Under-use of recommended hearing checks in older community-dwelling adults in three European settings

Background: Based on current evidence (Bagai A. et al., JAMA 2006) annual hearing checks should be performed in all older people. Methods: This secondary analysis of the PRO-AGE trial (BMC Medical Research Methodology 2007, 7:1, 2) includes 7314 community-dwelling persons aged ≥65 years from Hamburg (Germany), Solothurn (Switzerland), and London (UK). Subjects completed a self-administered multidimensional questionnaire, questions on preventive care use, hearing (Hearing Handicap Inventory for the Elderly), function, comorbidity, and socio-demographics. Results: Prevalence of underuse (no hearing checks within preceding 12 months by self-report) was 64% in Hamburg, 71% in Solothurn, and 90% in London. Significant (p<0.01 in multivariate logistic analyses) determinants of under-use differed between sites. In Hamburg and London, in persons aged 65 to 74 underuse was higher than in older persons (Hamburg, OR 1.6, 95% CI 1.2-2.2; London, OR 2.2, 95% CI 1.4-3.4). In Solothurn, in women underuse was higher than in men (OR 1.5, 95 % CI 1.2-1.8). In London, in persons without hearing impairment underuse was more prevalent than in persons with hearing impairment (OR 2.9, 95% CI 1.8-4.6). Functional ability, comorbidity, and education were not significantly associated with underuse. Conclusion: Underuse differed between sites, and in part between subgroups according to age, gender, or presence of hearing impairment. Surprisingly, comorbidity, social network or functional ability played no role in underuse. The lack of guidelines and other system factors seem to be more relevant than individual factors for explaining underuse of recommended hearing checks in older persons.