Hearing is a key component of intrinsic capacity and is essential for communication, social participation, and independence among older people. Age-related hearing loss is highly prevalent and increases substantially with age. When unaddressed, hearing loss can contribute to functional decline, reduced quality of life, social isolation, depression, and cognitive impairment. Hearing aids and related hearing care services are effective and cost-effective interventions that can significantly improve hearing function and daily functioning. However, despite the large number of older people who could benefit from hearing aids, access to hearing care services remains limited in many settings, resulting in a substantial treatment gap. Measuring the proportion of older people in need of hearing aids who receive hearing aid services provides an important indicator of access to rehabilitative care for hearing loss. Monitoring this indicator can help identify gaps in service provision and support efforts to strengthen hearing care within health systems as part of universal health coverage and healthy ageing initiatives .
Definition:
Hearing capacity is commonly measured using pure tone audiometry and classified based on audiometric thresholds in the better ear. Hearing loss refers to a decline in hearing capacity that may range from mild to profound. For this indicator, “need for hearing aids” refers to hearing loss at a severity level where amplification is typically indicated (for example, moderate or greater hearing loss), based on objective assessment where available, or a validated functional measure of hearing difficulty where audiometry is not feasible. Hearing aid services include assessment for amplification, fitting or provision of hearing aids, follow-up adjustment, and maintenance or replacement services.
Disaggregation:
Age (five-year age groups), sex, income level, education level, place of residence (urban or rural), living arrangement (community or residential care), disability status, and nationally relevant population groups.
Method of measurement
This indicator is measured using population-based surveys that assess hearing function and capture use of hearing services. Individuals in need of hearing aids are identified using standardized hearing assessment, preferably pure tone audiometry, applying a threshold consistent with at least moderate hearing loss in the better ear (for example, greater than 40 dB hearing level). Where audiometry is not available, a validated self-reported measure of functional hearing difficulty may be used to identify likely need, recognizing that this may reduce comparability. Among individuals classified as in need, receipt of hearing aid services during the past 12 months is established through questions on hearing care uptake, including hearing assessment for amplification, fitting or provision of hearing aids, adjustment or follow-up care, or other hearing-care visits related to hearing aid management. Individuals reporting at least one hearing aid service contact during the reference period are counted in the numerator. The indicator is calculated as the percentage of those in need who received hearing aid services during the past 12 months. Survey estimates should apply sampling weights and account for complex survey design where applicable.
Other possible data sources:
Insurance claims database
Pharmacy and device reimbursement records
Hearing-aid dispensing database
Preferred data sources:
Representative population-based surveys with hearing assessment
This indicator measures reported receipt of hearing aid services but does not assess the quality of assessment and fitting, appropriateness of amplification, adherence, or effective and sustained use. Estimates may be affected by misclassification of need, particularly when self-reported hearing difficulty is used instead of objective testing. Self-reported service use may be subject to recall error and may not capture informal or unrecorded acquisition of low-cost amplification devices. Where “current hearing aid use” is used as a proxy for service uptake, coverage may be overestimated because device ownership may reflect services received outside the past 12 months. Differences in hearing loss thresholds, testing protocols, and service definitions may limit comparability across settings.
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