2- https://doi.org/10.1044/leader.fmp.22072017.6
Tackling the Toll of Hearing Loss on Executive Function
Translate Article 
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 ...
- Research Article
- 215
- 10.1001/jama.2012.321
- Mar 21, 2012
- JAMA
Hearing Loss in Older Adults
- Research Article
- 83
- 10.1001/jama.2021.2566
- Mar 23, 2021
- JAMA
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)
- Research Article
- 2
- 10.1044/2021_aja-20-00124
- Jun 9, 2021
- American Journal of Audiology
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.
- Research Article
- 17
- 10.2217/ahe.12.5
- Apr 1, 2012
- Aging Health
Aging HealthVol. 8, No. 2 EditorialHow does hearing loss affect the brain?Arthur Wingfield & Jonathan E PeelleArthur Wingfield* Author for correspondenceVolen National Center for Complex Systems, MS 013, Brandeis University, Waltham, MA 02454-9110, USA. Search for more papers by this authorEmail the corresponding author at wingfield@brandeis.edu & Jonathan E PeelleDepartment of Neurology, University of Pennsylvania, Philadelphia, PA 19104, USASearch for more papers by this authorPublished Online:17 Apr 2012https://doi.org/10.2217/ahe.12.5AboutSectionsView ArticleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareShare onFacebookTwitterLinkedInReddit View articleKeywords: brain volumecognitive functionfunctional imaginghearing acuitylistening effortReferences1 Cruickshanks KJ, Wiley TL, Tweed TS et al. Prevalence of hearing loss in older adults in Beaver Dam, Wisconsin. The Epidemiology of Hearing Loss Study. Am. J. Epidemiol.148,879–886 (1998).Crossref, Medline, CAS, Google Scholar2 Lethbridge-Cejku M, Schiller JS, Bernadel L. Summary health statistics for U.S. adults: National Health Interview Survey, 2002. Vital Health Stat.10,1–151 (2004).Google Scholar3 Tun PA, O’Kane G, Wingfield A. Distraction by competing speech in young and older adult listeners. Psychol. Aging17,453–467 (2002).Crossref, Medline, Google Scholar4 Wingfield A, Tun PA, McCoy SL. Hearing loss in older adulthood: what it is and how it interacts with cognitive performance. Curr. Dir. Psychol. Sci.14,144–148 (2005).Crossref, Google Scholar5 Wingfield A, McCoy SL, Peelle JE, Tun PA, Cox LC. Effects of adult aging and hearing loss on comprehension of rapid speech varying in syntactic complexity. J. Am. Acad. Audiol.17,487–497 (2006).Crossref, Medline, Google Scholar6 Rönnberg J, Rudner M, Lunner T. Cognitive hearing science: the legacy of Stuart Gatehouse. Trends Amplif.20,1–9 (2011).Google Scholar7 Lin FR. Hearing loss and cognition among older adults in the United States. J. Gerontol. Med. Sci.66A,1131–1136 (2011).Crossref, Google Scholar8 Lin FR, Metter EJ, O’Brien RJ, Resnick SM, Zonderman AB, Ferrucci L. Hearing loss and incident dementia. Arch. Neurol.68,214–220 (2011).Crossref, Medline, Google Scholar9 Gates GA, Anderson ML, McCurry SM, Feeney MP, Larson EB. Central auditory dysfunction as a harbinger of Alzheimer dementia. Arch. Otolaryngol. Head Neck Surg.137,390–395 (2011).Crossref, Medline, Google Scholar10 Peelle JE, Troiani V, Grossman M, Wingfield A. Hearing loss in older adults affects neural systems supporting speech comprehension. J. Neurosci.31,12638–12643 (2011).Crossref, Medline, CAS, Google Scholar11 Mulrow CD, Aguilar C, Endicot JE et al. Quality-of-life changes and hearing impairment. A randomized trial. Ann. Intern. Med.113,188–194 (1990).Crossref, Medline, CAS, Google Scholar12 van Hooren SAH, Anteunis LJC, Valentijn SAM, Bosma H, Ponds RW, van Boxtel MPJ. Does cognitive function in older adults with hearing impairment improve by hearing aid use? Int. J. Audiol.44,265–271 (2005).Crossref, Medline, CAS, Google Scholar13 Gopinath B, Schneider J, McMahon CM, Teber E, Leeder SR, Mitchell P. Severity of age-related hearing loss is associated with impaired activities of daily living. Age Ageing41,195–200 (2012).Crossref, Medline, Google ScholarFiguresReferencesRelatedDetailsCited ByApproaches for Ear-targeted Delivery Systems in Neurosensory Disorders to avoid Chronic Hearing Loss Mediated Neurological DiseasesCNS & Neurological Disorders - Drug Targets, Vol. 21, No. 6High-Frequency Cochlear Amplifier Dysfunction: A Dominating Contribution to the Cognitive-Ear Link6 January 2022 | Frontiers in Aging Neuroscience, Vol. 13Associated Systemic Health Conditions Associated with Treacher Collins Syndrome1 January 2022Effects of Sensorineural Hearing Loss on Cortical Synchronization to Competing Speech during Selective Attention24 February 2020 | The Journal of Neuroscience, Vol. 40, No. 12Neural Signatures of Working Memory in Age-related Hearing LossNeuroscience, Vol. 429Physiologische Veränderungen im Altersgang29 April 2020Effect of sensorineural hearing loss on neurocognitive and adaptive functioning in survivors of pediatric embryonal brain tumor28 November 2019 | Journal of Neuro-Oncology, Vol. 146, No. 1Experiments in macaque monkeys provide critical insights into age-associated changes in cognitive and sensory function23 December 2019 | Proceedings of the National Academy of Sciences, Vol. 116, No. 52Unexpected association between subclinical hearing loss and restorative sleep in a middle-aged and elderly Japanese population27 March 2018 | BMC Research Notes, Vol. 11, No. 1Gray Matter Atrophy Is Associated With Cognitive Impairment in Patients With Presbycusis: A Comprehensive Morphometric Study23 October 2018 | Frontiers in Neuroscience, Vol. 12COMPARATIVE CLINICAL AND AUDIOLOGICAL CHARACTERISTICS OF THE AUDITORY ANALYZER CONDITION IN PATIENTS WITH CHRONIC TUBOTYMPANIC OTITIS MEDIAWorld of Medicine and Biology, Vol. 13, No. 62Satisfaction with Hearing Aids among Aged Patients with Different Degrees of Hearing Loss and Length of Daily UseJournal of Audiology and Otology, Vol. 19, No. 1 Vol. 8, No. 2 Follow us on social media for the latest updates Metrics Downloaded 228 times History Published online 17 April 2012 Published in print April 2012 Information© Future Medicine LtdKeywordsbrain volumecognitive functionfunctional imaginghearing acuitylistening effortFinancial & competing interests disclosureA Wingfield’s research is supported by NIH grant AG019714 from the National Institute on Aging. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.No writing assistance was utilized in the production of this manuscript.PDF download
- Discussion
- 24
- 10.1016/s0140-6736(15)60208-2
- Mar 1, 2015
- The Lancet
Hearing loss: a global health issue
- Research Article
- 5
- 10.1080/21695717.2021.1909329
- May 7, 2021
- Hearing Balance and Communication
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.
- Supplementary Content
- 51
- 10.1159/000371595
- Feb 1, 2015
- Audiology and Neurotology
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.
- Research Article
- 23
- 10.1300/j052v25n03_08
- Jan 1, 2006
- Journal of Nutrition For the Elderly
Hearing loss has been associated with poor vitamin B12 status in some, but not all studies. This study examined a possible relationship between age-related hearing loss and poor B12 status in 93 older adults using different indices of B status. Hearing loss was defined as pure-tone average threshold > 25 decibel hearing level. Participants with methylmalonic acid (MMA) > 271 nmol/L at baseline received 1,000 μg/d, and those with MMA <271 nmol/L were randomly assigned to receive 0,25, or 100 Ltg/d of B12. In a series of logistic regression analyses, compared with participants with normal hearing, those with impaired hearing had a significantly higher serum mean MMA concentrations in the best and the worst ears and a higher prevalence of elevated MMA (> 271 nmol/L) in the worst ear only. Thus, elevated MMA concentration may be associated with hearing loss in older adults. However, short-term B12 supplementation was unrelated to improvements in hearing status in B12-deficient individuals.
- Research Article
- 447
- 10.1001/jama.289.15.1976
- Jan 1, 2003
- JAMA
Hearing loss is the third most prevalent chronic condition in older adults and has important effects on their physical and mental health. Despite these effects, most older patients are not assessed or treated for hearing loss. To review the evidence on screening and management of hearing loss of older adults in the primary care setting. We performed a search from 1985 to 2001 using MEDLINE, HealthSTAR, EMBASE, Ageline, and the National Guideline Clearinghouse for articles and practice guidelines about screening and management of hearing loss in older adults, as well as reviewed references in these articles and those suggested by experts in hearing impairment. We reviewed articles for the most clinically important information, emphasizing randomized clinical trials, where available, and identified 1595 articles. Screening tests that reliably detect hearing loss are use of an audioscope, a hand-held combination otoscope and audiometer, and a self-administered questionnaire, the Hearing Handicap Inventory for the Elderly-Screening version. The value of routine screening for improving patient outcomes has not been evaluated in a randomized clinical trial. Screening is endorsed by most professional organizations, including the US Preventive Services Task Force. While most hearing loss in older adults is sensorineural and due to presbycusis, cerumen impaction and chronic otitis media may be present in up to 30% of elderly patients with hearing loss and can be treated by the primary care clinician. In randomized trials, hearing aids have been demonstrated to improve outcomes for patients with sensorineural hearing loss. Nonadherence to use of hearing aids is high. Prompt recognition of potentially reversible causes of hearing loss, such as sudden sensorineural hearing loss, is important to maximize the possibility of functional recovery. While untested in a clinical trial, older adults can be screened for hearing loss using simple methods, and effective treatments exist and are available for many forms of hearing loss.
- Research Article
- 10.1097/aud.0000000000001797
- Feb 6, 2026
- Ear and hearing
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.
- Research Article
- 39
- 10.1371/journal.pone.0228349
- Jan 27, 2020
- PLOS ONE
Hearing loss (HL) is a frequent problem among the elderly and has been studied in many cohort studies. However, pure tone audiometry-the gold standard-is rather time-consuming and costly for large population-based studies. We have investigated if self-reported hearing loss, using a multiple choice question, can be used to assess HL in absence of pure tone audiometry. This study was performed within 4,906 participants of the Rotterdam Study. The question (in Dutch) that was investigated was: 'Do you have any difficulty with your hearing (without hearing aids)?'. The answer options were: 'never', 'sometimes', 'often' and 'daily'. Mild hearing loss or worse was defined as PTA0.5-4(Pure Tone Average 0.5, 1, 2 & 4 kHz) ≥20dBHL and moderate HL or worse as ≥35dBHL. A univariable linear regression model was fitted with the PTA0.5-4 and the answer to the question. Subsequently, sex, age and education were added in a multivariable linear regression model. The ability of the question to classify HL, accounting for sex, age and education, was explored through logistic regression models creating prediction estimates, which were plotted in ROC curves. The variance explained (R2) by the univariable regression was 0.37, which increased substantially after adding age (R2 = 0.60). The addition of sex and educational level, however, did not alter the R2 (0.61). The ability of the question to classify hearing loss, reflected in the area under the curve (AUC), was 0.70 (95% CI 0.68, 0.71) for mild hearing loss or worse and 0.86 (95% CI 0.85, 0.87) for moderate hearing loss or worse. The AUC increased substantially when sex, education and age were taken into account (AUC mild HL: 0.73 (95%CI 0.71, 0.75); moderate HL 0.90 (95%CI 0.89, 0.91)). Self-reported hearing loss using a single question has a good ability to detect hearing loss in older adults, especially when age is accounted for. A single question cannot substitute audiometry, but it can assess hearing loss on a population level with reasonable accuracy.
- Research Article
- 10
- 10.3389/fpsyg.2021.640300
- Jan 4, 2022
- Frontiers in Psychology
Chinese-speaking older adults usually do not perceive a hearing problem until audiometric thresholds exceed 45 dB HL, and the audiometric thresholds of the average hearing-aid (HA) user often exceed 60 dB HL. The purpose of this study was to examine the relationships between cognitive and hearing functions (measured as audiometric or speech reception thresholds) in older Chinese adults with HAs and with untreated hearing loss (HL). Participants were 49 Chinese older adults who used HAs and had moderate to severe HL (HA group), and 46 older Chinese who had mild to moderately severe HL but did not use HAs (untreated; or UT group). Multiple linear regression analysis was employed to evaluate how well age, education level, audiometric thresholds, and speech perception in noise were related to performance on general cognitive function, working memory, executive function, attention, and verbal learning tests. Results showed that speech perception in noise alone accounted for 13–25% of the variance in general cognitive function, working memory, and executive function in the UT group, and 9–21% of the variance in general cognitive function and verbal learning in the HA group (i.e., medium effect sizes). Audiometric thresholds did not explain any proportion of the variance in cognitive functioning in the HA or UT group. Thus, speech perception in noise accounts for more variance in cognitive performance than audiometric thresholds, and is significantly associated with different cognitive functions in older Chinese adults with HAs and with untreated HL.
- Research Article
- 77
- 10.1001/jama.2020.24855
- Mar 23, 2021
- JAMA
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.
- Research Article
- 10.1044/leader.ftr4.14112009.14
- Sep 1, 2009
- The ASHA Leader
Audiologic Management of the Older Patient
- Components
- 16
- 10.1371/journal.pone.0228349.r006
- Jan 27, 2020
IntroductionHearing loss (HL) is a frequent problem among the elderly and has been studied in many cohort studies. However, pure tone audiometry—the gold standard—is rather time-consuming and costly for large population-based studies. We have investigated if self-reported hearing loss, using a multiple choice question, can be used to assess HL in absence of pure tone audiometry.MethodsThis study was performed within 4,906 participants of the Rotterdam Study. The question (in Dutch) that was investigated was: ‘Do you have any difficulty with your hearing (without hearing aids)?’. The answer options were: 'never', 'sometimes', 'often' and 'daily'. Mild hearing loss or worse was defined as PTA0.5-4(Pure Tone Average 0.5, 1, 2 & 4 kHz) ≥20dBHL and moderate HL or worse as ≥35dBHL. A univariable linear regression model was fitted with the PTA0.5–4 and the answer to the question. Subsequently, sex, age and education were added in a multivariable linear regression model. The ability of the question to classify HL, accounting for sex, age and education, was explored through logistic regression models creating prediction estimates, which were plotted in ROC curves.ResultsThe variance explained (R2) by the univariable regression was 0.37, which increased substantially after adding age (R2 = 0.60). The addition of sex and educational level, however, did not alter the R2 (0.61). The ability of the question to classify hearing loss, reflected in the area under the curve (AUC), was 0.70 (95% CI 0.68, 0.71) for mild hearing loss or worse and 0.86 (95% CI 0.85, 0.87) for moderate hearing loss or worse. The AUC increased substantially when sex, education and age were taken into account (AUC mild HL: 0.73 (95%CI 0.71, 0.75); moderate HL 0.90 (95%CI 0.89, 0.91)).ConclusionSelf-reported hearing loss using a single question has a good ability to detect hearing loss in older adults, especially when age is accounted for. A single question cannot substitute audiometry, but it can assess hearing loss on a population level with reasonable accuracy.
