TY - JOUR
AU - D. R. Friedmann
AU - A. Winchester
AU - O. Bender
AU - J. Ching
AU - A. Nicholson
AU - F. Hamilton
AU - J. Chodosh
AU - V. V. Dickson
A1 - 
AB - BACKGROUND: Age-related hearing loss is common and a particularly prevalent disability among Veterans. In response, comprehensive hearing services are available within the Veterans Affairs (VA) integrated healthcare system. Severe hearing loss may pose distinct communication challenges inadequately addressed by hearing aids, but data suggest severe hearing loss is often not treated differently. We sought to identify barriers and facilitators to evidence-based and individualized management of severe hearing loss from the perspectives of VA clinicians and Veterans. METHODS: We used purposeful sampling to conduct remote semi-structured video interviews with 33 current VA clinicians encompassing multiple disciplines and 39 Veterans with severe hearing loss over approximately an 18 month period (May 2022 to December 2023). We analyzed qualitative data using content thematic analysis. Coding categories were summarized within each participant; then across all participants to yield clinician-specific and Veteran themes. RESULTS: In the sample of 33 VA clinicians (20 audiologists, 9 otolaryngologists and 4 primary care clinicians), the overarching theme of qualitative data is that hearing loss is undertreated in the Veteran population. Across clinician groups, the qualitative data revealed multi-level factors (system-, clinician-, and patient-level) that influence the delivery of hearing care and management for Veterans with severe hearing loss. Interviews revealed that efficient access and collaborative care facilitate evidence-based practice. Among Veterans, inadequately managed hearing loss impacts quality of life; lack of knowledge and misconceptions about hearing care options and system-level barriers influence Veterans' perceptions of their hearing care and management. CONCLUSION: Although hearing care is available to Veterans, multi-level factors influence the delivery of hearing care and management for Veterans with severe hearing loss. Greater attention both in primary and specialty care is needed to ensure tailored treatments are available to Veterans with severe hearing loss across the integrated VA health care system.; Key points ○ Severe hearing loss leads to communication challenges requiring distinct rehabilitation strategies. ○ Rehabilitation for severe hearing loss is impacted by patient preferences and provider knowledge both in primary and specialty care. ○ Qualitative research with Veterans and clinicians may help explain current hearing care management and provide actionable steps towards improving care. Why does this paper matter? ○ Rehabilitating age‐related hearing loss has broad implications for healthy aging. ○ Veterans are at particular risk for accelerated hearing loss related to exposures during training and deployment. ○ Severe hearing loss poses particular communication challenges that require distinct treatment paradigms. ○ The Veterans Affairs (VA) network is the nation's largest integrated health care system and prioritizes hearing care and rehabilitation through the provision of millions of hearing aids. ○ This provides a unique lens to explore the management of Veterans with severe hearing loss. ○ While cochlear implants are known to be underutilized globally, one might expect that Veterans with persistent communication challenges would be more likely to receive cochlear implants if recommended. In this paper, we identify and contextualize barriers and facilitators of evidence‐based care for Veterans with severe hearing loss through semi‐structured interviews with a national sample of VA clinicians including audiologists, otolaryngologists, and primary care providers. We also recruited a diverse national sample of Veterans, all with severe hearing loss, to describe their experiences with hearing care in the VA and their preferences for rehabilitation. Understanding the system, clinician, and patient factors that impact care are critical context to developing an intervention that supports evidence‐based hearing rehabilitation.; eng
AD - Department of Otolaryngology-Head and Neck Surgery, NYU Grossman School of Medicine, New York, New York, USA.; Veterans Affairs New York Harbor Healthcare System, New York, New York, USA.; Department of Population Health, NYU Grossman School of Medicine, New York, New York, USA.; NYU Rory Meyers College of Nursing, New York, New York, USA.; Department of Medicine, Division of Geriatric Medicine and Palliative Care, NYU Grossman School of Medicine, New York, New York, USA.; University of Connecticut, Elisabeth DeLuca School of Nursing, Storrs, Connecticut, USA.
AN - 41720576
BT - J Am Geriatr Soc
C5 - Healthcare Disparities; Education & Workforce
CP - 4
DA - Apr
DO - 10.1111/jgs.70353
DP - NLM
ET - 20260220
IS - 4
JF - J Am Geriatr Soc
LA - eng
N2 - BACKGROUND: Age-related hearing loss is common and a particularly prevalent disability among Veterans. In response, comprehensive hearing services are available within the Veterans Affairs (VA) integrated healthcare system. Severe hearing loss may pose distinct communication challenges inadequately addressed by hearing aids, but data suggest severe hearing loss is often not treated differently. We sought to identify barriers and facilitators to evidence-based and individualized management of severe hearing loss from the perspectives of VA clinicians and Veterans. METHODS: We used purposeful sampling to conduct remote semi-structured video interviews with 33 current VA clinicians encompassing multiple disciplines and 39 Veterans with severe hearing loss over approximately an 18 month period (May 2022 to December 2023). We analyzed qualitative data using content thematic analysis. Coding categories were summarized within each participant; then across all participants to yield clinician-specific and Veteran themes. RESULTS: In the sample of 33 VA clinicians (20 audiologists, 9 otolaryngologists and 4 primary care clinicians), the overarching theme of qualitative data is that hearing loss is undertreated in the Veteran population. Across clinician groups, the qualitative data revealed multi-level factors (system-, clinician-, and patient-level) that influence the delivery of hearing care and management for Veterans with severe hearing loss. Interviews revealed that efficient access and collaborative care facilitate evidence-based practice. Among Veterans, inadequately managed hearing loss impacts quality of life; lack of knowledge and misconceptions about hearing care options and system-level barriers influence Veterans' perceptions of their hearing care and management. CONCLUSION: Although hearing care is available to Veterans, multi-level factors influence the delivery of hearing care and management for Veterans with severe hearing loss. Greater attention both in primary and specialty care is needed to ensure tailored treatments are available to Veterans with severe hearing loss across the integrated VA health care system.; Key points ○ Severe hearing loss leads to communication challenges requiring distinct rehabilitation strategies. ○ Rehabilitation for severe hearing loss is impacted by patient preferences and provider knowledge both in primary and specialty care. ○ Qualitative research with Veterans and clinicians may help explain current hearing care management and provide actionable steps towards improving care. Why does this paper matter? ○ Rehabilitating age‐related hearing loss has broad implications for healthy aging. ○ Veterans are at particular risk for accelerated hearing loss related to exposures during training and deployment. ○ Severe hearing loss poses particular communication challenges that require distinct treatment paradigms. ○ The Veterans Affairs (VA) network is the nation's largest integrated health care system and prioritizes hearing care and rehabilitation through the provision of millions of hearing aids. ○ This provides a unique lens to explore the management of Veterans with severe hearing loss. ○ While cochlear implants are known to be underutilized globally, one might expect that Veterans with persistent communication challenges would be more likely to receive cochlear implants if recommended. In this paper, we identify and contextualize barriers and facilitators of evidence‐based care for Veterans with severe hearing loss through semi‐structured interviews with a national sample of VA clinicians including audiologists, otolaryngologists, and primary care providers. We also recruited a diverse national sample of Veterans, all with severe hearing loss, to describe their experiences with hearing care in the VA and their preferences for rehabilitation. Understanding the system, clinician, and patient factors that impact care are critical context to developing an intervention that supports evidence‐based hearing rehabilitation.; eng
PY - 2026
SN - 0002-8614
SP - 1089
EP - 1098+
ST - Veteran and Provider Perspectives on Rehabilitation for Severe Hearing Loss
T1 - Veteran and Provider Perspectives on Rehabilitation for Severe Hearing Loss
T2 - J Am Geriatr Soc
TI - Veteran and Provider Perspectives on Rehabilitation for Severe Hearing Loss
U1 - Healthcare Disparities; Education & Workforce
U3 - 10.1111/jgs.70353
VL - 74
VO - 0002-8614
Y1 - 2026
ER -