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Hearing Loss and Healthy Aging Workshop Summary Tracy A. Lustig and Steve Olson, Rapporteurs Forum on Aging, Disability, and Independence Board on Health Sciences Policy Division of Behavioral and Social Sciences and Education PREPUBLICATION COPY: UNCORRECTED PROOFS

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THE NATIONAL ACADEMIES PRESS 500 Fifth Street, NW Washington, DC 20001 NOTICE: The workshop that is the subject of this workshop summary was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. This activity was supported by contracts between the National Academy of Sciences and the Academy of Doctors of Audiology; the American Academy of Audiology; the American Academy of Otolaryngology–Head and Neck Surgery; American Geriatrics Society; the American Speech-Language-Hearing Association; Cochlear Americas; the European Hearing Instrument Manufacturers Association; the Gerontological Society of America; the Hearing Industries Association; the Hearing Loss Association of America; Hi HealthInnovations; LeadingAge; MED-EL Corporation, USA; the National Institute on Aging (Contract No. HHSN26300038); the National Institutes of Health’s National Institute on Aging and National Institute on Deafness and Other Communication Disorders (Contract No. HHSN26300048); The SCAN Foundation (Contract No. 12-004), Sound World Solutions; United HealthCare; the U.S. Department of Education’s National Institute on Disability and Rehabilitation Research (Contract No. ED-OSE-12-P-0066); and the U.S. Department of Veterans Affairs (Contract No. VA268-12-P-0014). The views presented in this publication do not necessarily reflect the views of the organizations or agencies that provided support for the activity. International Standard Book Number 0-309-0XXXX-X Additional copies of this workshop summary are available for sale from the National Academies Press, 500 Fifth Street, NW, Keck 360, Washington, DC 20001; (800) 624-6242 or (202) 334-3313; http://www.nap.edu. For more information about the Institute of Medicine, visit the IOM home page at: www.iom.edu. Copyright 2014 by the National Academy of Sciences. All rights reserved. Printed in the United States of America The serpent has been a symbol of long life, healing, and knowledge among almost all cultures and religions since the beginning of recorded history. The serpent adopted as a logotype by the Institute of Medicine is a relief carving from ancient Greece, now held by the Staatliche Museen in Berlin. Suggested citation: IOM (Institute of Medicine) and NRC (National Research Council). 2013. Hearing loss and healthy aging: Workshop summary. Washington, DC: The National Academies Press. PREPUBLICATION COPY: UNCORRECTED PROOFS

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The National Academy of Sciences is a private, nonprofit, self-perpetuating society of distinguished scholars engaged in scientific and engineering research, dedicated to the furtherance of science and technology and to their use for the general welfare. Upon the authority of the charter granted to it by the Congress in 1863, the Academy has a mandate that requires it to advise the federal government on scientific and technical matters. Dr. Ralph J. Cicerone is president of the National Academy of Sciences. The National Academy of Engineering was established in 1964, under the charter of the National Academy of Sciences, as a parallel organization of outstanding engineers. It is autonomous in its administration and in the selection of its members, sharing with the National Academy of Sciences the responsibility for advising the federal government. The National Academy of Engineering also sponsors engineering programs aimed at meeting national needs, encourages education and research, and recognizes the superior achievements of engineers. Dr. C. D. Mote, Jr., is president of the National Academy of Engineering. The Institute of Medicine was established in 1970 by the National Academy of Sciences to secure the services of eminent members of appropriate professions in the examination of policy matters pertaining to the health of the public. The Institute acts under the responsibility given to the National Academy of Sciences by its congressional charter to be an adviser to the federal government and, upon its own initiative, to identify issues of medical care, research, and education. Dr. Harvey V. Fineberg is president of the Institute of Medicine. The National Research Council was organized by the National Academy of Sciences in 1916 to associate the broad community of science and technology with the Academy’s purposes of furthering knowledge and advising the federal government. Functioning in accordance with general policies determined by the Academy, the Council has become the principal operating agency of both the National Academy of Sciences and the National Academy of Engineering in providing services to the government, the public, and the scientific and engineering communities. The Council is administered jointly by both Academies and the Institute of Medicine. Dr. Ralph J. Cicerone and Dr. C. D. Mote, Jr., are chair and vice chair, respectively, of the National Research Council. www.national-academies.org PREPUBLICATION COPY: UNCORRECTED PROOFS

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PLANNING COMMITTEE FOR A WORKSHOP ON HEARING LOSS AND HEALTHY AGING1 ALAN M. JETTE (Co-Chair), Professor of Health Policy and Management and Director, Health and Disability Research Institute, Boston University School of Public Health FRANK R. LIN (Co-Chair), Assistant Professor of Otolaryngology–Head and Neck Surgery, Geriatric Medicine, Mental Health, and Epidemiology, Johns Hopkins University BRENDA BATTAT, Executive Director (retired), Hearing Loss Association of America LUCILLE B. BECK, National Program Director, Audiology and Speech Pathology, and Chief Consultant, Rehabilitation and Prosthetic Services, Patient Care Services, U.S. Department of Veterans Affairs NIKOLAI BISGAARD, Vice President, Intellectual Property Rights and Industry Relations, GN ReSound A/S KAREN J. CRUICKSHANKS, Professor of Ophthalmology and Visual Sciences and Population Health Sciences, University of Wisconsin School of Medicine and Public Health LUIGI FERRUCCI, Scientific Director and Chief, Longitudinal Studies Section, National Institute on Aging JAMES FIRMAN, President and Chief Executive Officer, National Council on Aging CAROLE M. ROGIN, President, Hearing Industries Association 1 Institute of Medicine and National Research Council planning committees are solely responsible for organizing the workshop, identifying topics, and choosing speakers. The responsibility for the published workshop summary rests with the workshop rapporteurs and the institution. PREPUBLICATION COPY: UNCORRECTED PROOFS v

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IOM-NRC FORUM ON AGING, DISABILITY, AND INDEPENDENCE1 ALAN M. JETTE (Co-Chair), Boston University School of Public Health, MA JOHN W. ROWE (Co-Chair), Columbia University, New York, NY KELLY BUCKLAND, National Council on Independent Living, Washington, DC JOE CALDWELL, National Council on Aging, Washington, DC MARGARET L. CAMPBELL, National Institute on Disability and Rehabilitation Research, Washington, DC EILEEN M. CRIMMINS, University of Southern California, Los Angeles PEGGYE DILWORTH-ANDERSON, Gillings School of Global Public Health, University of North Carolina, Chapel Hill STEVEN C. EDELSTEIN, PHI, Bronx, NY THOMAS E. EDES, U.S. Department of Veterans Affairs, Washington, DC TERRY FULMER, Bouvé College of Health Sciences, Northeastern University, Boston, MA NAOMI L. GERBER, Center for the Study of Chronic Illness and Disability, George Mason University, Fairfax, VA ROBERT HORNYAK, Administration for Community Living, Washington, DC LISA I. IEZZONI, Harvard Medical School, Boston, MA JUDITH D. KASPER, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD KATHY KREPCIO, John J. Heldrich Center for Workforce Development, Rutgers, The State University of New Jersey, New Brunswick, NJ NANCY LUNDEBJERG, American Geriatrics Society, New York, NY RHONDA MEDOWS, United HealthCare, Washington, DC LARRY MINNIX, LeadingAge, Washington, DC ARI NE’EMAN, National Council on Disability, Washington, DC RENÉ SEIDEL, The SCAN Foundation, Long Beach, CA JACK W. SMITH, U.S. Department of Defense, Falls Church, VA RICHARD SUZMAN, National Institute on Aging, Bethesda, MD IOM and NRC Staff TRACY A. LUSTIG, Forum Director GOOLOO WUNDERLICH, Senior Program Officer, Division of Behavioral and Social Sciences and Education, National Research Council Y. CRYSTI PARK, Senior Program Assistant ANDREW M. POPE, Director, Board on Health Sciences Policy, Institute of Medicine 1 Institute of Medicine and National Research Council forums do not issue, review, or approve individual documents. The responsibility for the published summary rests with the workshop rapporteurs and the institution. PREPUBLICATION COPY: UNCORRECTED PROOFS vii

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Reviewers This workshop summary has been reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise, in accordance with procedures approved by the National Research Council’s Report Review Committee. The purpose of this independent review is to provide candid and critical comments that will assist the institution in making its published workshop summary as sound as possible and to ensure that the workshop summary meets institutional standards for objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the process. We wish to thank the following individuals for their review of this workshop summary: JUDY R. DUBNO, Medical University of South Carolina NOREEN GIBBENS, Hi HealthInnovations ELLEN MORGENSTERN, The Foundation of the National Committee to Preserve Social Security and Medicare Although the reviewers listed above have provided many constructive comments and suggestions, they did not see the final draft of the workshop summary before its release. The review of this workshop summary was overseen by DAVID B. REUBEN, University of California, Los Angeles. Appointed by the Institute of Medicine, he was responsible for making certain that an independent examination of this workshop summary was carried out in accordance with institutional procedures and that all review comments were carefully considered. Responsibility for the final content of this workshop summary rests entirely with the rapporteurs and the institution. PREPUBLICATION COPY: UNCORRECTED PROOFS ix

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Contents 1 INTRODUCTION, BACKGROUND, AND OVERVIEW OF THE WORKSHOP 1-1 Background, 1-2 Overview of the Workshop, 1-4 Organization of the Workshop Summary, 1-5 2 HEARING LOSS: TWO PERSPECTIVES 2-1 Living with Hearing Loss, 2-1 Hearing Technologies from a Consumer Perspective, 2-5 3 THE CONNECTION BETWEEN HEARING LOSS AND HEALTHY AGING 3-1 The Consequences of Untreated Hearing Loss, 3-1 The Impact of Hearing Loss on Physical Functioning, 3-2 Functional Reserves and Hearing, 3-4 Aging and Hearing Loss: Why Does It Matter?, 3-5 The Impact of Hearing Loss on Cognition, 3-6 Psychosocial Impacts, 3-7 Other Issues, 3-10 4 CURRENT APPROACHES TO HEARING HEALTH CARE DELIVERY 4-1 The Spectrum of Hearing Impairment and Interventions, 4-1 The Current U.S. Hearing Health Care Model, 4-5 An International Perspective, 4-7 5 HEARING TECHNOLOGIES 5-1 A Technology Overview, 5-1 Current FDA Standards, 5- 5 Wireless Standards, 5-8 Health Technology Assessment: Role in Technology Development and Use, 5-10 6 INNOVATIVE MODELS 6-1 The Community Health Worker Model, 6-1 Teleaudiology, 6-3 The Primary Care Setting, 6-5 Social Enterprise Business Models, 6-7 Inclusive Design, 6-9 7 CONTEMPORARY ISSUES IN HEARING HEALTH CARE 7-1 Healthy People 2020, 7-1 The Changing Health Care System, 7-2 NIDCD Research Working Group on Accessible and Affordable Hearing Health Care, 7-4 8 COLLABORATIVE STRATEGIES FOR THE FUTURE 8-1 American Public Health Association, 8-1 American Geriatrics Society, 8-2 AARP, 8-3 Participants’ Reflections on the Workshop, 8-4 PREPUBLICATION COPY: UNCORRECTED PROOFS xi

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REFERENCES R-1 APPENDIXES A WORKSHOP AGENDA A-1 B SPEAKER BIOGRAPHICAL SKETCHES B-1 PREPUBLICATION COPY: UNCORRECTED PROOFS xii