Health Status Attributes: DISCUSSION

Health Status Attributes

This study was conducted to determine the influence of hearing loss on health status attributes in African-American older adults. The hearing loss exhibited by subjects involved in this study are equivalent with previous age-, race-, and gender-related studies of hearing loss by other investigators using similar older adult populations. These findings are important because hearing loss ranks among the top four chronic health conditions experienced by older individuals, exceeded by only arthritis, high blood pressure, and heart disease, followed by orthopedic problems, cataracts, chronic sinusitis, and diabetes mellitus.

In terms of health status, the SF-36 has gained acclaim in medical and healthcare literature, in that it provides indices which are useful in understanding the burden associated with chronic health conditions. It should be noted that SF-36 scores obtained from African-American older adults in this sample are consistent with national SF-36 norms that account for the influence of age and gender. Additionally, Cronbach’s coefficient alpha across SF-36 attributes ranged from 0.82 to 0.86. Cronbach’s alpha is an index of reliability associated with the variation accounted for by the true score of each underlying construct. Higher levels of internal consistency are harmonious with increased reliability, and scores that equal or exceed 0.7 are preferable. Reliability tests are especially important when the derivative variables are intended for subsequent predictive analyses. If the intended scale(s) show(s) poor internal consistency reliability, then individual items within scales must be re-examined, modified, or completely changed. Due to the high levels of internal consistency reliability across SF-36 attributes obtained in this investigation, modifications were not needed.
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From bivariate analyses, hearing loss was significantly related to greater self-perceived deficits on five of the eight health status attributes (PF, SF, VT, RP, MH) on the SF-36. The most noteworthy finding from bivariate analyses occurred between hearing loss and physical function (PF: r=-0.39, p<0.01, see Table 4) as well as between hearing loss and role limitations due to physical problems (RP: r=-0.33, pO.Ol, see Table 4). This condition remained in OLS models that isolated the effect of hearing loss on physical function (PF: 6=-0.15, F=3.98, pO.Ol, see Table 5) and the effect of hearing loss on role limitations due to physical problems (RP: B=-0.29, F=3.47, pO.Ol, see Table 5), even after controlling for experimental confounds. However, a noticeable trend occurred; bivariate relations between hearing loss and each health status attribute was noticeably reduced in the OLS approach, and this occurrence is likely due to the variance shared by the combined effects of the other variables.

Findings contained here link hearing loss to HRQoL deficits in African-American older adults, yet these findings are limited, as they also suggest that hearing loss by itself is not an extremely robust predictor of health status. It is certain that other conditions, such as multiple medication usage as well as the presence of multiple medical conditions, may have a greater impact on health status than does hearing loss. It is also readily apparent that multiple medication usage superimposed upon multiple medical conditions has the ability to contribute equally if not greater to the total variance in health attitudes, health-seeking behaviors, and overall health status. At the core of this issue is that relatively little is known about how these prevailing medical conditions in African-American older adults, in addition to the increased likelihood of hearing loss, play a role in HRQoL. The influence of hearing impairment and its effect on health status lies in the difficulties that presbyacusis imposes on communication ability and ultimately independence— assertions that are readily supported clinically.
Management of hearing impairment lies in identifying the presence of the condition. Primary care physicians and other healthcare providers can improve the detection process by utilizing a questionnaire approach and an audioscope as part of their screening regimen, and patients with suspected hearing impairment from the physical examination and screening procedures should be referred to an otolaryngologist and an audiologist for a more comprehensive evaluation. If hearing impairment is confirmed, then the healthcare provider(s) should insist upon an intervention program geared towards improving communication. However, several reports have determined that a large portion of older adults with hearing problems are neither diagnosed, treated, nor actively involved in audiological rehabilitation.  The consequences of this circumstance are apparent in a recent large-scale study, where it was found that untreated hearing loss has serious long-term emotional and social consequences for older persons. When comparisons were made with individuals with hearing loss and used hearing aids, individuals with untreated hearing loss were more apt to report sadness, depression, worry, anxiety, paranoia, and less social activity. Even when controlling for external factors, such as the respondent’s age, gender, and income, greater reductions in social, psychological, and functional health remained. These long-term consequences are pertinent to this study, as there were several African-American older adults who exhibited substantial hearing impairment and were not interested in further intervention, possibly obtaining hearing aids, or free trial periods with assistive listening devices. Hence, the long-term HRQoL effects of untreated hearing loss—even after controlling for sociodemographic factors—among these subjects are highly probable. canadian pharmacy viagra

Several predisposing factors, other than the prevailing high cost of hearing aids, are offered that may preclude African-American older adults from utilizing hearing healthcare services. Lack of knowledge on behalf of African-American elderly and possibly their primary care providers of where to obtain assistance from hearing healthcare practitioners, how patient-provider relationships influence compliance behaviors, and lack of culturally sensitive educational materials about hearing loss serve as a few exam ples. It may be due to these attitudes and/or preexisting conditions that hearing loss in African-American older adults may go untreated for extended periods of time and warrants further inquiry.


This investigation provides data to support the notion that hearing loss is capable of contributing to HRQoL deficits, in terms of health status attributes determined via the SF-36 in African-American older adults. Generalizations based on the data contained here are most germane to independent older African-American adults with mild-to-moderate sensorineural hearing impairment. Trends from the data also suggest that African-American older adults with more pronounced degrees of hearing loss may exhibit greater self-perceived deficits in HRQoL than African-American older adults with lesser degrees of hearing loss. This study adds to the existing literature, as relatively few investigations to date exist that have determined hearing impairment through formalized audiometric testing in African-American older adult populations. More studies that identify hearing impairment among culturally diverse older adults, examine hearing loss and quality-of-life conditions across racial/ethnic boundaries, monitor utilization and compliance patterns of hearing healthcare services, and consider socioeconomic/demographic indicators in determining the influence of hearing loss are in dire need. buy cialis soft tabs

Category: Health

Tags: African Americans, blacks, elderly, health status, hearing loss, quality of life

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