Age-Related Hearing Loss, Methylmalonic Acid, and Vitamin B12 Status in Older Adults

Hearing Loss in Older Adults

ImportanceAge-related sensorineural hearing loss is a common health problem among adults. Nearly 16% of US adults 18 years or older report difficulty hearing. The prevalence of perceived hearing loss increases with age. Hearing loss can adversely affect an individual’s quality of life and ability to function independently and has been associated with increased risk of falls, hospitalizations, social isolation, and cognitive decline.ObjectiveTo update its 2012 recommendation, the US Preventive Services Task Force (USPSTF) commissioned a systematic review on screening for hearing loss in adults 50 years or older.PopulationAsymptomatic adults 50 years or older with age-related hearing loss.Evidence AssessmentBecause of a lack of evidence, the USPSTF concludes that the benefits and harms of screening for hearing loss in asymptomatic older adults are uncertain and that the balance of benefits and harms cannot be determined. More research is needed.RecommendationThe USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for hearing loss in older adults. (I statement)

For some years, policy makers and medical scientists have both begun to focus more on chronic noncommunicable diseases. It is well known that cardio-cerebrovascular disease, tumors, diabetes, and chronic obstructive pulmonary disease (COPD), are considered areas of major interest in many scientific projects and health programs. The economic impact of cardio-cerebrovascular disease in EU alone is more than EUR 200 billion, while tumors have an impact of EUR 150 billion. The direct and indirect cost of brain disorders exceeds EUR 700 billion a year. Among the brain disorders, the devastating impact of dementia on affected individuals and the burden imposed on their families and society has made prevention and treatment of dementia a public health priority. Interventions that could merely delay the onset of dementia by 1 year would result in a more than 10% decrease in the global prevalence of dementia in 2050. Unfortunately, there are no known interventions that currently have such effectiveness. The manifestations of age-related hearing loss in many older adults are subtle and, thus, hearing loss is often perceived as an unfortunate but inconsequential part of aging. Researchers report that hearing loss seems to speed up age-related cognitive decline. Researchers suggest that treating hearing loss more aggressively could help delay cognitive decline and dementia. Furthermore, there is an increasing interest in better understanding the pathophysiologic correlations between hearing loss and dementia. Hearing loss in older adults, in fact, is associated independently with poorer cognitive functioning, incident dementia, and falls. Further research investigating the basis of this connection as well as the pathomechanism of the two diseases will further our ability to treat dementia.

Hearing loss was associated with age or presbycusis is the most common cause of hearing loss and has adverse effects on the quality of life, communication and social functioning of the older adults. So, the present study was conducted to investigate hearing loss and its associated factors in the older adults of Amirkola city. This cross-sectional study is part of the third phase of the Amirkola Health and Ageing Cohort Project (AHAP), which was conducted in 2023–2024 on all people aged 60 years and older. The data collection tool included a demographic profile questionnaire and history of some chronic diseases. The data about hearing loss is self-reported and by asking the older adults, “Have you ever felt that you have hearing loss?” was obtained. Some chronic diseases such as diabetes and hypertension were diagnosed based on examinations and standard tests. After entering the SPSS22 software, the data were statistically analyzed using t-test, chi-square and multiple logistic regression. Among 1878 older adults studied, 834(50.2%) were men and 827 (49.8%) were women. Out of the total older adults studied, 755 (45.5%) had hearing loss. The prevalence of hearing loss in men was 55.3% and in women was 44.7% (P < 0.001). Hearing loss was also significantly higher among participants in the older age group (P < 0.0001), illiteracy (P < 0.002), unemployment (P = 0.002), those with more chronic diseases (P < 0.001), having multiple medications (P = 0.002), and those with lower body mass index (BMI) (P = 0.001). In the multiple logistic regression analysis, factors contributing to hearing loss in the older adults were age over 85 years and female gender, (P = 0.018), BMI (P = 0.020), inability to perform activities daily living (ADL) (P = 0.046) and number of chronic diseases P < 0.001). This study showed that hearing loss is highly prevalent in older adults in the city of Amirkola. Based on the finding of this study, it seems that an interdisciplinary and joint approach to the field of hearing loss screening and identification at the first level of health care services and referring patients to the second level is essential for the timely treatment of hearing loss.

You have accessThe ASHA LeaderFrom My Perspective1 Jul 2017Tackling the Toll of Hearing Loss on Executive FunctionWe need to think beyond the speech chain—and hearing aids—to fully address effects of hearing loss on older adults’ cognitive health. M. Kathleen Pichora-Fuller, andPhD Natalie PhillipsPhD M. Kathleen Pichora-Fuller Google Scholar More articles by this author , PhD and Natalie Phillips Google Scholar More articles by this author , PhD https://doi.org/10.1044/leader.FMP.22072017.6 SectionsAbout ToolsAdd to favorites ShareFacebookTwitterLinked In Remember those graduate school lessons about the speech chain—in which a message travels between sender and receiver in stages, from one person’s intention to another person’s understanding? For decades, we communication sciences and disorders professionals have used this model to consider how communication breakdowns relate to disorders of speech production or hearing. But it’s important that we also think beyond this model when considering one person’s difficulty understanding what another is saying. Hearing can be challenging even when a talker’s speech and a listener’s audiogram are technically “normal.” These challenges may come from poor room acoustics, incomprehensible messages, background noise or distorting technologies such as poor PA systems that thwart transmission of the speech signal. These factors interfere with hearing more as we get older, making us work harder to understand a message. The speech-chain model is certainly useful, but most versions of it don’t factor in whether message senders and receivers will expend extra effort trying to make it work—and if they must deliberately allocate mental resources to overcome communication obstacles (see sources). The reality is that most people will need to expend that extra effort as they get older; as hearing deteriorates (see “Lost in the Midst”), they’ll need to concentrate harder when adverse conditions threaten to break the speech chain. The inevitable result is a greater burden on people’s cognitive resources and executive functioning. So, to effectively intervene with older patients, we need to look beyond hearing aids alone and train them on strategies to reduce the demands of listening on the brain. To effectively intervene with older patients, we need to look beyond hearing aids alone and train them on strategies to reduce the demands of listening on the brain. Passive hearing versus active listening The brain controls the speech chain largely by cognitive executive functions: a collection of processes people use to guide behavior toward a goal (see sources). These processes promote self-initiated actions. They involve cognitive flexibility, planning, working memory, updating and shifting tasks or mental sets, goal maintenance, monitoring and regulation of performance, and inhibition or suppression of overlearned responses. In brief, executive functions, often governed by brain networks including the prefrontal cortex, reflect how or whether a person goes about doing something. In the book “The Human Frontal Lobes: Functions and Disorders,” Adam Gazzaley and Mark D’Esposito argue that executive control influences sensory input (including audition and vision), internal states (including emotion and cognition), and motor and behavioral output (including speech and language production). In effect, executive control is what differentiates passive hearing from active listening. Executive control functions may help to explain how and whether people listen effectively in a given situation, regardless of whether they have normal or impaired hearing. Age-related declines Active listening requires “executive attention”—the ability to shut out distractions and focus on a main task or goal. Psychologists have found that executive attention rests on strong relationships between working memory and executive functioning. To a lesser extent, it also rests on processing speed, a general processing resource related to many aspects of higher-level cognition and known to decline with age (see sources). Some of these executive-attention subcomponents decline more rapidly than others over the adult lifespan. For example, in adults older than 60, the ability to suppress habitual or dominant responses and the ability to divide attention efficiently appear to decline more quickly than abilities such as verbal fluency and reasoning. Now consider some older listeners’ increasing difficulties with understanding speech: Their difficulties may stem from an interaction of age-related declines in peripheral and central auditory processing, working memory, and divided attention. Certainly, age appears to be related to declines in performance on simple listening tasks—such as word recognition in quiet or noise—according to evidence we reviewed in a recent chapter (see sources). Giving older listeners more context can help improve performance. But age-related differences often persist when listening tasks are more cognitively demanding and involve memory or attention. Thus, older adults draw heavily on auditory processing and executive functions when trying to understand what others are saying in many everyday situations. And the risk of developing clinically significant cognitive impairment appears to be greater for older adults with hearing loss than for peers with better hearing. Active listening requires “executive attention”—the ability to shut out distractions and focus on a main task or goal. Dementia and hearing The everyday consequences of hearing impairment become significantly more serious when a person has one of the major neurodegenerative dementias. Auditory symptoms of these dementias include deficits in perception, auditory apperception, the semantic processing of sounds and emotions, and nonverbal auditory working memory and attention (see sources). Within the last decade, researchers have linked dementia with central and peripheral hearing loss. For example, in the journal Cognitive Behavioral Neurology, George A. Gates and colleagues report evidence of an association between central presbycusis and executive dysfunction. They suggest both may result from similar neurodegenerative processes. The real call to action here for geriatric health (in addition to screening hearing) is to identify older adults in the pre-clinical or asymptomatic phase of dementia—typically called mild cognitive impairment (MCI). It is at this stage that people could benefit the most from interventions. Consider that people with MCI are about five times more likely to develop dementia than their cognitively healthy peers (5 to 10 percent versus 1 to 2 percent). The drive to identify people at-risk for and in the early stages of dementia has sparked clinical interest in subjective cognitive impairment (SCI), in which people who perform normally on cognitive tests experience a subjective decline in cognition. Studies indicate that people with SCI are at higher risk for transitioning to MCI and dementia; one study found almost a quarter of people with SCI developed MCI over four years (see sources). What’s more, hearing impairment emerged as one of the strongest predictors of SCI, along with depressive symptoms and poor psychological well-being, in a study of a population-based sample by Julian Benito-Leon and colleagues (published in the Journal of Alzheimer’s Disease). Our hope is that future studies further probe relationships among hearing loss, executive functions and cognitive impairment in older adults. The speech chain and the brain Growing awareness of the connection between auditory and cognitive aging has inspired new research and raised questions about the implications of cognitive decline for audiology practice. Optimistically, many older adults can enjoy better audibility due to advances in hearing technologies. We can hope that better hearing will result in better cognitive health and quality of life. However, many older adults delay seeking help for hearing problems for decades. And those who do purchase hearing aids may struggle to adjust to them without professional support. This, in turn, can affect cognitive functioning: For example, epidemiological research led by Paul Mick (published in the journal Ear and Hearing) found that older adults with unacknowledged or unaddressed hearing loss performed more poorly on cognitive tests and showed a greater risk of social isolation compared with peers with normal hearing. Can hearing aids counteract cognitive decline and dementia? Although the evidence is still sparse, it’s unlikely that amplification alone will be sufficient. But this doesn’t mean older adults with hearing loss are doomed to social isolation and dementia. Viewed through the lens of the speech-chain model, hearing aids would seem a viable solution to the problem of compromised auditory input. If an older adult wears an appropriately fit hearing aid or assistive technology and receives appropriate support services, then the speech chain should be improved. However, if the person experiences a decline in cognitive executive-control functions, the speech chain may malfunction when demanding listening tasks drain diminished cognitive resources. In such everyday situations, it is very likely that listeners will quit listening, especially when the effort of listening exceeds the perceived value of achieving their listening goals. As quitting becomes a more frequent coping strategy, the person may increasingly withdraw from social interactions—which may exacerbate declines in cognition or other aspects of health. This downward spiral in health has implications for how we address hearing loss in older adults: We advise going beyond the traditional focus on hearing aids to include a focus on executive attention and active listening. A useful guideline here is the Framework for Understanding Effortful Listening (FUEL), the consensus paper of the Eriksholm Workshop on “Hearing Impairment and Cognitive Energy.” For example, FUEL proposes that we train patients on strategies to improve the allocation of cognitive resources. For example, patients can select quieter spaces or learn to use context to reduce listening demands. Other areas of training could include breaking complex tasks into smaller ones and using conversational strategies and multimodal cues to increase focus of attention, improve self-efficacy, and optimize support from conversational partners. Many of these behavioral interventions are already familiar to rehabilitative audiologists, but they take on a new meaning when we rethink the speech chain to link to the brain—and shift the emphasis from passive hearing to active listening. Sources Albers M. W., Gilmore G. C., Kaye J., Murphy C., Wingfield A., Bennett D. A., … Zhang L. I. (2015). At the interface of sensory and motor dysfunctions and Alzheimer’s disease.Alzheimer’s and Dementia, 11(1), 70–98. https://doi.org/10.1016/j.jalz.2014.04.514 CrossrefGoogle Scholar Albert M. S., DeKosky S. T., Dickson D., Dubois B., Feldman H. H., Fox N. C., … Phelps C. H. (2011). The diagnosis of mild cognitive impairment due to Alzheimer’s disease: recommendations from the National Institute on Aging–Alzheimer’s Association workgroups on diagnostic guidelines for Alzheimer’s disease.Alzheimer’s and Dementia, 7, 270–279. https://doi.org/10.1016/j.jalz.2011.03.008 CrossrefGoogle Scholar Amieva H., Ouvrard C., Giulioli C., Meillon C., Rullier L., & Dartigues J. F. (2015). Self-reported hearing loss, hearing aids & cognitive decline in the elderly: A 25 -year study.Journal of the American Geriatrrics Society, 63(10), 2099–104. https://doi.org/10.1111/jgs.13649 CrossrefGoogle Scholar Banich M. T. (2009). Executive function: The search for an integrated account.Current Directions in Psychological Science, 18, 89–94. https://doi.org/10.1111/j.1467-8721.2009.01615.x CrossrefGoogle Scholar Benito-Leon J., Mitchell A. J., Vega S., & Bermejo-Pareja F. (2010). A population-based study of cognitive function in older people with subjective memory complaints.Journal of Alzheimer’s Disease, 22, 159–170. https://doi.org/10.3233/JAD-2010-100972 CrossrefGoogle Scholar Gates G. A., Gibbons L. E., McCurry S. M., Crane P. K., Feeney M. P., & Larson E. B. (2010). Executive dysfunction and presbycusis in older persons with and without memory loss and dementia.Cognitive and Behavioral Neurology: Official Journal of the Society for Behavioral and Cognitive Neurology, 23(4), 218–223. https://doi.org/10.1097/WNN.0b013e3181d748d7 CrossrefGoogle Scholar Gazzaley A., & D’Esposito M. (2007). Unifying prefrontal cortex function: Executive control, neural networks, and top-down modulation. In Miller B. L. & Cummings J. L. (Eds.), The Human Frontal Lobes: Functions and Disorders (2nd ed. 187–206). New York: Guilford Press. Google Scholar Gorno-Tempini M. L., Hillis A. E., Weintraub S., Kertesz A., Mendez M., Cappa S. F., … Grossman M. (2011). Classification of primary progressive aphasia and its variants.Neurology, 76, 1006–1014. https://doi.org/10.1212/WNL.0b013e31821103e6 CrossrefGoogle Scholar Hardy C. J., Marshall C. R., Golden H. L., Clark C. N., Mummery C. J., Griffiths T. D., … Warren J. D. (2016). Hearing and dementia.Journal of Neurology, 263, 2339–2354. https://doi.org/10.1007/s00415-016-8208-y CrossrefGoogle Scholar Lezak M. D., Howieson D. B., & Loring D. W. (2004). Neuropsychological Assessment. (4th ed.) Oxford: Oxford University Press. Google Scholar McCabe D. P., Roediger H. L., McDaniel M. A., Balota D. A., & Hambrick D. Z. (2010). The relationship between working memory capacity and executive functioning: Evidence for a common executive attention construct.Neuropsychology, 24, 222–243. https://doi.org/10.1037/a0017619 CrossrefGoogle Scholar McKhann G. M., Knopman D. S., Chertkow H., Hyman B. T., Jack C. R., Kawas C. H., … Phelps C. H., … (2011). The diagnosis of dementia due to Alzheimer’s disease: Recommendations from the National Institute on Aging-Alzheimer’s Association workgroups on diagnostic guidelines for Alzheimer’s disease.Alzheimer’s & Dementia, 7, 263–269. https://doi.org/10.1016/j.jalz.2011.03.005 CrossrefGoogle Scholar Mick P. T., & Pichora-Fuller M. K. (2016). Is hearing loss associated with poorer health in older adults who might benefit from hearing screening?.Ear and Hearing, 37(3), e194–e201. https://doi.org/10.1097/AUD.0000000000000267 CrossrefGoogle Scholar Mitchell A. J., Beaumont H., Ferguson D., Yadegarfar M., & Stubbs B. (2014). Risk of dementia and mild cognitive impairment in older people with subjective memory complaints: Meta-analysis.Acta Psychiatrica Scandinavica, 130, 439–451. https://doi.org/10.1111/acps.12336 CrossrefGoogle Scholar Petersen R. C. (2011). Clinical practice: Mild cognitive impairment.New England Journal of Medicine, 364, 2227–2234. https://doi.org/10.1056/NEJMcp0910237 CrossrefGoogle Scholar Petersen R. C., Caracciolo B., Brayne C., Gauthier S., Jelic V., & Fratiglioni L. (2014). Mild cognitive impairment: A concept in evolution.Journal of Internal Medicine, 275, 214–228. https://doi.org/10.1111/joim.12190 CrossrefGoogle Scholar Pichora-Fuller M. K., Alain C., & Schneider B. (2017). Older adults at the cocktail party (pp.). In Middlebrooks J., Simon J., Popper A., & Fay R. R. (Eds.), The Auditory System at the Cocktail Party (227–259), Springer Handbook of Auditory Research. Springer: Berlin. https://doi.org/10.1007/978-3-319-51662-2_9 CrossrefGoogle Scholar Pichora-Fuller M. K., Kramer S. E., Eckert M., Edwards B., Hornsby B., Humes L., … Wingfield A. (2016). Hearing impairment and cognitive energy: The framework for understanding effortful listening (FUEL).Ear and Hearing, 37 Supp. 5S–S27. https://doi.org/10.1097/aud.0000000000000312 CrossrefGoogle Scholar Royall D. R., Lauterbach E. C., Cummings J. L., Reeve A., Rummans T. A., Kaufer D., … Coffey C. E. (2002). Executive control function: A review of its promise and challenges for clinical research.Journal of Neuropsychiatry and Clinical Neurosciences( 14(4), 377–405. https://doi.org/10.1176/jnp.14.4.377 CrossrefGoogle Scholar Weintraub S., Wicklund A. H., & Salmon D. P. (2012). The neuropsychological profile of Alzheimer disease.Cold Spring Harbor Perspectives in Medicine, 2, a006171. https://doi.org/10.1101/cshperspect.a006171 CrossrefGoogle Scholar Author Notes M. Kathleen Pichora-Fuller, PhD, is a professor in the Department of Psychology at the University of Toronto in Mississauga, Ontario, Canada. [email protected] Natalie Phillips, PhD, is a professor in the Department of Psychology and Centre for Research in Human Development at Concordia University in Montreal, Quebec, Canada. [email protected] Advertising Disclaimer | Advertise With Us Advertising Disclaimer | Advertise With Us Additional Resources FiguresSourcesRelatedDetailsCited byPerspectives of the ASHA Special Interest Groups3:6 (43-50)1 Jan 2018Cognition and Hearing Aids: What Should Clinicians Know?Pamela E. Souza Volume 22Issue 7July 2017 Get Permissions Add to your Mendeley library History Published in print: Jul 1, 2017 Metrics Current downloads: 1,273 Topicsasha-topicsleader_do_tagasha-article-typesleader-topicsCopyright & Permissions© 2017 American Speech-Language-Hearing AssociationLoading ...

Objective This study aimed to assess categories underlying subjective hearing loss (SHL) in older adults using the International Classification of Functioning, Disability (ICF) and Health-Brief Core Set for Hearing Loss (ICF-BCS-HL). Design A cross-sectional study. One-hundred and thirty-one independent-living older adults (Mage = 72.32, SD = 6.83), who completed the speech, spatial, and quality of hearing (SSQ) scale and a set of clinically accepted outcome measurements linked with selected categories listed in the ICF-BCS-HL. Results A linear regression analysis model was fitted with the outcome measurements after controlling for age, sex, education, multimorbidity, and hearing aid use. The model showed 5 significant predictors underlying the SSQ-total score: HL (ß = −.38, p ≤ .001), dizziness handicap (ß = −.35, p ≤ .001), cognitive decline (ß = .17, p < .05), multimorbidity (ß = .12, p < .005), and poor ability to accept the noise level (ß = −.16, p = p < .05). Predictors varied across the SSQ-subscales scores, however. Conclusion A link of SHL with HL, cognitive deficits, poor ability to accept background noise level, and multimorbidity, collectively or individually, were well-established. So far, little attention has been paid to the impact of dizziness handicap of elderly patients when evaluating their SHL.

Purpose The prevalence of dementia has increased in recent years and, along with hearing loss, can negatively impact the health of older adults. The purpose of this retrospective cross-sectional study was to establish self-reported hearing loss and associated factors in older adults at a memory clinic. Method Researchers conducted a retrospective cross-sectional study on factors associated with self-reported hearing loss (i.e., lifestyle, general health, cognition, functional capacity). Data were taken from medical records of older adults (≥ 60 years old) who received care between 2017 and 2018 at a memory clinic located at the Southern Santa Catarina University in Brazil. Analysis included the Pearson chi-squared test and logistic regression, estimation of the crude and adjusted odds ratios (OR), with respective confidence intervals of 95%. Results Researchers analyzed the medical records of 257 older adults and verified a prevalence of 13.2% of these adults with self-reported hearing loss. There was a higher prevalence of the outcome (i.e., self-reported hearing loss) in older adults who reported tinnitus (35.2%), those with mild cognitive impairment (14.7%), and those who were sedentary (19.2%). After adjustment for confusion factors, tinnitus (OR = 4.63; p = .019) and sedentarism (OR = 2.89; p = .029) were still associated with the outcome. Conclusions Tinnitus and sedentarism were associated with hearing loss in older adults receiving care at a memory clinic. As a public health issue, presbycusis needs to be included in the health planning and health promotion agendas, with effective control, prevention, and treatment measures.

Hearing Wellness Toolkit for Primary Care

Hearing loss is a prevalent condition in older adults. Epigenetic age acceleration has emerged as a potential biomarker for age-related diseases; however, there is limited evidence of the link between epigenetic age acceleration and hearing loss in older adults or how it varies by sex. This study is to investigate (1) the association between epigenetic age acceleration and hearing function and (2) sex differences in this association. Data from the Health and Retirement Study, a large, nationally representative sample of adults aged 50 yrs and older, were analyzed. The study included 1755 adults from the 2016 sample with epigenetic data. Epigenetic age acceleration included five epigenetic clocks: Horvath's age acceleration (HorvathAA), Hannum's age acceleration (HannumAA), phenotypic age acceleration (PhenoAA), GrimAge acceleration (GrimAA), and methylation-based pace of aging estimate (DunedinPoAm). Multivariable regression models assessed the association between epigenetic age acceleration and mean hearing test score (linear) and hearing loss (logistic). The mean chronological age of 68.4 (SD = 9.4) was higher than the mean epigenetic age ranging from 53.9 (SD = 8.9) for HannumAge to 67.1 (SD = 8.6) for GrimAge. Overall, 58.4% of participants had hearing loss, with a mean hearing test score of 4.6 (1.4). Phenotypic age acceleration, GrimAA, and methylation-based pace of aging estimate were significantly associated with lower hearing test scores (β [95% confidence interval {CI}] = -0.081 [-0.15 to -0.01]; -0.150 [-0.22 to -0.08]; -0.089 [-0.16 to -0.02], respectively). These associations remained significant in females, while only GrimAA was still significant in males. GrimAA was associated with higher odds of hearing loss (odds ratio [95% CI] =1.23 [1.05 to 1.44]), and remained significant in females (1.47 [1.18 to 1.83]), but not in males. This study highlights the potential of epigenetic age acceleration as a biomarker for hearing loss in older adults and underscores the importance of sex differences in aging research. Findings suggest further research is needed to explore epigenetic mechanisms as potential targets for interventions to mitigate hearing loss in older adults, particularly among females.

There are no recent population-based data on the prevalence of hearing loss in older adults using standard audiometric testing. The population-based Epidemiology of Hearing Loss Study was designed to measure the prevalence of hearing loss in adults aged 48-92 years, residing in Beaver Dam, Wisconsin. Hearing thresholds were measured with standardized protocols using pure-tone air- and bone-conduction audiometry in sound-treated booths. The examination also included an otoscopic evaluation, screening tympanogram, and a questionnaire on hearing-related medical history, noise exposure, other potential risk factors, and self-perceived hearing handicap. Of the 4,541 eligible people, 3,753 (82.6%) participated in the hearing study (1993-1995). The average age of participants was 65.8 years, and 57.7% were women. The prevalence of hearing loss was 45.9%. The odds of hearing loss increased with age (odds ratio (OR) = 1.88 for 5 years, 95% confidence interval (CI) 1.80-1.97) and were greater for men than women (OR = 4.42, 95% CI 3.73-5.24). The male excess of hearing loss remained statistically significant after adjusting for age, education, noise exposure, and occupation (OR = 3.65). These results demonstrate that hearing loss is a very common problem affecting older adults. Epidemiologic studies are needed to understand the genetic, environmental, and sex-related determinants of age-related hearing loss and to identify potential intervention strategies.

ImportanceHearing loss is common in older adults and associated with adverse health and social outcomes.ObjectiveTo update the evidence review on screening for hearing loss in adults 50 years or older to inform the US Preventive Services Task Force.Data SourcesMEDLINE, Cochrane Library, EMBASE, and trial registries through January 17, 2020; references; and experts; literature surveillance through October 8, 2020.Study SelectionEnglish-language studies of accuracy, screening, and interventions for screen-detected or newly detected hearing loss.Data Extraction and SynthesisDual review of abstracts, full-text articles, and study quality. Meta-analysis of screening test accuracy studies.Main Outcomes and MeasuresQuality of life and function, other health and social outcomes, test accuracy, and harms.ResultsForty-one studies (N = 26 386) were included, 18 of which were new since the previous review. One trial enrolling US veterans (n = 2305) assessed the benefits of screening; there was no significant difference in the proportion of participants experiencing a minimum clinically important difference in hearing-related function at 1 year (36%-40% in the screened groups vs 36% in the nonscreened group). Thirty-four studies (n = 23 228) evaluated test accuracy. For detecting mild hearing loss (>20-25 dB), single-question screening had a pooled sensitivity of 66% (95% CI, 58%-73%) and a pooled specificity of 76% (95% CI, 68%-83%) (10 studies, n = 12 637); for detecting moderate hearing loss (>35-40 dB), pooled sensitivity was 80% (95% CI, 68%-88%) and pooled specificity was 74% (95% CI, 59%-85%) (6 studies, n = 8774). In 5 studies (n = 2820) on the Hearing Handicap Inventory for the Elderly–Screening to detect moderate hearing loss (>40 dB), pooled sensitivity was 68% (95% CI, 52%-81%) and pooled specificity was 78% (95% CI, 67%-86%). Six trials (n = 853) evaluated amplification vs control in populations with screen-detected or recently detected hearing loss over 6 weeks to 4 months. Five measured hearing-related function via the Hearing Handicap Inventory for the Elderly; only 3 that enrolled veterans (n = 684) found a significant difference considered to represent a minimal important difference (>18.7 points). Few trials reported on other eligible outcomes, and no studies reported on harms of screening or interventions.Conclusions and RelevanceSeveral screening tests can adequately detect hearing loss in older adults; no studies reported on the harms of screening or treatment. Evidence showing benefit from hearing aids on hearing-related function among adults with screen-detected or newly detected hearing loss is limited to studies enrolling veterans.

Klotho is a protein with various biological functions, including anti-aging effects. Although research suggests Klotho plays a key role in auditory function, the relationship between serum Klotho levels and high-frequency hearing loss (HFHL) in older adults remains unclear. We analyzed data from individuals aged 70-79 years participating in the 2009-2010 cycle of the National Health and Nutrition Examination Survey. Multivariate logistic regression models were employed to assess the relationship between serum Klotho levels and HFHL. Restricted cubic splines were utilized to evaluate linearity and examine the dose-response relationship. Additionally, we performed subgroup analyses to evaluate the consistency of this relationship across various subgroups. In this study of 422 elderly individuals aged 70-79 years (mean age 73.8 years, with 47.4% male participants), the median serum Klotho concentration was 754.6 pg/mL. Multivariable logistic regression analysis consistently demonstrated that higher serum Klotho levels were associated with a reduced risk of HFHL across various models (ORs: 0.24-0.32, p = 0.020-0.028). Additionally, restricted cubic spline analysis confirmed a linear negative association between serum Klotho levels and HFHL risk, with a p-value for nonlinearity of 0.474. Subgroup analyses did not reveal any statistically significant interactions modifying this relationship. Serum Klotho levels are inversely associated with the risk of HFHL. 3 Laryngoscope, 135:1169-1176, 2025.

Age-related hearing loss is the third most common health condition affecting elderly individuals. The relationship between lycopene in blood and sensorineural hearing loss in elderly adults has rarely been reported. This study aimed to elucidate the connection between serum lycopene levels and sensorineural hearing loss among elderly individuals. This cross-sectional study included 693 participants aged 70–80 years from the National Health and Nutrition Examination Survey (NHANES) from 2017 to 2018. The outcomes included sensorineural low-frequency hearing loss [pure-tone average (PTA) at 0.5, 1, and 2 kHz ≥ 20 dB], speech-frequency hearing loss (PTA at 0.5, 1, 2, and 4 kHz ≥ 20 dB), and high-frequency hearing loss (PTA at 4, 6, and 8 kHz ≥ 20 dB). Multivariate logistic regression analysis was used to determine the relationship between lycopene in blood and the risk of hearing loss. There were 418 (60.3%), 522 (75.3%), and 667 (96.2%) participants who experienced hearing loss at low, speech, and high frequencies, respectively. Serum total lycopene (OR = 0.575, 95% CI 0.337–0.984) and serum cis-lycopene (OR = 0.334, 95% CI 0.112–0.994) were associated with a lower risk of low-frequency hearing loss after adjusting for covariates. Among male participants, the serum total, cis-, and trans-lycopene levels were inversely related to low- and speech-frequency hearing loss. However, no relationship was observed among the female participants. In conclusion, our findings indicate that increased serum lycopene levels are associated with a decreased prevalence of sensorineural low-frequency hearing loss in older adults, especially in men.

To review studies investigating cochlear implant (CI) outcomes in older adults, and to develop a conceptual framework demonstrating important interactions between characteristics of hearing disability, aging, and the CI intervention. Review of English literature with titles containing the words "cochlear implant" and generic term referring to older adults or numerical value for age greater than 65. Hearing loss is a prevalent consequence of aging and poses special challenges for older adults. Particularly when superimposed on other age-related conditions, presbycusis (age-related hearing loss) places older adults at risk for social isolation and associated psychological and general health sequelae. The increasing cognitive demand of verbal communication and the diminished sense of social and physical connectedness can contribute to a feeling of vulnerability and poor health that worsens with advancing presbycusis. This cascade of downstream effects of hearing loss has implications for the self-assessment of health-related quality of life (HRQoL) and resulting estimates of associated costs. There is accumulating evidence of a potential role for CI in older adults with poor word understanding despite conventional hearing aid use. This review of the literature provides strong evidence of the benefits of restoring communication capacity in the deaf and hard-of-hearing geriatric population. There is, however, a lack of attention to communication performance in the real world and HRQoL outcomes, and significant gaps in knowledge regarding how CI rehabilitation interacts with changing psychosocial and functional status with aging. A broader conceptual framework than is currently available for the role of CI rehabilitation in the management of severe-to-profound hearing loss in older adults is proposed. It is posited that the use of such a model in future investigations is needed to guide multidisciplinary investigations into the unique challenges of hearing loss in older adults and may open new opportunities for innovation.

Lipid and C‐reactive Protein Levels as Risk Factors for Hearing Loss in Older Adults