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Abstract
Objective: To investigate the impact of the severity of age-related hearing loss (ARHL) and tinnitus, presence of ARHL and/or tinnitus, and physical frailty on the health-related quality of life (HRQoL) and domain-specific HRQoL in Chinese community-dwelling older adults.Design: This was a cross-sectional study of a community-based cohort.Participants: We evaluated Chinese older adults (n = 429, 183 men and 246 women) aged ≥ 58years.Measurements: The severity of HL and tinnitus were measured using pure-tone audiometry and the Tinnitus Handicap Inventory (THI), respectively. Physical frailty was measured using the five-item Fried scale. HRQoL was assessed using the Assessment of Quality of Life-8-Dimension (AQoL-8D) multi-attribute utility instrument (35 HRQoL items and eight domain-specific HRQoL subcategories). Low HRQoL (HRQoL score or subscores in the highest quintile) was used as a dependent variable in logistic regression analyses adjusted for demographic (Model 1) and health-related (Model 2) and psychosocial (Model 3) confounders.Results: Age-related hearing loss severity was an independent determinant of senses in the physical dimension of HRQoL after adjusting for all covariates. Tinnitus severity was significantly associated with HRQoL and with independent living, senses, and pain in the physical dimension after adjusting for demographic and health-related covariates and was still associated with independent living and senses after adjusting for all covariates. The presence of ARHL and/or tinnitus was significantly associated with independent living and senses in the physical dimension after adjusting for all the covariates. Physical frailty was an independent determinant of HRQoL, independent living, and pain in the physical dimension and with mental health, happiness, and coping in the psychosocial dimension after adjusting for demographic and health-related covariates. The association with HRQoL, independent living, and pain in the physical dimension, and with happiness and coping in the psychosocial dimension remained significant after adjusting for the covariates. Depressive symptoms, social dysfunction, and a number of comorbidities were critical determinants of psychosocial HRQoL.Conclusion: Physical frailty has a stronger and more profound effect on HRQoL, particularly on independent living and pain in the physical dimension and on happiness and coping in the psychosocial dimension. Domain-specific HRQoL should be considered in the management of patients with ARHL with tinnitus and physical frailty.Clinical Trial Registration: www.ClinicalTrials.gov, identifier: NCT2017K020.
Highlights
The number and characteristics of participants were the same as those in our recently published article describing the association of frailty phenotypes with age-related hearing loss and tinnitus [3]
This study found an association of ARHL severity with the senses domain of health-related quality of life (HRQoL), and the association remains significant after adjusting for demographic, health-related, and psychosocial covariates
The use of a multidimensional HRQoL questionnaire and the three models, with successive adjustments for different covariates, provided original information on these relationships. These results extend our understanding of the association among the severity of ARHL [8, 9], tinnitus [10, 18], physical frailty [13, 14, 26], and the presence of ARHL and/or tinnitus
Summary
429 community-dwelling Chinese older adults (age ≥58 years) were recruited from our previous cross-sectional cohort and normative z-scores of the neuropsychological test battery, including executive or attention, language, and memory domains [3, 25]. Physical frailty was evaluated using the five-item Fried scale (weakness, slowness, unexplained weight loss, fatigue, and low physical activity) with Chinese reference values [26, 27]. The. Fried scale score ranges from 0 to 5, with scores 3–5 and 1–2 indicating frail and prefrail, respectively. Study on ARHL with tinnitus and general health [22]. The number and characteristics of participants were the same as those in our recently published article describing the association of frailty phenotypes with age-related hearing loss and tinnitus [3]
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