Under-diagnosis of Hearing Loss in Primary Care: Evidence from the English Longitudinal Study of Ageing (ELSA)

Background: Hearing loss is a major public health issue that affects one-in-six people and over 11 million people across the UK. Hearing loss is far beyond a sensory impairment, and is associated with negative physical, social, cognitive, economic and emotional consequences. Primary health care (PHC) is the point of referral to NHS audiological services for hearing loss in adults. However, as hearing loss almost always develops gradually, people do not see it as a dramatic health problem requiring urgent intervention. The aim of this study was to examine the patterns of the diagnosis of hearing loss in primary care. Method: Cross-sectional analysis comparing self-reported hearing data and data acquired by an objective assessment of hearing ability, from the Wave 7 of the English Longitudinal Study of Ageing (ELSA) (n=9,666). Hearing loss was defined as >35dB HL at 3.0 kHz, in the better-hearing ear. Questions were on hearing difficulties of the participants, hearing in noise, quality of care in hearing, and hearing aid recommendation (Figure 1). Results: The prevalence of the self-reported hearing difficulties in ELSA Wave 7 (n=9,666), was 39.3% (n=3,801/9,666). Of those, 51.3% (n=1,949/3,801) did not discuss their hearing problems with a primary care health professional, and were not referred to an ear specialist. An increase of approximately 23% in the number of hearing aid users is estimated among the participants with hearing loss, provided that those that have difficulty in following a conversation in background noise have told a health professional in primary care about their hearing difficulty. Implications: The self-identification of hearing difficulties is a major non-financial barrier for the initiation of help-seeking, which can affect the referral to ear specialists and the consequent hearing aid uptake. Our findings can offer an explanation why those of a lower socioeconomic position use specialist health services less frequently, in spite of the financial support of the treatment and hearing aid provision through the NHS in the UK. Our findings support the need for health policy strategies, aiming for an early detection of hearing problems and an increase in hearing aid uptake and use in specific population groups, to mitigate the adverse effects of hearing loss in older adults in England.