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a Institute on Aging, Departments of
b Gerontology, University of South Florida, Tampa
c Communication Science and Disorders, University of South Florida, Tampa
d Epidemiology and Biostatistics, University of South Florida, Tampa
Yuri Jang, Institute on Aging, University of South Florida, 13201 Bruce B. Downs Blvd., MDC-56, Tampa, FL 33612 E-mail: yjang{at}hsc.usf.edu.
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Abstract |
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Methods. These hypotheses were tested with a hierarchical regression model using a stratified sample of 425 community-dwelling older individuals (mean age = 72.2).
Results. Individuals with more recent stressful life events, higher levels of neuroticism, and less emotional support reported greater hearing problems after controlling for objectively screened hearing. In addition to the main effects, a significant interaction was observed between neuroticism and screened hearing, indicating that the combination of poor hearing and high neuroticism increased the level of self-perceived hearing problems.
Conclusions. The findings suggest that the effects of nonauditory factors should be taken into account in the application of self-assessed measures of hearing problems.
RESEARCH that compares audiometric data and self-reports has consistently shown only a moderate correlation between objective hearing ability and subjective perception (1)(2)(3). Because individuals with similar audiometric deficits exhibit a wide range of perceived hearing difficulties (4), it is important to examine the determinants of subjective perception of hearing problems. In addition to objectively screened hearing, the present study examined nonauditory factors, including stressful life conditions, neuroticism, and social resources, as potential factors that may influence self-perceived hearing problems.
Stressful life conditions may amplify the negative perception of hearing problems. For example, the coexistence of hearing loss with visual impairment, chronic disease, or disability may make older individuals evaluate their sensory functioning in a more negative way (5)(6). Similarly, stressful life events also may influence individuals' internal standards for self-evaluation by changing personal values and expectations (7). Studies have shown that individuals who recently experienced stressful life events overestimated their limitations (8)(9).
The personality characteristic of neuroticism is widely known as an important factor that influences individuals' subjective perception and expression. Studies have shown that individuals high in neuroticism appraise situations as more stressful or threatening and have more somatic complaints (10)(11)(12). A growing literature suggests that neuroticism is associated with unfavorable self-reports of functional and sensory problems (4)(13).
On the other hand, individuals with greater social resources have been shown to have a favorable perception of hearing problems (14). The existence of strong social ties and support from others may bolster older individuals' self-esteem and positively influence self-perception of hearing problems.
Based on the above review, we hypothesized that older individuals would perceive their hearing problems as more severe when they experienced stressful life conditions (visual impairment, chronic disease, disability, and recent stressful life events), had higher levels of neuroticism, and had fewer social resources.
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Methods |
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Measures
Screening of hearing.--
Hearing was assessed using a Welch Allyn audioscope (Welch Allyn Inc., Skaneateles Falls, NY). The screening was conducted using 25 dBHL signals at 1000 and 2000 Hz. These frequencies were chosen based on screening guidelines from the American Speech-Language-Hearing Association (16). The number of failed responses (2 signals x 2 ears) was used in the analysis.
Self-perceived hearing problems.-- Individuals' percep-tion of hearing problems was assessed by the Hearing Handicap Inventory for the Elderly–Screening Version (17). The scale includes 10 items such as "do you have a difficulty in hearing that causes you to feel embarrassed when you meet new people?" Responses were scored as 0 (no), 2 (sometimes), or 4 (yes).
Visual impairment.-- Distance vision was assessed using directional Es, given at 4 meters (18). Individuals were encouraged to wear eyeglasses or contact lenses if they needed them. Both eyes were tested together. The test was conducted by beginning with 4/12 (20/60) and branching to either 4/40 (20/200) or 4/8 (20/40), depending upon the response. At each step, three or four correct answers out of four letters indicated success. If two answers were correct, one more trial was given.
Chronic disease.-- A series of questions was asked to determine whether a doctor ever told participants that they had specific diseases. The list contained 11 types of chronic diseases, including heart disease, heart attack, stroke, cancer, and arthritis.
Disability.-- Disability was measured with 17 items from the Activities of Daily Living (19), Instrumental Activities of Daily Living (20), Physical Performance (21), and Functional Health (22) scales. Scores were coded as 0 (no difficulty), 1 (some difficulty), 2 (a lot of difficulty), or 3 (unable to do).
Stressful life events.-- Recent life events were measured by selected items from the Louisville Older Persons Events Schedule (23). Based on prior research (24), 24 items identified as negative life events by the majority of elders were used in the present study. Examples of events are new illness or injury, death of significant others, and reduction in income. Participants were asked to report if certain events had occurred within the past 12 months using a yes/no format.
Neuroticism.-- Neuroticism was measured with the 12 items from the NEO-Five Factor Inventory (25). Participants were asked to indicate how they agreed with statements such as "I rarely feel fearful or anxious" using a 5-point Likert scale ranging from "strongly agree" to "strongly disagree."
Social resources.-- Social network was measured with items from the Lubben's Social Network Scale (26). Measures included the number of relatives or friends seen at least once a month, frequency of contact, and the number of relatives or friends the subject felt close to. For received social support, a composite measure from the work of Krause and Borawski-Clark (27) was used, including instrumental support (such as help with chores) and emotional support (such as having others listen and show interest). For each type of support, respondents reported how often they received that support (never to very often).
Other variables.-- Demographic information included age (in years), gender (0 = male, 1 = female), marital status (0 = not married, 1 = married), and education (in years).
Analytic Strategy
To assess determinants of self-perceived hearing problems, a hierarchical regression model was estimated by entering independent blocks of predictors with the entry order being (i) demographic variables, (ii) screened hearing, (iii) stressful life conditions, (iv) neuroticism, and (v) social resources. In a subsequent step, interaction terms of screened hearing with other significant factors were added to the main effects.
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Discussion |
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Independent of screened hearing, individuals who recently experienced stressful life events reported more difficulties with hearing. This finding likely reflects a response shift due to changes in internal standards (7). Experience of stressful life events may make older individuals more susceptible to limitations and in this way may accentuate negative evaluation of hearing problems.
As hypothesized, individuals with higher levels of neuroticism had a more adverse perception of their hearing problems. In addition to the main effects, neuroticism interacted with screened hearing in predicting self-perceived hearing problems, in that the combination of poor hearing and high neuroticism led to an increased perception of hearing problems. This finding lends further support to a growing literature showing that neuroticism plays an important role in increasing adverse self-perceptions of physical problems (4)(10)(11)(12)(13). In an earlier paper using the same sample (13), we found that individuals who scored high on neuroticism were more likely to report greater disability when actual physical performance was controlled.
Among various types of social resources, only emotional support was a significant predictor of self-perceived hearing problems. As older individuals received more emotional support, they were likely to have a more positive perception of hearing problems. Receiving emotional support from others may bolster older individuals' self-esteem or self-worth and help them reach a more positive judgment regarding their sensory functioning.
The present study is limited by utilization of a nonrepresentative sample and cross-sectional design. However, it has important implications for research and practice. The findings suggest that self-perceived hearing problems should be understood in a broad context including personal, social, and environmental factors. Given that a considerable amount of variance in self-reported hearing problems was explained by nonauditory factors, special attention should be paid to stressful life conditions, neuroticism, and social resources in interpreting data based on self-reports.
Received December 13, 2001
Accepted February 12, 2002
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This article has been cited by other articles:
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  Y. Jang, J. A. Mortimer, W. E. Haley, B. J. Small, T. E. H. Chisolm, and A. B. Graves The Role of Vision and Hearing in Physical, Social, and Emotional Functioning Among Older Adults Research on Aging, March 1, 2003; 25(2): 172 - 191. [Abstract] [PDF]
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 Y. Jang, J. A. Mortimer, W. E. Haley, and A. B. Graves The Role of Neuroticism in the Association Between Performance-Based and Self-Reported Measures of Mobility J Aging Health, November 1, 2002; 14(4): 495 - 508. [Abstract] [PDF]
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