[MUSIC] Welcome, I'm Carrie Nieman and we'll be covering community based approaches to hearing care. The issue of age related hearing loss is not new, but our approach has been changing over the recent years. A lot of my work and our work at the Cochlear Center is based on bringing a public health approach to understanding and addressing age related hearing loss. Issues regarding lack of access, low uptake of a recommended health behavior disparities in care these are not new issues. And we can look to public health broadly to consider what approaches are being used in other areas like diabetes, hypertension, cancer screening, among others. There's a rich history of community partnership and community delivered efforts that formed the bedrock of how we extend resources and expertise more broadly. We're going to take a look at what we can learn from public health and apply it to the issue of how do we get hearing care to more older adults? With that said, I will be solely focusing on older adults and age related hearing loss. So we'll now get into more about community delivered hearing care in practice. Where does community delivered hearing care fit into recent efforts to address hearing loss as a public health priority? And what do current efforts and community based care look like? To ensure we're all on the same page when I speak about community delivered hearing care and I'm talking about expanding the number and types of ways older adults can access hearing care. And again, not about replacing existing models of care but adding to it. Again, very broadly defined it is hearing care that takes place in diverse settings, utilizes trained paraprofessionals and employs audiologists and/or ENTs in a supervisory role and often employs mobile or mHealth technologies. So where does the need for community delivered hearing care fit within recent efforts. There have been substantial efforts in this area over the past several years that have brought hearing loss and hearing care to be a clear national and international public health priority. In the US it began in 2015 with the President's Council of Advisors on Science and Technology or the PCAST report. And then it was followed in 2016 by the National Academies of Science Engineering and Medicines yearlong committee report on hearing care. Globally, the World Health Organization's World wrote a report on hearing, released in March 2021 is the first of its kind. A product of global collaboration and takes a life course approach as well as a public health perspective to hearing loss. The World Report called specifically for community based approaches. The Lancet Commission on hearing loss is another important global effort. Each of these fit within the World Health Organization's decade of healthy aging from 2020 to 2030, which is 10 years of focused collaboration to advance access to healthy aging globally. Together these national and international efforts echo some of the same themes and needs. We need affordable technology, new and more models of hearing care and for that care to be integrated into existing care systems. Nationally, the PCAST report was the first to call for over the counter hearing aids within the United States. And then the NASEM report in 2016 quickly followed and laid a path forward and extending access to care. Both echoing the recommendation for over the counter hearing aids as well as including specific calls for action around community based and community delivered hearing care, including through models that utilize community health workers. What quickly followed was a major change in policy in 2017aidsin the United States. The underlying goal of OTC hearing aids is to set standards, increased competition and hopefully decrease costs and improve quality. It is also the first time for a consumer driven market within hearing aids and hopefully that opens up the opportunity for the needs of users to be more closely reflected in devices. And to me most importantly, it is a critical component of opening doors to new and different ways of delivering hearing care and it's an important opportunity that we cannot miss. Over the counter devices currently exist in the United States. Even before over the counter hearing aids debut on the market, for examples of some of the devices that are currently available as personal sound amplifiers or peace apps, there's a number of larger handheld devices. This is not meant to be an exhaustive list, but really just a sample, an example of some of the over the counter devices that already exist and that can be leveraged within some of these different models of hearing care. Some of these larger handheld devices can be wonderful options for older adults who may have limitations in terms of manual dexterity or have difficulty in terms of manipulating buttons or remembering different steps. So for individuals with cognitive impairment, these larger devices can also be very helpful, particularly if they are put on and off by a care partner. It's another example of some of the over the counter devices that are currently available, there's some smaller ear level devices. Again by no means is this meant to be comprehensive but just give you a sense of some of the devices that are currently available. These are two examples from Sound World Solutions that we use in our research and again ear level devices that some waves look like traditional hearing aids and then others look more like a bluetooth headset. They have relatively larger buttons that can be more easily manipulated by older adults and they are all rechargeable in that they don't rely on small hearing aid batteries. But can be used in an ongoing basis without the need to keep buying these small batteries and having to manipulate them. Against certainly not perfect, but they are some high quality options already available over the counter market. There's a need for improvement in terms of how closely hearing aids and amplification devices to mirror the needs of older adults. Human factors are important to consider when we're thinking about a piece of technology for an older adult, if they're goinna be using it on a regular basis. When you're considering over the counter devices and I hope for over the counter devices in the future is that they incorporate some of these human factors. Things like manual dexterity, cognitive function, reflecting on and thinking about where does an individual's prior technology experience and openness fit within, picking a device that may work best for them? Do they have access to a smartphone in order to use it? And what do they need in terms of their own technology in order to be able to access some of these over the counter devices. And also thinking about what type of support and how is that support access for older adults. And also because we are talking about a piece of technology and individuals. Technology self efficacy is also important to consider. These are all elements that should be considered and need to be considered in kind of this new and emerging over the counter landscape. And provides an opportunity for innovation and for engagement of older adults in technology development in ways that we haven't done before. And again, these over the counter devices are really the bedrock of what allows us to think about some of these community delivered methods. In addition to the devices themselves, there have also been advancements in terms of mHealth or mobile health within hearing screening. Again, the two devices that I have here, hereScreen and SHOEBOX again are not meant to be an exhaustive list, but a sample of some of the devices that are currently available here. HearScreen comes out of South Africa and Yvette spawn of holes work there, which originated with community health workers providing hearing screening in a range of settings and with a range of older adults as well as children. In order to provide access to hearing screening in environments that would traditionally haven't done. SHOEBOX is another company again, a tablet based hearing screening that has been used in diverse settings as well and with diverse populations. Each of these provide different algorithms in terms of noise monitoring and noise cancelation. It can be easily used both either as an automated screening protocol or something that can be delivered and used by audiologists in terms of a more detailed examination. Just like over the counter devices, some of these mobile technologies in hearing training also provide the foundation for how and why we can do what we can do within a community based setting. Before I talk about some examples of community delivered hearing care, we'll just refresh what we mean by task sharing and how does that fit in with the in community delivered hearing care. Task sharing or task shifting involves a rational redistribution of tasks among health workforce teams. Specific tasks are moved where appropriate from highly qualified health workers to health workers with shorter training and fewer qualifications in order to make more efficient use of available human resources for health. And what makes cash sharing possible? Typically is the partnership with community health workers and CHWs are defined as frontline public health workers who are a trusted member of and or has an unusually close understanding of the community served. And it's important approach in order to reach at risk underserved populations a way to address health disparities and has proven time and time again to be an effective and cost effective approach. So I'm going to highlight a few examples that come from a range of settings, both in the US and globally of where communities delivered hearing care is in practice. The first is Orendo Bien which is an effort led by Nicole Marrone based out of the University of Arizona and is an NIH funded or National Institutes of Health funded trial. The program has trained a team of promotorasor community health workers based out of federally qualified health centers along the US Mexico border. The promotoras provide a five week group oral rehabilitation program specifically designed for spanish speaking older adults with hearing loss. Initial pilot study results demonstrated increased self efficacy reductions in stigma and an increase in the number of older adults going on to receive hearing care, including hearing aids. The results of the pilot study informed a larger randomized controlled trial, which is finishing up in 2020 and the results are expected in 2021. Another effort is a public private partnership based in India and funded primarily through Medtronic called Shruti. The Shruti program conducts hearing screenings by community health workers that are then reviewed by otolaryngologist and then the community health workers go back out to fit over the counter hearing aids with these individuals. Since 2013, the program is now in 65 hospitals and has screened more than 650,000 individuals. The program has raised awareness, increased work performance and social interactions among those who have received devices and increased access to hearing care. The scale and speed in which the Shruti program has grown, illustrates the value of partnerships outside the traditional confines of research. The last program we will discuss is our teams work in Baltimore. It's similar to Shruti and uses some of the same over the counter devices. The here's intervention is designed to be delivered by older adult peer mentors or peer educators, which are a type of community health worker. Who go through a two hour session that includes education on age related hearing loss, basic oral rehabilitation and step by step fitting and orientation to an over the counter listening device. In our initial pilot study, we found significant reduction communication difficulty and depressive symptoms. Larger randomized controlled trial of the hearers program is also wrapping up in 2020 and results are expected in 2021. In terms of what does the Baltimore here's program look like in action. Our older adult peer educators or peer mentors are identified leaders in their communities, whether it's senior centers or affordable housing and they're overseen by a team of audiologists. Our older adult peer educators or peer mentors they look very different from kind of who we traditionally think about in terms of delivering hearing care in terms of an audiologist or an otolaryngologist. I think demonstrates some of the power and promise of community delivered hearing care. [MUSIC]
