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Principal Investigator: FRANK R LIN
Organization: JOHNS HOPKINS UNIVERSITY
Fiscal Year: 2024
Award: $611,956
Funding agency: National Institute on Deafness and Other Communication Disorders
PROJECT SUMMARY
Hearing loss is a chronic condition prevalent in two-thirds of adults >70 years and may be a potentially
modifiable risk factor for adverse health outcomes including dementia. However, uptake and sustained use of
hearing aids in adults is low, with <20% of older adults with hearing loss reporting use, among whom up to 30-
40% may discontinue hearing aid use over time. These limitations may stem in part from the reliance of the
current best-practice model of hearing healthcare (HHC) on clinic-based visits that requires multiple in-person
sessions between an audiologist and a patient for all ongoing technical and self-management support services.
Incorporation of asynchronous and synchronous telehealth into HHC to complement clinic-based visits would
allow for routine troubleshooting of communication challenges, hearing aid technical issues, and reinforcement
of self-management support strategies. Determining if a HHC model that incorporates audiological telehealth
improves long-term hearing aid use and other patient-centered outcome measures has direct implications for
both future clinical care standards and ongoing Medicare legislative bills pertaining to HHC coverage. Our
interdisciplinary consortium of investigators has a singular opportunity to evaluate the potential benefits of a
telehealth audiology model on long-term hearing aid use and other outcomes in a large cohort of racially-
diverse, community-dwelling older adults who are existing hearing aid users. In the ongoing Aging & Cognitive
Health Evaluation in Elders (ACHIEVE) randomized trial, we recruited 977 adults ages 70-84 with untreated
mild-to-moderate hearing loss from January 2018 to October 2019 who were randomized 1:1 to a hearing
intervention (i.e., conventional clinic-based delivery of hearing services and technologies) versus a successful
aging education control intervention. Participants are now being followed for 3 years post-randomization at the
four ACHIEVE field sites, and the goal of this NIA-funded multisite trial (R01AG055426) is to determine if
hearing loss treatment versus an aging education control intervention reduces cognitive decline. From 2021-
2022, as participants in the hearing intervention group (n=490) complete their pre-specified three years of
follow-up in the ACHIEVE trial, we propose to recruit these existing hearing aid users and randomize them to
receive either continued conventional clinic-based delivery of hearing care services or a model that
incorporates telehealth. At 1 year post-randomization, the primary outcome (hours of hearing aid use) will be
contrasted between the two groups, and participants in the conventional HHC arm will then cross-over and
also receive telehealth HHC. All participants will continue to be followed for 2 years post-randomization. Aim 1:
To compare the effect of the telehealth versus conventional HHC delivery model on hours of hearing aid use
(primary outcome) and other patient-centered hearing and communication outcomes at 1 year post-
randomization. Aim 2: To compare the effect of the telehealth versus the conventional HHC delivery model on
secondary outcomes of social, mental, physical, and cognitive functioning at 1 year post-randomization.
Terms: <21+ years old><Active Follow-up><Adult><Adult Human><Age><Aging><Amentia><Area><Audiology><COVID crisis><COVID epidemic><COVID pandemic><COVID-19 crisis><COVID-19 epidemic><COVID-19 era><COVID-19 global health crisis><COVID-19 global pandemic><COVID-19 health crisis><COVID-19 pandemic><COVID-19 period><COVID-19 public health crisis><COVID-19 years><Caring><Chronic><Clinic><Clinical><Cognitive><Cognitive Disturbance><Cognitive Impairment><Cognitive decline><Cognitive function abnormal><Communication><Communication challenge><Communication difficulty><Communities><Complement><Complement Proteins><Congresses><Control Locus><County><Dementia><Disturbance in cognition><Education><Educational aspects><Elderly><Evaluation><Follow-Up Studies><Followup Studies><Funding><Future><Goals><Health><Health Educators><Health Insurance for Aged and Disabled, Title 18><Health Insurance for Disabled Title 18><Healthcare><Hearing><Hearing Aids><Hearing Loss><Hour><Hypoacuses><Hypoacusis><Impaired cognition><Individual><Intervention><Intervention Strategies><Investigators><Investments><Measures><Medicare><Mental Health><Mental Hygiene><Modeling><Outcome><Outcome Measure><Participant><Patient outcome><Patient-Centered Outcomes><Patient-Focused Outcomes><Patients><Persons><Physical Function><Policies><Provider><Psychological Health><Psychological reinforcement><Randomization trial><Randomized><Reinforcement><Reporting><Research Personnel><Research Resources><Researchers><Resources><Risk Factors><Role><SARS-CoV-2 epidemic><SARS-CoV-2 global health crisis><SARS-CoV-2 global pandemic><SARS-CoV-2 pandemic><SARS-coronavirus-2 epidemic><SARS-coronavirus-2 pandemic><Sampling><Self Efficacy><Self Management><Service delivery model><Service model><Services><Severe Acute Respiratory Syndrome CoV 2 epidemic><Severe Acute Respiratory Syndrome CoV 2 pandemic><Severe acute respiratory syndrome coronavirus 2 epidemic><Severe acute respiratory syndrome coronavirus 2 pandemic><Site><Social Functioning><Specific qualifier value><Specified><Technology><Time><Title 18><Transportation><Visit><Washington><active followup><adulthood><advanced age><ages><arm><assistive hearing device><assistive listening device><care delivery><care delivery model><care services><care systems><clinical care><cognitive dysfunction><cognitive function><cognitive loss><cohort><complementation><coronavirus disease 2019 crisis><coronavirus disease 2019 epidemic><coronavirus disease 2019 global health crisis><coronavirus disease 2019 global pandemic><coronavirus disease 2019 health crisis><coronavirus disease 2019 pandemic><coronavirus disease 2019 public health crisis><coronavirus disease crisis><coronavirus disease epidemic><coronavirus disease pandemic><coronavirus disease-19 global pandemic><coronavirus disease-19 pandemic><dysfunctional hearing><efficacy trial><follow up><follow-up><followed up><followup><function socially><functional outcomes><functioning social><geriatric><group intervention><health care><health care delivery model><health care model><health insurance for disabled><healthcare delivery model><healthcare model><healthy aging><healthy human aging><hearing amplification><hearing assistance><hearing assistive device><hearing challenged><hearing defect><hearing deficient><hearing deficit><hearing device><hearing difficulty><hearing dysfunction><hearing impairment><hearing loss therapy><hearing loss treatment><improved><interventional strategy><malleable risk><measurable outcome><mental function><modifiable risk><multi-site trial><multisite trial><older adult><older adulthood><outcome measurement><patient centered><patient oriented><patient oriented outcomes><post intervention><primary outcome><racial diversity><racially diverse><randomisation><randomization><randomized trial><randomly assigned><recruit><secondary outcome><senior citizen><severe acute respiratory syndrome coronavirus 2 global health crisis><severe acute respiratory syndrome coronavirus 2 global pandemic><social role><stem><telehealth><treatment for hearing loss><uptake>