摘要：Objectives. We determined factors associated with hearing aid acquisition in older adults. Methods. We conducted a population-based, prospective study that used information from 3 examinations performed on study participants as part of the Epidemiology of Hearing Loss Study (1993–2005). We included participants (n = 718; mean age = 70.5 years) who exhibited hearing loss at baseline or the first follow-up and had no prior history of hearing aid use. We defined hearing loss as a pure tone threshold average (PTA) at 0.5, 1, 2, and 4 kilohertz in the better ear of greater than 25 decibels Hearing Level. Results. The 10-year cumulative incidence of hearing aid acquisition was 35.7%. Associated factors included education (college graduate vs all others: hazard ratio [HR] = 2.5; 95% confidence interval [CI] = 1.5, 4.1), self-perception of hearing (poor vs good or better: HR = 2.5; 95% CI = 1.3, 5.0), score on a perceived hearing handicap inventory (+ 1 difference: HR = 1.1; 95% CI = 1.0, 1.1), and PTA (+ 5 dB difference: HR = 1.4; 95% CI = 1.2, 1.6). Conclusions. The low rate of hearing aid ownership among older adults is a problem that still needs to be addressed. A number of observational studies have reported that hearing loss negatively affects quality of life. 1 – 5 Among the participants in the Epidemiology of Hearing Loss Study (EHLS), significant relationships were found between severity of hearing loss and impaired physical and social functioning. 1 Other studies have revealed a positive influence of hearing aid usage on quality of life. 6 – 12 A systematic review and meta-analysis of studies related to hearing aids and quality of life concluded that hearing aid usage in adults was associated with improvements in psychological, social, and emotional well-being when hearing-specific and communication-specific measures were used for quality-of-life assessment. 6 In a randomized trial among older patients at Veterans Affairs clinics, results suggested that hearing aid use led to significant improvements in social and emotional functioning, communication, cognition, and depression, with all effects except cognition being sustained for at least 1 year. 7 , 8 Despite the psychosocial benefits of hearing aid use, it has been estimated that just 20% to 25% of hearing-impaired individuals use hearing aids. 13 – 15 A 1995 study revealed that only about one third of adults aged 70 years or older who had a reported hearing problem had used hearing aids within the past year. 16 Researchers have conducted clinic-based investigations and cross-sectional population studies and surveys to evaluate characteristics related to seeking help for a hearing loss and obtaining hearing aids. In general, the factors found to have an influence on the decision to seek help include a self-perception of reduced hearing ability or decline in hearing sensitivity, negative impact of hearing quality on daily life, and comments or encouragement from others. 17 – 20 Conversely, studies investigating characteristics associated with not seeking treatment for a hearing loss have found that denial of the loss, self-image implications, fear of social consequences, fear of aging, acceptance of a hearing loss as a normal part of the aging process, and lack of social pressure have played a role. 18 , 21 Hearing aids in particular were not sought because of concerns regarding cost, effectiveness, stigma, and discomfort. 18 , 21 , 22 Previous studies have not been population based and prospective in nature and have not evaluated multiple factors simultaneously, including demographic characteristics, standard measures of hearing ability, and self-perception of hearing quality and handicap. Some studies have been conducted in clinical populations in which participants have already made a decision to seek help for a perceived hearing loss. 17 , 20 Factors influencing the decision to acquire a hearing aid among patients seen at an audiology clinic may differ from those in effect among participants in a population-based study of aging. Investigators in the Netherlands have conducted population studies, but those were cross-sectional in design; also, in the Netherlands the cost of a hearing aid may be partially reimbursed, either through public funding or the patient's employer. 18 , 19 Because cost may be an important factor in the decision to acquire a hearing aid, the results of studies conducted in the Netherlands may be expected to differ from studies conducted in the United States, where hearing aids are not universally covered by private health insurance or Medicare. Previous survey work investigating the prevalence of hearing aid use in the United States has relied on self-reported hearing loss or hearing difficulty, which may introduce error and which prevents any adjustment for measured hearing loss. 21 , 22 In addition, survey work is subject to response bias and may not be representative of the general population. Our goal for this population-based study was to estimate, for the first time, the 10-year incidence of hearing aid acquisition among participants with a demonstrated hearing loss and to determine the factors that predicted hearing aid purchase.
