Achieving optimal outcomes: Insights from the ACHIEVE Study audiologists on treating hearing loss in older adults

Discover how best practice hearing interventions can transform the lives of older adults by enhancing communication and fostering independence. Explore key findings from the ACHIEVE Study and learn practical strategies to support your patients in their journey towards better hearing health.

Hearing loss is linked to increased loneliness1, frailty2, risk of falls2, cognitive decline3, poorer provider communication4, and hospitalizations.5 In addition to these challenges, stigma around hearing loss can prevent individuals from seeking necessary treatment which further impacts quality of life.

Despite its high prevalence among older adults6-9, hearing treatment remains underutilized. Patients often pursue hearing healthcare to improve their quality of life and because of encouragement from loved ones but adopting hearing aids takes time to integrate into daily life.

However, tailored hearing interventions can make a meaningful difference. This article explores the ACHIEVE Study, which evaluated these interventions and revealed two important insights:

  • Personalized hearing care can greatly enhance communication and well-being.
  • Individuals with additional health factors may experience supportive benefits from hearing interventions alongside improved communication.

Read on to learn more about the study and practical strategies for supporting your patients.

The ACHIEVE Study

Launched in 2018, the Aging and Cognitive Health Evaluation in Elders (ACHIEVE) Study involved 977 older adults aged 70-84 with mild to moderate hearing loss from four U.S. communities.10,11

Participants were recruited from two sources:

  1. Existing participants of a heart health study (Atherosclerosis Risk in Communities Study [ARIC] cohort).
  2. Newly recruited healthy volunteers (de novo cohort).

The ACHIEVE study represents the longest and largest randomized hearing intervention study, aiming to assess whether hearing intervention versus a health education control could slow cognitive decline over three years.

Study findings and implications

The primary outcome analysis of the overall cohort revealed no difference between hearing intervention and control on cognitive change over three years.12

However, a sensitivity analysis indicated that:

  • Individuals recruited from the ARIC study might experience potential cognitive benefits from the hearing intervention, warranting further exploration.12
  • Participants in the ARIC cohort had more comorbidities and risk factors for cognitive decline. While the intervention may not universally slow cognitive decline, it may hold promise for specific groups.

Secondary analyses showed:

  • Significant improvements in communicative function after six months.13
  • These benefits lasted for three years.13

These results underscore the importance of recommending hearing interventions to older adults to enhance communication and potentially improve other health aspects.  Ongoing research continues to evaluate the effects of hearing intervention on other brain, social, and physical health outcomes.  

So, what was the hearing intervention provided in the ACHIEVE study?  The intervention was designed based on professional guidelines and expert clinician input, with published details available.12-17

The ACHIEVE hearing intervention was designed to balance standardization with personalization:

  • Participants received consistent, standardized, top-notch intervention regardless of their study site while also feeling their unique needs were met.15
  • The approach was personalized to address each participant’s unique needs, making visits something they would look forward to.

Intervention timeline

Over approximately eight weeks post-randomization, participants in the hearing intervention assignment received a comprehensive intervention where they set personal goals, received hearing aids and assistive devices, and learned effective self-management and communication habits. Although each visit followed a structured format, individual goals and journeys varied.

Audiologists collaborated with participants to personalize the experience by:

  • Selecting appropriate accessories.
  • Choosing effective communication strategies.
  • Addressing setbacks along the way.

Ongoing support

Participants attended booster sessions every six months across the next three years. These sessions allowed for technology checks and offered opportunities for study audiologists to encourage participants and ensure they remained engaged with their hearing program.

Key insights from audiologists

Over the course of the study, the ACHIEVE audiologists identified several key insights:

  1. Clear communication: Using straightforward language and avoiding technical jargon helped improve patient understanding and confidence. Breaking down the use of hearing aids into manageable steps was particularly beneficial for individuals who may be unfamiliar with technology.
  2. Comprehensive resources: The ACHIEVE Hearing Intervention provided participants with the Hearing Loss Toolkit for Self-Management17 and video clips from C2Hear Reusable Learning Objects.18-20 These resources, featuring clear visuals and easy-to-read text, supported participants in independently managing their hearing aids and hearing loss.
  3. Personalized care: The Client Oriented Scale of Improvement (COSI) 21 was used to capture patient-centered goals, allowing interventions to be tailored to each participant’s unique needs. This personalized approach proved essential for effective outcomes.
  4. Involving family: Engaging family members and care partners was instrumental in helping participants integrate hearing aids and communication strategies into daily life more smoothly.
  5. Encouragement and follow-up: Celebrating small victories and providing ongoing encouragement built patient confidence. Routine follow-ups were crucial for ensuring long-term success, particularly for older adults who may be navigating new technologies.

Conclusion and impact

The ACHIEVE Study underscores the significance of structured yet personalized hearing interventions in enhancing both hearing and overall well-being. Our audiologists advocate for a best practice, patient-centered approach to increase the acceptance and effectiveness of these interventions. Sharing our experiences and lessons learned fosters collaboration, influencing policy, practice, and the field at large.

We extend our gratitude to the ACHIEVE participants for their invaluable contributions, which, along with support from our funding sources, enables us to share these insights. We should all continue to learn from scientific research studies, but also from our older patients to better tailor how we provide care. Their experiences encourage us to be curious and creative in our approach.

Based on our study findings:

  • We can reassure patients and families that hearing interventions support overall well-being and may have potential benefits for maintaining cognitive health.
  • Using this program can improve communication and may support overall health. This reinforces the importance of increasing access to hearing loss diagnosis, treatment, and prevention.
  • Highlighting the benefits of hearing interventions, rather than emphasizing negative outcomes like dementia risk, can motivate patients and reduce stigma.

Let’s continue to uplift each other and advance our practice through shared knowledge and insights. Our dedication as audiologists to improving our patients’ well-being is invaluable, and together, we can make a profound difference in the lives of those we serve.

References:

1. Mick, P., & Pichora-Fuller, M. K. (2016). Is Hearing Loss Associated with Poorer Health in Older Adults Who Might Benefit from Hearing Screening?. Ear and hearing, 37(3), e194–e201. https://doi.org/10.1097/AUD.0000000000000267

2. Kamil, R. J., Betz, J., Powers, B. B., Pratt, S., Kritchevsky, S., Ayonayon, H. N., Harris, T. B., Helzner, E., Deal, J. A., Martin, K., Peterson, M., Satterfield, S., Simonsick, E. M., Lin, F. R., & Health ABC study (2016). Association of Hearing Impairment With Incident Frailty and Falls in Older Adults. Journal of aging and health, 28(4), 644–660. https://doi.org/10.1177/0898264315608730

3. Lin F. R. (2011). Hearing loss and cognition among older adults in the United States. The journals of gerontology. Series A, Biological sciences and medical sciences, 66(10), 1131–1136. https://doi.org/10.1093/gerona/glr115

4. Reed, N. S., Stolnicki, W., Gami, A., Myers, C., Kohn, C., & Willink, A. (2021). Association of Self-Reported Trouble Hearing and Patient-Provider Communication with Hospitalizations among Medicare Beneficiaries. Seminars in hearing, 42(1), 26–36. https://doi.org/10.1055/s-0041-1725998

5. Genther, D. J., Frick, K. D., Chen, D., Betz, J., & Lin, F. R. (2013). Association of hearing loss with hospitalization and burden of disease in older adults. JAMA, 309(22), 2322–2324. https://doi.org/10.1001/jama.2013.5912

6. Cruickshanks, K. J., Tweed, T. S., Wiley, T. L., Klein, B. E., Klein, R., Chappell, R., Nondahl, D. M., & Dalton, D. S. (2003). The 5-year incidence and progression of hearing loss: the epidemiology of hearing loss study. Archives of otolaryngology–head & neck surgery, 129(10), 1041–1046. https://doi.org/10.1001/archotol.129.10.1041

7. Agrawal, Y., Platz, E. A., & Niparko, J. K. (2008). Prevalence of hearing loss and differences by demographic characteristics among US adults: data from the National Health and Nutrition Examination Survey, 1999-2004. Archives of internal medicine, 168(14), 1522–1530. https://doi.org/10.1001/archinte.168.14.1522

8. Mitchell, P., Gopinath, B., Wang, J. J., McMahon, C. M., Schneider, J., Rochtchina, E., & Leeder, S. R. (2011). Five-year incidence and progression of hearing impairment in an older population. Ear and hearing, 32(2), 251–257. https://doi.org/10.1097/AUD.0b013e3181fc98bd

9. Reed, N. S., Garcia-Morales, E. E., Myers, C., Huang, A. R., Ehrlich, J. R., Killeen, O. J., Hoover-Fong, J. E., Lin, F. R., Arnold, M. L., Oh, E. S., Schrack, J. A., & Deal, J. A. (2023). Prevalence of Hearing Loss and Hearing Aid Use Among US Medicare Beneficiaries Aged 71 Years and Older. JAMA network open, 6(7), e2326320.

10. National Library of Medicine (U.S.) (2018, January 1 – 2023, June 12). Aging and Cognitive Health Evaluation in Elders (ACHIEVE) Randomized Trial. Identifier: NCT03243422.

11. Deal, J. A., Goman, A. M., Albert, M. S., Arnold, M. L., Burgard, S., Chisolm, T., Couper, D., Glynn, N. W., Gmelin, T., Hayden, K. M., Mosley, T., Pankow, J. S., Reed, N., Sanchez, V. A., Richey Sharrett, A., Thomas, S. D., Coresh, J., & Lin, F. R. (2018). Hearing treatment for reducing cognitive decline: Design and methods of the Aging and Cognitive Health Evaluation in Elders randomized controlled trial. Alzheimer’s & dementia (New York, N. Y.), 4, 499–507. https://doi.org/10.1016/j.trci.2018.08.007

12. Lin, F. R., Pike, J. R., Albert, M. S., Arnold, M., Burgard, S., Chisolm, T., Couper, D., Deal, J. A., Goman, A. M., Glynn, N. W., Gmelin, T., Gravens-Mueller, L., Hayden, K. M., Huang, A. R., Knopman, D., Mitchell, C. M., Mosley, T., Pankow, J. S., Reed, N. S., Sanchez, V., … ACHIEVE Collaborative Research Group (2023). Hearing intervention versus health education control to reduce cognitive decline in older adults with hearing loss in the USA (ACHIEVE): a multicentre, randomised controlled trial. Lancet (London, England), 402(10404), 786–797. https://doi.org/10.1016/S0140-6736(23)01406-X

13. Sanchez, V. A., Arnold, M. L., Garcia Morales, E. E., Reed, N. S., Faucette, S., Burgard, S., Calloway, H. N., Coresh, J., Deal, J. A., Goman, A. M., Gravens-Mueller, L., Hayden, K. M., Huang, A. R., Mitchell, C. M., Mosley, T. H., Jr, Pankow, J. S., Pike, J. R., Schrack, J. A., Sherry, L., Weycker, J. M., … ACHIEVE Collaborative Study (2024). Effect of hearing intervention on communicative function: A secondary analysis of the ACHIEVE randomized controlled trial. Journal of the American Geriatrics Society, 10.1111/jgs.19185. Advance online publication. https://doi.org/10.1111/jgs.19185

14. Sanchez, V. A., Arnold, M. L., Reed, N. S., Oree, P. H., Matthews, C. R., Clock Eddins, A., Lin, F. R., & Chisolm, T. H. (2020). The Hearing Intervention for the Aging and Cognitive Health Evaluation in Elders Randomized Control Trial: Manualization and Feasibility Study. Ear and hearing, 41(5), 1333–1348. https://doi.org/10.1097/AUD.0000000000000858

15. Arnold, M. L., Haley, W., Lin, F. R., Faucette, S., Sherry, L., Higuchi, K., Witherell, K., Anderson, E., Reed, N. S., Chisolm, T. H., & Sanchez, V. A. (2022). Development, assessment, and monitoring of audiologic treatment fidelity in the aging and cognitive health evaluation in elders (ACHIEVE) randomised controlled trial. International journal of audiology, 61(9), 720–730. https://doi.org/10.1080/14992027.2021.1973126

16. Sanchez, V. A., Arnold, M. L., Betz, J. F., Reed, N. S., Faucette, S., Anderson, E., Burgard, S., Coresh, J., Deal, J. A., Eddins, A. C., Goman, A. M., Glynn, N. W., Gravens-Mueller, L., Hampton, J., Hayden, K. M., Huang, A. R., Liou, K., Mitchell, C. M., Mosley, T. H., . . . Chisolm, T. H. Description of the Baseline Audiologic Characteristics of the Participants Enrolled in the Aging and Cognitive Health Evaluation in Elders Study. American Journal of Audiology. https://doi.org/doi:10.1044/2023_AJA-23-00066

17. Arnold, M. L., Oree, P., Sanchez, V., Reed, N., & Chisolm, T. (2019). Development and Formative Assessment of the Hearing Loss Toolkit for Self-Management. Seminars in hearing, 40(1), 49–67. https://doi.org/10.1055/s-0038-1676783

18. Ferguson, M., & Henshaw, H. (2015). Computer and Internet Interventions to Optimize Listening and Learning for People With Hearing Loss: Accessibility, Use, and Adherence. American journal of audiology, 24(3), 338–343. https://doi.org/10.1044/2015_AJA-14-0090

19. Ferguson, M., Brandreth, M., Brassington, W., Leighton, P., & Wharrad, H. (2016). A Randomized Controlled Trial to Evaluate the Benefits of a Multimedia Educational Program for First-Time Hearing Aid Users. Ear and hearing, 37(2), 123–136. https://doi.org/10.1097/AUD.0000000000000237

20. Maidment, D. W., Coulson, N. S., Wharrad, H., Taylor, M., & Ferguson, M. A. (2020). The development of an mHealth educational intervention for first-time hearing aid users: combining theoretical and ecologically valid approaches. International journal of audiology, 59(7), 492–500. https://doi.org/10.1080/14992027.2020.1755063

21. Dillon, H., James, A., & Ginis, J. (1997). Client Oriented Scale of Improvement (COSI) and its relationship to several other measures of benefit and satisfaction provided by hearing aids. Journal of the American Academy of Audiology, 8(1), 27–43.

Author Details:

Jacqueline M. Weycker, AuD, Study Audiologist

Dr. Weycker is a research audiologist at the University of Minnesota in the School of Public Health. She is the lead study audiologist at the Minneapolis field site for the ACHIEVE study. Jackie is deeply committed to improving and advocating for accessible and equitable hearing healthcare.

LinkedIn: https://www.linkedin.com/in/jacqueline-weycker-3671ba99/

Laura Sherry, AuD, Study Audiologist

Dr. Sherry is a research audiologist in the Department of Otolaryngology-Head & Neck Surgery, Division of Research at the Johns Hopkins University, School of Medicine. Her research interests include the correlation between hearing loss and cognitive decline, as well as improving accessibility to hearing healthcare. Sherry is the lead study audiologist at the Washington County field site for the ACHIEVE study.

Sarah Faucette, AuD, PhD, Associate Professor

Dr. Faucette is an Associate Professor at the University of Mississippi Medical Center. She serves at ACHIEVE’s Jackson site as the lead research audiologist. Faucette also teaches Audiological Management in the UMMC AuD program and works clinically in adult diagnostics and treatment.

Haley N. Calloway, AuD, Assistant Professor

Dr. Calloway is an Assistant Professor in the Department of Otolaryngology at the University of South Florida. She is a clinical audiologist and specializes in diagnosing and treating hearing disorders for adult and pediatric populations. She is also a Research Audiologist in the Auditory Rehabilitation & Clinical Trials Laboratory.

Victoria A. Sanchez, AuD, PhD, Associate Professor

Dr. Sanchez is a clinician scientist at the University of South Florida where she provides patient care, teaches and mentors trainees, and conducts research in the Auditory Rehabilitation & Clinical Trials Laboratory.  

LinkedIn:  www.linkedin.com/in/victoria-sanchez-aud-phd-60009119a

Source of Funding:

The Aging and Cognitive Health Evaluation in Elders (ACHIEVE) Study is supported by the National Institute on Aging (NIA) grant R01AG055426, with magnetic brain resonance examination funded by NIA R01AG060502 and with previous pilot study support NIAR34AG046548 and the Eleanor Schwartz Charitable Foundation, in collaboration with the Atherosclerosis Risk in Communities (ARIC) Study, supported by National Heart, Lung and Blood Institute contracts (HHSN268201100005C, HHSN268201100006C, HHSN268201100007C,HHSN268201100008C, HHSN268201100009C, HHSN268201100010C,HHSN268201100011C, and HHSN268201100012C). Neurocognitive data in ARIC is collected by U01 2U01HL096812, 2U01HL096814, 2U01HL096899, 2U01HL096902, 2U01HL096917 from the NIH (NHLBI, NINDS, NIA and NIDCD), and with previous brain MRI examinations funded by R01HL70825 from the NHLBI. Hearing aids, hearing assistive technologies, and related materials used in the ACHIEVE Study were provided at no cost to the researchers or the participants from Sonova/Phonak LLC. The funders of the study, nor the sponsoring manufacturer, had no role in study design, data collection, data analysis, data interpretation, or writing of the report. 

Acknowledgments:  Members of the ACHIEVE Collaborative Research Group are listed at achievestudy.org. The authors thank the staff and participants of the ACHIEVE and ARIC studies for their important contributions.