Hospital-Based Hearing Screening for Older Adults: Insights from Two Clinical Pilot Studies

The Problem Hospital-Based Hearing Screening Solves

Hearing loss is one of the most common, least diagnosed conditions in older adult populations. The presentation surfaces a series of prevalence figures that make the scale of the issue concrete: in the US, hearing loss affects 1 in 5 people 12 years or more. In Canada, the Canadian Health Measure Survey (2012-2015) found hearing loss affecting 19% of people ages 20-79, 54% of those 40-79, and 93% of those 70-79 — and prevalence increases with each decade, affecting around 89% of individuals 80 years or more. The World Health Organization projects that 2.5 billion people worldwide will experience hearing decline by 2050.

Less well known is the rate at which hearing loss goes undiagnosed in clinical populations who present for other concerns. 77% of Canadians with measurable hearing difficulty do not report it. Most Americans show similar under-reporting. The barriers are familiar: hearing decline is gradual and easy to normalize, hearing aid stigma persists despite modern devices being far smaller and more discreet, physicians lack systematic tools to assess hearing during routine visits, and patients underestimate their own decline.

The consequence is that patients arrive at appointments — for cognitive evaluations, for rehabilitation, for general geriatric care — with hearing impairments that affect both the clinical encounter and the longer arc of patient outcomes. Hearing loss is independently associated with cognitive decline, social isolation, depression, and reduced engagement with care.

The question two SHOEBOX-led pilot studies set out to answer: can systematic hearing screening be implemented in real hospital settings, and does it produce measurable change in clinical practice?

Two Pilot Settings, One Research Question

The studies ran in parallel at three Canadian hospitals, with shared learnings between teams:

• Geriatric rehabilitation unit at Bruyère Hospital (Ottawa) — July to September 2020. New admissions to the unit were offered hearing screening within their first three days. The setting allowed for longer patient stays and follow-up.
• Memory clinics at Bruyère Hospital (Ottawa) and Baycrest Hospital (Toronto) — February to December 2020. Patients with cognitive concerns received hearing screening as part of their clinic visit. The pandemic forced a mid-study pivot from in-person tablet-based screening to web-based screening.

Both used SHOEBOX hearing screening tools — SHOEBOX QuickTest for tablet-based in-clinic screening and SHOEBOX Online for the remote/web-based portion of the memory clinic work. Screening was administered by trained technicians, not audiologists, at frequencies of 1k, 2k, and 4k Hz.

Both studies began with a smaller validation study — 25 participants screened with SHOEBOX QuickTest and with conventional audiology — to confirm that the screener produced clinically reliable results in the target population before the full pilots launched. This validation step was non-negotiable for stakeholder buy-in. The result: the screener was reliable enough for clinical use, with the only meaningful bias being a slight over-referral pattern (false positives more than false negatives), which is the preferred error direction for a screener intended to flag patients for audiological follow-up.

Inside the Pilot Studies — Implementation, Results, and Practice Change

Implementation: Multi-Level Stakeholder Engagement Made the Pilots Possible

The single most important pilot-design factor — confirmed across both studies — was systematic engagement with every level of hospital stakeholders before any patients were screened. Senior leadership needed to see patient-care value. Clinical champions inside each unit needed to validate that screening wouldn’t disrupt patient flow. Technicians delivering the screening needed clear workflows. And critically, key performance indicators were defined before the pilots launched, so all parties agreed on what success would look like.

This sounds procedural; it’s the most common reason hospital screening initiatives fail. Without pre-defined KPIs and multi-level buy-in, screening either gets blocked at implementation or generates data that no one acts on.

Geriatric Rehab Pilot — Results

Seventy-four newly admitted patients to the geriatric rehab unit at Bruyère were offered hearing screening within their first three days. Seventy-three (99%) showed reduced or very reduced hearing. Among them:

• 54% had never previously been told they had hearing loss
• 35% were surprised by their screening result
• Most screenings took under two minutes
• Total technician time per patient ranged from 4 to 25 minutes, with the upper end reflecting cases that required assistance or had technical issues

Screening results were shared immediately with the clinical care team via a simple printed results card. This direct handoff — patient → screener → clinical care team — was the implementation detail that made physician behavior change possible.

Physician Behavior Change Following Screening

After the geriatric rehab pilot, surveyed physicians reported measurable changes in their care practices:

• Increased ear-wax checks — a simple intervention that resolves a meaningful proportion of conductive hearing complaints
• Increased use of pocket talkers — assistive listening devices that improve communication during the clinical encounter itself
• A six-fold increase in audiology referrals — routing patients with measurable loss into the audiological follow-up they hadn’t been receiving
• Increased sharing of hearing results across the broader care team — including notations on patient boards indicating which ear the patient heard better from, so staff could position themselves accordingly

The most striking outcome wasn’t the screening itself; it was the change in clinical communication. Care teams started writing on patient boards “Hears better in right ear” so that anyone visiting the patient — nurses, family, attending physicians — knew how to communicate. Screening was the trigger. Practice change was the result.

Memory Clinic Pilot — Results

The memory clinic studies at Bruyère and Baycrest produced complementary findings on a different question: does hearing screening belong in memory clinic workflows?

• Less than half of patients with measurable hearing loss reported having hearing difficulty — confirming the under-reporting pattern in a population where hearing affects cognitive test validity
• More than half of accompanying family members had concerns about the patient’s hearing that the patient themselves had not raised — making family engagement a credible signal worth capturing in clinic workflows
• 93% of patients, families, and physicians believed hearing screening should be offered as a standard part of memory clinic visits — exceptional consensus across all three stakeholder groups
• Almost all screenings completed in under five minutes

A six-fold increase in audiology referrals from memory clinic visits

The memory clinic pilot also surfaced an operational nuance that matters for replication: family members who would later be helping the patient navigate the screening were given the test themselves first, as a no-results “familiarization” run. This dramatically reduced confusion and improved completion rates among patients who needed assistance.

Why This Matters Beyond the Pilots — Hearing’s Clinical Entanglement

For audiology practices and hearing care professionals reading this, the geriatric rehab results may be the more striking finding. For hospital systems and memory clinic physicians, the entanglement of hearing and cognition is the more actionable insight.

Memory testing routinely asks patients to repeat words. If a patient cannot hear the words clearly, the cognitive measurement is contaminated — and the patient may be inappropriately characterized as having more cognitive decline than they actually do. Hearing screening before cognitive evaluation produces a cleaner cognitive assessment and a more accurate clinical picture.

This is not a hypothetical concern. The Lancet Commission on Dementia Prevention identified hearing loss as the largest modifiable risk factor for dementia. The clinical incentive to screen hearing in any cognitive-care setting is now substantial — and the pilots demonstrate that doing so is operationally feasible.

Replication: What Hospitals Considering This Should Know

Both pilots produced a consistent implementation playbook for hospital systems, considering hearing screening:

1. Get multi-level stakeholder buy-in before launch. Senior leadership, clinical champions, technicians, and ideally the audiology team that will receive referrals.
2. Run a validation step. Twenty-five to thirty patients were screened with both the screening tool and conventional audiology to demonstrate to the clinical team that the screener produces actionable results.
3. Define KPIs before launch. What does success look like? Completion rate? Referral rate? Physician practice change? Pre-define these, so the data can be evaluated against agreed criteria.
4. Integrate into existing patient flow. New admissions, intake appointments, or routine geriatric assessments — screening should attach to a moment that’s already happening, not create a new workflow burden.
5. Make results immediate. Print or display a simple results card at the time of screening so the clinical team has the information when they need it. Delays kill clinical action.
6. Prepare for assistance needs. Some patients need help completing the screener — language barriers, technical familiarity, cognitive support. Pre-train technicians for assistance scenarios and consider family member engagement as a multiplier.

Content disclaimer: This post is adapted from a webinar presented by Amy Fraser, PhD, Manager, Research, Data and Analytics at SHOEBOX Ltd. The pilot study results, hospital partnerships, and clinical outcomes reflect the data available at the time of the original presentation. Bruyère Hospital and Baycrest Hospital are named here based on the speaker’s published presentation; confirm permission status with research/legal before publish. Readers should consult their SHOEBOX account team for the latest research and the full pilot study documentation.