Association between vision and hearing impairment and successful aging over five years

Protocol for the co-design of an online support service for adults with hearing loss

INTRODUCTION

Untreated hearing loss is reported to negatively impact on an individual's quality of life, affecting their psychological and physical health and placing them at greater risk of developing dementia. Despite this, hearing loss management is often delayed by up to a decade. This is likely due to difficulties in navigating the hearing care pathway, and the absence of a central, unbiased reference point for consumer-friendly hearing health information and resources. We intend to co-design an online support service for adults with hearing loss with the following aims: 1) to understand unmet needs and consumer barriers to accessing hearing health information, 2) to identify solutions to these unmet needs that can be developed into prototype ideas, 3) to incrementally build on iterations of a prototype until a usable online support service is developed and ready for real-life testing with end-users, and 4) to test and evaluate the usability, accessibility, and effectiveness of the prototype from the consumer's perspective, so that the prototype can be refined into the final product.

METHODS AND ANALYSIS

This will be a mixed method study. Consumers will be involved in all stages of the design of the project following the Hasso Plattner model of design thinking. The qualitative component will involve sprints and semi-structured interviews to access the consumer perspective and understand unmet needs and challenges regarding the access of online hearing health information. For the quantitative component, an online survey will be administered prior to prototype testing as part of the remote usability study to collect self-efficacy and eHealth literacy outcome measures via validated questionnaires. Data collection will also be performed post-prototype testing for evaluation purposes. Finally, heuristic evaluation of the prototype will be conducted by an eLearning expert to help refine the prototype into the final product.

Association of vision and hearing impairment and dietary diversity among the oldest old in China: findings from the Chinese longitudinal healthy longevity survey

BACKGROUND

The presence of sensory impairment among older age cohorts exerts a significant impact on both individuals and society generally. Although the impact of dietary patterns on health is vital across all stages of life, there still a paucity of comprehensive research on the association between dietary variety and sensory impairments.

OBJECTIVE

To investigate the potential relationship between dietary diversity and the prevalence of visual and hearing impairment or dual sensory impairments (visual and hearing impairment) among the oldest old population.

METHODS

This is a cross-sectional study relied on data obtained from the 2018 survey conducted by the Chinese Longitudinal Healthy Longevity Survey (CLHLS). Subjects aged 80 and older with complete vision and hearing data were included in the study. Multivariate logistic regression models were developed to examine the association between dietary components and visual and hearing impairment while controlling for age, gender, socioeconomic demographic factors, living habits, other food habits, and general health status.

RESULTS

The study included 10,093 participants, with an average age of 92.29 ± 7.75 years. Vision and hearing function were assessed based on the ability to distinguish the direction of the break in the circle and the requirement for hearing aids, respectively. Upon controlling for confounding variables, individuals with a greater Dietary Diversity Score (DDS, the number of food groups, range: 1-11) had a reduced likelihood of experiencing visual impairment (odds ratio [OR] = 0.944, 95% confidence interval [CI], 0.915-0.974) and dual sensory impairment (OR = 0.930, 95% CI, 0.905-0.955). In comparison to the low dietary variety group (insufficient dietary diversity, DDS < 4), the high dietary diversity group (sufficient dietary diversity, DDS ≥ 4) exhibited a decreased risk of visual impairment (OR = 0.820, 95% CI, 0.713-0.944) and dual sensory impairment (OR = 0.751, 95% CI, 0.667-0.846). However, no statistically significant correlation was observed between dietary diversity and the presence of only hearing impairment (OR = 0.924, 95% CI, 0.815-1.047) (P < 0.05). CONCLUSIONS AND IMPLICATIONS: The synthesis of research findings suggests that following diverse dietary patterns and healthy nutritional practices may be an effective and affordable way to prevent age-related decline in visual impairment and dual sensory impairment.

The relationship between self-reported sensory decline and cognitive frailty in older persons

This study aimed to explore the relationship between self-reported sensory decline, including poor hearing and vision, and cognitive frailty in older persons. This cross-sectional study analyzed data from the 2020 National Survey of Living Conditions and Welfare Needs of Older Koreans. Binomial logistic regression analysis was performed to analyze the relationship between self-reported sensory decline and cognitive frailty. Of 9,692 participants, 39.8 % experienced sensory decline. The prevalence of cognitive frailty was 15.7 % among participants with poor hearing, 6.9 % among those with poor vision, and 17.9 % among those with combined poor hearing and vision. In our model, adjusted for sociodemographic and health-related variables, the cognitive frailty was significantly associated with poor hearing alone and combined poor hearing and vision. The findings suggest that healthcare professionals should prioritize their attention to the risk of cognitive frailty in older adults experiencing poor hearing alone and combined with poor vision.

Subjective and Objective Hearing Loss Among US Adult Cancer Survivors

Importance

Cancer survivors are at a higher risk of developing hearing loss (HL) due to older age, chemotherapy, and radiotherapy. However, the prevalence of HL among US cancer survivors remains unknown. Additionally, there is a lack of uniform HL screening guidelines for this enlarging population.

Objective

To estimate the prevalence of subjective HL and objective HL by audiometry test among cancer survivors and compare them with the general population as well as to assess the performance of subjective HL questions in detecting true (ie, audiometry-confirmed) HL.

Design, Setting, and Participants

In a cross-sectional design, adults between ages 20 and 80 years who had audiometry testing and responded to a hearing questionnaire from the National Health and Nutrition Examination Survey (2011-2012, 2015-2016, and 2017 to March 2020 prepandemic survey cycles) were selected. Data analysis was conducted from August 13, 2022, to July 26, 2023.

Main Outcomes and Measures

The weighted prevalence of subjective HL (troublesome hearing and tinnitus) and objective HL (speech-frequency HL and high-frequency HL) by audiometry were calculated. Analyses with χ2 testing and multiadjusted logistic regression models were used to compare HL between cancer survivors and the general population. To evaluate the performance of subjective HL questions as a tool to screen for objective HL by audiometry, areas under the curve were estimated using age- and gender-adjusted logistic regression.

Results

Among the total 9337 participants (weighted n = 90 098 441; 51.2% women), 10.3% were cancer survivors. Compared with the general population, cancer survivors had a higher prevalence of troublesome hearing (adjusted odds ratio [AOR], 1.43; 95% CI, 1.11-1.84), tinnitus (AOR, 1.28; 95% CI, 0.94-1.74), speech-frequency HL (AOR, 1.43; 95% CI, 1.11-1.85), and high-frequency HL (AOR, 1.74; 95% CI, 1.29-2.34). When using the subjective HL tool and questioning regarding whether the participants were having troublesome hearing and/or tinnitus in screening for HL, the age- and gender-adjusted area under the curve was 0.88 in detecting speech-frequency HL and 0.90 in detecting high-frequency HL.

Conclusion and Relevance

The findings of this study suggest that cancer survivors have a significantly higher prevalence of HL than the general population. Two subjective HL questions could potentially accurately identify those who have true HL and provide a simple and efficient screening tool for health care professionals. Cancer survivors and their families should be educated and encouraged to discuss hearing concerns, and health care professionals should facilitate raising awareness and provide early screening and timely referral when HL is identified.

Relationship between tinnitus and olfactory dysfunction: audiovisual, olfactory, and medical examinations

Introduction

Sensory dysfunctions and cognitive impairments are related to each other. Although a relationship between tinnitus and subjective olfactory dysfunction has been reported, there have been no reports investigating the relationship between tinnitus and olfactory test results.

Methods

To investigate the relationship between tinnitus and olfactory test results, we conducted sensory tests, including hearing and visual examinations. The subjects included 510 community-dwelling individuals (295 women and 215 men) who attended a health checkup in Yakumo, Japan. The age of the subjects ranged from 40 to 91 years (mean ± standard deviation, 63.8 ± 9.9 years). The participants completed a self-reported questionnaire on subjective tinnitus, olfactory function, and hearing function, as well as their lifestyle. The health checkup included smell, hearing, vision, and blood examinations.

Results

After adjusting for age and sex, the presence of tinnitus was significantly associated with subjective olfactory dysfunction, poor olfactory test results, hearing deterioration, vertigo, and headache. Additionally, high serum calcium levels and a low albumin/globulin ratio were significantly associated with low physical activity and nutrition. Women scored higher than men in olfactory and hearing examinations, but there was no gender difference in vision examinations.

Conclusion

Subjective smell dysfunction and poor smell test results were significantly associated with tinnitus complaints. Hearing and vision were associated even after adjusting for age and sex. These findings suggest that evaluating the mutual relationships among sensory organs is important when evaluating the influence of sensory dysfunctions on cognitive function.

Food Insecurity and Hearing Loss Are Interrelated: A Cross-Sectional Population-Based Study

OBJECTIVES

We aimed to assess whether objectively measured hearing loss and self-perceived hearing handicap in adults are independently associated with food insecurity, and vice versa.

DESIGN

Cross-sectional population-based study.

POPULATION

2,500 participants aged 50+ years from the Blue Mountains Hearing Study, with both complete pure-tone audiometry data and information on food security status.

MEASUREMENTS

The pure-tone average of frequencies 0.5, 1.0, 2.0 and 4.0 kHz (PTA0.5-4KHz) >25 dB HL in the better ear, established the presence of hearing loss. Self-perceived hearing handicap was assessed by administering the Hearing Handicap Inventory for Elderly Screening (HHIE-S total scores of ≥8 indicates hearing handicap). A 12-item food security survey was administered, comprising statements related to individual and household food situations.

RESULTS

Food insecurity was reported by 12.8% of study participants. After adjusting for all potential confounders, any self-perceived hearing handicap significantly increased the likelihood of participants reporting food insecurity by 94% (p<0.0001). Participants reporting any, mild or severe self-perceived hearing handicap had around 2-fold greater odds of experiencing food insecurity. Objectively measured hearing loss did not significantly influence the food security status of study participants. Conversely, food insecurity was significantly associated with both objectively measured hearing loss and self-perceived hearing handicap: multivariate-adjusted OR 1.37 (95% CI 1.01-1.88) and OR 1.83 (95% CI 1.40-2.39), respectively.

CONCLUSIONS

Food insecurity was an important social determinant of hearing health among community-dwelling adults. Conversely, participants with a significant self-perceived hearing handicap were more likely to experience food insecurity. These findings add to our understanding of the substantial public health impact of both food insecurity and hearing loss and may highlight areas for future intervention.

Longitudinal relationship between sensory impairments and depressive symptoms in older adults: The mediating role of functional limitation

BACKGROUND

The underlying mechanism between sensory impairments (SIs) and depressive symptoms among Chinese older adults is not well understood. This study aims to explore the mediating role of functional limitation on the longitudinal relationship between SIs and depressive symptoms among older adults in China.

METHODS

A total of 4130 older adults who participated in the 3-year follow-up China Health and Retirement Longitudinal Study (CHARLS) were included in the analysis. The hierarchical multiple linear regression model and nonparametric bootstrapping method were employed to explore the relationship between SIs and depressive symptoms, and the mediating role of functional limitation in this link.

RESULTS

The prevalence of self-reported hearing impairment (HI) only, vision impairment (VI) only, and dual sensory impairment (DSI) at baseline were 5.7%, 22.2%, and 58.6%, respectively. After adjusting for controlling variables, older adults with DSI had significantly higher levels of depressive symptoms compared with those without SIs at baseline (β = .07, p = .005). The magnitude of mediation effect from DSI to depressive symptoms via functional limitation was a*b = 0.060 (BCa 95% confidence interval: 0.031-0.094).

CONCLUSIONS

Functional limitation partially mediated the relationship between DSI and depressive symptoms among Chinese older adults. Interventions of DSI and functional limitation should be included in depressive symptoms prevention among older adults in China.

Association of vision and hearing status with depressive symptoms among middle-aged and older Chinese adults

Objective

Long-term untreated vision and hearing impairments can negatively impact physical and mental wellbeing. We investigated the association of vision and hearing status with depressive symptoms among middle-aged and older Chinese adults.

Methods:

This was a prospective cohort study of 9,492 participants from the China Health and Retirement Longitudinal Study (CHARLS) carried out in 2011, 2013, 2015, and 2018. This study used self-reported vision and hearing status to determine the degree of impairment. Depressive symptoms were examined using the 10-item Center for Epidemiologic Studies Depression Scale (CESD-10), with a total score of ≥ 12 indicating depressive symptoms. A Cox proportional hazards model adjusted for age, sex, residence, marital status, educational level, smoking history, alcohol consumption, hypertension, diabetes, heart disease, digestive disease, arthritis, wearing glasses, and hearing aids was used to estimate the association of vision and hearing status with depressive symptoms among middle-aged and older Chinese adults.

Results:

Of the 9,492 participants [mean (SD) age at CHARLS baseline, 58.12 (9.00) years], 3,238 (34.11%) participants reported incident depressive symptoms during the 7-year follow-up period. Participants who self-reported only vision impairment [hazard ratios (HR): 1.14, 95% confidence intervals (CI): 1.05–1.24], only hearing impairment (HR: 1.24, 95% CI: 1.06–1.46), and both vision and hearing impairments (HR: 1.25, 95% CI: 1.08–1.45) were independently associated with a greater increase in the hazard risk of incident depressive symptoms compared to those without vision and hearing impairments. An increase in participants' vision and hearing scores was associated with a significant increase in the hazard risk of incident depressive symptoms (HR: 1.04, 95% CI: 1.03–1.06).

Conclusion:

Vision and hearing status was associated with increased depressive symptoms among middle-aged and older Chinese adults during the 7-year follow-up period. Participants' use of glasses and hearing aids did not improve their depressive symptoms. Our findings may facilitate the development of effective treatments to prevent and treat vision and hearing impairments, thereby enhancing the physical and mental wellbeing of middle-aged and older adults.

Targeting Sirtuin1 to treat aging-related tissue fibrosis: From prevention to therapy

Fibrosis, which is characterized by excessive extracellular matrix (ECM) deposition, is a wound-healing response to organ injury and may promote cancer and failure in various organs, such as the heart, liver, lung, and kidney. Aging associated with oxidative stress and inflammation exacerbates cellular dysfunction, tissue failure, and body function disorders, all of which are closely related to fibrosis. Sirtuin-1 (SIRT1) is a class III histone deacetylase that regulates growth, transcription, aging, and metabolism in various organs. This protein is downregulated in organ injury and fibrosis associated with aging. Its expression and distribution change with age in different organs and play critical roles in tissue oxidative stress and inflammation. This review first described the background on fibrosis and regulatory functions of SIRT1. Second, we summarized the relationships of SIRT1 with other proteins and its protective action during fibrosis in the heart, liver, lung and kidney. Third, the activation of SIRT1 in therapies of tissue fibrosis, especially in liver fibrosis and aging-related tissue injury, was analyzed. In conclusion, SIRT1 targeting may be a new therapeutic strategy in fibrosis.

The Relationship between Experienced Respiratory Symptoms and Health-Related Quality of Life in the Elderly with Chronic Obstructive Pulmonary Disease

Background

Chronic obstructive pulmonary disease (COPD) is one of the diseases that usually present at an advanced age. Respiratory symptoms in patients with COPD are the most important for making treatment decisions and understanding the adverse effects on health-related quality of life (HRQoL). This study aimed to investigate HRQoL in elderly patients with COPD and examine the relationship between this in relation to respiratory symptoms experienced by them and their demographic characteristics.

Methods

This is a descriptive, correlational study of elderly patients with COPD who were hospitalized in five different hospitals in an urban area of Iran. A consecutive sampling method was used. Demographic data form, the respiratory symptoms component of St. George's Respiratory Questionnaire (SGRQ), and the Short Form 36 Health Survey Questionnaire (SF-36) were applied for data collection.

Results

The patients (n = 217) reported low HRQoL, and this impairment was more observed in the physical component. There was a significant inverse relationship between the experienced respiratory symptoms and physical (p=0.03) and mental (p < 0.001) components of HRQoL. Moreover, the female gender, the low level of education, the increased duration of the disease, the increased number of hospitalizations during the past year, and the use of two classes of drugs simultaneously were associated with the impaired HRQoL.

Conclusion

Our findings inform healthcare providers about the negative impacts of respiratory symptoms and other related factors on the HRQoL of elderly patients with COPD. Nurses and other healthcare providers should proactively identify respiratory symptoms and design appropriate caring strategies to improve HRQoL among this group.

The inaugural World Report on Hearing: From barriers to a platform for change

The inaugural World Report on Hearing was recently published by the World Health Organisation, and outlines the burden of hearing loss, and strategies to overcome this through preventative and public health approaches. Here, we identify barriers to wide-scale adoption, including historic low prioritisation of hearing loss against other public health needs, a lack of a health workforce with relevant training, poor access to assistive technology, and individual and community-level stigma and misunderstanding. Overcoming these barriers will require multi-sector stakeholder collaboration, involving ear and hearing care professionals, patients, communities, industry and policymakers.