Participation restriction of adults and elderly users of an audiology clinic: association with auditory and social-environmental factors

ABSTRACT

Purpose

To verify the association between restrictions to auditory participation and quality of life, self-perceived health, auditory factors and sociodemographic aspects of adults and elderlies assisted in an audiology service.

Methods

The study included 152 participants; restrictions to auditory participation were assessed using the instruments Hearing Handicap Inventory for Adults - HHIA and the Hearing Handicap Inventory for Elderly - HHIE. In order to assess the quality of life, participants answered the World Health Organization Quality of Life - abbreviated version (WHOQOL-bref). Sociodemographic characteristics were assessed using a questionnaire to characterize the participants; and by the Brazilian Criteria ABEP. The results of the hearing assessment were also collected. Descriptive, bivariate statistical analyzes (p ≤ 0.20) and multiple logistic regression (p ≤ 0.05) were performed.

Results

Regarding social class, individuals belonging to classes B1 and C2 had, respectively, 4.75 and 7.73 times greater chances of presenting restrictions to auditory participation compared to individuals of class D. Regarding hearing factors, disabling hearing loss increased by 3.4 times the chance of presenting perception of restriction to auditory participation. In the environmental domain of the WHOQOL-bref instrument, each unit increased in the score was associated with a decrease of 0.96 times in the chance of perceived restriction in auditory participation.

Conclusion

We found that the use of the amplifying hearing aid by itself, despite its benefits, did not eliminate the restrictions on auditory participation of most participants.

Keywords
Hearing; Quality of Life; Environment; Questionnaires; Disabled Persons

RESUMO

Objetivo

Verificar a associação entre a restrição à participação auditiva com a qualidade de vida, a autopercepção de saúde, os fatores auditivos e os aspectos sociodemográficos de adultos e idosos atendidos em um serviço de audiologia.

Método

Participaram do estudo 152 indivíduos e a restrição à participação auditiva foi avaliada por meio dos instrumentos Hearing Handicap Inventory for Adults – HHIA e o Hearing Handicap Inventory for Elderly – HHIE. Para a avaliação da qualidade de vida os participantes responderam o World Health Organization Quality of Life- versão abreviada (WHOQOL-bref). As características sociodemográficos foram avaliadas por meio de um questionário de caracterização dos participantes e pelo Critério Brasil ABEP, também foram coletados os resultados da avaliação auditiva. Foram realizadas análises estatísticas descritiva, bivariada (p ≤ 0,20) e regressão logística múltipla (p ≤ 0,05)

Resultados

Em relação à classe social, indivíduos pertencentes às classes B1 e C2 possuíam respectivamente, 4,75 e 7,73 vezes chances maiores de apresentar restrição à participação auditiva quando comparados aos indivíduos da classe D. Em relação aos fatores auditivos, ter perda auditiva incapacitante aumentou em 3,4 vezes a chance de apresentar percepção de restrição à participação auditiva. No domínio ambiental do instrumento Whoqol-Bref, a cada unidade aumentada no escore, houve diminuição de 0,96 vezes a chance de percepção de restrição na participação auditiva.

Conclusão

Verificou-se que apenas o uso do aparelho de amplificação sonora individual, apesar dos benefícios, não foi capaz de eliminar a presença da restrição à participação auditiva da maioria dos participantes.

Descritores
Audição; Qualidade de Vida; Ambiente; Questionários; Pessoas com Deficiência

INTRODUCTION

Hearing loss is a major public health problem and can have several negative impacts. In 2008, the World Health Organization (WHO) estimated that approximately 466 million people had disabling hearing loss, i.e., more than 6% of the world population; of these, 432 million were adults. Moreover, the WHO projections indicate that the number may increase to 630 million by 2030 and reach over 900 million by 2050⁽¹⁾. The last demographic census of the Brazilian Institute of Geography and Statistics (IBGE) showed that approximately 9 million citizens had hearing loss, which represents 5.1% of the population. According to the same source, hearing was the third most reported disability⁽²⁾.

The World Health Organization uses a biosocial model to characterize the functional consequences of hearing loss (disability) that also considers adaptations to the environment and involvement of the individual in everyday situations (participation restriction)⁽³⁾. Thus, the hearing-related participation restriction is related to the individual’s self-perception regarding their hearing limitations and the potential impacts on their relationships with family, friends, and strangers, on their lifestyle, social and emotional situations, and quality of life⁽⁴⁾.

The consequences of hearing loss vary among individuals and are influenced by health conditions, level of sociability, ability to adapt to adverse situations, and experiences throughout life. Therefore, individuals with similar hearing characteristics may present different levels of participation restriction; in addition, there is no direct association of the restriction with the degree of hearing loss^(4,5).

A Swedish study that aimed to translate and validate the Amsterdam Inventory for Auditory Disability and Handicap (AIADH) and describe the hearing difficulties and quality of life of 74 participants found that men presented worse results in the auditory evaluation at the frequencies of 2, 3, 4 and 6 kHZ, worse scores in the evaluation of the sound source location and used more non-verbal strategies to communicate, while presenting better quality of life compared to women. Thus, the researchers concluded that the hearing evaluation alone was not enough to determine the psychosocial effects and the impact on the quality of life of people with hearing loss. They also reported the importance of the development of training programs to raise insight in order to minimize the consequences of hearing loss⁽⁶⁾.

The use of the Individual Sound Amplification Device (ISAD) is the primary intervention for adults with hearing loss. Among the benefits provided by this device are improved interpersonal relationships and reduced disability, participation restriction, and depression^(7,8).

A study carried out in the United Kingdom aimed to verify the association between the use of ISAD and improvement in cognitive performance — evaluated by means of social isolation and the presence of depression — assessed 164,770 individuals aged between 40 and 69 years. The results showed that the use of ISAD improved cognitive performance and a positive association of ISAD use with social isolation or depression. In view of the results, the authors concluded that the impact of ISAD use on cognition is not related to social isolation or depression; the findings suggested that the benefit was related to the increased audibility of sounds related to the participants' daily activities⁽⁹⁾.

Another study that investigated the level of satisfaction of 40 ISAD users by means of the Satisfaction Amplification in Daily Life (SADL), found that the study participants were satisfied with their ISADs during the performance of daily life activities regardless of the type and degree of hearing loss. The authors also concluded that adequate counselling and guidance influenced the positive evaluation of satisfaction⁽¹⁰⁾.

The several impacts caused by hearing loss that are not related to altered anatomical functions and structures have led researchers and professionals to complement hearing evaluations with the use of questionnaires addressing the hearing-related participation restriction and quality of life^(11-14). These instruments help to measure the efficacy and effectiveness of treatments.

This study aimed to verify the association between hearing-related participation restriction with quality of life, auditory and sociodemographic factors of adult and elderly individuals seen at a Brazilian audiology clinic.

METHODS

This is a cross-sectional analytical observational study with a probabilistic sample consisting of 152 adults and elderly individuals seen at the Audiology Department of a public hospital in the city of Belo Horizonte, state of Minas Gerais, Brazil.

The research was approved by the Research Ethics Committee of Universidade Federal de Minas Gerais, under protocol number CAAE 25014913.0.0000.5149. All research participants were informed about the voluntary nature of the study, its objectives, and methodological paths, and agreed to sign the Informed Consent Form (ICF).

Study participants

We carried out a sample calculation considering the annual flow of 7,680 individuals seen in the outpatient clinics that make up the Audiology Department of the hospital: The Hearing Health Clinic and the Audiology Outpatient Clinic. A simple random sampling was considered with a confidence level of 99%. The sample was stratified per clinic: 114 individuals seen at the Hearing Health Clinic and 38 individuals seen at the Audiology Outpatient Clinic aged 18 years or older participated in the study. The participants underwent pure-tone threshold audiometry and immittance testing and signed the ICF on the day of data collection.

Hearing-related participation restriction

The Hearing Handicap Inventory for Adults (HHIA)⁽¹⁵⁾ and the Hearing Handicap Inventory for the Elderly (HHIE)⁽¹⁶⁾ were used to assess self-perception of hearing-related participation restriction.

Both questionnaires are composed of 25 questions and assess the social and emotional consequences of hearing impairment. The total score values range from 0 to 100 and the higher the score, the greater the self-perception of hearing-related participation restriction, i.e., the greater the difficulties in hearing and non-auditory factors.

Quality of life

The quality of life of the participants in the present study was assessed by applying the version validated for Brazilian Portuguese of the World Health Organization Quality of Life – abbreviated (WHOQOL-BREF)⁽¹⁷⁾. This instrument is composed of 26 questions, two of which refer to self-perceived quality of life and satisfaction with health condition, while the other 24 questions are distributed across other domains. The instrument was applied in a single meeting and the researcher asked the participants to evoke the memories of their routine in the two weeks preceding the research to select the answer most appropriate to their situation. The answers to the questions varied in score from 1 to 5. The final score for each domain was calculated by a syntax considering the answers to each question, which resulted in final scores on a scale from 0 to 100, where the higher the score, the better the participant’s evaluation⁽¹⁷⁾.

Sociodemographic and clinical characterization

To obtain the sociodemographic data, the participants answered a questionnaire characterizing the users of the outpatient clinics and the Criterio Brasil ABEP⁽¹⁸⁾. The questionnaire was prepared by the researchers and included questions about gender, age, place of residence, and education level. Information regarding the reason and the specialty of the healthcare professional who referred the participants for hearing evaluation was also collected. The research participants self-evaluated their hearing by means of a visual scale numbered from 0 to 10, where the higher the score, the better the evaluation.

To complement the sociodemographic data evaluation, we applied the Criterio Brasil ABEP, an instrument that verifies the characteristics of their residence (presence and quantity of given items in the residence) and the education level of the head of the family. The criteria proposed by the literature were followed in the analysis of this instrument.

Auditory evaluation

For the results obtained in the pure-tone threshold audiometry and immittance testing, the values of the best ear were considered. The audiometric thresholds were classified according to type and degree. The hearing loss were also classified as disabling or non-disabling. The World Health Organization defines disabling hearing loss in adults as the permanent elevation of the hearing threshold in the best ear to levels above 40 dBHL⁽¹⁹⁾.

Statistical analysis

We carried out descriptive analysis of the variables by means of absolute and relative frequency distribution for categorical variables and numerical synthesis for continuous variables.

For the association analysis, we selected as response variable hearing-related participation restriction and as explanatory variables quality of life, sociodemographic and auditory factors. Pearson's chi-square test was used to assess the association between the response variable and the explanatory variables for the categorical variables, and the non-parametric Man-Whitney test for the continuous variables, since all of them had asymmetrical distribution, as assessed by the Kolmogorov-Sminorv test (p-values ≤ 0.05). Variables with statistically significant associations at the 20% level (p<0.20) in the univariate analysis were considered for entry into the initial multiple logistic regression model. The manual backward method was adopted, and variables with associations at the 5% significance level were maintained. The magnitude of the associations was assessed by the odds ratios and their respective 95% confidence intervals. The adequacy of the models was evaluated by the Hosmer and Lemeshow test. The Statistical Package for the Social Sciences (SPSS), version 21.0, was used for all analyses.

RESULTS

The study sample was composed of 152 individuals aged between 18 and 92 years; the mean age was 61.8 years. Ninety elderly individuals (59.2%) and 62 adults (40.8%) participated in the study, and most of the individuals were female (53.9%).

Most participants (63.2%) lived in the city of Belo Horizonte, capital of the state of Minas Gerais, and 27% of the sample reported living in the outskirts of the capital. Regarding economic class, according to the criteria proposed by Criterio Brasil ABEP, the following results were obtained: class A2 (0.7%), class B1 (14.5%), class B2 (12.5%), class C1 (29.6%), class C2 (26.3%), and class D (16.4%). The evaluation of education level showed that the mean number of years of schooling of the participants was 5.9 years (minimum 0 and maximum 16 years).

As to the clinic, 75% of the participants were seen at the Hearing Health Clinic and 25% at the Audiology Outpatient Clinic. Most of the referrals for hearing evaluation were made by ear, nose, and throat physicians (74.8%), followed by speech-language therapists (16.6%). Most participants (88.8%) have had a hearing evaluation before.

The results of the evaluation of the hearing-related participation restriction showed that 63 participants (41.4%) had no restriction, 21 (13.8%) had mild restriction, 20 (12.5%) had moderate restriction, and 49 (32.2%) individuals had significant hearing-related participation restriction.

The results presented below refer to the univariate analysis of the association between hearing-related participation restriction with sociodemographic and auditory factors, and quality of life. For the entry in the initial logistic regression model, associations were considered at a significance level of 20% (p≤0.20).

Among the variables analyzed, an association was observed at the 20% level between the presence of hearing-related participation restriction and female gender (p= 0.188) and economic class (p= 0.036), as shown in Table 1.

Table 1
Analysis of the association of the presence of hearing-related participation restriction with sociodemographic variables

Characteristics	Hearing-related participation restriction		p-value *
	No	Yes
Gender
Female	30 (47.6)	52 (58.4)	0.188
Male	33 (52.4)	37 (41.6)
Total	63 (100.0)	89 (100.0)
Life cycle
Adult	25 (39.7)	37 (41.6)	0.815
Elderly	38 (60.3)	52 (58.4)
Total	63 (100.0)	89 (100.0)
Education level
≤ 8 years	43 (68.3)	63 (72.4)	0.581
> 8 years	20 (31.7)	24 (27.6)
Total	63 (100.0)	87 (100.0)
Critério Brasil ABEP
Class B1	7 (11.3)	15 (16.9)	0.036
Class B2	7 (11.3)	12 (13.5)
Class C1	24 (38.7)	21 (23.6)
Class C2	10 (16.1)	30 (33.7)
Class D	14 (22.6)	11 (12.4)
Total	62 (100.0)	89 (100.0)
Place of residence
Belo Horizonte	43 (68.3)	53 (59.6)	0.502
Outskirts of Belo Horizonte	15 (23.8)	26 (29.2)
Other	5 (7.9)	10 (11.2)
Total	63 (100.0)	89 (100.0)
Age ##
Median	67.00	68.00	0.679**
Mean	62.24	64.00
Standard deviation	18.21	17.26

• ^*
  Pearson’s chi-square;
• ^**
  Mann Whitney test;
• ^#
  1 individual excluded, Class A1;
• ^##
  In years

The analysis of association between the presence of hearing-related participation restriction and auditory factors found that all variables showed statistical significance (Table 2). It is worth noting the positive association between the presence of participation restriction and the following variables: presence of disabling hearing loss (p= 0.003) and hearing self-evaluation (p= <0.001).

Table 2
Analysis of the association of presence of hearing-related participation restriction with auditory factors (n=152)

Characteristics	Hearing-related participation		p-value *
	No	Yes
Outpatient clinic
Hearing Health	40 (63.5)	74 (83.1)	0.006
Audiology	23 (36.5)	15 (16.9)
Total	63 (100.0)	89 (100.0)
First evaluation
Yes	13 (20.6)	4 (4.5)	0.002
No	50 (79.4)	85 (95.5)
Total	63 (100.0)	89 (100.0)
Disabling Hearing Loss
Yes	31 (49.2)	65 (73.0)	0.003
No	32 (50.8)	24 (27.0)
Total	63 (100.0)	89 (100.0)
Degree of Loss in Best Ear
Normal	21 (33.3)	13 (14.6)	0.009
Mild/Moderate	33 (52.4)	50 (56.2)
Moderately severe/Severe/Profound	9 (14.3)	26 (29.2)
Total	63 (100.0)	89 (100.0)
Type of Hearing Loss in Best Ear **
No hearing loss	20 (31.7)	13 (14.6)	0.023
Neurosensorial	36 (57.1)	57 (64.0)
Conductive/Mixed	7 (11.1)	19 (21.3)
Total	63 (100.0)	89 (100.0)
Hearing grade
Mean	7.2	5.5	<0.001
Standard deviation	1.9	2.7
Median	7.0	5.0

• ^*
  Pearson’s chi-square;
• ^**
  Variable not considered in logical regression analysis

For the analysis of the association between the presence of hearing-related participation restriction and quality of life, we chose to regroup the categories of the questions referring to self-perceived quality of life and health condition (Table 3). We observed that all variables related to quality of life were associated with the presence of hearing-related participation restriction at a 20% level. The mean score of all domains assessed by the WHOQOL-BREF was lower for the individuals who presented hearing-related participation restriction.

Table 3
Analysis of association of the presence of hearing-related participation restriction with quality of life (n=152)

Characteristics	Hearing-related participation restriction		p-value *
	No	Yes
Quality of life
Low/Very low/Medium	13 (20.6)	27 (30.3)	0.181
Good/Very good	50 (79.4)	62 (69.7)
Total	63 (100.0)	89 (100.0)
Satisfaction with health condition
Unsatisfied	14 (22.2)	31 (34.8)	0.093
Satisfied	49 (77.8)	58 (65.2)
Total	63 (100.0)	89 (100.0)
Physical domain
Mean	71.2	66.2	0.143
Standard deviation	17.9	20.5
Median	75.0	67.9
Psychological domain
Mean	77.9	71.9	0.032
Standard deviation	19.7	20.6
Median	79.2	75.0
Social relations domain
Mean	77.6	71.8	0.118
Standard deviation	18.3	23.5
Median	75.0	75.0
Environmental domain
Mean	67.7	60.8	0.002
Standard deviation	12.9	14.7
Median	68.8	62.5

• ^*
  Pearson’s chi-square test or Mann Whitney test

The odds ratio analyses show that, regarding social class, individuals belonging to classes B1 and C2 had respectively 4.75- and 7.73-times greater chances of presenting hearing-related participation restriction when compared to individuals from class D (Table 4). Regarding auditory factors, having a disabling hearing loss increased by 3.4 times the chance of presenting perceived hearing-related participation restriction. We also found that the higher the score of the hearing self-evaluation, the lower the chance of perceived hearing-related participation restriction. As to the environmental domain of the WHOQOL-BREF instrument, each unit increment in its score decreases by 0.96 times the chance of perceived hearing-related participation restriction.

Table 4
Results of the multiple logistical regression analysis between the presence of hearing-related participation restriction and selected variables

Characteristics	Initial model		Final model
	OR (IC 95%)	p-value*	OR (IC 95%)	p-value *
Sex	1.68 (0.72-3.90)	0.230	1.64 (0.74-3.64)	0.221
Critério Brasil ABEP
Class B1	4.93 (1.13-21.47)	0.034	4.75 (1.19-18.97)	0.027
Class B2	3.05 (0.71-13.14)	0.134	3.24 (0.82-12.79)	0.093
Class C1	1.24 (037.-4.18)	0.724	1.25 (0.40-3.88)	0.703
Class C2	9.21 (2.20-38.53)	0.002	7.73 (2.07-28.90)	0.002
Outpatient clinic	1.84 (0.57-5.97)	0.308	−	−
First evaluation	2.69 (0.62-11.74)	0.188	−	−
Disabling hearing loss	2.96 (0.84-10.43)	0.092	3.40 (1.44-8.04)	0.005
Degree of hearing loss
Mild/Moderate	0.84 (0.19-3.72)	0.819	−	−
Moderately severe/Severe/Profound	1.11 (0.17-7.13)	0.912	−	−
Hearing grade	0.76 (0.62-0.93)	0.007	0.74 (0.616-0.90)	0.002
Quality of life	0.94 (0.32-2.82)	0.917	−	−
Satisfaction with health condition	2.07 (0.71-6.06)	0.184	−	−
Physical domain	1.01 (0.98-1.04)	0.580	−	−
Psychological domain	1.02 (0.98-1.05)	0.355	−	−
Social relations domain	1.03 (0.98-1.03)	0.800	−	−
Environmental domain	0.95 (0.91-0.99)	0.014	0.96 (0.93-0.99)	0.008
Constant	1.30	0.897	22.16	0.011

• ^*
  Adjustment of initial/final models (Hosmer e Lemeshow): p= 0.728/p=0.741
• Reference categories: Sex - male; Critério Brasil ABEP- Class D; Clinic - Audiology; first evaluation - no; Disabling hearing loss - no; Degree of hearing loss - normal; Quality of life - low; Satisfaction with health condition: unsatisfied

DISCUSSION

The characterization of the research participants showed the predominance of elderly individuals, women, and users seen at the Hearing Health Clinic. These aspects can be explained by the improvement in health conditions and consequently the increase in life expectancy of the Brazilian population. According to information from the Brazilian Institute of Geography and Statistics (IBGE)⁽²⁾, in the year 2000 the elderly represented 7.1% of the population, whereas in 2013 this representation had increased to 13%. Women also represent more than 50% of the Brazilian population⁽²⁾.

The process of hearing loss due to ageing causes cognitive changes, reduced speech understanding in noisy environments, and psychosocial impacts⁽²⁰⁾. Brazilian^(21,22), European^(13,23), and North American⁽²⁴⁾ literature have shown the benefits of the use of hearing aids in reducing the negative impacts on hearing-impaired individuals. In view of the importance of health promotion for people with hearing loss, in 2004 the Brazilian government implemented the National Policy for Auditory Health Care, which offers hearing aids free of charge and performs complete follow-up from fitting to hearing rehabilitation⁽²⁵⁾. The teaching hospital where the study was carried out is one of the references of care of people with hearing loss, a situation that justifies the fact that most of the sample was composed of users of the Hearing Health Clinic. This information reinforces the importance of public policies for the promotion of well-being and the attempt to reduce potential restrictions caused by hearing loss.

In the association between the presence of hearing-related participation restriction and sociodemographic factors, both in the univariate analysis and in the logistic regression, only the socioeconomic classification presented a result with statistical significance. It was observed that having a low socioeconomic status increased the chances of the individual presenting hearing-related participation restriction. This finding corroborates a study⁽⁹⁾ that estimated the prevalence of hearing impairment in individuals aged 40 to 69 years in the United Kingdom. Information was collected on the use of Individual Sound Amplification Device (ISAD), buzzing, noise exposure, and sociodemographic data. The findings showed that 10% of the 164,770 participants had hearing loss and statistically significant results between the presence of hearing loss and lower socioeconomic status, advanced age, and exposure to noise at work or listening to loud music.

Among the characteristics of the sample, we also found that most of the participants had low education levels, with less than eight years of study, but no association was found between the education level and the presence of hearing-related participation restriction. Low education levels make it difficult for individuals to get qualified job opportunities with higher salaries; these situations are reflected in the socioeconomic status evaluation. However, there was an association between low socioeconomic status and the presence of hearing-related participation restriction. It is worth pointing out that education is one of the items of Criterio Brasil ABEP⁽¹⁸⁾ used in the present study to analyze socioeconomic status. Thus, it is possible to infer that participants with low education levels also presented worse socioeconomic conditions.

Regarding education level, the findings of the present research do not corroborate the results of the prospective study carried out in Norway with the objective of verifying the association between hearing loss and the socioeconomic conditions of 17,593 participants. Its results showed that men with less than 10 years of education and with a professional occupation requiring fewer years of study are at higher risk of hearing loss⁽⁵⁾. Another population-based study conducted in Sweden investigated the association between self-reported hearing impairment and sociodemographic characteristics in 19,045 individuals aged 20 to 64 years. The results indicated that the participants who obtained income by means of manual labor, with a lower level of education, reported greater hearing impairment when compared to the individuals who did not perform manual labor⁽²⁶⁾. Since the present study was carried out with a cross-sectional design, we did not verify the causalities of the results obtained, and the sample size, smaller when compared to the abovementioned studies, may also have influenced the findings.

In view of the aforementioned, it can be inferred that the participants of the Brazilian research, for having a lower education level and being of low income have been more vulnerable to occupations that required less academic qualification and to work environments more exposed to noise throughout their lives, a situation that over the years increased their risk of developing hearing difficulties causing activity and participation restrictions.

According to the literature, an individual with hearing loss when seeking help may go through stages that involve the acknowledging the hearing loss, personal experiences, interaction with society and, finally, a decision⁽²⁷⁾. In the present research, we found a statistically significant association of presence of hearing-related participation restriction with the variable disabling hearing loss and hearing self-evaluation. The odds ratio logistic regression model showed that having disabling hearing loss and low scores in the hearing evaluation increases the chances of the individual presenting hearing-related participation restriction. The findings of the present research corroborate a study⁽²⁷⁾ whose objective was to investigate the acceptance of hearing loss and showed that the non-acceptance of hearing loss was related to an increase in emotional discomfort, a situation that can cause participation restriction.

As to the association of the presence of hearing-related participation restriction with quality of life, we also observed from the global evaluation that most of the research participants reported having a good or very good quality of life and were satisfied with their general health condition. Quality of life evaluation is subjective and is related to multiple factors, among them the interpersonal relationships stability and good health⁽²⁸⁾. Quality of life is also influenced by the individual's ability to adapt to the environment in which he/she lives. Elderly people with a better ability to adapt tend to suffer lower emotional impacts when facing daily life adversities⁽²⁹⁾. Given the results presented, it is inferred that the research participants associated the positive evaluation of quality of life with good health status. We may also consider that when assessing quality of life, the participants, mostly elderly people, were aware of the potential limitations caused by ageing and adapted to this condition of life.

As for the four domains assessed by the WHOQOL-BREF, both in the univariate analysis and in the logistic regression model, a statistically significant relationship was found between the presence of hearing-related participation restriction and the environmental domain. This domain includes questions about safety, the physical environment, financial resources, opportunities to acquire information, leisure, and transportation. These findings corroborate a Brazilian study that evaluated the quality of life of elderly people with normal hearing and with presbycusis users of ISADs⁽²⁸⁾. In this research, which also used the WHOQOL-BREF, we noticed a positive association between presbycusis and the worst perception of quality of life in the environmental domain; thus, the results indicated that hearing loss, regardless of the use of ISADs, limits access to the environment.

The other domains assessed by the WHOQOL-BREF, which did not show a statistically significant association with the presence of participation restriction, assessed the physical, psychological, and social relations factors. The findings of the present research partly corroborate an American study⁽³⁰⁾. In assessing quality of life, no statistically significant differences were found between the use of ISAD and the optimization of cognitive aspects and social behavior, but a statistically significant relationship was found between the use of ISAD and the improvement of physical aspects. Unlike the findings of the present study, another Brazilian study⁽²⁹⁾ whose goal was to assess the quality of life of elderly individuals before and after ISAD fitting showed a significant improvement in the physical, psychological, and social relations domains following ISAD fitting. These data show the importance of referral to ISAD fitting services and to auditory rehabilitation as a support to improve emotional and social aspects in individuals with hearing loss.

CONCLUSION

The results of the present study show that individuals with disabling hearing loss and lower socioeconomic conditions are more likely to present hearing-related participation restriction. The findings also show the importance of considering the influence of environmental factors on the impact caused by the restriction. We found that the use of ISADs alone, despite its benefits, did not eliminate the hearing-related participation restriction for most participants. These findings reinforce the importance of clinical interventions that consider the results of the hearing evaluation in addition to the life context of each patient.

• Study conducted at Universidade Federal de Minas Gerais – UFMG - Belo Horizonte (MG), Brasil.
• Financial support: CNPq (Research Productivity - PQ 305782/2015-0), CAPES (Finance Code 001).

REFERÊNCIAS

• ¹
  WHO: World Health Organization. Addressing the rising prevalence of hearing loss [Internet]. Geneva: WHO; 2018 [citado em 2020 Jun 30]. Disponível em: https://apps.who.int/iris/bitstream/handle/10665/260336/9789241550260-eng.pdf?sequence=1&ua=1
  » https://apps.who.int/iris/bitstream/handle/10665/260336/9789241550260-eng.pdf?sequence=1&ua=1
• ²
  IBGE: Instituto Brasileiro de Geografia e Estatística. Censo demográfico: resultados [Internet]. Rio de Janeiro: IBGE; 2014 [citado em 2015 Nov 9]. Disponível em: http://censo2010.ibge.gov.br/resultados
  » http://censo2010.ibge.gov.br/resultados
• ³
  Alfakir R, Holmes AE, Noreen F. Functional performance in older adults with hearing loss: application of the International Classification of Functioning brief core set for hearing loss: a pilot study. Int J Audiol. 2015;54(9):579-86. http://dx.doi.org/10.3109/14992027.2015.1023903 PMid:25816864.
  » http://dx.doi.org/10.3109/14992027.2015.1023903
• ⁴
  Helvik AS, Jacobsen G, Wennberg S, Arnesen H, Ringdahl A, Hallberg LR. Activity limitation and participation restriction in adults seeking hearing aid fitting and rehabilitation. Disabil Rehabil. 2006;28(5):281-8. http://dx.doi.org/10.1080/09638280500160311 PMid:16492622.
  » http://dx.doi.org/10.1080/09638280500160311
• ⁵
  Helvik AS, Krokstad S, Tambs K. Socioeconomic inequalities in hearing loss in a healthy population sample: the HUNT study. Am J Public Health. 2009;99(8):1376-8. http://dx.doi.org/10.2105/AJPH.2007.133215 PMid:19542048.
  » http://dx.doi.org/10.2105/AJPH.2007.133215
• ⁶
  Hallberg LR, Hallberg U, Kramer SE. Self-reported hearing difficulties, communication strategies and psychological general well-being (quality of life) in patients with acquired hearing impairment. Disabil Rehabil. 2008;30(3):203-12. http://dx.doi.org/10.1080/09638280701228073 PMid:17852289.
  » http://dx.doi.org/10.1080/09638280701228073
• ⁷
  McArdle R, Chisolm TH, Abrams HB, Wilson RH, Doyle PJ. The WHO-DAS II: measuring outcomes of hearing aid intervention for adults. Trends Amplif. 2005;9(3):127-43. http://dx.doi.org/10.1177/108471380500900304 PMid:16244759.
  » http://dx.doi.org/10.1177/108471380500900304
• ⁸
  Dawes P, Cruickshanks KJ, Fischer ME, Klein BE, Klein R, Nondahl DM. Hearing-aid use and long-term health outcomes: hearing handicap, mental health, social engagement, cognitive function, physical health, and mortality. Int J Audiol. 2015;54(11):838-44. http://dx.doi.org/10.3109/14992027.2015.1059503 PMid:26140300.
  » http://dx.doi.org/10.3109/14992027.2015.1059503
• ⁹
  Dawes P, Fortnum H, Moore DR, Emsley R, Norman P, Cruickshanks K, et al. Hearing in middle age: a population snapshot of 40- to 69-year olds in the United Kingdom. Ear Hear. 2014;35(3):e44-51. http://dx.doi.org/10.1097/AUD.0000000000000010 PMid:24518430.
  » http://dx.doi.org/10.1097/AUD.0000000000000010
• ¹⁰
  Dashti R, Khiavi FF, Sameni SJ, Bayat A. Satisfaction with hearing aids among aged patients with different degrees of hearing loss and length of daily use. J Audiol Otol. 2015;19(1):14-9. http://dx.doi.org/10.7874/jao.2015.19.1.14 PMid:26185786.
  » http://dx.doi.org/10.7874/jao.2015.19.1.14
• ¹¹
  Lutman ME, Robinson DW. Quantification of hearing disability for medicolegal purposes based on self-rating. Br J Audiol. 1992;26(5):297-306. http://dx.doi.org/10.3109/03005369209076651 PMid:1486358.
  » http://dx.doi.org/10.3109/03005369209076651
• ¹²
  Kramer SE, Kapteyn TS, Festen JM, Tobi H. Factors in subjective hearing disability. Audiology. 1995;34(6):311-20. http://dx.doi.org/10.3109/00206099509071921 PMid:8833311.
  » http://dx.doi.org/10.3109/00206099509071921
• ¹³
  Metselaar M, Maat B, Krijnen P, Verschuure H, Dreschler WA, Feenstra L. Self-reported disability and handicap after hearing-aid fitting and benefit of hearing aids: comparison of fitting procedures, degree of hearing loss, experience with hearing aids and uni- and bilateral fittings. Eur Arch Otorhinolaryngol. 2009;266(6):907-17. http://dx.doi.org/10.1007/s00405-008-0847-x PMid:19005632.
  » http://dx.doi.org/10.1007/s00405-008-0847-x
• ¹⁴
  Umansky AM, Jeffe DB, Lieu JE. The HEAR-QL: quality of life questionnaire for children with hearing loss. J Am Acad Audiol. 2011;22(10):644-53. http://dx.doi.org/10.3766/jaaa.22.10.3 PMid:22212764.
  » http://dx.doi.org/10.3766/jaaa.22.10.3
• ¹⁵
  Newman CW, Weinstein BE, Jacobson GP, Hug GA. The Hearing Handicap Inventory for Adults: psychometric adequacy and audiometric correlates. Ear Hear. 1990;11(6):430-3. http://dx.doi.org/10.1097/00003446-199012000-00004 PMid:2073976.
  » http://dx.doi.org/10.1097/00003446-199012000-00004
• ¹⁶
  Ventry IM, Weinstein BE. The hearing handicap inventory for the elderly: a new tool. Ear Hear. 1982;3(3):128-34. http://dx.doi.org/10.1097/00003446-198205000-00006 PMid:7095321.
  » http://dx.doi.org/10.1097/00003446-198205000-00006
• ¹⁷
  leck MPA, Louzada S, Xavier M, Chachamovich E, Vieira G, Santos L, et al. Application of the Portuguese version of the abbreviated instrument of quality life WHOQOL-bref. Rev Saude Publica. 2000;34(2):178-83. http://dx.doi.org/10.1590/S0034-89102000000200012 PMid:10881154.
  » http://dx.doi.org/10.1590/S0034-89102000000200012
• ¹⁸
  ABEP: Associação Brasileira de Empresas de Pesquisa. Critério de Classificação Econômica Brasil [Internet]. São Paulo: ABEP; 2014 [citado em 2015 Out 9]. Disponível em: http://www.abep.org/criterio-brasil
  » http://www.abep.org/criterio-brasil
• ¹⁹
  WHO: World Health Organization. Deafness and hearing loss [Internet]. Geneva: WHO; 2020 [citado em 2020 Jun 30]. Disponível em: https://www.who.int/en/news-room/fact-sheets/detail/deafness-and-hearing-loss
  » https://www.who.int/en/news-room/fact-sheets/detail/deafness-and-hearing-loss
• ²⁰
  Chisolm TH, Willott JF, Lister JJ. The aging auditory system: anatomic and physiologic changes and implications for rehabilitation. Int J Audiol. 2003;42(Supl. 2):S3-10. http://dx.doi.org/10.3109/14992020309074637 PMid:12918622.
  » http://dx.doi.org/10.3109/14992020309074637
• ²¹
  Luz VB, Silva MC, Scharlach RC, Iório MCM. Correlation between the handicap and the benefit of hearing aid use in adults and elderly. Rev Soc Bras Fonoaudiol. 2011;16(2):160-6. http://dx.doi.org/10.1590/S1516-80342011000200009
  » http://dx.doi.org/10.1590/S1516-80342011000200009
• ²²
  Guarinello AC, Marcelos SB, Ribas A, Marques JM. Analysis of the perception of a group of seniors about their hearing handicap before and after hearing aid use. Rev Bras Geriatr Gerontol. 2013;16(4):739-45. http://dx.doi.org/10.1590/S1809-98232013000400008
  » http://dx.doi.org/10.1590/S1809-98232013000400008
• ²³
  Vuorialho A, Karinen P, Sorri M. Counselling of hearing aid users is highly cost-effective. Eur Arch Otorhinolaryngol. 2006;263(11):988-95. http://dx.doi.org/10.1007/s00405-006-0104-0 PMid:16799805.
  » http://dx.doi.org/10.1007/s00405-006-0104-0
• ²⁴
  Preminger JE, Meeks S. Evaluation of an audiological rehabilitation program for spouses of people with hearing loss. J Am Acad Audiol. 2010;21(5):315-28. http://dx.doi.org/10.3766/jaaa.21.5.4 PMid:20569666.
  » http://dx.doi.org/10.3766/jaaa.21.5.4
• ²⁵
  Brasil. Ministério da Saúde. Portaria n. 2.073/GM, de 28 de setembro de 2004. Institui a Política Nacional de Atenção à Saúde [Internet]. Diário Oficial da União; Brasília; 2004 [citado em 2016 Jan 20]. Disponível em: http://bvsms.saude.gov.br/bvs/saudelegis/gm/2004/prt2073_28_09_2004.html
  » http://bvsms.saude.gov.br/bvs/saudelegis/gm/2004/prt2073_28_09_2004.html
• ²⁶
  Pierre PV, Fridberger A, Wikman A, Alexanderson K. Self-reported hearing difficulties, main income sources, and socio-economic status; a cross-sectional population-based study in Sweden. BMC Public Health. 2012;12:874. http://dx.doi.org/10.1186/1471-2458-12-874 PMid:23067045.
  » http://dx.doi.org/10.1186/1471-2458-12-874
• ²⁷
  Manchaiah VKC, Molander P, Rönnberg J, Andersson G, Lunner T. The acceptance of hearing disability among adults experiencing hearing difficulties: a cross-sectional study. BMJ Open. 2014;4(1):e004066. http://dx.doi.org/10.1136/bmjopen-2013-004066 PMid:24401726.
  » http://dx.doi.org/10.1136/bmjopen-2013-004066
• ²⁸
  Ribas A, Kozlowski L, Almeida G, Marques JM, Silvestre RAA, Mottecy CM. Quality of life: comparing results in elderly with and without presbyacusis. Rev Bras Geriatr Gerontol. 2014;17(2):353-62. http://dx.doi.org/10.1590/S1809-98232014000200012
  » http://dx.doi.org/10.1590/S1809-98232014000200012
• ²⁹
  Mondelli MF, Souza PJ. Quality of life in elderly adults before and after hearing aid fitting. Rev Bras Otorrinolaringol. 2012;78(3):49-56. PMid:22714847.
• ³⁰
  Dawes P, Emsley R, Cruickshanks KJ, Moore DR, Fortnum H, Edmondson-Jones M, et al. Hearing loss and cognition: the role of hearing aids, social isolation and depression. PLoS One. 2015;10(3):e0119616. http://dx.doi.org/10.1371/journal.pone.0119616 PMid:25760329.
  » http://dx.doi.org/10.1371/journal.pone.0119616

Publication Dates

• Publication in this collection
  30 Aug 2021
• Date of issue
  2021

History

• Received
  14 July 2020
• Accepted
  19 Dec 2020