COST-BENEFIT ANALYSIS OF HEARING CARE SERVICES AMONG MEDICARE BENEFICIARIES WITH HEARING AIDS

Abstract Hearing care services for older adults with hearing aids are underutilized and are not covered by the Medicare program. Little information exists to the value of hearing care services for older adults with hearing aids. Using the Medicare Current Beneficiary Survey 2013, we conducted a cross-sectional analysis of the impact of hearing care services use on Medicare spending among those with hearing aids. Older Medicare beneficiaries with hearing aids that received hearing care services in the previous 12 months were propensity score matched to those who did not receive services. Average annual Medicare spending was $8196 (CI:$6670-$9723) among Medicare beneficiaries who used hearing care services and $10,709 (CI:$8878-12541) among matched controls. Spending differences were driven by higher skilled nursing facility and home health spending among matched controls. Increasing access to hearing care services among Medicare beneficiaries with hearing aids may provide value to the health care system and Medicare program.

among older adults.Specifically, hearing impairment strains communication via degraded auditory encoding while vision impairment distresses ability to read and interpret visual cues.The presence of dual sensory impairment, defined as concurrent hearing and vision impairment, may exacerbate these effects.The potential consequences of age-related sensory loss on health care interactions and outcomes are beginning to surface in epidemiologic studies demonstrating poorer patient-provider communication, higher incurred health care costs, increased risk of 30-day readmission, and longer length of stay when compared to individuals without sensory loss.Importantly, these associations may be amenable to intervention via sensory aids; however, uptake to sensory care is low.Notably, less than 20% of persons with hearing impairment have hearing aids and over 55% of Medicare Beneficiaries with reported vision problems have not had an eye examination in the prior year.Affordability and access may contribute to lack of sensory care uptake as Medicare explicitly excludes coverage of vision and hearing services.In this symposium, we will review current and new evidence for whether sensory loss affects health care outcomes, including satisfaction with care and medical costs, and present data on how persons with sensory loss interact with the health care system based on the need and reasons for accompaniment to care visits.Further, we will discuss and provide evidence for how sensory care may mitigate these associations.Lastly, we will place these results within the context of quality care and policy initiatives.

HEARING LOSS AND HEALTH CARE SATISFACTION
Nicholas Reed, 1 Nicholas Reed, 1 Amber Willink, 1 Jennifer Deal, 1 and Frank R. lin 1 , 1. Johns Hopkins University, Baltimore, Maryland, United States Hearing loss (HL) impacts two-thirds of adults over 70 years and affects patient-provider communication which could limit satisfaction.We used two cross-sectional cohorts, The Atherosclerosis Risk in Communities Study (ARIC, n=250) and the Medicare Current Beneficiaries Survey (MCBS,n=12,311) to examine the relationship between HL (subjective and objective measures) and self-report satisfaction with quality of health care using multivariable-adjusted logistic regression.In ARIC, there was an interaction between HL and age such that HL had a greater impact on odds of dissatisfaction as age increased.In an 85-year-old, for every 10 dB increase in HL, the odds of being dissatisfied increased 1.33 (95% Confidence Interval [CI]:0.96-1.83).In MCBS, compared to participants with no trouble hearing, those with a lot of trouble hearing had 1.7 times the odds ( 95% CI = 1.150-2.623) of being dissatisfied.This has implications for patient-centered care planning given that Medicare ties reimbursement to patient-reported satisfaction.

COST-BENEFIT ANALYSIS OF HEARING CARE SERVICES AMONG MEDICARE BENEFICIARIES WITH HEARING AIDS
Amber Willink, 1 Amber Willink, 1 Nicholas S. Reed, 1 and Frank R. Lin The combination of sensory and cognitive impairment is increasingly prevalent among older adults and may be an important driver of healthcare cost due to functional disability and reduced self-care.This presentation focuses on the relationship between hearing and/or vision impairment and cognitive impairment with hospital admissions and healthcare cost using data from the Medicare Current Beneficiary Survey, a nationally representative sample of communitydwelling adults.We show that the presence of sensory impairment is associated with increased risk of hospitalization regardless of dementia status.In adjusted models, annual total healthcare costs were generally higher among those with sensory impairments compared to those without sensory impairments.We will also discuss work related to the development of a prognostic model that provides estimates of hospitalization risk among older adults with self-reported hearing and/or vision impairment.This model may help inform allocation of health care resources to those at highest risk for adverse outcomes.

SLEEP IN LATE LIFE: RECENT RESEARCH ON PSYCHIATRIC CORRELATES AND TREATMENT
Chair: Mary E. Dozier, South Texas Veterans Health Care System, San Antonio, Texas, United States Sleep is an often overlooked health factor, particularly in older adults.Sleep disturbance is associated with increased functional impairment as well as poorer cognitive, mental, and physical health trajectories.Understanding the clinical impact of disturbed sleep, and the optimal targets for intervention, is critical for the promotion of health and well-being in older adults.This symposium will highlight recent findings that advance the extant knowledge on the interplay of sleep disturbance and physical and psychiatric co-morbidities in older adults across a variety of settings.Darina V. Petrovsky will discuss the impact of medical, demographic, and contextual factors on excessive daytime sleepiness in older adults receiving long-term services and supports.Kathi L. Heffner will present data on a recent study examining change in slow wave sleep, and subsequent change in osteoarthritis pain, following insomnia treatment.Courtney Bolstad will discuss the differential impact of onset, maintenance, and terminal insomnia on anxiety and depression symptoms in communitydwelling older adults.Eliza Davidson will present research on the association between sleep disturbance and hoarding symptoms in older adults engaged in behavioral interventions for hoarding disorder.Finally, Christina McCrae will discuss the relationship between sleep and cognition in older adults with insomnia.

I CAN'T SLEEP IN MY BED: THE RELATIONSHIP BETWEEN SLEEP AND LATE-LIFE HOARDING
Eliza J. Davidson 1 Mary E. Dozier 2 Michael Nadorff 3 Catherine R. Ayers 1 , 1. VA San Diego Healthcare System,San Diego,California,United States,2. South Texas 1, 1. Johns Hopkins University,Baltimore,  Maryland, United StatesHearing care services for older adults with hearing aids are underutilized and are not covered by the Medicare program.Little information exists to the value of hearing care services for older adults with hearing aids.Using the Medicare Current Beneficiary Survey 2013, we conducted a cross-sectional analysis of the impact of hearing care services use on Medicare spending among those with hearing aids.Older Medicare beneficiaries with hearing aids that received hearing care services in the previous 12 months were propensity score matched to those who did not receive services.