ACHIEVE Hearing Intervention Follow-Up Study

This study is a multi-site randomized efficacy trial of a telehealth versus conventional clinic-based hearing healthcare (HHC) delivery model among older adults who are existing hearing aid users to determine if a telehealth HHC model improves hearing aid use and other communication outcomes compared to clinic-based HHC.

Participants will be recruited from the ongoing Aging & Cognitive Health Evaluation in Elders (ACHIEVE) randomized trial in which the investigators recruited 977 adults ages 70-84 with untreated mild-to-moderate hearing loss from January 2018 to October 2019 who were randomized to a hearing intervention (i.e., conventional clinic-based delivery of hearing services and technologies) versus a successful aging education control intervention (i.e., one-on-one sessions with a health educator on topics important for healthy aging). From 2021-2022, as participants in the hearing intervention group (fixed sample, n=490) complete the pre-specified three years of follow-up in the ACHIEVE trial, the investigators will recruit these existing hearing aid users and randomize the participants 1:1 to receive continued conventional clinic-based delivery of hearing care services versus a model that incorporates telehealth. Accounting for loss to follow-up and death, the investigators conservatively estimate that n=400 participants currently in the hearing intervention group will be recruited into this two-year follow-up study.

The main analyses will be conducted at one-year post-randomization when hours of hearing aid use (primary outcome) and patient-centered hearing and communication, social functioning, and quality of life secondary outcomes will be contrasted between the two intervention groups.

After one year of follow-up, participants randomized to the conventional HHC arm will cross-over and also receive telehealth HHC, while participants randomized to the telehealth HHC arm will continue to receive telehealth HHC. All participants will continue to be followed for 2 years post-randomization for observational analyses, with data collection follow-up visits occurring every 6 months.

To be eligible for the current study, participants must:

• have been eligible for and participated in the hearing intervention arm of the ACHIEVE trial (see original eligibility criteria below)
• agree to be randomized to receive continued hearing care via either a telehealth or conventional delivery model, and
• agree to participate in the follow-up study.

Original ACHIEVE Inclusion Criteria:

• Age 70-84 years
• Community-dwelling, fluent English speaker
• Availability of participant in area for study duration
• Adult-onset hearing impairment, defined as four-frequency pure tone average (PTA, 0.5-4 kilohertz (kHz), better ear) ≥30 decibel (dB) hearing level (HL) (decibels hearing level) & <70 dB HL
• Speech recognition scores in quiet ≥60% in better ear
• Mini-Mental State Exam (MMSE) score ≥23 for participants with high school degree or less, or ≥25 for participants with some college education or more

Original ACHIEVE Exclusion Criteria:

• Reported disability in ≥2 activities of daily living (ADLs)
• Vision impairment (worse than 20/63 on the Minnesota Near Vision Card)
• Self-reported use of a hearing aid in the past 1 year
• Medical contraindication to use of hearing aids (e.g., draining ear)
• Unwilling to wear hearing aids on a daily basis
• Conductive hearing impairment with air-bone gap >15 dB in two or more contiguous frequencies in both ears