Hearing Impairment, Strategies and Outcomes in VA Emergency Departments

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Hearing loss disrupts communication, which in turn jeopardizes effective medical care. Hearing loss is associated with poor mental and physical health, and is remarkably prevalent among older Veterans (close to 80% with bilateral >40 decibel hearing loss, among those 80 and older). Every year, several hundred thousand hearing loss-impacted older persons visit VA Emergency Departments (EDs) – noisy settings that are among the most “difficult listening situations” in clinical medicine. Many older adults will arrive without a hearing assistance device, given the low rate of hearing aid use in the elderly population. Extensive research underscores the importance of good communication during “care transitions” – points in time when patients leave one care setting for another. In the case of the ED, discharge to home may be a risky transition for patients who do not understand discharge instructions, such as which medications to take, or how to recognize “red flag” symptoms that indicate the urgent need for further medical attention. Patients who lack understanding of discharge instructions are at risk for repeat ED visits and/or hospitalizations. The goal of this study is to test whether providing hearing assistance devices to older age hearing impaired patients in the ED setting will improve in-ED understanding and preparation for discharge. The proposed intervention, the Hearing Impairment, Strategies and Outcomes in VA Emergency Departments (HearVA-ED) will be conducted in the Emergency Departments of the Manhattan and Brooklyn VAs of the New York Harbor Healthcare System and will recruit hearing impaired ED patients who are 60 years and older and have been admitted to the ED with a low acuity triage score indicating a high likelihood of discharge home. We will identify hearing impairment by using the Hearing Handicap Inventory for the Elderly survey (HHIE-S). We will randomize consenting patients who fail the screening to either receipt of a simple hearing assistance device (a “PockeTalkerTM”) during their ED stay or usual care. We will test whether the provision of a PockeTalkerTM is feasible in this environment (by measuring the amount of device use), whether providing the device improves self-reported quality of hearing and understanding during the ED stay, and whether use of the device improves the quality of preparation for post-discharge care. If this randomized controlled trial demonstrates beneficial effects for in-ED use of a simple hearing assistance device for hearing impaired patients, this strategy can be disseminated throughout the VA healthcare system.