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Dr
Dr Katrina Davis Dr Katrina Davis MRCPsych*, ST4 Old Age Psychiatry trainee
Katrina Davis MRCPsych*
y , ST4 Old Age
g Psychiatry
y
y trainee
ᶧ
Professor Adrian Davis
P
Professor
f
Ad i Davis
Adrian
D i , Director MRC Hearing and Communication Group & DH lead , Director
Di t MRC Hearing
H i and
d Communication
C
i ti Group
G
& DH lead
l d
advisor on Physiological Diagnostics and Audiology
advisor on Physiological Diagnostics and Audiology
ᶧ
ᶧ
Ms Julia
Ms Julia Maier
l Maier‐McAlpine
McAlpine
l
, Ms Pauline Smith
Ms Pauline
l Smith
h & Mr Bob Erens
& Mr Bob
b Erens**
**.
*SSouth London and Maudsley
*South
th London
L d and
d Maudsley
M d l Rotation / Oxleas
R t ti / Oxleas
Rotation
O l
NHS Trusts,
NHS Trusts, T t ᶧMRC Hearing and Communication MRC Hearing
H i and
d Communication
C
i ti
G
Group/UCL
Group/UCL Partners, /UCL Partners,
P t
**N
**National
National Centre for Social Research (NatCen)
ti
l Centre
C t for
f Social
S i l Research
R
h (NatCen)
(N tC )
y
TTo investigate the impact of To
i
investigate
ti t the
th impact
i
t off
h i g and
hearing
hearing and communication d communication
i ti
impairment on mood and QoL
impairment on mood and QoL
y
In large representative sample of In
large
l g representative
p
sample
pl off
elderly
elderly living in the community in ld ly liliving
i g iin th
the community
ity iin
E l d
England
y
Usingg validated
Using validated screening tools
l d d screeningg tools
l
y
To inform debate around early To
inform debate around earlyy
d t tio aand
detection
detect
detection and intervention in elderly
d intervention
i tte e ti
t o in
i eelderly
ld
de ly
High prevalence in the elderly and rises Hi
High
gh p
prevalence
l
i the
in
th elderly
ld ly and
d rises
i
steeply
steeply with age
l with
i h age
y
S
Severity
it
A
Approx
Approx prevalence
prevalence
l
Bil
Bilateral
Bilateral hearing loss of 35dB HL
l hearing
h i loss
l
off 35dB HL
• 10+% of those aged 70y
10 % off those
10+%
h
aged
g d 70
70yy
• By mid
By mid‐70s,
mid 70s, increases to 50%
70s increases to 50%
‐ struggle to follow and participate in struggle
t
l to
t follow
f ll and
d participate
ti i t in
i
conversation when background
conversation when background noise
g
noise
Bilateral hearing loss over 50dB HL
Bilateral hearing loss over 50dB HL
• 50% by mid
50% by
b mid‐80s
id 80s
80
‐ any conversation becomes difficult
anyy conversation becomes difficult
y
I
Increases
Increases risk of depression
risk
i k off depression
d p
i
4
3
2
1
0
OR
RR
Meta
M
Meta‐analysis
t analysis by l i by
b
Huangg, Dongg et al 2010
Huang, Dong et al 2010
explored
explored link between l d lilinkk b
between
disability
y and depression
p
disability and depression
included 9 studies l d d 9 studies
d
included
lookingg at hearingg
looking at hearing impairment with
impairment with ~19
~19,000
19,000 subjects
000 subjects
bj t
4
3
2
1
0
Relative Risk
Relative Risk
Odds Ratio
Odds Ratio
Population study of long
Population
study of long‐term
long term conditions focussing term conditions focussing
on se
o
on sensory problems
sensory
so y p
problems
ob
ble s
o
o ~1000
1000 community
community‐dwelling people aged ≥60y
community‐
dwelling people aged ≥60y
o Random
Random cluster location sampling with quotas aiming R
d
cluster
l t location
l ti sampling
li with
ith quotas
t aiming
i i
to be
to be representative of whole population in England
b representative
p
i off whole
h l population
p p l i iin England
gl d
F
f
p
i d interview
i
i
Face‐to‐face
computer‐assisted
computer‐assisted interview
o
o
o
h 20 minutes
Less than 20 minutes
Less
than
o
D li
d by
b non‐clinical
li i l survey staff
ff
Delivered by non
Delivered
clinical survey staff I l d d objective
Included
bjj ti screening
i g ffor h
hearing
i g lloss and
d
Included objective screening for hearing loss and depression
o Both
Both commonly go undetected, therefore asking about B
th commonly
ly ggo undetected
d t t d therefore
th f
asking
ki g about
b t
them
them is insufficient
h
is insufficient
ff
ii.
◦
◦
◦
Hearingg:
h k Screener
HearCheck
In qu
In quiet room with hearing aids removed
quiet
ie room
i h hearing
hea i g aids
d
oo with
aid
ds removed
e o ed
Six tones in each ear
Si tones in
Six
i each
h ear
1kHz – Loud (55dB), Medium (35dB), Soft (20dB)
1kHz
Loud ((55dB)) Medium ((35dB)) Soft ((20dB))
3kHz
Loud
(55dB),
3kH – Loud (75dB), Medium (55dB), Soft (35dB)
L d (75dB),
(75dB) Medium
M di
(55dB) Soft
S ft (35dB)
3kHz Depression
i
p
ii.
ii
◦
◦
x
x
◦
◦
x
Patient
Health
Questionnaire
(PHQ‐2)
Patient Health Questionnaire 2 (PHQ‐2)
P
ti t H
lth Q
ti
i 2 ((PHQ
2))
Originally
Originally two questions:
q ti
O igi lly two
t questions:
“during
during the past month how often have you been the past month how often have you been
b h d by
bothered
bothered by feeling down, depressed or hopeless?
by feeling
f l g down
d
, depressed
d p
d or hopeless?”
h p l ?”
“during
during the past month how often have you been the past month how often have you been
b h d by
bothered
bothered by little interest or pleasure in doing things?
by little
li l interest
i
or pleasure
pl
i doing
in
d i g things?”
hi g ?”
Sensitivity 100%, Specificity 77% in over
Sensitivity
100% Specificity 77% in over‐65s
over 65s1
Specificity can be improved by an ‘impact’
Specificity can be improved by an impact question
question2
“during
during the last month how worried, annoyed or upset g the last month how worried, annoyed
y or upset
p
h
have
have you been about feeling like this?
you been
b
about
b t feeling
f li like
lik this?”
thi ?”
1. Li et al 2007. Validity of the PHQ
1
Li ett all 2007 V
Validity
lidit off th
the PHQ
PHQ‐2
2 in
2 in Identifying Major Depression in Older People
i Identifying
Id tif i Major
M j Depression
D
i in
i Older
Old People
P
l
2 Arroll et al 2005. Effect of the addition of a 2.
et al 2005 Effect
ff off the addition off a “help”
“help
p” question...
question
q
N= 1014
N
N=
1014
Drawn from everyy Government Office Region
Drawn from every Government Office Region in England
g
in England
g
Q
Quota
Male Total
Male –
M l – 60
Male
Male 60‐69
69
Male
Male l – 70‐79
Male 80+
Male –
F
Female
Female l – Total
T t l
Female
Female –
l – 60‐69
Female – 70
Female 70‐79
79
F
Female
Female l – 80+
80
Workingg
BME
SStudy Subjects
Study
d Subjects
S bj
45%
22%
16%
%
7%
55%
25%
18%
12%
15%
5 5%
5.5%
Population ≥ 60y
P
Population
l i ≥ 60
60y
46%
24%
15%
%
7%
54%
25%
18%
11%
18%
4 2%
4.2%