| Author(s): | Helen Weatherlya; |
|---|---|
| Institution(s): | a Centre for Health Economics, University of York; |
| Production date: | February 2023 |
| Acknowledgements: | Lucy Stuttard, Francesco Longo, Simon Walker |
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In the UK, more than 800,000 people are severely or profoundly deaf, that is 1.32% of the total population.1 Health and social care workers and care professionals need robust evidence to provide information and advice for people with hearing loss. Hearing loss, particularly when acquired in adulthood, is associated with adverse outcomes across a range of life domains including reduced quality of life, social networks, social inclusion, work, mental and physical health, and cognitive decline.2-8 Hearing dogs are a type of assistance dog and they may benefit recipients by reducing their reliance on ongoing care as well as supporting independence in the community. This summary reports evidence from Stuttard et al, 2021.9
In the United Kingdom, one in six adults have hearing loss and around one in a hundred are severely or profoundly deaf.1 Hearing loss is associated with increased risk of poorer quality of life and negative impacts on many life domains including social networks and social inclusion, work and mental and physical health, cognitive decline and increased risk of dementia.2-8 The severity of hearing loss increases the risk for, and severity of, negative impacts on people’s lives.
For those with severe or profound hearing loss, hearing aids offer little benefit.3 Whilst cochlear implants may be an option for some individuals, they can only partially Improve the impact of hearing loss on managing and participating in everyday life. Where people are unable to benefit from audiological interventions, or achieve limited benefit, the focus shifts to adaptation to hearing loss and the prevention (or minimisation) of adverse outcomes.3
Rehabilitation interventions, addressing speech perception/communication skills, functional adaptation (including equipment provision) and emotional support needs, may be available but these are short term and typically provided soon after experiencing a significant deterioration in hearing. Overall, evidence on their effectiveness is poor quality and equivocal, particularly in terms of sustained benefit. Hearing dogs offer an alternative type of rehabilitative intervention. The study on which this summary is based is the first randomised controlled trial evaluating hearing dogs.9 It generated evidence on the impacts hearing dogs can have on people’s lives in addressing their care and support needs, and their effectiveness and cost-effectiveness. A key implication for adult social care practice concerns the awareness and understanding of hearing dogs as a potential intervention and source of support for people with long-term or recently acquired hearing loss. Findings have relevance for sensory impairment teams and service commissioners.
Hearing dogs are dogs that are trained to provide ‘sound support’, that is the ability to respond to common sounds of daily living such as the doorbell ringing or a family member calling the name of the person with hearing loss. Hearing dogs use different behaviours to identify the sound and alert the person with hearing loss.9 Accredited hearing dog providers are available in many European countries, also in North America, Australia and New Zealand. They adhere to international standards for the assistance dog industry.10 Hearing Dogs for Deaf People is the only charity that provides accredited hearing dogs to UK residents.
As with other assistance dogs, hearing dogs have legal entitlements to access public, workplace and commercial/business spaces which typically prohibit pet dogs.11 Hearing dog recipients are encouraged to take their hearing dog with them whenever they leave their home. On these occasions, the dog wears a jacket that clearly conveys it is a working dog supporting someone with hearing loss. The hearing dog partnership is supported by the provider via on-going, individualised support.
The evidence on the effectiveness of hearing dogs on recipient’s lives is limited12-18 although it does indicate that hearing dogs have the potential to positively affect a range of outcomes. The randomised controlled trial on which this case summary is based evaluated the impacts of a hearing dog on the mental wellbeing, anxiety, depression, problems associated with hearing loss (responding to sounds, fearfulness/social isolation), and perceived dependency on others.
One hundred and sixty five participants were randomised to either receive a hearing dog (83 people), or not receive a hearing dog (82 people on the waiting list to receive a hearing dog). Over the six month time frame of the study recipients of a hearing dog had significantly improved mental wellbeing, anxiety, depression, functioning, fearfulness/social isolation, and perceived dependency compared to people with hearing loss and no hearing dog.
Recently, 15 first-time hearing dog recipients were interviewed twice: first, between four and six months after receiving their dog and then again six months later (work is as yet unpublished). For the first few months after receiving a hearing dog, recipients had to make various adjustments. These including adjusting their home and work routines; renegotiating support roles previously assumed by family members; managing hearing dog responsibilities (including a commitment to daily soundwork training); and dealing with associated challenges, for example confrontations in public settings, such as shops, with people unfamiliar with the legal access rights of hearing dogs.
Over time these adjustments and challenges were traded off against the growing positive impacts experienced. Recipients also said that Hearing Dogs for Deaf People’s thorough process of matching recipients with dogs, and the on-going involvement and support of a local Hearing Dogs for Deaf People Partnership Instructor, were successful aspects of the hearing dog partnership.
Recipients reported a wide range of positive impacts across various life domains, including:
Benefits could emerge within the first few months and, as the hearing dog partnership consolidated over time, these continued to develop, becoming more wide-ranging and/or far-reaching in intensity. Impacts in different domains were typically interconnected, where positive impacts in one area of life reinforced or supported change in another, and increased positive outcomes in the original domain. Some recipients reported reduced use of technologies to support hearing (e.g. hearing aids, cochlear implants, pagers, alarms), which was typically attributed to the hearing dog’s continual and constant presence providing both soundwork support and a sense of safety.
This summary reports the findings from a randomised controlled trial of Hearing Dogs for Deaf People.9 The only other economic evaluation found assessed the cost-effectiveness analysis of ‘certified service dogs’ but did not include participants with hearing dogs in the effectiveness study.19
The cost-effectiveness analysis found that, given the current model of provision in the UK whereby the costs of hearing dogs are borne by the charitable sector (Hearing Dogs for Deaf People ((HDfDP), this intervention is a worthwhile investment when seen from a public sector perspective. Compared to usual care, hearing dogs reduced use and costs of public sector health and social care services, and improved QALY-based outcomes. The probability that the hearing dog was cost-effective under this scenario was 94% for three cost-effectiveness thresholds (£15,000, £20,000, £30,000). Whilst it was not cost-effective for the full cost of hearing dogs to be borne by the health and social care sector, a partial contribution by the public sector to the hearing dog partnership could represent value for money (that is, health benefits would exceed the health opportunity costs).
To our knowledge, no other cost-effectiveness study of hearing dogs for deaf people has been undertaken. The study reported here focused on the health and social care perspective and it would be possible to include the impact of hearing dogs on recipients’ productivity, the benefits and costs to their informal unpaid carers, and the benefits and costs to family members or hearing dog for deaf people volunteers involved in hearing dog training. At present, no threshold is available to undertake cost-effectiveness analyses from the health and social care (combined) perspective for reflecting how much benefit would be gained from alternative use of resources.
In the UK, accredited hearing dogs are provided by a single charity, Hearing dogs for Deaf People (www.hearingdogs.org.uk) which also bears the cost of training and matching the dogs with recipients. At present, there are 982 hearing dogs helping deaf people (https://www.hearingdogs.org.uk/helping-deaf-people/). As with other charities addressing health and social care needs, it would appear that the health and social care statutory sector benefits from the service provided by Hearing Dogs for Deaf People. However, given its dependency on charitable donations, the extent to which the charity can exceed current rates of provision – and thus further benefit the public sector – is unclear.
Reference to the main study referred to in the summary: Stuttard L, Boyle P, Fairhurst C, et al (2021) Hearing dogs for people with severe and profound hearing loss: a wait-list design randomised controlled trial investigating their effectiveness and cost-effectiveness. Trials 22:200.
Helen Weatherly and Lucy Stuttard
NIHR School for
Social Care Research
