in the HA USER group (n = 38) (P < 0.001). The mean Pre and Post SRTs in patients using monolateral or bilateral HAs are presented in Table 2. The differences between the two time-points were significant for both groups (P < 0.001 for the monolateral HA USER group; P = 0.019 for the bilateral HA USER group; Wilcoxon signed rank test).

Table 2.

Mean Speech Reception Threshold (SRT) and Oldenburg Satz (OLSA) scores in monolateral and bilateral hearing aid (HA) users who were included in a prospective study to investigate the factors that influence the adherence to HA at 1 year.

HA USER	SRT Pre, dB	SRT Post, dB	SRT difference, dB	OLSA Pre, dB SNR	OLSA Post, dB SNR	OLSA difference, dB SNR
Monolateral HA USER group
Mean	75.5(n = 13)	61.5(n = 13)	14.0	11.0(n = 5)	5.2(n = 5)	5.8
Range	45–110	40–110	P < 0.001			2.5–10.8P = 0.014
Bilateral HA USER group
Mean	70.4(n = 25)	50.0(n = 25)	20.4	6.2(n = 6)	3.7(n = 6)	2.5
Range	45–110	35–65	P = 0.019			−8.1–9.0NS

The number of patients able to perform the test is shown in parentheses.

SNR, signal-to-noise ratio; NS, no significant difference (P ≥ 0.05).

Wilcoxon rank-sum test was used for the SRT analysis and Student’s t-test was used for the OLSA analysis.

With regards to the OLSA test results, only 11 patients undertook the OLSA test during both the Pre (unaided) and Post (aided) evaluations. The mean ± SD score during the Pre evaluation was 8.4 ± 3.7 dB SNR (range, 1.5–13.8 dB SNR) and during the Post evaluation was 4.4 ± 4.3 dB SNR (range, −1.3–12.2 dB SNR) in the HA USER group (n = 11) (P = 0.012). The mean ± SD difference was 4.0 ± 5.5 dB SNR (range, –8.1–10.8 dB SNR). Table 2 shows the difference in OLSA scores during the Pre and Post evaluations in the monolateral and bilateral HA USER groups. Despite the small sample size, the difference was significant in the monolateral HA USER group (Student’s t-test; P = 0.014), but not in the bilateral HA USER group.

The responses to the questionnaires in the monolateral and bilateral HA USER groups are presented in Table 3. There was a small reduction in cognitive performance (MOCA test) observed in the monolateral HA USER group when comparing Pre and Post evaluations; whereas, there was no difference in the bilateral HA USER group. There was a worsening in quality of life (AQoL-8D) observed in the total cohort and in both subgroups. The ‘senses’ AQoL-8D subscale showed an improvement in the total cohort and in the bilateral HA USER group (−0.32 and –0.39 points, respectively), while it worsened in the monolateral HA USER group (+0.31 points). The HHIE score showed a significant difference between Pre and Post evaluation for the total cohort (P = 0.002). After stratifying the cohort into monolateral and bilateral HA users, only the patients that used two HAs showed a significant improvement of HHIE score (P < 0.001). The bilateral HA USER group was more satisfied with the HA effects (IOI-HA score of 29.2) compared with the monolateral HA USER group (IOI-HA score of 24.9) after 1 year, but there was no significant difference between the two groups.

Table 3.

Mean questionnaire scores in monolateral and bilateral hearing aid (HA) users who were included in a prospective study to investigate the factors that influence the adherence to HA at 1 year.

HA USER	MOCAn = 35			AQoL-8Dn = 39			HHIEn = 39			IOI-HAn = 38
HA USER	Pre	Post	Difference	Pre	Post	Difference	Pre	Post	Difference	Post
Monolateral HA USER group	19.7	17.8	−1.9NS	77.2	88.5	+11.3NS	19.4	20.9	+1.5NS	24.9
Bilateral HA USER group	19.7	19.7	0.0NS	76.2	80.6	+4.4NS	24.1	13.2	−10.9P < 0.001	29.2
Total cohort	18.6	19.1	+0.5NS	78.8	83.3	+4.5P = 0.012	24.5	15.8	−8.7P = 0.002	27.9

Data are presented as mean score.

The number of patients able to perform the test is shown in parentheses.

Comparisons were undertaken with either Student’s t-test or Wilcoxon signed rank test according to the normality of the data (the latter being used only for the HHIE scores).

MOCA, Montreal Cognitive Assessment; AQoL-8D, Assessment of Quality of Life; HHIE, Hearing Handicap Inventory in the Elderly; IOI-HA, International Outcome Inventory for Hearing Aids; NS, no significant difference (P ≥ 0.05).

From an evaluation of item 1 of the IOI-HA questionnaire at the Post evaluation of 39 patients, three patients used their HA for 1–4 h/day; 10 patients used their HA for 4–8 h/day; and 26 used their HA for >8 h/day. No significant difference in the mean number of comorbidities was observed between patients that used their HA ≤ 8 h/day (n = 13; mean ± SD comorbidities, 1.5 ± 0.8) and those with a higher HA daily use (>8 h/day; n = 26; mean ± SD comorbidities, 1.5 ± 1.1).

Discussion

The primary aim of this observational, prospective study was to describe the level of adherence of elderly patients to HA use in the first year after fitting. A total of 69.8% (60 of 86 patients) continued to use one or two HAs at 1 year after the first fitting. Only six patients (7.0%) were classified as non-users, while the remaining patients were either dead or did not answer the interview. This rate of non-user was considerably lower compared with data reported in the recent literature. For example, a previous study demonstrated that 19.5% of study participants were no longer users of their HA.²⁴ The study showed that non-use of HAs was correlated with listening difficulties in noisy environments and uncomfortable devices.²⁴ Another study reported that 15.5% of study participants were non-users of HA.²⁵ The study reported that the issues most strongly associated with HA non-use were no perceived need, handling difficulties and not optimal sound quality, whereas it did not find any correlation with cosmetic concerns.²⁵ Continuous HA use was reported in 41% of patients in a recent study that evaluated the HA usage patterns in a group of 1961 HA users by evaluating HL degree, socio-economic indicators and user-related factors.²⁶ In contrast to this current study, it included a wider adult population, not just elderly patients.²⁶ The different findings from these studies are partly related to different sample populations, time of follow-up and methodological approaches used (e.g. survey, interviews or personal letter form). The population recruited in the current study had moderate-to-severe HL with threshold levels higher than those reported in these other studies.²⁷ Therefore, it would be reasonable to assume that the current study has investigated a population with greater rehabilitation needs. It is important to emphasise that different factors are related to the successful use of HA such as the degree of hearing loss, motivation, time of device use, typology of HL (like hearing threshold asymmetry), presence of concomitant tinnitus or number of HA adaptations after the first HA use.^28,29

It should also be noted that most of the published literature have been retrospective studies,^{5,13–15,26,30–32} whereas this current study was prospective. It is important to note that 10 patients did not answer the telephone interview, so it was not possible to determine if there were some HA users in this sample. This current study analysed different factors in order to provide a better understanding of which factors were correlated with the use of HA in elderly adults. The current study found that hearing threshold, cognitive status and quality of life perception were better in the USER group 1-year of HA use.

The current study found that the mean age at the first HA fitting was approximately 6 years lower in the USER group compared with the NON-USER group, although the difference was not significant. Previous studies do not agree that there is a relationship between age and HA use. For example, one report demonstrated an absence of a correlation between age and HA adherence;³⁰ whereas another study reported a correlation between lower age and higher HA satisfaction.²⁴ This latter study described a decrease of 0.3 points of HA satisfaction for every 1 year of increased age.²⁴

It is well known that older adults can present with many comorbidities including difficulties with movement.³³ This can result in them missing frequent appointments after the initial HA fitting, a situation than could lead to them not receiving adequate support for proper HA use. The current study demonstrated that a similar proportion of patients in the USER and NON-USER groups had at least one comorbidity and the presence of comorbidities was not associated with HA adherence. Six of 60 patients (10.0%) in the USER group and none of the patients in the NON-USER group were affected by either mild cognitive disorder, dementia or depression. In addition, the mean number of comorbidities per patient was not correlated with the adherence to HA use. In contrast to the current data, a previous study reported that the presence of at least one comorbidity was correlated with a lower HA use of 3.3 h/day compared with participants who reported no comorbidities; in particular, participants with health-related problems used their hearing aids 3 h less per day compared with healthy participants.²⁵

In the present study, there was a significant difference in the mean PTA between the two groups (NON-USER group, 87.5 dB; USER group, 70.8 dB; P = 0.017; Wilcoxon rank-sum test) at the Pre evaluation. Some research reports that subjects with identical audiograms had different perceived hearing difficulties,³⁰ whereas other research has found a correlation between the degree of HL and usage of hearing devices.²⁵ Both of these studies reported that non-users had a better hearing threshold compared with users.^25,30 In contrast, the current study found a better hearing threshold in the USER group compared with the NON-USER group. This difference was probably associated with sampling criteria because the current study recruited patients with moderate-to-severe HL, whereas other studies have included patients with less severe HL.²⁷ There was a significant difference in the PTA in the HA USER group between the two time-points (23.3 dB; P < 0.001). The median SRT was 65 dB during the Pre evaluation compared with 55 dB during the Post evaluation in the HA USER group (P < 0.001). All study participants that used HAs showed an improvement of the auditory threshold with their HAs both in quiet and noisy conditions. It is possible that the audiological benefits, correlated with the HA use, was a cause of the adherence to HA over the 1-year follow-up.

This current study found that another factor that might influence HA use was the cognitive status because the USER group had a higher MOCA score than the NON-USER group at baseline, but the difference was not significant. Despite a lower score for all of the participants in the current study compared with the general population (score for general population ≥26/30),²⁰ the HA USER group had a higher MOCA score than the HA NON-USER group at baseline. The current study demonstrated no deterioration of cognitive abilities after 1 year of HA based on the MOCA score. These current data agree with recent publications. For example, it was reported that untreated or poorly treated HL results not only in reduced speech audibility, but also in social isolation, depression and negatively impacts on cognitive function.³⁰ Despite this, to date, literature shows controversial results concerning the correlation between HL and cognitive status.³⁴

Comorbidities, alteration of cognitive status, difficulties in speech perception and social isolation are just some of the factors that affect older adults with HL.^5,6,25,28,29 Consequently, the quality of life of these patients can be impaired.³¹ There is evidence that older adults with HL have a worse quality of life than people without HL.^31,35 In the current study, patients in the USER group had a moderately better AQoL-8D score than NON-USERS although the difference was not significant. There was no significant difference in the ‘senses’ subscale of the AQoL-8D questionnaire between the USER and NON-USER groups. It is important to note that despite the HA USER group experiencing a worsening quality of life perception at 1-year after the first fitting of their HA with an increase of +4.5 points between Pre and Post assessment, the ‘senses’ subscale showed an improvement of −0.32 points in this group. A previous study showed that quality of life in older adults that use HA was correlated with different factors, especially socioeconomic position and depressive state.³⁶ In the current study, HA use improved the hearing status of patients but other aspects of their lives had worsened as a consequence of ageing. For these reasons and given the age-related decline in sensoriality, it is important to use quality of life questionnaires that have a dimension that specifically addresses hearing, to eliminate any confounding factors.³⁷ Future research should evaluate the quality of life in these particular patients for a longer period of use (i.e. >1 year). A recent study demonstrated how HAs impact on quality of life beyond 1 year of HA use.³⁷

The current study did not find any significant correlation between HA use and HHIE score at the Pre evaluation visit, but there was a significant reduction of the score after 1 year of HA use (24.5 versus 15.8, respectively). In agreement with the current study, a previous study reported a reduction of the HHIE score from 30.8 points before to 18 points after 6 months of HA use.³⁸ Another study reported a correlation between use of HAs and HHIE score in older adults.³¹ It is possible to conclude that the use of HAs favoured emotional and social adjustment in everyday life. In accordance with these findings, the IOI-HA score, which measures the satisfaction of HA users and the impact of the devices on life, showed a score of 27.9 in the current study, which was similar to that of another study (24.97 at 3 months after use of HA).³²

The current study also evaluated the advantages of binaural amplification by stratifying the study population into monolateral and bilateral HA USER groups. Bilateral HA USERS demonstrated HA benefits in speech audiometry under quiet conditions (20.4 points on the SRT test), but not in speech audiometry under noisy conditions (–2.5 points on the OLSA test). In contrast, monolateral HA USERS demonstrated HA benefits in speech audiometry under quiet conditions (14 points on the SRT test), but a significant drop of −5.8 points on the OLSA test. The greater improvement in the OLSA score in the monolateral HA USER group was probably related to a worse score at the Pre evaluation compared with the bilateral HA USER group. The bilateral use of HA resulted in a significant improvement in the HHIE score and an improvement in the ‘senses’ subscale of the AQoL-8D at 1-year of follow-up. In contrast, both the monolateral and bilateral HA USER groups showed worsening total scores on the AQoL-8D questionnaire, which might have resulted from other general issues related to ageing. No significant differences were found in the MOCA scores in the bilateral and monolateral HA USER groups, but there was a slight worsening in the monolateral HA USER group and a stabilization in the bilateral HA USER group over the study period. Previous studies have not demonstrated any differences in IOI-HA satisfaction score for HA use in monolateral compared with bilateral HA patients.^32,39 In contrast and in agreement with the current data, another study reported that bilateral HA users had a higher score (i.e. higher satisfaction with their HA) compared with monolateral HA users.⁴⁰ In general, the current study population shows good performances with bilateral HA use. A previous study reported a preference for bilateral HAs, but there were no predictive factors associated with monolateral or bilateral HA preference.⁴¹ Another study also reported a preference for bilateral HA use in older adults.²⁴

This current study had several limitations. First, only a small number of the patients completed the protocol 1 year after the first fitting of the HA, which was partly due to the SARS-COVID19 pandemic. Secondly, the study did not use specific tests for hearing impaired people (e.g. use of the MOCA-HI instead of the MOCA test). It would not be possible to undertake a randomized controlled trial given the characteristics of the population under investigation.

In conclusion, this current study demonstrated that the rate of HA adherence in a sample of elderly adults with moderate-to-severe HL was high. The HA USER group had a significantly better PTA than the NON-USER group at baseline. The HA USER group were younger, had a better MOCA score for cognitive capacity and a better quality of life perception compared with the NON-USER group at baseline, although none of the differences were significant. The use of HAs was not correlated with the number of the comorbidities per patient or the HHIE score. The use of HAs over 1 year resulted in an improvement of the auditory performances, a reduction of the effect of the hearing impairment in everyday situations and an absence of deterioration of cognitive function, although there was a slight reduction in the quality of life. In general, bilateral HA users showed better performances and better satisfaction compared with monolateral HA users. These findings suggest that the use of the HAs in elderly adults had a positive impact.

Footnotes

Acknowledgements

We would like to thank all study participants who underwent evaluations throughout the study.

Author contributions

Conceptualization: D.C.; methodology: D.C.; software: A.S.; validation: S.G. and D.S.; formal analysis: E.F.; investigation: S.G.; data curation: S.G.; writing – original draft preparation: S.G. and A.S.; writing – review and editing: A.S. and S.G.; visualization: D.S.; supervision: D.C.; project administration: D.C. All authors have read and agreed to the published version of the manuscript.

Declaration of conflicting interest

The authors declare that there are no conflicts of interest.

Funding

This research received no specific grant from funding agency in the public, commercial, or not-for-profit sectors.

ORCID iDs

Sara Ghiselli

Domenico Cuda

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