The leaky pipeline of hearing care: primary to secondary care evidence from the English Longitudinal Study of Ageing (ELSA)

Objective: The proportions of older adults' transitions through acknowledging their hearing loss to getting access to treatment are unknown. This was examined using data from a nationally representative cohort in England. Design: Patient and healthcare factors associated with referrals were examined cross-sectionally, through primary to secondary care. Non-report predictors identified using multiple logistic regression models. Study sample: 8529 adults with hearing data in the English Longitudinal Study of Ageing Wave 7. Results: Nearly 40% of those with acknowledged hearing loss did not tell a doctor or nurse (n = 857/2249). Women (OR 2.68, 95% CI 2.14-2.98), retirees (OR 1.30, 95% CI 1.17-1.44), those with foreign education (OR 2.74, 95% CI 2.47-3.04), lower education (OR 2.86, 95% CI 2.58-3.18), smokers (OR 4.39, 95% CI 3.95-4.87), and heavy drinkers (OR 1.67, 95% CI 1.58-1.85) were more likely to not report hearing loss. Of those who acknowledged and reported hearing difficulties, willingness to try hearing aid(s) was high (78.9%). Conclusions: Unacknowledged, or acknowledged but not reported hearing loss by individuals, and non-referrals by primary healthcare professionals, are barriers to accessing hearing healthcare. Future research should report hearing aid use as the proportion of individuals who acknowledge their hearing loss, to avoid an overestimation of the non-use of hearing aids within study samples.