Hearing Loss in Later Life: A qualitative investigation of the barriers and facilitators to managing hearing loss for older adults living with frailty

Hearing loss and frailty are common in later life. Frailty is a condition in which individuals have low grip strength, low energy, and low physical activity. Both hearing loss and frailty can affect quality of life and wellbeing, and many older adults with frailty live with other health conditions. However, there is little information on the specific challenges faced by older adults who have both hearing loss and frailty, including the extra effort this requires, and the support needed to use hearing aids effectively and regularly. To prepare for this study, we spoke with older adults with hearing loss who shared their challenges in communicating with family, caregivers, and healthcare professionals, as well as the difficulties of managing their hearing aids.

Aim: To explore the barriers and facilitators to managing hearing loss for older people living with frailty using the Burden of Treatment Theory, to identify how to better meet their support needs.

Specific questions we seek to answer:

• What are the motivational and cognitive processes that underpin the decision to initiate help-seeking, or not, for hearing loss?
• What barriers and facilitators do older adults living with frailty experience when accessing and engaging with audiology services (Including when initially seeking support for hearing loss via a GP or practice nurses).
• What barriers and facilitators do older adults living with frailty experience when using hearing aids?
  – Why do some older adults with frailty and hearing loss not wear their hearing aids, or not wear them as often as they should?
• How aware are older adults with frailty and hearing loss of other hearing supportive technologies (e.g., special doorbells/vibrating fire alarms and alarm clocks)?
• What support do older adults living with frailty consider important for managing their hearing loss?

We will identify twenty-five older adults with both hearing loss and frailty and conduct in-depth interviews with them. To participate in the study, they will need to have been diagnosed with hearing loss or currently own or have previously owned a hearing aid. Interviews will take place in the older adult’s home or a location of their choice. Discussions will cover their reasons for seeking help with hearing loss, experiences with audiology services, challenges using hearing aids, support considered helpful, awareness of other hearing tools (like special doorbells), and what they feel is important for managing hearing loss. Since many older adults rely on spouses, family, or friends for hearing support, we will include some of these communication partners (up to 10) in the interviews to hear their perspectives.

Data will be thematically analysed, using the Burden of Treatment Theory, to identify barriers and facilitators to managing hearing loss within the context of the research questions.

Once interview findings are available, we will hold a stakeholder workshop, including two audiologists and around three older adult participants (identified from earlier interviews). Workshops will explore recommendations for managing hearing loss, and future research requirements.

The study will be informed by Patient and Public Involvement and Engagement (PPIE) throughout. Chris Quinn, PPIE co-applicant has written a blog reflecting on his own hearing loss journey and the impact it has had throughout his life as part of this study. You can read here.

Dr Lesley Brown (Chief Investigator), Academic Unit for Ageing and Stroke Research, Bradford Teaching Hospitals NHS Foundation Trust

Ms Alexandra Farrell, Audiology Department, Bradford Royal Infirmary, Bradford Teaching Hospitals NHS Foundation Trust

Professor Anne Forster, Academic Unit for Ageing and Stroke Research, University of Leeds / Bradford Teaching Hospitals NHS Foundation Trust

Dr Ronan McGarrigle, School of Psychology, University of Leeds

Dr Rahena Mossabir, Academic Unit for Ageing & Stroke Research, Bradford Teaching Hospitals NHS Foundation Trust

Mr Chris Quinn, PPIE co-applicant

01/12/2025 – 31/03/2027

This project is funded by the National Institute for Health and Care Research (NIHR) under its Research for Patient Benefit (RfPB) Programme (Grant Reference Number NIHR208655). The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care.

For further information please contact:
Lesley Brown, Chief Investigator Lesley.brown@bthft.nhs.uk, or
Liz Graham, Project Manager/Researcher liz.graham@bthft.nhs.uk