Twenty-five older adults living with both hearing loss and frailty will sit for in-depth interviews about what makes it harder or easier to manage their hearing day to day. Hearing loss and frailty—marked by low grip strength, low energy, and low physical activity—each independently worsen quality of life, increase depression risk, and raise the chance of falls. Yet almost nothing is known about the specific obstacles faced by older people who have both conditions and still live in the community. Current audiology services and hearing aid support were not designed with frailty in mind. This study uses the Burden of Treatment Theory to systematically map where the extra effort falls—from seeking help, to attending appointments, to using hearing aids at home—and what helps. If the research succeeds, it will produce practical guidance for audiology services and primary care practitioners on how to tailor support for this group. The findings will also feed into a stakeholder workshop that will plan future interventions. Infographics will be created for older adults themselves, and results will go to NHS England’s Frailty Implementation Advisory Group, potentially reshaping how hearing care is delivered to a vulnerable population that current services may be failing.
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Research Question What are the barriers and facilitators to managing hearing loss in older adults with frailty and how can we improve support for this population? Background Both hearing loss and frailty are common in older adults. Frailty is marked by low grip strength, low energy, and low physical activity all of which may make managing hearing loss challenging. Hearing loss or frailty can result in poorer quality of life, increased depression, and falls. However, little is known about the specific challenges faced by community-dwelling older adults living with both hearing loss and frailty and the support they need to more effectively manage their hearing loss. Aims and Objectives To use the Burden of Treatment Theory to explore barriers and facilitators to managing hearing loss for older people living with frailty to help identify ways to better meet their support needs. Design and Methods This proposed study will identify 25 older adults (≥ 65 years) living with hearing loss and frailty. Participants will be identified from established cohort studies that capture data on hearing loss and frailty (electronic Frailty Index score). Additional recruitment will take place from community groups to ensure diversity if required. Following informed consent researchers will conduct in-depth qualitative interviews. Discussion topics will include motivations for seeking hearing support (or not), experience with audiology services (if attended), challenges to using hearing aids, and any beneficial support received. Additional areas of inquiry will cover their awareness of hearing support technologies (e.g., specialised doorbells) and participant priorities for managing their hearing loss. Some participants may invite their spouse or family member (communication partner) to participate in a dyadic interview. A Patient and Public Involvement group, who informed this application, will ensure the study materials are suitable, inform discussion topic guides, and participate as practice interviewees. Analysis Two researchers will analyse interview transcripts using the "Burden of treatment" framework to assess the additional effort required by older adults with frailty to manage hearing loss. Themes will be identified in areas such as support-seeking for hearing loss, access to audiology services, and adaptation to hearing aid use in daily life, aiming to identify areas where support can be enhanced. A stakeholder workshop will use interview findings to inform plans for future intervention development for older adults with frailty and hearing loss. Delivery timeline Months -3 to 3: appoint researcher, finalise protocol and interview topic guides, obtain regulatory approvals. Months 4 to 12: Recruit older adults (and communication partners where applicable); Conduct interviews, analyse data and conduct a final workshop. Months 10 to 15: Dissemination activities and produce final report. Anticipated Impact and Dissemination Findings will be translated into: Infographics of key points tailored for different audiences (e.g., older adults Patient Participation Group); publication of results/recommendations in a targeted journal (primary care practitioners or audiology services); presentation to the Frailty Implementation Advisory Group (representation from NHS England, Integrated Care Boards, and local authorities); summary guidance for audiology services (if applicable); and identification of areas of need and content for future intervention development.
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