Loss In Older Adults Research Articles

Managing comorbid cognitive impairment and hearing loss in older adults: a UK survey of audiology and memory services.

midlife hearing loss is a potentially modifiable risk factor for dementia. Addressing comorbid hearing loss and cognitive impairment in services for older adults may offer opportunities to reduce dementia risk. to explore current practice and views amongst UK professionals regarding hearing assessment and care in memory clinics and cognitive assessment and care in hearing aid clinics. national survey study. Between July 2021 and March 2022, we distributed the online survey link via email and via QR codes at conferences to professionals working in National Health Service (NHS) memory services and audiologists working in NHS and private adult audiology services. We present descriptive statistics. 135 professionals working in NHS memory services and 156 audiologists (68% NHS, 32% private sector) responded. Of those working in memory services, 79% estimate that >25% of their patients have significant hearing difficulties; 98% think it useful to ask about hearing difficulties and 91% do so; 56% think it useful to perform a hearing test in clinic but only 4% do so. Of audiologists, 36% estimate that >25% of their older adult patients have significant memory problems; 90% think it useful to perform cognitive assessments, but only 4% do so. Main barriers cited are lack of training, time and resources. although professionals working in memory and audiology services felt addressing this comorbidity would be useful, current practice varies and does not generally address it. These results inform future research into operational solutions to integrating memory and audiology services.

Protecting cognitive function in older adults with age-related hearing loss: Insights from The Irish Longitudinal Study on Ageing (TILDA) and the role of hearing aids

BackgroundAge-related hearing loss (ARHL) is prevalent in adults over 70, impairing hearing sensitivity and speech perception. ARHL has been linked to an increased risk of cognitive decline and dementia. However, most affected adults are not receiving adequate treatment, including hearing aids. ObjectiveThis study aimed to evaluate the impact of ARHL on cognitive decline in older adults participating in the Irish Longitudinal Study on Aging (TILDA). Design: MethodsData from four TILDA waves, a 6-year follow-up, was collected and analyzed using zero-inflated Poisson regression. The primary outcome, cognitive function, was assessed using Mini-Mental State Examination (MMSE) total score and error counts. ResultsOur analysis revealed that age, education, use of aids to help with hearing, and history of stroke were significantly associated with error counts at baseline. Additionally, poor hearing was associated with a negative change in MMSE score from wave 4, indicating the potential role of ARHL in cognitive decline. When further adjusted for age, sex, history of stroke, hypertension, any emotional, nervous, or psychiatric problem, polypharmacy, and hearing aids, the zero-inflated Poisson model indicated that poor hearing, use of hearing aids, stroke, hypertension, and polypharmacy all predicted MMSE error counts in follow-up assessments. Moreover, the use of hearing aids was associated with a decreased likelihood of cognitive decline. ConclusionARHL was independently associated with cognitive decline, underscoring the importance of addressing hearing loss in older adults. Future research should explore the potential of hearing aids to protect cognitive functioning in older adults.

Dietary magnesium and calcium intake is associated with lower risk of hearing loss in older adults: A cross-sectional study of NHANES.

Dietary intake as a modifiable factor has been reported to be associated with hearing loss (HL). The relationship between magnesium (Mg) and calcium (Ca) as common dietary nutrients and HL in the elderly has rarely been reported. This study aimed to assess the association between Mg and Ca intake and HL in older adults. This cross-sectional study included participants aged ≥70 years from the National Health and Nutrition Examination Survey (NHANES) 2005-2006, 2009-2010, and 2017-2018. Outcomes were low-frequency [pure-tone averages (PTAs) at 500, 1000, and 2000 Hz >25 dB] and speech-frequency (PTAs at 500, 1000, 2000, and 4,000 Hz >25 dB) HL. Multivariate logistic analysis was utilized to explore the association between dietary Mg and Ca intake and their combined intake (Ca/Mg, Ca*Mg) and HL, and was described as odds ratio (OR) and 95% confidence interval (CI). A total of 1,858 participants were included, of which 1,052 (55.95%) had low-frequency HL and 1,349 (72.62%) had speech-frequency HL. Dietary Ca intakes [OR = 0.86, 95%CI: (0.74-0.99)] and Mg intakes [OR = 0.81, 95%CI: (0.68-0.95)] and Ca * Mg [OR = 0.12, 95%CI: (0.02-0.87)] were associated with lower odds of low-frequency HL after adjusting for confounders. Similar, dietary Ca intakes [OR = 0.85, 95%CI: (0.77-0.95)] and Mg intakes [OR = 0.78, 95%CI: (0.68-0.90)] and Ca * Mg [OR = 0.23, 95%CI: (0.05-0.78)] were related to lower odds of speech-frequency HL. For different levels of Mg and Ca intake, the combined intake of Ca (≥1,044 mg) and Mg (≥330 mg) was related to lower odds of low-frequency HL [OR = 0.02, 95%CI: (0.00-0.27)] and speech-frequency HL [OR = 0.44, 95%CI: (0.21-0.89)]. Dietary intakes of Mg and Ca were associated with lower odds of HL and are a promising intervention to be further explored in older adults with HL.

Functional autonomy and 12-month mortality in older adults with proximal femoral fractures in an orthogeriatric setting: risk factors and gender differences.

Proximal femur fractures have a negative impact on loss of functional autonomy and mortality. The aim of this retrospective study was to evaluate functional autonomy and mortality in a group of older adults with hip fractures managed in an orthogeriatric setting 12months after discharge and to determine if gender affected outcome. In all participants, we assessed clinical history, functional pre-fracture status using activities of daily living (ADL) and in-hospital details. At 12months after discharge, we evaluated functional status, place of residence, hospital readmissions and mortality. We studied 361 women and 124 men and we observed a significant reduction in the ADL score at 6months (1.15 ± 1.58/p < 0.001 in women and 1.45 ± 1.66/p < 0.001 in men). One-year mortality (33.1% in men and 14.7% in women) was associated with pre-fracture ADL score and reduction in ADL at 6months (HR 0.68/95%, CI 0.48-0.97/p < 0.05 and HR 1.70/95%, CI 1.17-2.48/p < 0.01, respectively) in women, and new hospitalisations at 6months and polypharmacy in men (HR 1.65/95%, CI 1.07-2.56/p < 0.05 and HR 1.40/95%, CI 1.00-1.96/p = 0.05, respectively) in Cox's regression model. Our study suggests that functional loss in older adults hospitalised for proximal femur fractures is greatest in the first 6months after discharge, and this increases the risk of death at 1year. Cumulative mortality at 12months is higher in men and appears to be related to polypharmacy and new hospital admissions 6months after discharge.

The predictive utility of atherosclerosis-related risk factors as predictors of the prognosis of idiopathic sudden sensorineural hearing loss in older adults

Background There have been few studies to date exploring prognostic outcomes associated with idiopathic sudden sensorineural hearing loss (ISSNHL) in order adults. Objective This investigation was designed to explore the relationship between atherosclerosis-related risk factors and ISSNHL outcomes among older individuals. Material and methods In total, 172 older adults diagnosed ISSNHL from 2016 to 2021 were retrospectively evaluated to compare demographic and clinical test results. Results Relative to healthy controls, ISSNHL patients exhibited significant differences in hypertension incidence and factors related to coagulation. With respect to prognosis, age, onset days, hypertension, the degree of hearing loss, type of hearing curve, fibrinogen and D-dimer levels were significant univariate prognostic factors, whereas multivariate logistic analysis showed that hypertension (p = .005) and D-dimer concentration (p = .000) were related to the treatment outcome of older ISSNHL patients. The area under the curve (AUC) for D-dimer levels was 0.795 (95% CI: 0.724–0.866). When using a D-dimer cut-off threshold value of 107.5 ng/mL, the sensitivity and specificity values of 77.0% and 76.7%. Conclusions The present results indicate that hypertension incidence and D-dimer levels may be presented as an important prognostic indicator in older affected ISSNHL individuals.

Different neuroanatomical correlates for temporal and spectral supra-threshold auditory tasks and speech in noise recognition in older adults with hearing impairment.

Varying degrees of pure-tone hearing loss in older adults are differentially associated with cortical volume (CV) and thickness (CT) within and outside of the auditory pathway. This study addressed the question to what degree supra-threshold auditory performance (i.e., temporal compression and frequency selectivity) as well as speech in noise (SiN) recognition are associated with neurostructural correlates in a sample of 59 healthy older adults with mild to moderate pure-tone hearing loss. Using surface-based morphometry on T1-weighted MRI images, CT, CV, and surface area (CSA) of several regions-of-interest were obtained. The results showed distinct neurostructural patterns for the different tasks in terms of involved regions as well as morphometric parameters. While pure-tone averages (PTAs) positively correlated with CT in a right hemisphere superior temporal sulcus and gyrus cluster, supra-threshold auditory perception additionally extended significantly to CV and CT in left and right superior temporal clusters including Heschl's gyrus and sulcus, the planum polare and temporale. For SiN recognition, we found significant correlations with an auditory-related CT cluster and furthermore with language-related areas in the prefrontal cortex. Taken together, our results show that different auditory abilities are differently associated with cortical morphology in older adults with hearing impairment. Still, a common pattern is that greater PTAs and poorer supra-threshold auditory performance as well as poorerSiN recognition are all related to cortical thinning and volume loss but not to changes in CSA. These results support the hypothesis that mostly CT undergoes alterations in the context of auditory decline, while CSA remains stable.

COVID-19 as an Independent Risk Factor for Weight Loss in Older Adults Living in Nursing Homes

Introduction: In nursing homes, where residents are at elevated risk for malnutrition, the specific additive effect of the coronavirus disease 2019 (COVID-19) on weight loss has not yet been adequately evaluated. This study aimed to determine the factors independently associated with weight loss in nursing home residents who survived the first wave of the COVID-19 pandemic, whether they have contracted COVID-19 or not. Methods: This research was a retrospective study conducted in three nursing homes. Residents who survived the first French COVID-19 lockdown (March to May 2020) were included, provided their weight records were available. Baseline data included the body mass index (BMI), capacity to self-feed, need for texture-modified food, disability, and legal guardianship status. The diagnosis of COVID-19 was based on the results of a positive reverse transcriptase-polymerase chain reaction test. Univariate and multivariate logistic regression analyses were used to investigate associations between resident characteristics, COVID-19 status, and at least 5% weight loss. Results: Of the 316 included residents (72% female, mean age of 88 years, 48% severely disabled, and 38% under legal guardianship), 111 (35%) contracted COVID-19 and 102 (32%) lost at least 5% of their body weight. No difference was observed between the baseline characteristics of residents subsequently affected or unaffected by COVID-19. In the univariate analysis, old age, severe disability, texture-modified food, the need for close mealtime supervision, and COVID-19 were significantly associated with at least 5% weight loss. In the multivariate logistic regression analysis, COVID-19 (p = 0.02) and the need for close mealtime supervision (p = 0.02) were associated with weight loss in a model that also included age, BMI, texture-modified food, disability, and nursing home. Conclusion: For nursing home residents, COVID-19 was an independent risk factor for weight loss. Weight loss was most common in residents needing close mealtime supervision, suggesting that organizational issues may have affected the quality of the nutritional care provided during the lockdown.

Distinct disease mechanisms may underlie cognitive decline related to hearing loss in different age groups

BackgroundHearing loss in older adults is associated with increased dementia risk. Underlying mechanisms that connect hearing loss with dementia remain largely unclear.MethodsWe studied the association of hearing loss and biomarkers...

Posterior white matter hyperintensities are associated with reduced medial temporal lobe subregional integrity and long-term memory in older adults

White matter hyperintensities are a marker of small vessel cerebrovascular disease that are strongly related to cognition in older adults. Similarly, medial temporal lobe atrophy is well-documented in aging and Alzheimer’s disease and is associated with memory decline. Here, we assessed the relationship between lobar white matter hyperintensities, medial temporal lobe subregional volumes, and hippocampal memory in older adults.We collected MRI scans in a sample of 139 older adults without dementia (88 females, mean age (SD) = 76.95 (10.61)). Participants were administered the Rey Auditory Verbal Learning Test (RAVLT). Regression analyses tested for associations among medial temporal lobe subregional volumes, regional white matter hyperintensities and memory, while adjusting for age, sex, and education and correcting for multiple comparisons.Increased occipital white matter hyperintensities were related to worse RAVLT delayed recall performance, and to reduced CA1, dentate gyrus, perirhinal cortex (Brodmann area 36), and parahippocampal cortex volumes. These medial temporal lobe subregional volumes were related to delayed recall performance. The association of occipital white matter hyperintensities with delayed recall performance was fully mediated statistically only by perirhinal cortex volume.These results suggest that white matter hyperintensities may be associated with memory decline through their impact on medial temporal lobe atrophy. These findings provide new insights into the role of vascular pathologies in memory loss in older adults and suggest that future studies should further examine the neural mechanisms of these relationships in longitudinal samples.

Restoration of quality of life in elderly with hearing loss

&lt;p&gt;&lt;strong&gt;Background:&lt;/strong&gt; This study is looking at the daily life consequences of hearing loss in older adults, and how hearing aids (HA) can affect their lives.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Method:&lt;/strong&gt; Everyone who took part in the study had their hearing checked using basic tests. The McCarty Alpiner scale is a way to measure how much personal affection someone has. The Arabic international outcome inventory for hearing aids was used to measure the benefits of using hearing aids.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results:&lt;/strong&gt; There was a moderate correlation between hearing measurements without hearing aids and psychological, social, and vocational affection. The hearing aid improves your ability to hear, and the better your hearing gets, the higher your hearing threshold will be. However, there is no correlation between age and gender, and this is mainly due to differences in how hearing is processed in males and females. The improvement in the audiological profile of the patient suggests that their personal outcome will be better.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Daily life consequences of hearing loss and general life Satisfaction are closely related. Hearing aid is a beneficial rehabilitation method for presbycusis.&lt;/p&gt;

Assessment and Management of Appetite Loss in Older Adults: An ICFSR Task Force Report

The Appetite loss in older people is an important unmet clinical need in geriatrics. The International Conference on Frailty and Sarcopenia Research (ICFSR) organized a Task Force on April 20th 2022, in Boston, to discuss issues related to appetite loss in older people, in particular, the assessment tools currently available, its evaluation in the primary care setting, and considerations about its management. There is a high heterogeneity in terms of the etiology of appetite loss in older people and a gold standard assessment tool for evaluating this condition is still absent. Although this may render difficult the management of poor appetite in clinical practice, validated assessment tools are currently available to facilitate early identification of appetite loss and support care decisions. As research on biomarkers of appetite loss progresses, assessment tools will soon be used jointly with biomarkers for more accurate diagnosis and prognosis. In addition, efforts to foster the development of drugs with a favorable risk/benefit ratio to combat poor appetite should be strengthened.

THE GUIDING POWER OF LOSS REFLECTION: FINAL MEMORIES AND FUTURE CARE

Abstract The life story framework emphasizes that past loss experiences guide current attitudes and behaviors. Final memories from the death of a spouse promote post-loss meaning-making. Through reliable narrative analysis, this study delineates positive and negative affective sequences in final memories from spousal loss in older adults (N = 65; Mage = 81.59). It also examines reported confidence in successfully caring for another seriously ill close other the future. Results demonstrate that 62% of participants narrated their final memories with affect, and 38% told semantic, affectively neutral narratives. Additionally, those who narrated positive or neutral final memories exhibited more confidence in future caregiving than those who narrated negative memories, t = 2.24, p &amp;lt; .05. As care systems are increasingly reliant on family members to provide car for the seriously ill, links between past loss experiences, current caregiving confidence, and future care mastery emerge as areas of research prioritization.

Usability, acceptabilityand clinical utility of a mobile app to screen for hearing loss in older adults in a geriatric rehabilitation hospital.

Hearing loss is a common problem for older adults entering rehabilitation hospitals. To pilot a hearing loss screening device to determine feasibility, usability, and impact on patient outcomes. We screened all patients newly admitted to a geriatric day hospital for hearing loss using the SHOEBOX® QuickTest (SHOEBOX Ltd.) app as part of a quality improvement programme. We measured the time it took for each patient to complete screening and recorded any issues they had using the app. We recorded the number of patients who screened positive who did not have a previous diagnosis and changes in physician behaviours after they received their patients' results. Seventy-four patients with a mean age of 83.4 years used the hearing screener. All patients were able to complete the screening with a mean time to completion of 10 min and 48 s. Ninety-nine percent of patients screened positive for hearing loss. Of these positives 56% were in participants not already known to have hearing loss. Physicians often changed their behaviour after receiving results by using assistive devices during visits and referring to audiology for formal testing. Screening for hearing loss is feasible in a geriatric day hospital. The SHOEBOX QuickTest app is acceptable, usable, resulting in the identification of undiagnosed hearing loss and in changes to physician behaviour.

Sensitivity and specificity of hearing tests for screening hearing loss in older adults

ObjectivesThe study aimed to determine the most appropriate hearing screening test to identify disabling hearing loss for adults aged 65 years or older. MethodsThis study included 577 older adults. Four hearing screening tests were considered in the study, including the Hearing Handicap Inventory for Elderly Screening (HHIE-s), three single question tests, the whisper test, and the finger rub test. The sensitivity and specificity of these tests referenced to the hearing threshold of disabling hearing loss were estimated. ResultsAmong all tests, only the single self-perception question (0.7064 for sensitivity; 0.7225 for specificity) and whisper test (0.7833 for sensitivity; 0.7708 for specificity) could obtain both sensitivity and specificity higher than 70% for adults aged ≥65 years. ConclusionOverall, we suggest using the whisper test to identify disabling hearing loss (>40 dB HL at the better ear) for adults aged 65 years or older. However, if the conditions do not permit, the single self-perception question is also acceptable. Moreover, HHIE-s might not be a good test to detect disabling hearing loss for adults aged 80 years or older.

Supervised high-load resistance training for improving muscle strength and quality in prediabetic older adults: A pilot randomized controlled trial

ObjectiveTo investigate the effects of high- and low-load supervised, volume-matched resistance training (RT) on body composition, muscle function, and functional capacity in older adults with prediabetes. MethodsOlder adults with prediabetes were recruited and randomly assigned to high-load RT (n = 13), low-load RT (n = 12), or control groups (n = 12). ResultsNo significant differences were observed in body composition at postintervention. High-load and low-load RT groups exhibited significant improvements in functional tests at postintervention compared with the control group. The high-load RT group exhibited a greater improvement in muscle strength and muscle quality at postintervention compared with the low-load RT group. ConclusionSupervised RT is useful in the prevention of muscle functional loss in older adults with prediabetes. High-load RT is superior for enhancing muscle strength and muscle quality, despite a similar increase in functional capacity.

How to Help My Older Patient With Obesity Lose Weight Safely When the Evidence Is Not Clear

Until recently, despite the deleterious the health consequences of their obesity, intentional weight loss by older adults usually was not recommended. Factors such as maladaptive metabolic changes and declines in physiologic function predispose this population to sarcopenic obesity, frailty, and impaired mobility, while accumulation of chronic comorbidities often results in polypharmacy. These considerations and more complicate both the decision to pursue weight loss and the safest method of doing so. Currently, specific guidelines for managing weight loss in older adults with obesity are widely lacking. We present a case from our Family Medicine practice of an older woman with obesity struggling with weight management. We present our recommendations for safely navigating the weight loss she desires using an evidence-based approach that incorporates a medically supervised calorie restricted diet, improved diet quality, and healthy physical activity recommendations that include resistance exercise.

Detection of dynamic changes in interaural delay by older adults (L).

The ability of older adults (48 to 72) with relatively intact low-frequency hearing to detect the motion of an acoustic source was investigated using dynamically varying interaural delays. Thresholds were measured using a single-interval two-alternative forced-choice task in which listeners determined if the sound source was moving or stationary. Motion thresholds were significantly larger than stationary localization thresholds. No correlation was observed between age and motion-detection ability for the age range tested. An interesting finding was that there were similar thresholds for older and younger adults. Results suggest reliance on dominant low-frequency binaural timing cues unaffected by high-frequency hearing loss in older adults.

Association between classic and specific bioimpedance vector analysis and sarcopenia in older adults: a cross-sectional study

BackgroundTo verify (1) the association between classic and specific bioelectrical impedance vector analysis (BIVA) with body composition, hydration, and physical performance in older adults with and without sarcopenia; (2) which BIVA most accurately distinguishes sarcopenia.MethodsA sample of 94 older adults with and without sarcopenia (29 men and 65 women, 60–85 years) was evaluated. The classic and specific BIVA procedures, Dual energy X-ray absorptiometry (DXA), and deuterium dilution were performed. Sarcopenia was defined by muscle weakness and low skeletal muscle index, while severity was indicated by low physical performance.ResultsThe BIVA's potential to monitor hydration and muscle mass loss in older adults seems feasible. Classic and specific BIVA were able to distinguish sarcopenia in women (p < 0.001), but not in men. When the sarcopenia criteria were individually analyzed, both classic and specific BIVA were able to distinguish low skeletal muscle index in women, while only classic BIVA did for men. For the criterion of slow physical performance, only the classic BIVA showed severity differences for women. The vectors of adults without sarcopenia of both sexes tended to be positioned in the left region of the ellipses, revealing a predominance of soft tissues.ConclusionsClassic BIVA has a distinct sarcopenic association with body composition, hydration, and physical performance in older adults, while specific BIVA was similar between groups. Both BIVAs are sensible to detect female morphological changes (skeletal muscle index) but not for functional (handgrip, 6-min walk test) sarcopenia criteria. These procedures are promising tools for monitoring sarcopenia risks during aging.

Deep learning predicts all-cause mortality from longitudinal total-body DXA imaging

BackgroundMortality research has identified biomarkers predictive of all-cause mortality risk. Most of these markers, such as body mass index, are predictive cross-sectionally, while for others the longitudinal change has been shown to be predictive, for instance greater-than-average muscle and weight loss in older adults. And while sometimes markers are derived from imaging modalities such as DXA, full scans are rarely used. This study builds on that knowledge and tests two hypotheses to improve all-cause mortality prediction. The first hypothesis is that features derived from raw total-body DXA imaging using deep learning are predictive of all-cause mortality with and without clinical risk factors, meanwhile, the second hypothesis states that sequential total-body DXA scans and recurrent neural network models outperform comparable models using only one observation with and without clinical risk factors.MethodsMultiple deep neural network architectures were designed to test theses hypotheses. The models were trained and evaluated on data from the 16-year-long Health, Aging, and Body Composition Study including over 15,000 scans from over 3000 older, multi-race male and female adults. This study further used explainable AI techniques to interpret the predictions and evaluate the contribution of different inputs.ResultsThe results demonstrate that longitudinal total-body DXA scans are predictive of all-cause mortality and improve performance of traditional mortality prediction models. On a held-out test set, the strongest model achieves an area under the receiver operator characteristic curve of 0.79.ConclusionThis study demonstrates the efficacy of deep learning for the analysis of DXA medical imaging in a cross-sectional and longitudinal setting. By analyzing the trained deep learning models, this work also sheds light on what constitutes healthy aging in a diverse cohort.

Machine learning-based muscle mass estimation using gait parameters in community-dwelling older adults: A cross-sectional study

BackgroundLoss of skeletal muscle mass is associated with numerous factors such as metabolic diseases, lack of independence, and mortality in older adults. Therefore, developing simple, safe, and reliable tools for assessing skeletal muscle mass is needed. Some studies recently reported that the risks of the incidence of geriatric conditions could be estimated by analyzing older adults’ gait; however, no studies have assessed the association between gait parameters and skeletal muscle loss in older adults. In this study, we applied machine learning approach to the gait parameters derived from three-dimensional skeletal models to distinguish older adults’ low skeletal muscle mass. We also identified the most important gait parameters for detecting low muscle mass. MethodsSixty-six community-dwelling older adults were recruited. Thirty-two gait parameters were created using a three-dimensional skeletal model involving 10-meter comfortable walking. After skeletal muscle mass measurement using a bioimpedance analyzer, low muscle mass was judged in accordance with the guideline of the Asia Working Group for Sarcopenia. The eXtreme gradient boosting (XGBoost) model was applied to discriminate between low and high skeletal muscle mass. ResultsEleven subjects had a low muscle mass. The c-statistics, sensitivity, specificity, precision of the final model were 0.7, 59.5%, 81.4%, and 70.5%, respectively. The top three dominant gait parameters were, in order of strongest effect, stride length, hip dynamic range of motion, and trunk rotation variability. ConclusionMachine learning-based gait analysis is a useful approach to determine the low skeletal muscle mass of community-dwelling older adults.