Hearing Impairment In Older Adults Research Articles

Hearing Screening for Older Adults With Cognitive Impairment: A Systematic Review.

: Hearing loss is the largest potentially modifiable risk factor for dementia. Early evaluation and intervention are crucial for older adults with cognitive impairment. However, pure-tone audiometry (PTA), the gold standard, may have limitations. This study reviewed auditory tests for detecting hearing loss in this population, comparing to PTA. Materials and Methods: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we conducted a systematic review in PubMed, Scopus, and Embase. Ten studies (1,071 participants) comparing auditory tests and PTA in patients with dementia and mild cognitive impairment were included. : Electrophysiological and behavioral tests demonstrated strong correlation and accurate hearing impairment detection compared to PTA. Conversely, self-reported assessment showed weaker correlations when aligned with hearing thresholds. : This study highlights the potential of electrophysiological and behavioral auditory tests in detecting hearing impairment in older adults with cognitive impairment, emphasizing the need for further research to develop practical screening protocols for this vulnerable population.

Mendelian randomization reveals the causal association between gout and hearing impairment in older adults.

With the global aging trend escalating, the holistic well-being of the elderly has become a paramount concern within public health. Traditional observational studies often struggle with confounding factors and establishing causality, leaving the relationship between age-related hearing loss (ARHL) and gout largely unexplored. Employing bidirectional two-sample Mendelian randomization (MR) analysis, this investigation elucidated the genetic underpinnings associated with age-related hearing impairment, gout, and urate levels within the IEU Open-GWAS database, thereby uncovering potential causal connections that underlie the intricate interplay between gout, serum urate concentrations, and auditory decline in the geriatric demographic. In the forward MR phase, a cohort of 30 single nucleotide polymorphisms was leveraged to dissect the causal dynamics between ARHL and both gout and urate concentrations. Conversely, in the reverse MR phase, gout and urate levels were posited as the exposome to delineate their impact on hearing acuity, employing an array of models for rigorous validation and sensitivity scrutiny. In the forward MR analysis, a statistically significant correlation was discerned between ARHL and gout (P = .003, odds ratio = 1.01, 95% confidence interval: 1.00-1.02), alongside a notable association with serum urate levels (P = .031, odds ratio = 1.39, 95% confidence interval: 1.03-1.88), intimating that ARHL could potentially influence the incidence of gout and urate concentrations. Conversely, the reverse MR investigation revealed that neither gout nor serum urate levels exerted significant impact on auditory degradation (P > .05), insinuating that these factors might not predominantly contribute to hearing loss. Sensitivity analyses concurred with this inference. This study enriches the comprehension of geriatric health intricacies and unveils that ARHL potentially influences gout and serum urate concentrations. This suggests that monitoring ARHL may play a crucial role in the early identification and management of gout and hyperuricemia, potentially contributing to a comprehensive approach to improving geriatric health outcomes.

Monitoring hearing and vision functions in older adults: rationale and process.

Hearing and vision impairment are highly prevalent in ageing individuals and are significant public health concerns given their meaningful impacts on individuals and society. Yet, many cases of both visual and hearing impairment remain unidentified and thus, unaddressed. This article describes the rationale and process of monitoring for visual and hearing impairment in older adults, by summarising guidance and resources available from the World Health Organisation (WHO) that were developed based upon the best current available evidence. It is recommended that vision screening be offered at least annually to adults aged over 50years and hearing screening be offered every 5years to adults aged 50-64years, and every 1-3years to adults aged 65years or older. Both hearing and vision screening can be conducted in community, home or clinical settings by trained health workers with simple equipment. More specifically, vision screening can be conducted with a simple eye chart. Hearing screening can be conducted without specialised equipment by using pure tones set to a fixed level, an automated mobile- or web-based digits-in-noise test, or the whispered voice test. Hearing screening can also be conducted in audiology clinics using pure-tone air conduction threshold testing. There exists WHO guidance to support the monitoring of hearing and vision impairment, which, when warranted, can facilitate referral for comprehensive assessment and prompt appropriate, person-centred interventions to mitigate the negative consequences of hearing and vision impairment.

Potential overestimation of cognitive impairment due to hearing loss: Impact of test modalities on cognitive test scores.

Hearing impairment in older adults may affect cognitive function and increase the risk of dementia. Most cognitive tests are delivered auditorily, and individuals with hearing loss may fail to hear verbal instructions. Greater listening difficulty and fatigue in acoustic conditions may impact test performance. This study aimed to examine the effect of decreased audibility on cognitive screening test performance in older adults. Older adults (n = 63) with different levels of hearing loss completed a standard auditory Mini-Mental State Examination test and a written version of the test. Individuals with moderate to moderately severe hearing loss (41-70 dB) performed significantly better on the written (24.34 ± 4.90) than on the standard test (22.55 ± 6.25), whereas scores were not impacted for mild hearing loss (less than 40 dB). Hearing evaluations should be included in cognitive assessment, and test performance should be carefully interpreted in individuals with hearing loss to avoid overestimating cognitive decline.

Longitudinal Changes in Resting-State Functional Connectivity and Gray Matter Volume Are Associated with Conversion to Hearing Impairment in Older Adults.

Hearing loss was recently identified as a modifiable risk factor for dementia although the potential mechanisms explaining this relationship are unknown. The current study examined longitudinal change in resting-state fMRI functional connectivity and gray matter volume in individuals who developed a hearing impairment compared to those whose hearing remained normal. This study included 440 participants from the UK Biobank: 163 who had normal hearing at baseline and impaired hearing at follow-up (i.e., converters, mean age = 63.11±6.33, 53% female) and 277 who had normal hearing at baseline and maintained normal hearing at follow-up (i.e., non-converters, age = 63.31±5.50, 50% female). Functional connectivity was computed between a priori selected auditory seed regions (left and right Heschl's gyrus and cytoarchitectonic subregions Te1.0, Te1.1, and Te1.2) and select higher-order cognitive brain networks. Gray matter volume within these same regions was also obtained. Converters had increased connectivity from left Heschl's gyrus to left anterior insula and from right Heschl's gyrus to right anterior insula, and decreased connectivity between right Heschl's gyrus and right hippocampus, compared to non-converters. Converters also had reduced gray matter volume in left hippocampus and left lateral visual cortex compared to non-converters. These findings suggest that conversion to a hearing impairment is associated with altered brain functional connectivity and gray matter volume in the attention, memory, and visual processing regions that were examined in this study.

Association of the use of hearing aids with the conversion from mild cognitive impairment to dementia and progression of dementia: A longitudinal retrospective study.

IntroductionHearing aid usage has been linked to improvements in cognition, communication, and socialization, but the extent to which it can affect the incidence and progression of dementia is unknown. Such research is vital given the high prevalence of dementia and hearing impairment in older adults, and the fact that both conditions often coexist. In this study, we examined for the first time the effect of the use of hearing aids on the conversion from mild cognitive impairment (MCI) to dementia and progression of dementia.MethodsWe used a large referral‐based cohort of 2114 hearing‐impaired patients obtained from the National Alzheimer's Coordinating Center. Survival analyses using multivariable Cox proportional hazards regression model and weighted Cox regression model with censored data were performed to assess the effect of hearing aid use on the risk of conversion from MCI to dementia and risk of death in hearing‐impaired participants. Disease progression was assessed with Clinical Dementia Rating Sum of Boxes (CDR‐SB) scores. Three types of sensitivity analyses were performed to validate the robustness of the results.ResultsMCI participants that used hearing aids were at significantly lower risk of developing all‐cause dementia compared to those not using hearing aids (hazard ratio [HR] 0.73, 95% confidence interval [CI], 0.61 to 0.89; false discovery rate [FDR] P = 0.004). The mean annual rate of change (standard deviation) in CDR‐SB scores for hearing aid users with MCI was 1.3 (1.45) points and significantly lower than for individuals not wearing hearing aids with a 1.7 (1.95) point increase in CDR‐SB per year (P = 0.02). No association between hearing aid use and risk of death was observed. Our findings were robust subject to sensitivity analyses.DiscussionAmong hearing‐impaired adults, hearing aid use was independently associated with reduced dementia risk. The causality between hearing aid use and incident dementia should be further tested.

Screening for Hearing Impairment in Older Adults by Smartphone-Based Audiometry, Self-Perception, HHIE Screening Questionnaire, and Free-Field Voice Test: Comparative Evaluation of the Screening Accuracy With Standard Pure-Tone Audiometry.

BackgroundHearing impairment is the most frequent sensory deficit in humans, affecting more than 360 million people worldwide. In fact, hearing impairment is not merely a health problem, but it also has a great impact on the educational performance, economic income, and quality of life. Hearing impairment is therefore an important social concern.ObjectiveWe aimed to evaluate and compare the accuracy of self-perception, Hearing Handicap Inventory for the Elderly-Screening (HHIE-S) questionnaire, free-field voice test, and smartphone-based audiometry as tests for screening moderate hearing impairment in older adults in China.MethodsIn this study, 41 patients were recruited through a single otology practice. All patients were older than 65 years. Patients with otorrhea and cognitive impairment were excluded. Moderate hearing impairment was defined as mean hearing thresholds at 500, 1000, 2000, and 4000 Hz >40 dB hearing loss (pure-tone average > 40 dB hearing loss). All patients completed 5 hearing tests, namely, the self-perception test, HHIE-S questionnaire test, free-field voice test, smartphone-based audiometry test, and standard pure-tone audiometry by the same audiologist. We compared the results of these tests to the standard audiogram in the better-hearing ear.ResultsThe sensitivity and the specificity of the self-perception test were 0.58 (95% CI 0.29-0.84) and 0.34 (95% CI 0.19-0.54), respectively. The sensitivity and the specificity of the HHIE-S questionnaire test were 0.67 (95% CI 0.35-0.89) and 0.31 (95% CI 0.316-0.51), respectively. The sensitivity and the specificity of the free-field voice test were 0.83 (95% CI 0.51-0.97) and 0.41 (95% CI 0.24-0.61), respectively. The sensitivity and the specificity of the smartphone-based audiometry test were 0.92 (95% CI 0.60-0.99) and 0.76 (95% CI 0.56-0.89), respectively. Smartphone-based audiometry correctly diagnosed the presence of hearing loss with high sensitivity and high specificity.ConclusionsSmartphone-based audiometry may be a dependable screening test to rule out moderate hearing impairment in the older population.

HEARING IMPAIRMENT, DEPRESSION, AND THE ROLE OF SOCIAL ACTIVITY AMONG CHINESE OLDER ADULTS

Studies suggest that depression is closely linked to hearing impairment, which is highly prevalent among older adults in the United States. There is evidence that social engagement may be impacted by hearing impairment in older adults. However, there is relatively little research on these associations among Chinese older adults. This study examines the relationships between hearing impairment, social activities, and depressive symptoms among older adults in China. Using nationally representative data from the China Health and Retirement Longitudinal Study 2011, we conducted cross-sectional analysis on adults age 60 years and older (n=10,994). Depressive symptoms were assessed by the 10-item Center for Epidemiologic Studies Depression scale and we considered self-reported hearing status (if participants wear a hearing aid and how they would rate their hearing), and social activities (i.e., volunteering, dancing, attending courses, etc.). Models were controlled for age, gender, education, and other covariates. Descriptive analysis showed that 9% of older adults experienced hearing impairment. Multiple linear regression analyses revealed that hearing impairment was positively associated with depressive symptoms among older Chinese adults (β=1.32, p<.001). Social activities were found to partially mediate the relationship between hearing status and depressive symptoms. Respondents with hearing impairment were less likely to engage in social activities (OR=.78, p<.01) and those who did not participate in social activities reported more depressive symptoms (β=1.28, p<.001). These findings suggest that Chinese older adults experiencing hearing loss are at greater risk of depression and that social activities play an important role in the relationship between hearing status and depression.

Association of inflammatory markers with hearing impairment: The English Longitudinal Study of Ageing

BackgroundHearing impairment is common at an older age and has considerable social, health and economic implications. With an increase in the ageing population, there is a need to identify modifiable risk factors for hearing impairment. A shared aetiology with cardiovascular disease (CVD) has been advanced as CVD risk factors (e.g. obesity, type 2 diabetes) are associated with a greater risk of hearing impairment. Moreover, low-grade inflammation is implicated in the aetiology of CVD. Accordingly, our aim was to investigate the association between several markers of inflammation – C-reactive protein, fibrinogen and white blood cell count – and hearing impairment. MethodsParticipants of the English Longitudinal Study of Ageing aged 50–93 were included. Inflammatory marker data from both wave 4 (baseline, 2008/09) and wave 6 (2012/13) were averaged to measure systemic inflammation. Hearing acuity was measured with a simple handheld tone-producing device at follow-up (2014/15). ResultsAmong 4879 participants with a median age of 63 years at baseline, 1878 (38.4%) people presented hearing impairment at follow-up. All three biomarkers were positively and linearly associated with hearing impairment independent of age and sex. After further adjustment for covariates, including cardiovascular risk factors (smoking, physical activity, obesity, diabetes, hypertension, cholesterol), memory and depression, only the association with white blood cell count remained significant: odds ratio per log-unit increase; 95% confidence interval = 1.46; 1.11, 1.93. ConclusionsWhile white blood cell count was positively associated with hearing impairment in older adults, no relationships were found for two other markers of low-grade inflammation.

Addressing Hearing Loss in Old Age Psychiatry

Rationale, aims and objectives: The United Kingdom has an increasingly ageing population. With age, hearing declines and the risk of dementia rises. Sensory impairment such as hearing loss is strongly correlated with cognitive decline, mental illness and dementia. Hearing loss has a negative association with quality of life. Addressing hearing impairment, with early recognition and treatment, is a significant public health issue. The main aims of this study were to: (1) evaluate current practice in Old Age Psychiatry in addressing hearing impairment in older adults in contact with mental health services; (2) evaluate the accessibility of Audiology and/or Ear, Nose and Throat (ENT) services and (3) evaluate the level of awareness among clinicians routinely shared with patients and families or carers regarding relevant associations with hearing loss. Method: A national cross-sectional study of the Royal College of Psychiatrists Faculty of Old Age Psychiatry members in England was conducted over 8 weeks. Results: The majority of respondents routinely established a history of hearing impairment in their patients, as well as the possession and regular use of hearing aids. However, a significant proportion did not advise patients of potential links between hearing loss and cognitive impairment (26%) or mental illness (40%). Most respondents reported that their awareness of these links was primarily based on professional experience, rather than published evidence or clinical guidelines. Additionally, 20% reported the experience of referring patients to Audiology and ENT services, was ‘difficult’ or ‘very difficult’. Conclusions: There is a need for further research into hearing loss and its impact on mental health and cognitive impairment, as well as scope to improve dissemination of existing evidence. The identified difficulty in referring to Audiology and ENT should be explored and addressed. Clinicians in Old Age Psychiatry have an important role in identifying hearing impairment and promoting use of hearing aids as part of the person-centered healthcare of this vulnerable population.

Hearing in Real-Life Environments (HERE): Structure and Reliability of a Questionnaire on Perceived Hearing for Older Adults.

The ability to hear in a variety of social situations and environments is vital for social participation and a high quality of life. One way to assess hearing ability is by means of self-report questionnaire. For questionnaires to be useful, their measurement properties, based on careful validation, have to be known. Only recently has consensus been reached concerning how to perform such validation and been published as COSMIN (consensus-based standards for the selection of health status measurement instruments) guidelines. Here the authors use these guidelines to evaluate the measurement properties of the "Hearing in Real-Life Environments" (HERE) questionnaire, a newly developed self-report measure that assesses speech perception, spatial orientation, and the social-emotional consequences of hearing impairment in older adults. The aim is to illustrate the process of validation and encourage similar examinations of other frequently used questionnaires. The HERE questionnaire includes 15 items with a numeric rating scale from 0 to 10 for each item and allows the assessment of hearing with and without hearing aids. The evaluation was performed in two cohorts of community-dwelling older adults from Finland (n = 581, mean 82 years) and the United Kingdom (n = 50, mean 69 years). The internal structure of the questionnaire and its relationship to age, hearing level, and self-reported and behavioral measures of speech perception was assessed and, when possible, compared between cohorts. The results of the factor analysis showed that the HERE's internal structure was similar across cohorts. In both cohorts, the factor analysis showed a satisfactory solution for three factors (speech hearing, spatial hearing, and socio-emotional consequences), with a high internal consistency for each factor (Cronbach's α's for the factors from 0.90 to 0.97). Test-retest analysis showed the HERE overall mean score to be stable and highly replicable over time (intraclass correlation coefficient = 0.86, standard error of measurement of the test score = 0.92). The HERE overall mean score correlated highly with another self-report measure of speech perception, the Speech Spatial Qualities of Hearing questionnaire (standardized regression coefficient [β] = -0.75, p < 0.001), moderately highly with behaviorally assessed hearing level (best-ear average: β = 0.45 to 0.46), and moderately highly with behaviorally measured intelligibility of sentences in noise (β = -0.50, p < 0.001). Using the COSMIN guidelines, the authors show that the HERE is a valid, reliable, and stable questionnaire for the assessment of self-reported speech perception, sound localization, and the socio-emotional consequences of hearing impairment in the context of social functioning. The authors also show that cross-cultural data collected using different data collection strategies can be combined with a range of statistical methods to validate a questionnaire.

Insulin-like growth factor 1 and hearing impairment in older adults: results from the English Longitudinal Study of Ageing

BackgroundAge-related hearing impairment is the most common hearing disorder, affecting two-thirds of people aged over 70 years in the UK. It is a major cause of disability, with considerable social and health implications, accompanied by a major economic burden. With the condition essentially incurable, the focus becomes identification of risk factors. The biological determinants of hearing impairment remain poorly understood. Despite a suggestion from animal studies that insulin-like growth factor 1 (IGF-1) is implicated in the development of hearing impairment, we know of no studies in human beings. Methods4398 participants with no missing data (mean age at baseline 64·2 years [SD 8·1], 55% women) from the English Longitudinal Study of Ageing provided serum concentrations of IGF-1 in 2008 and 2012. We used the average of these two measurement when available, one if not. Hearing acuity was measured with a HearCheck Screener (Siemens, Erlangen, Germany) in 2014. Hearing impairment was defined as hearing fewer than all six tones, three with decreasing intensity at two frequencies (1 kHz and 3 kHz). Logistic regression models were used to estimate odds ratios (OR) of hearing impairment across five quintiles of IGF-1 concentration. Presence of interaction and non-linearity were assessed by likelihood ratio tests. FindingsMean IGF-1 was 16·1 nmol/L (SD 5·2). In the full analytical sample, IGF-1 was not associated with subsequent hearing impairment (OR per 5 nmol increase in IGF-1 1·01, 95% CI 0·94–1·09). However, this association differed by age (pinteraction=0·03). Thus, in participants younger than 60 years (n=1402), IGF-1 was linearly associated with a lower risk of hearing impairment (0·85, 0·73–0·99) after adjustment for age, sex, smoking, height, body-mass index, cognitive function, education, and self-reported hearing at baseline. Among participants 60 years and older, there was some evidence of a J-shaped association (pcurvature=0·02). Compared with the lowest quintile of IGF-1, ORs for quintiles 2, 3, 4, and 5 were 0·94 (0·72–1·22), 1·13 (0·86–1·48), 0·97 (0·74–1·27), and 1·24 (0·95–1·62), respectively, but associations were not statistically significant. InterpretationIn people at the lower end of the older-age spectrum, there was some support for lower levels of IGF-1 being linked with hearing impairment. These results warrant replication and then testing in trials of IGF-1 supplementation. FundingThe English Longitudinal Study of Ageing is supported by the National Institute on Aging (grant numbers 2RO1AG7644 and 2RO1AG017644-01A1) and a consortium of the UK government departments coordinated by the Economic and Social Research Council. The funding bodies had no role in the study design; collection, analysis, and interpretation of data; writing of the abstract; and decision to submit the abstract for publication.

TREATMENT OF HEARING IMPAIRMENT IN OLDER ADULTS WITH COGNITIVE IMPAIRMENT: IMPORTANCE OF INCLUDING SIGNIFICANT OTHERS

TREATMENT OF HEARING IMPAIRMENT IN OLDER ADULTS WITH COGNITIVE IMPAIRMENT: IMPORTANCE OF INCLUDING SIGNIFICANT OTHERS

The effects of hearing impairment in older adults on communication partners: a systematic review.

Hearing impairment is highly prevalent in older adults and can affect the daily activities of a person who is hard of hearing (HOH). The impact of hearing impairment may also have collateral effects on the primary communication partner (CP; e.g., spouse, close family member, or caregiver) of the person who is HOH. We aimed to characterize the impact of hearing loss in a person who is HOH on his or her CP. We conducted a systematic review of manuscripts examining the consequences of hearing loss in a person who is HOH on the CP. We searched PubMed, Embase, Scopus, PyscINFO, CINAHL Plus with full text, and Web of Science for peer-reviewed articles using a predefined search string and hand-searched reference lists of relevant articles. We initially screened abstracts blinded for author and journal to eliminate irrelevant and duplicate articles. Descriptive information on study populations, hearing assessments, outcome metrics, and study findings were extracted from full-length manuscripts. Of the 1,047 abstracts retrieved from database searching and 5 hand-searched articles, 24 articles met inclusion criteria. These articles included observational clinical studies, randomized clinical trials, and epidemiologic studies. Overall, CPs experienced a restricted social life, increased burden of communication, and poorer quality of life (QOL) and relationship satisfaction. Effects of hearing impairment on a CP's mental health were unclear. Treatment of hearing loss in the person who is HOH tended to improve QOL, communication, feelings toward the person who is HOH, and activity participation of the CP. This review highlights the broad effects of hearing impairment and the importance of involving CPs in hearing loss treatment decisions.

Association between hearing impairment and lower levels of physical activity in older adults.

To determine whether hearing impairment, highly prevalent in older adults, is associated with activity levels. Cross-sectional. National Health and Nutritional Examination Survey (2005-06). Individuals aged 70 and older who completed audiometric testing and whose physical activity was assessed subjectively using questionnaires and objectively using body-worn accelerometers (N=706). Hearing impairment was defined according to the speech-frequency (0.5-4 kHz) pure-tone average in the better-hearing ear (normal <25.0 dB, mild 25.0-39.9 dB, moderate or greater ≥40 dB). Main outcome measures were self-reported leisure time physical activity and accelerometer-measured physical activity. Both were quantified using minutes of moderate-intensity physical activity and categorized as inactive, insufficiently active, or sufficiently active. Ordinal logistic regression analyses were conducted and adjusted for demographic and cardiovascular risk factors. Individuals with moderate or greater hearing impairment had greater odds than those with normal hearing of being in a lower category of physical activity as measured according to self-report (OR=1.59, 95% CI=1.11-2.28) and accelerometry (OR=1.70, 95% CI=0.99-2.91). Mild hearing impairment was not associated with level of physical activity. Moderate or greater hearing impairment in older adults is associated with lower levels of physical activity independent of demographic and cardiovascular risk factors. Future research is needed to investigate the basis of this association and whether hearing rehabilitative interventions could affect physical activity in older adults.

Association of hearing impairment and mortality in older adults.

Hearing impairment (HI) is highly prevalent in older adults and is associated with social isolation, depression, and risk of dementia. Whether HI is associated with broader downstream outcomes is unclear. We undertook this study to determine whether audiometric HI is associated with mortality in older adults. Prospective observational data from 1,958 adults ≥70 years of age from the Health, Aging, and Body Composition Study were analyzed using Cox proportional hazards regression. Participants were followed for 8 years after audiometric examination. Mortality was adjudicated by obtaining death certificates. Hearing was defined as the pure-tone average of hearing thresholds in decibels re: hearing level (dB HL) at frequencies from 0.5 to 4kHz. HI was defined as pure-tone average >25 dB HL in the better ear. Of the 1,146 participants with HI, 492 (42.9%) died compared with 255 (31.4%) of the 812 with normal hearing (odds ratio = 1.64, 95% CI: 1.36-1.98). After adjustment for demographics and cardiovascular risk factors, HI was associated with a 20% increased mortality risk compared with normal hearing (hazard ratio = 1.20, 95% CI: 1.03-1.41). Confirmatory analyses treating HI as a continuous predictor yielded similar results, demonstrating a nonlinear increase in mortality risk with increasing HI (hazard ratio = 1.14, 95% CI: 1.00-1.29 per 10 dB of threshold elevation up to 35 dB HL). HI in older adults is associated with increased mortality, independent of demographics and cardiovascular risk factors. Further research is necessary to understand the basis of this association and whether these pathways might be amenable to hearing rehabilitation.

Association between hearing impairment and self-reported difficulty in physical functioning.

To determine whether hearing impairment, defined by using objective audiometry, is associated with multiple categories of self-reported physical functioning in a cross-sectional, nationally representative sample of older adults. Multivariate secondary analysis of cross-sectional data. The 2005-06 and 2009-10 cycles of the National Health and Nutrition Examination Survey. Adults aged 70 and older who completed audiometric testing (N = 1,669). Hearing was measured using pure-tone audiometry. Physical functioning was assessed using a structured interview. In a model adjusted for age and demographic and cardiovascular risk factors, greater hearing impairment (per 25 dB hearing level (HL)) was associated with greater odds of physical disability in activities of daily living (odds ratio (OR) = 1.4, 95% confidence interval (CI) = 1.1-1.9), instrumental activities of daily living (OR = 1.6, 95% CI = 1.2-2.2), leisure and social activities (OR = 1.5, 95% CI = 1.1-2.0), lower extremity mobility (OR = 1.4, 95% CI = 1.1-1.7), general physical activities (OR = 1.3, 95% CI = 1.1-1.6), work limitation (OR = 1.4, 95% CI = 1.0-1.9), walking limitation (OR = 1.6, 95% CI = 1.3-2.0), and limitation due to memory or confusion (OR = 1.4, 95% CI = 1.1-1.8). Hearing impairment was not associated with limitations in amount or type of work done (OR = 1.2, 95% CI = 1.0-1.6). Hearing impairment in older adults is independently associated with greater disability and limitations in multiple self-reported categories of physical functioning.

An investigation of factors that influence help-seeking for hearing impairment in older adults

Objective: To examine the influence of audiological and non-audiological factors on help-seeking for hearing impairment (HI) in older adults. Design: A retrospective research design was employed. Participants completed 14 measures, after which two multivariate, multinomial logistic regression models were fitted to the data to determine which factors were associated with consultation for HI and hearing aid uptake. Study sample: Three-hundred-and-seven individuals who were 60 years or older and who presented with a unilateral or bilateral HI participated in the study. Non-hearing aid owners were assigned to a non-consulter group (n = 55) or a consulter group (n = 92); hearing aid owners were assigned to an unsuccessful hearing aid owner group (n = 75) or a successful hearing aid owner group (n = 85). Results: A similar combination of factors was associated with the decisions to consult a health professional about HI and/or to adopt hearing aids. The most important factors related to attitudinal beliefs (e.g. perceived benefits of hearing aids) and external cues to action (e.g. support from significant others). Greater HI also influenced consultation and adoption of hearing aids. Conclusions: Findings highlight the importance of non-audiological factors in hearing rehabilitation to improve consultation for HI and hearing aid adoption.

Association of hearing impairment with brain volume changes in older adults

Hearing impairment in older adults is independently associated in longitudinal studies with accelerated cognitive decline and incident dementia, and in cross-sectional studies, with reduced volumes in the auditory cortex. Whether peripheral hearing impairment is associated with accelerated rates of brain atrophy is unclear. We analyzed brain volume measurements from magnetic resonance brain scans of individuals with normal hearing versus hearing impairment (speech-frequency pure tone average>25dB) followed in the neuroimaging substudy of the Baltimore Longitudinal Study of Aging for a mean of 6.4years after the baseline scan (n=126, age 56–86years). Brain volume measurements were performed with semi-automated region-of-interest (ROI) algorithms, and brain volume trajectories were analyzed with mixed-effect regression models adjusted for demographic and cardiovascular factors. We found that individuals with hearing impairment (n=51) compared to those with normal hearing (n=75) had accelerated volume declines in whole brain and regional volumes in the right temporal lobe (superior, middle, and inferior temporal gyri, parahippocampus, p<.05). These results were robust to adjustment for multiple confounders and were consistent with voxel-based analyses, which also implicated right greater than left temporal regions. These findings demonstrate that peripheral hearing impairment is independently associated with accelerated brain atrophy in whole brain and regional volumes concentrated in the right temporal lobe. Further studies investigating the mechanistic basis of the observed associations are needed.

Screening of cognitive function and hearing impairment in older adults: a preliminary study.

Background. Previous research has found that hearing loss is associated with poorer cognitive function. The question is that when a hearing impairment is being compensated for by appropriately fitted monaural hearing aids, special precautions are still needed when screening cognitive function in older adults. Objective. This research examined cognitive function in elderly hearing aid users who used monaural hearing aids and whether the presence of a hearing impairment should be accounted for when screening cognitive function in these individuals. Methods. Auditory thresholds, sentence reception thresholds, and self-reported outcomes with hearing aids were measured in 34 older hearing aid users to ensure hearing aids were appropriately fitted. Mini-Mental State Examination (MMSE) results obtained in these participants were then compared to normative data obtained in a general older population exhibiting similar demographic characteristics. Stepwise multiple regression analyses were used to examine the effects of demographic and auditory variables on MMSE scores. Conclusions. Results showed that, even with appropriately fitted hearing aids, cognitive decline was significant. Besides the factors commonly measured in the literature, we believed that auditory deprivation was not being fully compensated for by hearing aids. Most importantly, screening of cognitive function should take into account the effects of hearing impairment, even when hearing devices have been appropriately fitted.