A structured hearing loss education program significantly increased the use of hearing screening among visiting nurses caring for older adults, according to a cluster randomized controlled trial published in PLOS One.
The study evaluated the “Hearing Loss Care Education Program for the Older Adults,” a targeted intervention designed by the authors to address documented gaps in visiting nurses’ knowledge and implementation of hearing care. Hearing loss is highly prevalent in older populations and is associated with depression, cognitive decline, frailty, and loss of independence. Yet prior research has shown that visiting nurses – who are often on the front lines of home-based geriatric care – frequently report limited training and low implementation rates for hearing-related interventions.
To assess their program’s effectiveness, investigators conducted a cluster randomized controlled trial across 22 visiting nursing stations in Japan. A total of 102 nurses participated, with 60 assigned to the intervention group and 42 to usual care. The intervention consisted of a 30-minute on-demand lecture followed by a 30-minute hands-on technical session. Educational content covered hearing loss pathophysiology, screening techniques, hearing aid care, communication strategies, ear canal assessment, and interprofessional collaboration. Practical training included finger-rub and whisper screening tests, hearing aid battery replacement, and earwax assessment using simulation tools.
The primary outcome was implementation of hearing care behaviors, particularly hearing screening. Nurses in the intervention group were more than eight times as likely to implement hearing screening compared with controls. No significant differences were observed for other hearing care behaviors, including hearing aid care or coordination with specialists.
The intervention also improved knowledge and confidence. The adjusted partial regression coefficient for knowledge gain was 3.34. All six confidence measures – including finger-rub testing, whisper testing, hearing aid battery replacement, and earwax assessment – showed statistically significant improvements in the intervention group.
The investigators noted that simple screening tools, such as finger-rub and whisper tests, are practical for home settings because they require no specialized equipment and can be performed quickly. This feasibility may explain why screening behavior changed more substantially than other domains of care, such as hearing aid management, which depend on patient-specific factors and available time during visits.
Despite the positive findings, several limitations warrant consideration. Baseline knowledge was slightly higher in the intervention group, and facilities in that arm were more likely to employ speech therapists, which may have influenced outcomes. The study was also conducted in a single Japanese prefecture, potentially limiting generalizability. Additional limitations included lack of blinding, use of investigator-developed outcome measures, and inability to assess outcomes among older adults receiving care.
Still, the findings suggest that a concise, skills-based educational intervention can meaningfully improve hearing screening uptake in home nursing practice. Given the high prevalence of untreated hearing loss among older adults and its links to broader health outcomes in this demographic, integrating structured hearing care training into visiting nurse education may represent a practical step toward improving geriatric care delivery.
Source: PLOS One.
