Only 40% of Aboriginal and Torres Strait Islander people who self-reported hearing loss during health checks at an Indigenous primary healthcare centre were referred for treatment and care, new research shows.
The study of more than 1,700 Aboriginal and Torres Strait Islander people aged 15 and over attending the clinic in Inala, Queensland found that almost 20% reported hearing loss but only around 40% of these were referred to audiology or ear, nose and throat specialists or received other management.
“This study shows that hearing loss in Aboriginal and Torres Strait Islander adults is undermeasured, underreported, and undermanaged,” the researchers concluded in the Australian Journal of Primary Health published online today 1 July 2024.
“Clear guidelines for referral pathways and management of hearing loss in the Aboriginal and Torres Strait Islander adult population are needed to improve access to successful management options available in Australia.”
However, they cautioned that, because the study examined only one urban setting, findings “might not be generalisable to other urban Aboriginal and Torres Strait Islander medical services”.
The study was the first to examine management of hearing loss in Aboriginal and Torres Strait Islander adults in a primary healthcare service.
Overall, 18.8% of those in the sample self-reported hearing loss but about 60% who reported this loss during a health check received no management.
Lead author of the study was audiologist Ms Alice Pender, from The Royal Brisbane and Women’s Hospital Audiology Department and the University of Queensland General Practice Clinical Unit.
The retrospective, observational study of Indigenous adults who had annual health checks at the clinic was conducted to determine self-reported hearing loss rates. A medical record audit of those reporting hearing loss from January to June 2021 was performed to identify management approaches, and the proportion who were appropriately managed.
The study analysed results from 1,735 patients who completed 3,090 health checks between July 2018 and September 2021. Hearing loss rates did not differ between men and women but increased from 10.7% for those aged 15–24 years to 38.7% for those aged 65 and over.
An audit of 73 patient medical records found 39.7% with self-reported hearing loss were referred by GPs to ENT/audiology or received other management, and 17.8% of patients owned hearing aids, but 44 (60.3%) showed no record of follow up. Positive outcomes were noted in the 40% who received management.
Actual hearing loss much higher
Researchers said the rate of measured hearing loss was 2.5 to five times higher than the rate of self-reported hearing loss in the study and another 2019 study, the NATSIHS Australian Bureau of Statistics study.
“This finding suggests that many adults with hearing loss do not self-report, which is supported by other research suggesting that self-reported hearing loss underestimates actual hearing loss, including in Aboriginal and Torres Strait Islander adults,” they said.
This suggested hearing loss affected a considerable proportion of Aboriginal and Torres Strait Islander adults, they added.
This study was the first in more than a decade to report hearing loss rates in a localised Aboriginal and Torres Strait Islander adult population.
“Its large patient population with high coverage and good representation provides robust evidence and makes an important contribution to this under-researched area of Aboriginal and Torres Strait Islander health,” the researchers said. “Significant changes to clinical management and government-funded referral options for hearing services are required to improve the management of self-reported hearing loss in this population.”
Don’t ask, ‘do you have hearing loss?’
Research translation has begun based on findings with one improvement strategy actioned being adding an automated alert system in the centre to prompt GPs to actively manage self-reported hearing loss in patients.
Another was a change of wording in the hearing question in the health check from, ‘Do you have hearing loss?’ to ‘Have you noticed trouble/difficulty hearing?’ The intent is to improve detection of self-reported-hearing loss but, an increased rate of hearing loss was not observed after changing the wording in the study.
“Although we were unable to determine why 60.3% of Aboriginal and Torres Strait Islander adults who self-reported hearing loss during their health checks did not proceed to ear and/or hearing services in the current study, we identified the urgent need for improved access and clearer referral pathways to ear and/or hearing services for this at-risk population,” researchers said.
They said their research was also important in light of growing evidence linking hearing loss to dementia risk as dementia rates were higher in Aboriginal and Torres Strait Islander adults because of social determinants of health that contribute to poorer health outcomes that affect dementia.
Improved education of primary care providers on the benefits of aural rehabilitation was also required, they said.
“Primary care providers’ attitudes and perceptions of hearing loss play an important part in its management,” they said.
Referral practices for hearing loss for Indigenous people aged 26–50 could be affected by lack of government funding for hearing services including hearing aids, they added.
Funding was a significant issue given this age group’s high parental and work responsibilities and urgent action was required to change government policies to ensure all Aboriginal and Torres Strait Islander adults were eligible for funding for aural rehabilitation, they said.
The study was partly funded by a Queensland Advancing Clinical Research Fellowship, the Royal Brisbane and Women’s Hospital and the RBWH Foundation Scholarship awarded to Pender. Other researchers were from The University of Queensland’s School of Health and Rehabilitation Sciences, the university’s Poche Centre for Indigenous Health, Toowong, Southern Queensland Centre of Excellence in Aboriginal and Torres Strait Islander Primary Health Care, Inala and The University of Canterbury, Christchurch, New Zealand.
