Improvement of older-person-specific QOL after hearing aid fitting and its relation to social interaction

Associations Between Vision and Hearing Impairment and Cardiovascular Diseases: A Longitudinal Cohort of Middle-Aged and Older Adults in China

BACKGROUND

Based on the severity of cardiovascular disease (CVD) and sensory impairment in China and the lack of research on this, the aims of our study were to assess the impact of hearing impairment (HI), visual impairment (VI), and concurrent HI and VI (termed dual sensory impairment) on CVD in elderly people, based on a representative sample of China.

METHODS AND RESULTS

We used data from the CHARLS (China Health and Retirement Longitudinal Study) for our survey of 11 332 participants. We calculated hazard ratios (HRs) and 95% 95% CIs for CVD, stroke, and cardiac events by using Cox proportional hazards models. HI and VI status were collected through self-reported questions. During the 7-year follow-up, a total of 2156 participants experienced CVD (including 745 stroke and 1605 cardiac events). Compared with the reference, individuals with VI had higher risk of CVD (HR, 1.24 [95% CI, 1.09-1.40]). Individuals with HI also had higher risk of CVD than those without HI (HR, 1.20 [95% CI, 1.09-1.33]). Compared with participants without VI and HI, individuals with dual sensory impairment had a 1.35-fold increased risk of CVD (HR, 1.35 [95% CI, 1.16-1.57]). In addition, individuals with dual sensory impairment also had increased risk of stroke and cardiac events.

CONCLUSIONS

Our study shows that HI and VI have a combined effect on the incidence of CVD. Based on the high prevalence of CVD around the world, early detection of sensory disorders and the adoption of appropriate measures may contribute to prevent CVD and reduce the burden of clinical diagnosis and treatment of CVD.

Design and Methods of the Early Age-Related Hearing Loss Investigation Randomized Controlled Trial

OBJECTIVE

Hearing loss has been identified as a major modifiable risk factor for cognitive decline. The Early Age-Related Hearing Loss Investigation (EARHLI) study will assess the mechanisms linking early age-related hearing loss (ARHL) and cognitive impairment.

STUDY DESIGN

Randomized, controlled, single-site, early phase II, superiority trial.

SETTING

Tertiary academic medical center.

PARTICIPANTS

One hundred fifty participants aged 55 to 75 years with early ARHL (severity defined as borderline to moderate) and amnestic mild cognitive impairment will be included.

INTERVENTIONS

Participants will be randomized 1:1 to a best practice hearing intervention or a health education control.

MAIN OUTCOME MEASURES

The primary study outcome is cognition measured by the Alzheimer Disease Cooperative Study-Preclinical Alzheimer Cognitive Composite. Secondary outcomes include additional measures of cognition, social engagement, and brain organization/connectivity.

RESULTS

Trial enrollment will begin in early 2024.

CONCLUSIONS

After its completion in 2028, the EARHLI trial should offer evidence on the effect of hearing treatment versus a health education control on cognitive performance, social engagement, and brain organization/connectivity in 55- to 75-year-old community-dwelling adults with early ARHL and amnestic mild cognitive impairment.

The use of assistive devices and social engagement among older adults: heterogeneity by type of social engagement and gender

Little is known about the relationship between the use of assistive devices for functional loss and social engagement. This study investigated whether wearing assistive devices (dentures and hearing aids) is associated with social engagement among older adults in South Korea. Potential heterogeneity by type of social engagement (informal social contact versus formal social activity) and gender was also examined. This study analyzed data from 3725 individuals aged 65 or older collected over the course of 6 waves of the Korean Longitudinal Study of Ageing (KLoSA) from 2008 to 2018 (2150 women and 1575 men). Individual fixed effects models were used to account for unobserved individual-level heterogeneity that could confound the relationship between wearing assistive devices and social engagement. The fixed effects estimates showed that wearing assistive devices is associated with a decrease in formal social activity (b =  - 0.034 for dentures and b =  - 0.077 for hearing aids), but not informal social contact. Gender-stratified fixed effects revealed that the association between wearing assistive devices and social engagement is statistically significant only for men. In men, wearing assistive devices is associated with a decrease in formal social activity (b =  - 0.049 for denture and b =  - 0.095 hearing aids). The findings of this study suggest that wearing assistive devices may reduce the formal social activity of older adults, particularly men. Policymakers should consider developing interventions to help older adults overcome the stigma associated with assistive devices, which can hinder their social integration.

Effectiveness of Auditory Training in Experienced Hearing-Aid Users, and an Exploration of Their Health-Related Quality of Life and Coping Strategies

Hearing aids (HA) are a fundamental component in restoring auditory function; however, they cannot completely alleviate all problems encountered by adults with hearing impairment. The aim of this study is twofold. Firstly, we assess the health-related quality of life and coping strategies of experienced HA users. Secondly, we assess whether HA users can benefit from auditory training. To this end, 40 participants who had worn HAs for more than 6 months participated in this study. Half of the participants received auditory training, while the other half served as a passive control. The training consisted of a personalized training scheme, with outcome measures including speech in noise perception in free-field and via direct streaming to the HA, phoneme identification, cognitive control, and health-related quality of life. Results showed that experienced HA users reported a relatively good quality of life. Health-related quality of life was correlated with aided speech perception in noise, but not with aided pure tone audiometry. Coping strategies were adaptive, leading to improved communication. Participants showed improvements in trained tasks, consonant identification, and speech in noise perception. While both groups yielded improved speech in noise perception at the end, post hoc analysis following a three-way interaction showed a significantly larger pre-post difference for the trained group in the streaming condition. Although training showed some improvements, the study suggests that the training paradigm was not sufficiently challenging for HA users. To optimize daily life listening, we recommend that future training should incorporate more exercises in noise and focus on cognitive control.

Cognitive decline, sensory impairment, and the use of audio-visual aids by long-term care facility residents

BACKGROUND

Hearing and vision impairments and the use of audio-visual aids are associated with cognitive decline in community-dwelling older people, but effects in long-term care facilities (LFCF) are unclear. We hypothesize that visual and hearing impairment are associated with cognitive decline and these relationships are mediated by using visual and hearing aids.

METHODS

Secondary data analysis of a longitudinal study was conducted in the 7 government-subsidized LTCF operated by one of the largest non-governmental organizations in Hong Kong using data between 2005 and 2016. Eligible residents were ≥ 60 years of age without severe cognitive impairment at baseline who had stayed in the facilities for more than 3 years. All variables were measured by using the Minimum Data Set-Resident Assessment Instrument Version 2.0, Hong Kong version. The outcome was cognitive decline. Predictors were visual and hearing impairments. Mediators were the use of visual and hearing aids. General linear models were employed to test the hypotheses.

RESULTS

Results for 2,233 residents were analyzed, with a mean age of 82.1 ± 8.2 years and a mean follow-up period of 4.4 ± 0.8 years. Results showed that those who had visual impairment (p = 0.004) and hearing impairments (p = 0.022) had a higher risk of cognitive decline. Using hearing aids (coefficient = 0.0186, p < 0.05) positively mediates the effect of hearing impairment on cognitive decline. Using visual aids (coefficient = -0.0881, p < 0.05) negatively mediates the effects of visual impairment on cognitive decline.

CONCLUSION

In LTCF, hearing and visual impairments are associated with a higher risk of cognitive decline. Hearing aids often-users were associated with a higher risk of cognitive decline. LTCF residents with visual impairment did not use visual aids. Use of visual aids demonstrated potential effects in slowing cognitive decline. A future study with a larger and more diverse sample with attention to quality of devices is proposed to confirm its effects.

The effect of hearing aids on cognitive function: A systematic review

RATIONALE

Dementia currently affects 50 million people globally with this expected to triple by 2050. Even though hearing loss is associated with cognitive decline, the underlying mechanisms are not fully understood. Considering hearing loss is the largest modifiable risk factor for developing dementia, it is essential to study the effect of hearing aids on cognitive function.

OBJECTIVE

To systematically review the existing literature to examine the evidence for using hearing aids intervention as a treatment for deteriorating cognitive function.

DESIGN

A search of PubMed, Cochrane Library, Embase and grey literature was conducted revealing 3060 unique records between 1990-2020. Two reviewers independently selected longitudinal studies observing the effects of hearing aids on cognitive function in persons without dementia at onset of the study. Due to the heterogeneity of the data, a meta-analysis could not be performed. Outcomes are described in a summary of findings table and portrayed diagrammatically.

RESULTS

We identified 17 unique studies, spanning 30 years of research and 3526 participants. The included studies made use of 50 different cognitive function tests. These tests were grouped into separate cognitive domains according to the DSM-V classification for further analysis. The most beneficial impact of hearing aids seems to be in the cognitive domain of executive function, with six studies showing improvement, two studies being inconclusive and three studies not demonstrating a significant effect. Three of five studies demonstrated significant improvement when screening for brief mental status. The least beneficial impact is seen in domain of complex attention, with eight studies showing no significant effects, compared with one demonstrating improvement with intervention.

CONCLUSIONS

Based on this systematic review, we conclude that there is controversy about the effects of hearing aids on cognition. Additional research through randomized clinical trials with standardized cognitive assessment and longer follow-up is warranted to further elucidate this relationship.

A review of the impact of hearing interventions on social isolation and loneliness in older people with hearing loss

PURPOSE

Hearing loss affects many older people and is associated with social isolation and loneliness. The impact of hearing interventions however has not been established. The objective of this review is to determine the impact of hearing interventions in older people with hearing loss on social isolation and loneliness.

METHODS

A literature review using PubMed, EMBASE and CINAHL databases was performed. Search terms included older people, elderly, aging, ageing, hearing aid, hearing rehabilitation, social isolation, loneliness and social interaction. English-language studies with participants aged over 60 years diagnosed with hearing loss comparing outcomes pre- and post-hearing interventions were included.

RESULTS

A total of 176 articles were identified of which seven met the inclusion criteria. Five studies examined the impact of traditional hearing aids whilst two articles examined outcomes after cochlear implantation. Several outcome measures were used. Loneliness outcomes were reported in three studies and social isolation outcomes in four. All studies reported improved social isolation and loneliness scores following hearing intervention.

CONCLUSIONS

Small sample sizes, a lack of high-quality evidence, heterogenicity between studies and the presence of confounding factors limits interpretation of the literature. At present, there is inadequate evidence to support the use of hearing interventions in the treatment of social isolation and loneliness in older people. Given the ageing population, the significance of this health burden cannot be underestimated, emphasising the need for further research.

Predictors of quality of life and attitude to ageing in older adults with and without dementia

OBJECTIVES

This study explored the quality of life (QoL) and attitudes to aging in older adults with and without dementia, and ascertained the main factors that predict QoL and attitude to ageing.

METHODS

A cross-sectional study involving 563 community-dwelling adults with (PwD) and without dementia (PwoD) >60 years of age was conducted in three Czech regions. A tools battery including the Quality of Life-Alzheimer's Disease Scale, Geriatric Depression Scale, Patient Dignity Inventory, Attitude to Aging Questionnaire (AAQ), Short Physical Performance Battery, and Barthel Index, were administered.

RESULTS

PwD had worse scores in QoL and AAQ (both p = 0.0001). Less depression (p < 0.001), better sense of dignity (p < 0.05), and lower pain (p < 0.05) in PwoD predicted better scoring for QoL and AAQ. Physical ability in PwoD (p < 0.05), living alone (p < 0.05) and self-sufficiency (p < 0.001) in PwDwere predictors influencing QoL.Age (p < 0.01) in PwoD, gender (p < 0.05) and physical ability (p < 0.001) in PwD influenced AAQ.

CONCLUSIONS

This research is the first study to show that dignity can influence the QoL and attitude to aging in community-dwelling older adults. Our findings suggest that depression and dignity are common predictors of QoL and AAQ in older adults with and without dementia.

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.

Gender Differences in the Association Between Hearing Loss and Cognitive Function

OBJECTIVE

This study aimed to determine the association between hearing loss and cognitive function by gender in a nationally representative sample of older adults.

METHODS

We used data from the National Health and Nutrition Examination Survey (2010-2011) for 655 participants aged 60 to 69 years. The cognitive functioning component consisted of the Consortium to Establish a Registry for Alzheimer's disease, the Animal Fluency Test, and the Digit Symbol Substitution Test. We created a composite z score to represent global cognitive function. Regression models were used to examine the association between hearing loss and cognitive function.

RESULTS

Moderate/severe hearing loss was significantly associated with lower composite z score in males (β = -28.67, 95% confidence interval [95% CI] = -57.13 to -0.20) but not in females (β = -8.82, 95% CI = -36.61 to 18.96).

CONCLUSION

There were gender differences in the association between hearing loss and cognitive function. Future studies need to investigate these gender-specific associations.

Age-related hearing loss and tinnitus, dementia risk, and auditory amplification outcomes

Age-related hearing loss (ARHL) or presbycusis, as the third leading cause of chronic disability in older adults, has been shown to be associated with predisposing cognitive impairment and dementia. Tinnitus is also a chronic auditory disorder demonstrating a growth rate with increasing age. Recent evidence stands for the link between bothersome tinnitus and impairments in various aspects of cognitive function. Both ARHL and age-related tinnitus affect mental health and contribute to developing anxiety, stress, and depression. The present review is a comprehensive multidisciplinary study on diverse interactions among ARHL, tinnitus, and cognitive decline in older adults. This review incorporates the latest evidence in prevalence and risk factors of ARHL and tinnitus, the neural substrates of tinnitus-related cognitive impairments, hypothesized mechanisms concerning the association between ARHL and increased risk of dementia, hearing amplification outcomes in cases with ARHL and cognitive decline, and preliminary findings on the link between ARHL and cognitive impairment in animal studies. Given extensive evidence that demonstrates advantages of using auditory amplification in the alleviation of hearing handicap, depression, and tinnitus, and the improvement of cognition, social communication, and quality of life, regular hearing screening programs for identification and management of midlife hearing loss and tinnitus is strongly recommended.