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Influence of Community-Based Hearing Screening on Presbycusis Detection among Older Adults in Nigeria

Abstract

Presbycusis, or age-related hearing loss, is an important public health concern among older adults in Nigeria and can negatively affect communication, social participation, emotional well-being, independence, and quality of life. The gradual nature of age-related hearing loss may cause many older adults and their families to consider hearing difficulties a normal consequence of ageing and therefore delay seeking professional assessment. Undetected hearing loss may contribute to social isolation, difficulties in communication, reduced participation in community activities, and challenges in accessing healthcare and other essential services. Older adults may also face additional barriers to hearing healthcare, including limited awareness, financial constraints, geographical inaccessibility, shortage of audiological services, inadequate screening facilities, and stigma associated with hearing impairment. Community-based hearing screening provides an opportunity to identify hearing difficulties among older adults through accessible screening activities conducted within communities, primary healthcare centres, elderly health programmes, mobile outreach services, and other community platforms. Early detection may facilitate timely audiological assessment, hearing rehabilitation, use of hearing devices where appropriate, communication support, and referral for further clinical evaluation. Against this background, this study investigates the influence of community-based hearing screening on presbycusis detection among older adults in Nigeria. The study will be anchored on the Health Belief Model, the International Classification of Functioning, Disability and Health (ICF) Framework, and the Health Systems Framework. The Health Belief Model explains how older adults' perceptions of susceptibility to age-related hearing loss, perceived severity, perceived benefits of screening, perceived barriers, and cues to action may influence participation in community-based hearing screening. The ICF Framework emphasizes the effects of hearing impairment on body functions, activities, participation, environmental factors, and personal factors, thereby providing a framework for understanding the broader consequences of hearing loss among older adults. The Health Systems Framework emphasizes service delivery, health workforce, health information, medical products and technologies, financing, and accessibility as essential components of effective community-based hearing screening and rehabilitation services. Collectively, these theoretical perspectives provide a suitable framework for explaining how community-based hearing screening may influence presbycusis detection among older adults in Nigeria. The study will adopt a quantitative cross-sectional analytical or quasi-experimental research design. The study population will comprise adults aged 60 years and above residing in selected communities across Nigeria. A multistage sampling technique will be used to select states, local government areas, communities, households, and eligible older adults. Community-based hearing screening will be measured using indicators such as availability of screening services, screening coverage, frequency of screening activities, accessibility of screening locations, hearing assessment procedures, pure-tone or other appropriate hearing screening methods, availability of trained audiologists or other qualified healthcare personnel, screening equipment, hearing-health education, and referral arrangements. Presbycusis detection will be assessed using indicators such as hearing screening results, elevated hearing thresholds consistent with age-related hearing loss, newly identified hearing impairment, severity of hearing loss, bilateral hearing difficulties, functional hearing complaints, referrals for comprehensive audiological assessment, audiological confirmation where available, and linkage to hearing rehabilitation services. Data will be collected using structured questionnaires, community screening registers, hearing assessment forms, audiological records, healthcare facility records, referral registers, and relevant programme documents. Descriptive statistics will be used to summarize participants' characteristics, screening coverage, hearing assessment findings, and patterns of presbycusis detection. Inferential statistical techniques, including chi-square tests, correlation analysis, and logistic or multiple regression analysis, will be used to determine the influence of community-based hearing screening on presbycusis detection. Where appropriate, presbycusis detection rates before and after implementation of community-based hearing screening activities may be compared to determine changes associated with the intervention. Diagnostic tests will also be conducted to assess the reliability, validity, and robustness of the findings. The study is expected to find that community-based hearing screening has a significant positive influence on presbycusis detection among older adults in Nigeria. Older adults who participate in community-based hearing screening are expected to have a higher likelihood of having previously undetected age-related hearing loss identified than older adults without access to such services. Community-based screening may facilitate early recognition of hearing impairment and provide opportunities for comprehensive audiological assessment, hearing rehabilitation, communication support, hearing-device evaluation where appropriate, and referral for additional clinical assessment. Bringing hearing screening services closer to older adults may reduce geographical, financial, and time-related barriers and encourage individuals who might otherwise accept hearing difficulties as a normal part of ageing to seek professional assessment. Early detection may also improve opportunities for rehabilitation and reduce the social and functional consequences associated with untreated hearing impairment. Conversely, inadequate screening coverage, limited audiological facilities, shortage of trained personnel, high costs of hearing services, low awareness, stigma, and weak referral and follow-up systems may reduce the effectiveness of community-based hearing screening. The study therefore expects accessible and well-organized community-based hearing screening to contribute significantly to improved detection and early management of presbycusis among older adults in Nigeria. The study is expected to contribute to the literature on community-based hearing screening, presbycusis detection, age-related hearing loss, older adult health, audiological healthcare, hearing rehabilitation, healthy ageing, community health services, preventive healthcare, and public health in Nigeria. The findings will provide useful information to the Federal Ministry of Health and Social Welfare, National Primary Health Care Development Agency, state ministries of health, primary healthcare centres, hospitals, audiologists, otolaryngologists, community health workers, geriatric health programmes, development partners, and policymakers regarding strategies for improving hearing health among older adults. The study will also provide evidence-based recommendations for expanding community-based hearing screening programmes, improving access to audiological assessment, increasing availability of trained audiologists and appropriate screening equipment, strengthening awareness of age-related hearing loss, reducing stigma associated with hearing impairment, improving referral and follow-up systems, strengthening access to hearing rehabilitation services, and integrating hearing screening into comprehensive community-based healthy ageing programmes across Nigeria.

Keywords: Community-based hearing screening, presbycusis detection, older adults, age-related hearing loss, hearing impairment, audiological screening, hearing rehabilitation, healthy ageing, community health services, preventive healthcare, Nigeria, public health.