Hearing loss and disability exit: Measurement issues and coping strategies

Sensory Loss and its Association with Different Types of Departures from the Labor Force Among Older Adults in the US

To investigate the association between sensory loss and the timing and type of self-reported departures from the labor force, via retirement or disability, we used data from the Health and Retirement Study, cycles 2004-2018. Based on self-reported sensory loss, we classified individuals into four groups: no sensory loss, hearing loss only, vision loss only, and dual sensory loss (vision and hearing loss). We assumed that older adults could leave the labor force either by retirement or due to disability. Because once one type of exit is observed the other type cannot be observed, we implemented a competing risk approach to estimate the instantaneous rate of departure (sub-distribution hazard rate) for leaving the labor force due to disability, treating retirement as a competing risk, and for departures via retirement, with disability as the competing risk. We found that compared to older adults with no sensory loss, adults with vision loss are at a higher risk for leaving the labor force via disability (when treating retirement as a competing risk). Compared to no sensory loss, hearing loss was associated with a higher risk for retirement in models treating disability as a competing risk. Given the differences between disability and retirement benefits (before and after retirement age), policies intended to keep people with sensory loss from early labor force departures, such as accommodations in the workplace and/or hearing and vision care coverage, might contribute to better retiring conditions and healthy aging among older adults with sensory loss.

Potential for prevention of dementia in Denmark

INTRODUCTION

According to previous estimates, 40% of dementia cases globally may be attributed to 12 potentially modifiable risk factors.

METHODS

We calculated national population attributable fractions (PAFs) for each risk factor and modeled the effects of proportional reductions in risk factor prevalence on dementia prevalence by calculating potential impact fractions (PIFs) for each factor.

RESULTS

The overall adjusted PAF for all risk factors was 35.2%. Physical inactivity, hearing loss, hypertension, and obesity accounted for 64% of the total prevention potential. The overall adjusted PIF was 4.1% at 10% risk factor prevalence reduction and 8.1% at 20% risk factor reduction.

DISCUSSION

Estimates of the potential for the prevention of dementia should be based on country-specific data on risk factor prevalence, as estimates based on global risk factor prevalence have limited relevance from a national perspective. Physical inactivity, hearing loss, hypertension, and obesity could be primary targets for prevention of dementia in Denmark.

HIGHLIGHTS

Overall adjusted PAF for potentially modifiable dementia risk factors was 35%. Physical inactivity, hearing loss, hypertension, and obesity had the largest prevention potential. Estimates of prevention potential should be based on national risk factor prevalence.

Hearing loss, sick leave, and disability pension: findings from the HUNT follow-up study

Background

Evidence on the association between hearing loss and sick leave or disability pension is to a great extent based on few cross-sectional studies and remains unclear. We aim to assess the associations in a long-term follow-up population study.

Methods

We used baseline data from a large population-based hearing study in Norway, the HUNT Hearing study (1996–1998). The sample included 21 754 adults (48.5% men, mean age at baseline 36.6 years). We used register data on sick leave and disability pension (1996–2011). Cox regression was used to assess the association between hearing loss at baseline (Pure tone average/PTA 0.5–4 kHz > 20 dB) and time to first physician-certified sick leave episode, as well as time to first disability pension payment.

Results

Hearing loss at baseline (yes/no) was weakly associated with time to first physician-certified sick leave episode: Hazard ratio (HR) 1.2 (95% confidence interval (CI) 1.1–1.3). Restricting the exposed group to people with both hearing loss and tinnitus, the HR was slightly increased: 1.3 (95% CI 1.1–1.6). Hearing loss in 1996–1998 was also associated with time to first received disability pension: HR 1.5 (95% CI 1.3–1.8). Stronger associations were found for disabling hearing loss (PTA > 35). Restricting the exposure to hearing loss and tinnitus, the HR was increased: 2.0 (95% CI 1.4–2.8).

Conclusions

This large population-based cohort study indicates that hearing loss is associated with increased risk of receiving disability pension, especially among younger adults and low educated workers. Hearing loss was weakly associated with sick leave.

Key findings about hearing loss in the working-life: a scoping review from a well-being perspective

OBJECTIVE

This scoping review investigated key findings about hearing loss (HL) in the working life (WL) from a well-being perspective.

DESIGN

A scoping review protocol was used to search the literature and to explore and extract key findings. A narrative analysis of key findings was used to group the data into themes. Study sample: Fifty-three articles from 29 different journals were included in the analysis.

RESULTS

The narrative analysis identified three broad themes; individual aspects, work environment and work organisation. Individual aspects concerned problems that workers with HL experienced in their working lives, strategies they used to manage their working lives and different aspects of health in relation to WL. Work environment focussed on the physical, organisational and social work environment. Work organisation identified aspects related to division of labour and employment status.

CONCLUSIONS

Several of the included papers revealed lots of findings but did not substantially discuss the findings from a WL perspective. HL and well-being in WL is a multidimensional phenomenon due to the interplay between the individual and the environment. This interplay is rarely discussed in the included papers. Furthermore, intersectional aspects are infrequently highlighted and need to be further explored in future research.

Can listening-related fatigue influence well-being? Examining associations between hearing loss, fatigue, activity levels and well-being

Objective

Well-being is influenced by the activities we undertake. Hearing loss may reduce well-being directly through increased listening-related fatigue due to cognitive and emotional strain in challenging situations. Hearing loss and hearing device use may also indirectly impact fatigue and well-being by altering the frequency and type of daily-life activities. This review examines the available literature to help understand the relationships.

Design

We provide (i) a summary of the extant literature regarding hearing loss, hearing device use and fatigue in adults, as well as regarding fatigue and daily-life activity (work, social and physical) and (ii) a systematic search and narrative review of the relationships between hearing loss, hearing device use and activity.

Study sample

The systematic search resulted in 66 eligible texts.

Results

Data examining well-being in persons with hearing loss are limited. Our literature review suggests that well-being can be related directly and indirectly to hearing loss, hearing device use, activity level and listening-related fatigue.

Conclusions

Variations and interactions between hearing loss, hearing device use, fatigue and activity levels can be expected to impact well-being in persons with hearing loss in direct and indirect ways. Future research linking hearing and daily-life fatigue should take account of activity levels.

Biomarkers as precursors of disability

Some social surveys now collect physical measurements and markers derived from biological samples, in addition to self-reported health assessments. This information is expensive to collect; its value in medical epidemiology has been clearly established, but its potential contribution to social science research is less certain. We focused on disability, which results from biological processes but is defined in terms of its implications for social functioning and wellbeing. Using data from waves 2 and 3 of the UK Understanding Society panel survey as our baseline, we estimated predictive models for disability 2-4 years ahead, using a wide range of biomarkers in addition to self-assessed health (SAH) and other socio-economic covariates. We found a quantitatively and statistically significant predictive role for a large set of nurse-collected and blood-based biomarkers, over and above the strong predictive power of self-assessed health. We also applied a latent variable model accounting for the longitudinal nature of observed disability outcomes and measurement error in in SAH and biomarkers. Although SAH performed well as a summary measure, it has shortcomings as a leading indicator of disability, since we found it to be biased in the sense of over- or under-sensitivity to certain biological pathways.