Hearing and quality of life in older adults

The impact of hearing aids on cognitive function and quality of life in patients with hearing impairment: A cross-sectional study

OBJECTIVE

Age-related cognitive decline involves a complex set of factors. Among these factors, hearing loss is considered to have a significant impact, but the effect of hearing aid use remains unresolved. The purpose of this study was to evaluate the effects of hearing aid use by simultaneously assessing various factors not only cognitive function but also frailty, anxiety, depression, and quality of life (QOL) in patients with hearing loss.

METHODS

The cross-sectional study at the Hearing Aid (HA) Center was conducted between 2020 and 2021. Initially, associations with cognitive function, QOL, frailty, and mental state among patients with hearing loss were examined, irrespective of whether they wore a hearing aid or not. Next, these patients were divided into HA users (using HA for more than 1 year) and non-users (no prior use of HA) with 42 patients in each group. The average age and 6-frequency pure tone audiometry (PTA) was 74.5 ± 6.5 years and 50.6 ± 12.1 dB, respectively. All participants filled out the questionnaire about their life style, medical condition. Mini-Mental State Examination (MMSE) for cognitive function, Hospital Anxiety and Depression Scale for mental state, Short Form 36 version 2 (SF-36v2) for QOL, and Kihon Checklist for frailty were compared between HA users and non-users and correlated with the auditory data (PTA and speech discrimination).

RESULTS

Among 84 patients, 40 had an MMSE score ≦26. All eight scores and three components of SF-36v2 were lower than those of the control group. The patients with hypertension were significantly more in HA user than in non-HA user, whereas there was no difference in diabetes, heart attack, stroke and education. Although HA users were older and showed hypertension more their PTA was worse than that of non-users, MMSE scores were not different between the groups. MMSE scores correlated with both PTA and speech discrimination in non-users but not in HA users. However, a multivariate analysis of the effect of HA use on MMSE scores adjusting for age, hypertension, and hearing loss, could not be revealed. The vitality and mental component summary of the SF-36v2 was better in HA users than in non-users.

CONCLUSION

Elderly patients with hearing loss were cognitively impaired and had low QOL. HA users showed better QOL score than non-HA user, especially about the mental condition. The absence of a correlation between MMSE scores and hearing loss in HA users suggests the potential use of HA in preventing cognitive decline.

Early Detection of Hearing Loss among the Elderly

BACKGROUND

Age-related hearing loss (ARHL) is a complex communication disorder that affects the cochlea and central auditory pathway. The goal of this study is to characterize this type of hearing loss and to identify non-invasive, inexpensive, and quick tests to detect ARHL among elderly adults, seeking to preserve quality of life and reduce the burden on healthcare systems.

METHODS

An observational, prospective study is conducted with >55-year-old subjects divided into the following groups: normal range (Group A), detected but not treated (Group B), and detected and treated (Group C). During follow-up, Speech Spatial Qualities (SSQ12), and Hearing Handicap Inventory in the Elderly Screening test (HHIE-S) questionnaires were assessed, along with hearing levels (hearing thresholds at 4 kHz were studied in more depth), and a series of tests and questionnaires to assess balance, cognitive level, level of dependence, and depression.

RESULTS

A total of 710 patients were included in this study. The duration of hearing loss (11.8 yr. in Group B and 21.0 yr. in Group C) and average time-to-treatment for Group C (14.1 yr.) are both protracted. Both of the used questionnaires show statistically significant differences among the groups, revealing greater handicaps for Group C. Audiometry performed at 4 kHz shows how hearing loss progresses with age, finding differences between men and women. There is a correlation between time-to-treatment in Group C and the cognitive test DSST (-0.26; p = 0.003).

CONCLUSIONS

HHIE-S, SSQ12, and 4 kHz audiometry are sensitive and feasible tests to implement in screening programs.

An Assessment of Hearing Health Care Needs in Rural West Central and South Alabama

PURPOSE

Hearing loss has become a significant public health concern because of its association with physical health, cognition, and emotional well-being. Age-related hearing loss is the third leading cause of global years lived with disability after lower back pain and migraine. Among other sensory disorders, hearing loss is ranked first. To help mitigate these health concerns, access to affordable hearing health care across rural and urban communities will be necessary.

METHOD

For this study, the needs of rural communities and their residents with hearing loss were explored. Individual interviews and focus group discussions with 26 adults with hearing loss, 14 friends and family of those with hearing loss, and 25 community members who worked and lived in rural communities were conducted.

RESULTS

Collectively, four themes emerged from qualitative analysis of the comments from all three groups, including Communication and Other Related Hearing Loss Issues, Social and Emotional Issues, Dealing with Hearing Loss, and Addressing Hearing Loss in the Community. Factors associated with the themes were mapped onto the Meikirch Model of Health to determine potential areas of intervention within the individual, society, and environment components of the model.

CONCLUSION

Future care mitigating health concerns for adults with hearing loss living in rural communities will involve interprofessional collaboration and increased access to hearing health care.

Health-related quality of life associated with sensory impairment in Chinese middle-aged and older adults: a cohort study

BACKGROUND

The impact of sensory impairment (SI) on individual multidimensional health has not been adequately explored in developing countries. This study examined the association of hearing or/and visual impairment with health-related quality of life (HRQoL) in the Chinese middle-aged and older population, and further explored potential discrepancies in associations by gender and rural-urban residence.

METHODS

This cohort study used four-wave data during 2011-2018 from the China Health and Retirement Longitudinal Study, and enrolled 13 342 community-dwelling adults aged 45 years or older. We employed linear mixed effects models to estimate the longitudinal associations between SI and HRQoL, and conducted interaction tests to assess gender or rural-urban differences in above associations.

RESULTS

Hearing impairment (HI) and visual impairment (VI) were separately and jointly associated with deteriorated overall HRQoL and decreased physical/mental component of HRQoL (all β<0, all p<0.05), and in particular, dual sensory impairment (DSI) exhibited greater impacts on HRQoL than either HI or VI alone. The impacts of SI on HRQoL were more evident among women or rural population than their counterparts (all p for interaction<0.05).

CONCLUSION

This study observed decreased HRQoL in association with SI. The greater impact of DSI underlines the need for integrated care for comorbid sensory conditions. Our findings also indicate the necessity to reduce the burden of SI among more vulnerable populations such as females and rural adults.

Clinical Impact of Genetic Diagnosis of Sensorineural Hearing Loss in Adults

HYPOTHESIS

Adult genetic sensorineural hearing loss (SNHL) may be underestimated.

BACKGROUND

The diagnosis of genetic hearing loss is challenging, given its extreme genetic and phenotypic heterogeneity, particularly in adulthood. This study evaluated the utility of next-generation sequencing (NGS) in the etiological diagnosis of adult-onset SNHL.

MATERIALS AND METHODS

Adults (>16 yr old) with SNHL were recruited at the Otolaryngology Department at Marqués de Valdecilla University Hospital (Spain). Environmental factors, acoustic trauma, endolymphatic hydrops, and age-related hearing loss were excluding criteria. An NGS gene panel was used, including 196 genes (OTOgenics v3) or 229 genes (OTOgenics v4) related to syndromic and nonsyndromic hearing loss.

RESULTS

Sixty-five patients were included in the study (average age at the onset of SNHL, 41 yr). Fifteen pathogenic/likely pathogenic variants considered to be causative were found in 15 patients (23% diagnostic yield) in TECTA (4), KCNQ4 (3), GJB2 (2), ACTG1 (1), COL2A1 (1), COCH (1), COCH/COL2A1 (1), STRC (1), and ABHD12 (1). Three patients had syndromic associations (20% of patients with genetic diagnosis) that had not been previously diagnosed (two Stickler type I and one polyneuropathy, hearing loss, ataxia, retinitis pigmentosa, cataract syndrome). Seven variants of unknown significance were found in COL11A1 (1), GSMDE (2), DNTM1 (1), SOX10 (1), EYA4 (1), and TECTA (1).

CONCLUSION

NGS gene panels can provide diagnostic yields greater than 20% for adult SNHL, with a significant proportion of variant of unknown significance that could potentially contribute to increasing diagnostic output. Identifying a genetic cause enables genetic counseling, provides prognostic information and can reveal unrecognized syndromes contributing to an accurate management of their associated manifestations.

Shifting the discourse on disability: Moving to an inclusive, intersectional focus

Individuals with disabilities comprise one of the largest marginalized groups in the United States and experience systemic barriers in health care. In Westernized communities, disability has historically been conceptualized via the medical model, which considers disability an individual-level deficit in need of correction. Although other models of disability (e.g., social model) have been developed to address the medical model's ableist shortcomings, these fail to consistently acknowledge intersectionality. Specifically, these models fail to consider that (a) a disabled individual may hold other marginalized or oppressed identities and (b) these intersecting oppressions may exacerbate health inequities. Intersectionality, which originates from Black feminist literature, describes the ways that systems of power and oppression (e.g., racism, sexism) interact to form an individual's unique experience. To date, the intersection of disability and other marginalized identities has been neglected in psychology and related fields, leaving little guidance for how scholars, clinicians, and other stakeholders can address disability via an intersectional lens. The present article discusses how a disability-affirmative, intersectional approach can serve as a strategy for challenging and reforming oppressive systems across the field of psychology. We assert that, ultimately, this approach has the potential to optimize and expand access to equitable, inclusive mental health care, and we propose actionable steps psychologists can take in research, practice, training, and policy in pursuit of this aim. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Auditory Perceptual Exercises in Adults Adapting to the Use of Hearing Aids

Older adults with age-related hearing loss often use hearing aids (HAs) to compensate. However, certain challenges in speech perception, especially in noise still exist, despite today's HA technology. The current study presents an evaluation of a home-based auditory exercises program that can be used during the adaptation process for HA use. The home-based program was developed at a time when telemedicine became prominent in part due to the COVID-19 pandemic. The study included 53 older adults with age-related symmetrical sensorineural hearing loss. They were divided into three groups depending on their experience using HAs. Group 1: Experienced users (participants who used bilateral HAs for at least 2 years). Group 2: New users (participants who were fitted with bilateral HAs for the first time). Group 3: Non-users. These three groups underwent auditory exercises for 3 weeks. The auditory tasks included auditory detection, auditory discrimination, and auditory identification, as well as comprehension with basic (syllables) and more complex (sentences) stimuli, presented in quiet and in noisy listening conditions. All participants completed self-assessment questionnaires before and after the auditory exercises program and underwent a cognitive test at the end. Self-assessed improvements in hearing ability were observed across the HA users groups, with significant changes described by new users. Overall, speech perception in noise was poorer than in quiet. Speech perception accuracy was poorer in the non-users group compared to the users in all tasks. In sessions where stimuli were presented in quiet, similar performance was observed among new and experienced uses. New users performed significantly better than non-users in all speech in noise tasks; however, compared to the experienced users, performance differences depended on task difficulty. The findings indicate that HA users, even new users, had better perceptual performance than their peers who did not receive hearing aids.

Quality of life of older adults and associated factors in Ghanaian urban slums: a cross-sectional study

OBJECTIVE

This study provides insight into the quality of life (QoL) of older adults living in urban slums in Ghana.

DESIGN

The study employed a community-based, cross-sectional design to assess QoL among older adults in two slums between April and May 2020. QoL was assessed using the WHO Quality of Life-Brief version (WHOQOL-BREF) questionnaire.

SETTINGS

Participants were drawn from two slums in Ghana, one in a fishing-dominated community and the other in an industrial community.

PARTICIPANTS

This study included 400 participants aged 60 and above who had lived in either slum for at least 1 month and were able to communicate verbally.

RESULTS

Although the means of all participants' transformed scores were poor in the physical and psychological domains, they were moderate in all other domains. When viewed as a whole, the perceived overall QoL is neither poor nor good and participants were neither satisfied nor dissatisfied with their health. Participants had a moderate level of QoL in the WHOQOL-BREF psychological (mean score 45.7), social (mean score 57.0) and environmental (mean score 51.6) domains. The mean score for physical QoL of older adults was 43.3, which denotes poor QoL. In all domains, male participants have a significantly higher mean QoL than their female counterparts. An analysis of variance comparing the living arrangements of participants showed that those who lived with extended family had high mean scores in environmental QoL, overall QoL and satisfaction with health. Regression analysis revealed that QoL was influenced mostly by the environmental (46.2%), followed by the psychological (43.7%), physical (31%) and social (20.4%) domains.

CONCLUSIONS

The findings from this study show that older adults living in slums had moderate psychological, social and environmental QoL and poor physical QoL. Although the mean scores for QoL are higher than anticipated, health policy development must take into account the specific needs of older adults.

Understanding the Cost-Effectiveness of Hearing Aids and Surgery for the Treatment of Otosclerosis

Purpose of Review

To summarize and critically review recent literature on the relative cost-effectiveness of hearing augmentation versus stapes surgery for the treatment of otosclerosis.

Recent Findings

Otosclerosis leads to reduced patient quality of life, which can be ameliorated by either stapes surgery, or hearing aid usage. The success of stapes surgery is high, and the risks of serious postoperative complications are low. Hearing aids don’t have the complications of surgery but are associated with long-term costs. Cost-effectiveness models have shown that stapes surgery is a cost-effective method for treating otosclerosis.

Summary

Both stapes surgery and hearing aids can improve patient-reported quality of life in otosclerosis. Stapes surgery has larger upfront costs and surgical risks, but hearing aids are associated with longer lifetime costs. Stapes surgery is cost-effective for the treatment of otosclerosis.

Neuropsychological profile of hearing-impaired patients and the effect of hearing aid on cognitive functions: an exploratory study

Few studies have investigated the neuropsychological profile of Hearing Loss (HL) subjects and the effects of hearing-aid on cognitive decline. We investigated the neuropsychological profile of HL patients at baseline and compared the neuropsychological profiles of patients with and without hearing-aid at 6 month. Fifty-six HL patients and 40 healthy subjects (HC) underwent neuropsychological and behavioral examination and were compared at baseline. Changes at follow-up were compared between HL patients with (N = 25) and without (N = 31) hearing-aids. At baseline, significant differences between HL and HC were found in MOCA test, Raven's Coloured Progressive Matrices (CPM) and SF-36. Among mild-HL patients, patients with hearing-aid significantly improved on the Clock Drawing Test (CDT) as compared to patients without hearing-aid. Our findings indicate that hearing loss is associated with both a reduced efficiency of the global cognitive state and a worse quality of life as compared to HC, supporting the association between HL and cognitive impairment. Moreover, only patients with mild-HL shows some cognitive improvement after using hearing-aid, suggesting that rehabilitative strategies may be more effective to delay cognitive decline in such patients. However, we cannot exclude that hearing-aids may affect cognitive decline in more severe-HL, but a longer follow-up is needed.

Factors Influencing the Quality of Life of Empty Nesters: Empirical Evidence from Southwest China

Quality of life is a widely accepted concept based on the notion that people’s lives have been subject to rapid development and industrialization. This study aims to explore the impact of different factors on the quality of life of empty nesters in Southwest China. The main factors explored are resilience and social supports (SS), highlighted here from different perspectives. Moreover, the correlations between other variables and quality of life are shown here. This study experimented with a hierarchical multiple regression model from survey data with 3583 valid responses. It argued that both resilience and social supports, including family members and friends, are significantly correlated with the Chinese empty nesters’ quality of life. Family support and friend support play a significant mediating role in the association between resilience and quality of life. However, neither government nor nongovernmental support significantly influences the quality of life. Therefore, the hypothetical recommendations of this study have been partially confirmed. The findings of this study provide a more comprehensive understanding of the overall mental and physical health of Chinese empty nesters.

Conventional versus notch filter amplification for the treatment of tinnitus in adults with mild-to-moderate hearing loss

INTRODUCTION

Conventional hearing aids are commonly recommended for the treatment of tinnitus, though results of studies investigating the efficacy of hearing aid-based tinnitus treatments have been mixed. Recently, it has been suggested that the addition of a notch filter around the tinnitus frequency might enhance lateral inhibitory mechanisms and thereby improve tinnitus severity relative to traditional processing. The primary aim of this study was to compare the effects of conventional versus notch filter amplification strategies on subjective tinnitus severity in adults with mild-to-moderate hearing loss and no previous hearing aid experience.

METHODS

Thirty-nine adults (mean age=53.6 years; SD=9.7 years) with bilateral, mild to moderate sensorineural hearing loss and an established clinical history of stable, tonal tinnitus participated in this double-blinded study. Each participant was randomly assigned to complete a 12-week hearing aid trial using either a conventional amplification strategy or a strategy which applied a notch filter at the given participant's tinnitus pitch match frequency. Tinnitus-related handicap and distress were assessed before and after the hearing aid trial via the Tinnitus Handicap Inventory (Newman et al., 1996) and the Tinnitus Questionnaire (Hallam et al., 1988).

RESULTS

Average tinnitus severity did not differ significantly between the conventional and notch filter amplification groups following treatment. Moreover, average pre- to post-intervention change scores were relatively low for both groups, indicating minimal effect of either treatment on tinnitus symptoms. Participant age, high-frequency pure-tone average hearing threshold, average daily hearing aid usage, and pre-intervention tinnitus severity ratings were not predictive of treatment success or failure.

DISCUSSION

Results of the present study suggest no significant effect of either conventional or notch filter amplification on average ratings of tinnitus severity following a 12-week hearing aid trial. However, as clinically meaningful changes in tinnitus severity were identified for some participants, future work is needed to better identify those individuals most likely to benefit, as well as optimal amplification characteristics.

Experiences of hearing aid use among patients with mild cognitive impairment and Alzheimer's disease dementia: A qualitative study

Objectives:

Hearing aid usage supports communication and independence; however, many do not use their hearing aids. This study explored the experiences of hearing aid use in adults with mild cognitive impairment or Alzheimer’s disease.

Methods:

Participants completed semi-structured interviews which were analysed using thematic analysis. Ten people (six males, age range 75–86 years old) with mild cognitive impairment or Alzheimer’s disease who had been fitted with hearing aids were recruited to the study.

Results:

We identified four major themes: (1) memory and other cognitive barriers to using hearing aids, (2) practical aspects of hearing aids, (3) benefits of hearing aids, and (4) ambivalence towards hearing aids.

Conclusions:

Participants perceived a significant impact of cognitive impairment on the experience of using hearing aids. This population may benefit from targeted strategies to support use of hearing aids. The findings from this study can inform future research to optimise use of hearing aids in this population.

AYA testis cancer: The unmet challenge

Testis cancer is considered a rare-incidence cancer but comprises the third most common cancer diagnosed within the adolescent and young adult (AYA) years (15-39 years). Most testis cancer patients can anticipate a survival outcome in excess of 95%. However, there are subgroups of AYA patients where outcomes are considerably worse, including younger adolescents, patients with certain histological subtypes, or from certain ethnic backgrounds. For those cured with chemotherapy, the toxicity of treatment and burden of late effects is significant. Newer germ cell tumor-specific biomarkers may identify patients who do not require further treatment interventions or may detect early recurrence, potentially reducing the burden of treatment required for cure. An international collaboration for this rare tumor is creating the forum for trial design, where these biomarker research questions are embedded. Going forward, AYA testis cancer patients could benefit from having a more personalized treatment plan, tailored to risk, that minimizes the overall burden of late effects.