Acuidade auditiva em idosos, raça/cor/etnia e outros fatores associados

Abstract

Introduction: hearing acuity loss is a high-prevalence health problem and has advanced with the aging process that has been occurring in Brazil and worldwide. Skin color/race/ethnicity alongside other sociodemographic and health conditions have been pointed out as potential associated factors that require attention to cope with the disease. Objectives: I) to verify the performance of health professionals regarding the knowledge of hearing loss in the elderly, through theoretical and practical training of the health teams of the Basic Units, in Santo Antônio de Jesus (Study 1); II) to investigate the influence of skin color/race/ethnicity on the association between health problems and hearing loss among the elderly using a cross-sectional pilot study (Study 2a) and through a systematic review (Study 2b) Method: Study 1 - an intervention study with 2b was conducted to prepare the health professionals of the units to apply the whisper test in the elderly. A questionnaire was used before and after training, in order to verify the instrumental ability of the professionals and also verify the effect of the intervention performed through in-service training. The statistical program employed was STATA 17. The degree of performance of the participants, before and after training, compared by statistical tests with a significance level of 5%. Study 2a - cross-sectional pilot investigation, of exploratory character. The participants were 56 elderly people assisted by the Unified Health System (SUS), in Santo Antônio de Jesus - BA. Data collection procedures included the application of an instrument to collect socio economic information, lifestyle characteristics and general and mental health conditions. Whisper test (screening of low hearing acuity) and audiological evaluation was also performed in each participant. To evaluate the hypothesis of association between the variables studied and hearing loss, the chi-square test with a significance level of 5% was used. Study 2b – a systematic review was conducted with meta analysis regarding the influence of skin color/race/ethnicity on the association between hearing loss and cognitive decline in the elderly. For this, rigorous eligibility criteria for the selection of studies were established and the search was performed using the electronic databases: MedLine/PubMed Web of Science, Scopus and VHL, and MedRxviv until May 2022. After data extraction and evaluation of the quality of the studies by two researchers, independently, the measures of global association between hearing loss and cognitive decline were estimated for the black and non-black groups (Beta and its 95% confidence intervals), Higgins and Thompson indicators were also estimated (I2) to evaluate the statistical heterogeneity of the data. It is emphasized that this project was submitted to the Research Ethics Committee, according to resolutions of the National Health Council nº. 466/12 and nº 580/18, and this received funding through the FAPESB/Nº 02/2020 notice – PROGRAM SUS RESEARCH. Results: In Study 1, the average performance of health professionals was increased after training to perform hearing loss screening. In Study 2a, only preliminary and non conclusive results were obtained. In Study 2b, 5,207 records were identified in the database searches, and 18 studies met the eligibility criteria. For black elderly, although without statistical significance, the specific magnitude of the association between hearing loss and cognitive decline increased (B=-0.64; CI95%=-3.36 to 2.07; I2=95.65%) when compared to the total sample, regardless of skin color/race/ethnicity. Conclusion: the training for the application of this screening, besides having low complexity, is feasible to be implemented in Primary Health Care. The findings of the systematic review show the existence of a significant association between hearing loss and cognitive decline in the elderly, besides signaling that among black individuals the magnitude of the association increases. This exploratory investigation points to the need to elucidate, through robust studies, the influence of skin color/race/ethnicity on health problems that affect the elderly population.