Hearing Impairment and Mental Health Among Married Couples

Association of Spouses' Sensory Loss with Depressive Symptoms, Self-Reported Health, and Functional Disability Among Middle-Aged and Older Adults in China: A Cross-Sectional Study

OBJECTIVE

To investigate cross-sectional associations between spouses' sensory loss and depressive symptoms, self-rated health, and functional disability.

METHODS

We included 10,410 individuals from the China Health and Retirement Longitudinal Study. We used the cross-sectional design and determined hearing loss, vision loss, and dual sensory loss by self-reports. We assessed depressive symptoms using the Center for Epidemiological Studies Depression Scale. We assessed self-reported health status using one item. Functional disability was defined as having difficulties in activities of daily living (ADL) and instrumental activities of daily living (IADL).

RESULTS

Individuals with spouses' dual sensory loss had a higher prevalence of depressive symptoms (45.19%), ADL (17.31%), and IADL impairments (21.97%) and a lower rate of self-rated good health (20.78%) than those with no or single loss. Spouse's sensory loss was associated with depressive symptoms, self-rated health, ADL, and IADL impairments (p < .05). Husbands' ADL impairments were associated with wives' vision loss (p < .05). Wives' IADL impairments were associated with husbands' hearing loss (p < .05).

CONCLUSIONS

Spouses' sensory loss was related to depressive symptoms, self-rated health, ADL, and IADL impairments. There was a gender specificity in the effect of spousal vision loss or hearing loss on ADL and IADL impairments.

Research Agenda and Applications for Preliminarily Validated Measures of d/Deaf and Hard of Hearing Stigma

In this special supplement of Ear and Hearing, we have presented preliminarily validated measures for stigma related to being d/Deaf or hard of hearing (d/DHH) in the United States and Ghana. In this concluding article, we suggest avenues for the future refinement and use of these measures. First, the measures should be further validated. Second, they should be used to assess the current state of d/DHH stigma and the importance of different kinds of stigma in different populations, which should in turn drive the development of interventions to reduce d/DHH stigma. Third, these measures can assist in evaluating the effectiveness and cost-effectiveness of those interventions. The evidence from this work can then inform investment cases and cost-of-condition studies, which will support advocacy efforts and policy development for reducing stigma and improving the lives of people who are d/DHH.

Development and Preliminary Validation of Stigma Measures for Care Partners of Persons Who Are d/Deaf or Hard of Hearing

OBJECTIVES

A great deal of literature documents the significant demands, both physical and psychosocial, that care partners experience when providing care to persons with a range of health conditions. There is, however, far less research available on care partners of adult persons who are d/Deaf or hard of hearing (d/DHH). In response to this gap, the authors developed measures of d/DHH stigma among care partners as part of the work of the Lancet Commission on Hearing Loss' Measures, Models, and Stigma Reduction Subgroup. The measures examined in this article are part of a larger set of parallel measures to enable comparison of stigma measurement across groups.

DESIGN

The present study describes the preliminary validation of five stigma scales specifically tailored for use to assess the prevalence and effect of stigma on the care partners of adult people who are d/DHH in the United States. Care partners in this context are defined broadly and can include spouses, partners, adult children, siblings, and friends of persons who are d/DHH. The scales describe the care partner's own assessment of how the person who is d/DHH experiences and perceives stigma as well as the care partner's own internalized, experienced, and perceived stigma as a result of their association with a person who is d/DHH. This latter set of three scales describes secondary stigma, or the stigma a person experiences related to their association with a member of a stigmatized group. Measures were developed through a process that included a literature review, Delphi groups with people who became d/DHH after they developed spoken language, cognitive interviews, and a pretest. An online, self-administered preliminary validation survey was conducted with 151 care partners.

RESULTS

Results support the internal reliability of each of the five stigma scales (ordinal α's all greater than 0.9) and that each scale is assessing a single factor.

CONCLUSIONS

Additional testing is needed to confirm the validity of these measures. After further validation, they can be used to assess the prevalence and effect of stigma on care partners of persons who are d/DHH and to evaluate the success of interventions developed to address stigma and its effects both on the care partner and the person who is d/DHH and receiving the care.

What impact does hearing impairment have on cognitive health in older married couples in China?

Hearing impairment is a common geriatric health problem and chronic stressor, and it is associated with poor cognitive outcomes. However, little is known about the impact of hearing impairment in married couples, particularly its potential spillover effects on the cognitive health among spouses of individuals with impairment. Drawing on a stress-proliferation perspective, we used actor-partner interdependence models to examine (1) whether an individual's hearing impairment influences their spouse's cognitive function; and (2) whether AL, symptoms of depression, and social participation serve as mediators for such an association. We utilized data from the 2015 (baseline) and 2018 (3-year follow-up) waves of the China Health and Retirement Longitudinal Study. 4434 couples were included at baseline, and 2190 couples remained after the 3-year follow-up. Hearing impairment among married women was associated with negative impacts on their spouses' cognitive function. Symptoms of depression and social participation may have served as potential mediators in this relationship. For married men, there was no statistically significant association between hearing impairment and spouses' cognitive function. Our findings suggest that hearing impairment among one spouse can lead to negative impacts on the other, but that this effect may depend on gender. Early diagnosis and couple-based interventions for hearing impairment are important for the cognitive health of both hearing-impaired individuals and their spouses.

A Pragmatic Clinical Trial of Hearing Screening in Primary Care Clinics: Effect of Setting and Provider Encouragement

OBJECTIVES

The prevalence of hearing loss increases with age. Untreated hearing loss is associated with poorer communication abilities and negative health consequences, such as increased risk of dementia, increased odds of falling, and depression. Nonetheless, evidence is insufficient to support the benefits of universal hearing screening in asymptomatic older adults. The primary goal of the present study was to compare three hearing screening protocols that differed in their level of support by the primary care (PC) clinic and provider. The protocols varied in setting (in-clinic versus at-home screening) and in primary care provider (PCP) encouragement for hearing screening (yes versus no).

DESIGN

We conducted a multisite, pragmatic clinical trial. A total of 660 adults aged 65 to 75 years; 64.1% female; 35.3% African American/Black completed the trial. Three hearing screening protocols were studied, with 220 patients enrolled in each protocol. All protocols included written educational materials about hearing loss and instructions on how to complete the self-administered telephone-based hearing screening but varied in the level of support provided in the clinic setting and by the provider. The protocols were as follows: (1) no provider encouragement to complete the hearing screening at home, (2) provider encouragement to complete the hearing screening at home, and (3) provider encouragement and clinical support to complete the hearing screening after the provider visit while in the clinic. Our primary outcome was the percentage of patients who completed the hearing screening within 60 days of a routine PC visit. Secondary outcomes following patient access of hearing healthcare were also considered and consisted of the percentage of patients who completed and failed the screening and who (1) scheduled, and (2) completed a diagnostic evaluation. For patients who completed the diagnostic evaluation, we also examined the percentage of those who received a hearing loss intervention plan by a hearing healthcare provider.

RESULTS

All patients who had provider encouragement and support to complete the screening in the clinic completed the screening (100%) versus 26.8% with encouragement to complete the screening at home. For patients who were offered hearing screening at home, completion rates were similar regardless of provider encouragement (26.8% with encouragement versus 22.7% without encouragement); adjusted odds ratio of 1.25 (95% confidence interval 0.80-1.94). Regarding the secondary outcomes, roughly half (38.9-57.1% depending on group) of all patients who failed the hearing screening scheduled and completed a formal diagnostic evaluation. The percentage of patients who completed a diagnostic evaluation and received a hearing loss intervention plan was 35.0% to 50.0% depending on the group. Rates of a hearing loss intervention plan by audiologists ranged from 28.6% to 47.5% and were higher compared with those by otolaryngology providers, which ranged from 15.0% to 20.8% among the groups.

CONCLUSIONS

The results of the pragmatic clinical trial showed that offering provider encouragement and screening facilities in the PC clinic led to a significantly higher rate of adherence with hearing screening associated with a single encounter. However, provider encouragement did not improve the significantly lower rate of adherence with home-based hearing screening.

Perceived Challenges and Emotional Responses in the Daily Lives of Older Adults With Disabilities: A Text Mining Study

This study explored the daily challenges and emotional reactions experienced by older adults living with various disabilities, employing both traditional and text mining approaches to ensure rigorous interpretation of qualitative data. In addition to employing a traditional qualitative data analysis method, such as thematic analysis, this paper also leveraged a text mining approach. By utilizing topic modeling and sentiment analysis, the study attempted to mitigate potential researcher bias and diminishes subjectivity in interpreting qualitative data. The findings indicated that older adults with visual impairments predominantly encountered challenges related to navigation, technology utilization, and online shopping. Individuals with hearing impairments chiefly struggled with communicating with healthcare providers, while those with mobility impairments face significant barriers in public participation and managing personal hygiene, such as showering. A prevailing sentiment of negative emotional states was identifiable among all participant groups, with those having visual impairments exhibiting more pronounced negative language patterns. The challenges perceived by participants varied depending on the types of disabilities they have. This study can serve as a valuable reference for researchers interested in a mixed-method strategy that combines conventional qualitative analysis with machine-assisted text analysis, illuminating the varied daily experiences and needs of the older adult population with disabilities.

The impact of hearing loss on trajectories of depressive symptoms in married couples

Hearing loss is a prevalent chronic stressor among older adults and is associated with numerous adverse health outcomes. The life course principle of linked lives highlights that an individual's stressors can impact the health and well-being of others; however, there are limited large-scale studies examining hearing loss within marital dyads. Using 11 waves (1998-2018) of the Health and Retirement Study (n = 4881 couples), we estimate age-based mixed models to examine how 1) one's own hearing, 2) one's spouse's hearing, or 3) both spouses' hearing influence changes in depressive symptoms. For men, their wives' hearing loss, their own hearing loss, and both spouses having hearing loss are associated with increased depressive symptoms. For women, their own hearing loss and both spouses having hearing loss are associated with increased depressive symptoms, but their husbands' hearing loss is not. The connections between hearing loss and depressive symptoms within couples are a dynamic process that unfolds differently by gender over time.

Hearing impairment, family financial support, and depressive symptoms among Chinese middle-aged and older adults

AIMS

Hearing impairment (HI) is prevalent among middle-aged and older adults, but few studies have examined its mental health consequences in China. This study investigated the association of HI with depressive symptoms and whether family financial support moderated the association among adults aged 45 in China.

METHODS

Data were obtained from three waves of the China Health and Retirement Longitudinal Study (2011, 2013 and 2015). Hearing impairment was defined as a self-reported hearing problem in one or both ears. Depressive symptoms were measured with CESD-10. Associations between HI and depressive symptoms were modeled using fixed-effect models.

RESULTS

People with self-reported hearing loss were more likely than those without hearing loss to have depressive symptoms, with an odds ratio of 1.25 [1.07-1.47]. The association remained significant after adjusting for socio-demographic characteristics, lifestyle behaviors, and health conditions. Family financial support moderated this association. Among those with HI, adults with a higher level of family financial support tend to have better performance on symptoms of depression.

CONCLUSIONS

HI was positively associated with depressive symptoms among adults aged ≥45 in China, and family financial support played a buffering role in the relationship between HI and depressive symptoms.

Nonverbal synchrony in subjects with hearing impairment and their significant others

Introduction

Hearing loss has a great impact on the people affected, their close partner and the interaction between both, as oral communication is restricted. Nonverbal communication, which expresses emotions and includes implicit information on interpersonal relationship, has rarely been studied in people with hearing impairment (PHI). In psychological settings, non-verbal synchrony of body movements in dyads is a reliable method to study interpersonal relationship.

Material and methods

A 10-min social interaction was videorecorded in 39 PHI (29 spouses and 10 parent-child dyads) and their significant others (SOs). Nonverbal synchrony, which means the nonverbal behaviors of two interacting persons (referring to both general synchrony and the role of leading) and verbal interaction (percentage of speech, frequency of repetitions, and queries) were analyzed by computer algorithms and observer ratings. Hearing-related quality of life, coping mechanisms, general psychopathology, quality of relationship, and burden of hearing loss experienced by SOs were assessed using questionnaires.

Results

In the 39 dyads, true nonverbal synchrony differed from pseudosynchrony [t (43.4) = 2.41; p = 0.02] with a medium effect size (d = 0.42). Gender of PHI had a significant effect on general synchrony (p = 0.025) and on leading by SOs (p = 0.017). Age gap correlated with synchronic movements (p = 0.047). Very short duration of hearing impairment was associated with lower nonverbal synchrony in the role of leading by SOs (p = 0.031). Feeling of closeness by PHI correlated negatively with the role of leading by SOs (p > 0.001) and feeling of closeness by SOs was positively associated with leading by PHI (p = 0.015). No correlation was detected between nonverbal synchrony and other questionnaires. Burden experienced by the SOs was higher in SOs who reported less closeness (p = 0.014).

Discussion

A longer hearing impairment leads to more nonverbal leading by SOs compared to PHI with very short duration of hearing loss, possibly because of the long-lasting imbalance in communication. If PHI felt more closeness, SOs led less and vice versa. Burden experienced by SOs negatively correlated with closeness reported by SOs. Use of nonverbal signals and communication might help to improve benefits of auditory rehabilitation for PHI and decrease burden experienced by SOs.

Demographic and Socioeconomic Disparities in Life Expectancy With Hearing Impairment in the United States

OBJECTIVES

Hearing impairment is one of the most common disabilities among older people, and its prevalence will increase as the U.S. population ages. However, little is known about social disparities in onset or transitions into and out of hearing impairment, nor how these transitions impact years of life to be spent impaired.

METHOD

We investigate the number of years an "average" person can expect to live with and without hearing impairment after age 50; sex, race, educational, and regional differences in these expectancies; and the implication of hearing impairment for remaining life expectancy. Bayesian multistate life table methods are applied to 9 waves of data from the Health and Retirement Study (1998-2014) to investigate social disparities in life expectancy with hearing impairment (n = 20,200) for the general population, people hearing impaired at age 50, and people hearing unimpaired at age 50.

RESULTS

Men, Hispanics, persons with less educational attainment, and those born in the south can expect to live a larger proportion of their remaining lives hearing impaired. Although transitions from hearing impaired to unimpaired occur, those with some hearing impairment at age 50 can expect to live more years with hearing impairment, and hearing impairment does not shorten remaining life expectancy.

DISCUSSION

Significant sociodemographic disparities in hearing impaired life expectancy exist. In contrast to past research, we find that hearing impairment does not affect total life expectancy. Future research should consider the consequences of hearing impairment for years to be lived with other age-related and potentially downstream health outcomes.