Self-report Measures of Hearing and Vision in Older Adults Participating in the Canadian Longitudinal Study of Aging are Explained by Behavioral Sensory Measures, Demographic, and Social Factors

What Explains the Link Between Hearing and Vision Impairment and Cognitive Function? Analysis of Mediating Effects in the USA, England and Ireland

OBJECTIVES

Hearing and vision impairments are associated with cognitive decline and dementia risk. Explanations for this include age-related processes impacting on sensory and cognitive function (common cause), or sensory impairments having a direct or indirect impact on cognition via social engagement, depression and physical activity (cascade). We tested whether associations between hearing, vision and episodic memory were mediated by allostatic load, social engagement, depression and physical activity.

METHODS

We used structural equation modelling with cross-sectional data from the USA (n = 4746, aged 50-101), England (n = 4907, aged 50-89) and Ireland (4292, aged 50-80) to model factors related to the common cause (indexed by allostatic load) and the cascade hypothesis with respect to cognitive ability (episodic memory).

RESULTS

Poorer hearing/vision was associated with lower social engagement, depression and sedentary lifestyle. Poor vision was not related to allostatic load, and poor hearing was associated with allostatic load in only one data set, contributing to a common-cause hypothesis. Lower social engagement, depression and a sedentary lifestyle were associated with poorer episodic memory, contributing to the cascade hypothesis. Using effect estimates to calculate the proportion of the total effects mediated by the combined mediator variables, up to two fifths of the relationship between hearing and vision with episodic memory can be explained by the mediators.

CONCLUSIONS

The association between hearing, vision and episodic memory is mediated by allostatic load, social engagement, depression, and physical activity. The finding that social engagement, depression, and physical activity mediate the association between sensory abilities and cognitive function supported the cascade hypotheses. Interventions to improve healthy lifestyle, reduce depression and foster social engagement of older people with sensory impairments are likely to be beneficial in preventing cognitive decline and dementia.

The Associations of Sensory Impairment With 10-Year Risk of Dementia and Alzheimer's Disease: The Health and Retirement Study, 2010-2020

BACKGROUND

Studies have examined the association between dual sensory impairment and late-life cognitive outcomes in the U.S with inconsistent findings.

OBJECTIVE

To examine the associations between sensory impairment and 10-year risk of dementia or Alzheimer's disease among U.S. adults aged ≥ 50.

METHODS

A prospective cohort study based on the Health and Retirement Study from 2010 to 2020. Individuals aged ≥ 50 years without self-reported dementia and Alzheimer's disease in 2010 were included in the analysis. Self-reported visual and hearing impairments were measures in 2010. Main failure events included self-reported incident dementia and Alzheimer's disease over a 10-year follow-up period. Participants were categorized as having no visual or hearing impairment, visual impairment only, hearing impairment only, and dual sensory impairment. Fine-Gray competing risk regression model was applied to estimate the associations of sensory impairment with incident dementia and Alzheimer's disease, adjusted for demographic characteristics, health behaviors, and health conditions at baseline.

RESULTS

Of 20,248 identified individuals, 14.6% had visual impairment only, 11.2% had hearing impairment only, and 9.1% had dual impairment at baseline. After adjusting for all covariates, dual sensory impairment was associated with higher risk of dementia (HR = 1.46, 95% CI: 1.23-1.73) and Alzheimer's disease (HR = 1.35, 95% CI: 1.03-1.76). Visual impairment only was also associated with incident dementia and Alzheimer's disease among individuals <65 years.

CONCLUSION

Older adults in the U.S. with visual and hearing impairments simultaneously had a particularly greater risk of dementia and Alzheimer's disease, indicating the needs of targeted screening for timely treatment and further prevention of dementia and Alzheimer's disease.

Moderating Role of Neighborhood Environment in the Associations Between Hearing Loss and Cognitive Challenges Among Older Adults: Evidence From US National Study

This study examined the associations between hearing loss and cognitive challenges among community-dwelling older adults and whether neighborhood characteristics (physical disorder and low social cohesion) moderated the associations. Cross-sectional national data from Round 11 of the National Health and Aging Trends Study were adopted (N = 2,515). Multinomial logistic regressions were used to examine associations among variables and interactive analyses were conducted to examine moderating effects. Results indicated significant relationships between the experience of hearing loss and possible dementia and between severe or profound hearing loss and probable dementia. Interactive models suggested that residing in neighborhoods with physical disorder and low social cohesion were negatively associated with possible dementia among older adults with moderate and severe or profound hearing loss, respectively, compared to those without hearing loss. Findings underscore the necessity of environmental and social interventions to enhance cognitive health among older adults with varying degrees of hearing challenges.

Longitudinal associations between sensory and cognitive functioning in adults 60 years or older in Sweden and Denmark

BACKGROUND

The objective of this study is to explore the bidirectional, longitudinal associations between self-reported sensory functions (hearing/vision) and cognitive functioning among older adults in Sweden and Denmark during the period 2004-2017.

METHODS

The study is based on data from The Survey of Health, Ageing and Retirement in Europe and consists of 3164 persons aged 60 to 93 years. Within-person associations between sensory and cognitive functions were estimated using random intercept cross-lagged panel models.

RESULTS

The results indicated that cognitive and sensory functions were associated within their respective domains over time. The results on the bidirectional associations between sensory functions and cognition over time showed weak and statistically non-significant estimates.

CONCLUSION

Our study showed no clear evidence for cross-lagged effects between sensory functions and cognitive functioning. Important to note, however, is that using longitudinal data to estimate change within persons is a demanding statistical test and various factors may have contributed to the absence of conclusive evidence in our study. We discuss several of these factors.

Strategies used during the cognitive evaluation of older adults with dual sensory impairment: a scoping review

BACKGROUND

Dual sensory impairment (DSI), the combination of visual and hearing impairments, is associated with increased risk for age-related cognitive decline and dementia. Administering cognitive tests to individuals with sensory impairment is challenging because most cognitive measures require sufficient hearing and vision. Considering sensory limitations during cognitive test administration is necessary so that the effects of sensory and cognitive abilities on test performance can be differentiated and the validity of test results optimized.

OBJECTIVE

To review empirical strategies that researchers have employed to accommodate DSI during cognitive testing of older adults.

METHODS

Seven databases (MEDLINE, Embase, Web of Science, CINAHL, PsycINFO, Global Health and the Evidence-Based Medicine Reviews databases) were searched for relevant articles integrating the three concepts of cognitive evaluation, aging, and DSI. Given the inclusion criteria, this scoping review included a total of 67 papers.

RESULTS

Twenty-eight studies reported five categories of strategies for cognitive testing of older adult participants with DSI: the assistance of experts, the modification of standardized test scoring procedures, the use of communication strategies, environmental modifications, and the use of cognitive tests without visual and/or auditory items.

CONCLUSIONS

The most used strategy reported in the included studies was drawing on the assistance of team members from related fields during the administration and interpretation of cognitive screening measures. Alternative strategies were rarely employed. Future research is needed to explore the knowledge-to-practice gap between research and current clinical practice, and to develop standardized testing strategies.

Self-reported dual sensory impairment and related factors: a European population-based cross-sectional survey

BACKGROUND

Data on population-based self-reported dual vision and hearing impairment are sparse in Europe. We aimed to investigate self-reported dual sensory impairment (DSI) in European population.

METHODS

A standardised questionnaire was used to collect medical and socio-economic data among individuals aged 15 years or more in 29 European countries. Individuals living in collective households or in institutions were excluded from the survey.

RESULTS

Among 296 677 individuals, the survey included 153 866 respondents aged 50 years old or more. The crude prevalence of DSI was of 7.54% (7.36-7.72). Among individuals aged 60 or more, 9.23% of men and 10.94% of women had DSI. Eastern and southern countries had a higher prevalence of DSI. Multivariable analyses showed that social isolation and poor self-rated health status were associated with DSI with ORs of 2.01 (1.77-2.29) and 2.33 (2.15-2.52), while higher income was associated with lower risk of DSI (OR of 0.83 (0.78-0.89). Considering country-level socioeconomic factors, Human Development Index explained almost 38% of the variance of age-adjusted prevalence of DSI.

CONCLUSION

There are important differences in terms of prevalence of DSI in Europe, depending on socioeconomic and medical factors. Prevention of DSI does represent an important challenge for maintaining quality of life in elderly population.

Association of changes in self-reported vision and hearing impairments with depressive symptoms in middle-aged and older adults: Evidence from a nationwide longitudinal study in China

OBJECTIVE

This study assessed the longitudinal relationship between changes in self-reported vision impairment (VI) and hearing impairment (HI), and depressive symptoms in adults aged ≥45 years.

METHODS

Data from the China Health and Retirement Longitudinal Study for 2015 and 2018 were used, with a sample size of 10,050. VI and HI were self-reported. The 10-item Center for Epidemiologic Studies Depression Scale (CES-D10) was used to assess depressive symptoms. Total scores and clinically significant depressive symptoms (CES-D10 scores ≥ 10) were used as outcomes and analyzed using generalized estimating equations with identity link and logit link functions.

RESULTS

Of all changes in HI with good vision, only persistent HI was associated with higher CES-D10 scores (OR 95% CI: 1.09-3.30). Both new-onset and persistent VI with good hearing were associated with CES-D10 scores (OR 95% CI, new-onset: 1.70-3.52; persistent: 1.58-2.78) and clinically significant depressive symptoms (OR 95% CI, new-onset: 1.41-2.56; persistent: 1.36-2.27). Persistent dual sensory impairment (DSI) was associated with the highest CES-D10 scores (OR 95% CI: 3.63-5.97) and the highest risk of clinically significant depressive symptoms (OR 95% CI: 1.78-2.85). Those who self-reported improvements in vision and hearing still had higher CES-D10 scores (OR 95% CI: 1.35-2.83) and a higher risk of clinically significant depressive symptoms (OR 95% CI: 1.03-2.02) than those maintaining good vision and hearing.

CONCLUSION

Self-reported VI and DSI are closely associated with depressive symptoms. Because VI and DSI are modifiable, interventions for them could also prevent depressive symptoms.

Association of hearing impairment with social participation restriction and depression: comparison between midlife and older adults

OBJECTIVES

This study examined the association between hearing impairment and depression, focusing on the role of restricted social engagement as a mediator and whether the mediating relationship differed between midlife individuals (45-64) and older adults (65+).

METHODS

Individuals aged 45 and older from the cross-sectional National Health and Nutrition Examination Survey 2017-2018 were analyzed (N = 3,020). A multiple-group path analysis was conducted to compare midlife individuals (n = 1,774) and older adults (n = 1,246).

RESULTS

The results indicated that among U.S. adults aged 45 or older, 12.3% reported having serious difficulty hearing (21.2% among older adults vs. 7.4% among midlife adults). In both age groups, significant direct relationship between hearing impairment and depression, as well as indirect relationship via social participation restriction, were found. However, a significant difference was found in the relationship between restricted social participation and depression by age group (i.e. moderated mediation): The coefficient was greater among midlife adults than among older adults (Δbmidlife-older=1.109-0.383 = 0.726, p<.001).

CONCLUSION

These findings highlight that adverse psychosocial effects of hearing impairment are also an important concern for midlife adults. As the importance of social engagement was greater among midlife adults with hearing impairment, age-specific interventions should be adopted to reduce depression associated with hearing impairment.

Social participation and tooth loss, vision, and hearing impairments among older Brazilian adults

BACKGROUND

Vision and hearing impairments can reduce participation in social activities. Given the prominent role of the mouth in face-to-face interactions, this study evaluated the associations of tooth loss, vision, and hearing impairments with social participation among older adults.

METHODS

This analysis included 1947 participants, aged 60+ years, who participated in three waves (2006, 2010, and 2015) of the Health, Wellbeing and Aging Study (SABE) in Brazil. Social participation was measured by the number of formal and informal social activities (requiring face-to-face interaction) participants were regularly involved in. Teeth were counted during clinical examinations and categorized as 0, 1-19, and 20+ teeth. Reports on vision and hearing impairments were classified into three categories (good, regular, and poor). The associations of each impairment with the 9-year change in the social participation score were tested in negative binomial mixed-effects models adjusting for time-variant and time-invariant covariates.

RESULTS

Each impairment was associated with the baseline social participation score and the annual rate of change in the social participation score. Participants with 1-19 (incidence rate ratio: 0.96, 95% CI: 0.91-1.01) and no teeth (0.92, 95% CI: 0.87-0.97), those with regular (0.98, 95% CI: 0.95-1.01) and poor vision (0.86, 95% CI: 0.81-0.90), and those with regular (0.94, 95% CI: 0.91-0.98) and poor hearing (0.91, 95% CI: 0.87-0.95) had lower baseline social participation scores than those with 20+ teeth, good vision, and good hearing, respectively. Furthermore, participants with 1-19 (0.996, 95% CI: 0.990-1.002) and no teeth (0.994, 95% CI: 0.987-0.999), those with regular (0.996, 95% CI: 0.992-0.999) and poor vision (0.997, 95% CI: 0.991-1.003), and those with regular (0.997, 95% CI: 0.992-1.001) and poor hearing (0.995, 95% CI: 0.990-0.999) had greater annual declines in the social participation score than those with 20+ teeth, good vision and good hearing, respectively.

CONCLUSION

This 9-year longitudinal study shows that tooth loss, vision, and hearing impairments are associated with reduced social participation among older adults.

Co-Creating a Digital Life-Integrated Self-Assessment for Older Adults: User Experience Study

BACKGROUND

Older adults are at increased risk of developing health disorders and functional decline. However, owing to time constraints and considerable effort, physicians rarely conduct comprehensive assessments to detect early signs of negative trajectories. If designed properly, digital technologies could identify health risks already at a preclinical stage, thereby facilitating preventive efforts and targeted intervention. For this purpose, a Life-integrated Self-Assessment (LiSA) tablet system will be developed through a structured co-creation process.

OBJECTIVE

This study aims to investigate older adults' perceptions of different self-assessment domains, components affecting user experience, risks and benefits associated with LiSA, characteristics of potential LiSA users, and the LiSA concept in general.

METHODS

A total of 10 community-dwelling older adults aged ≥70 years were recruited. In total, 6 co-creation workshops were held and started with expert input followed by semistructured discussion rounds. Participants performed hands-on activities with a tablet, including testing of preinstalled self-assessment apps. All workshops were audio recorded and additionally documented by the researchers using flipcharts, notes, and photos. Qualitative content analysis was used to analyze the data following a deductive-inductive approach guided by the Optimized Honeycomb Model for user experience.

RESULTS

The group (mean age 77.8, SD 5.1 years) was heterogeneous in terms of previous technology experience and health status. The mean workshop duration was 2 hours (122.5, SD 4.43 min), and an average of 8 (SD 1.15) participants attended each workshop. A total of 11 thematic categories were identified, covering results on all research questions. Participants emphasized a strong interest in conducting a digital self-assessment of physical activity and function and sensory and cognitive functions and requested additional features such as recommendations for actions or reminders. LiSA was perceived as empowering and a motivator to engage in active health care planning as well as enabling shared and informed decision-making. Concerns and barriers included the lack of technical competence, feelings of frustration, and fear of being left alone, with negative assessment results. In essence, participants expressed a positive attitude toward using LiSA repeatedly and identified it as an option to increase the chances of maintaining independence when growing older.

CONCLUSIONS

The co-creation participants supported the LiSA approach and were interested in performing regular self-assessments on a long-term basis. In their opinion, LiSA should include relevant assessments capturing physical activity and function and sensory and cognitive functions as well as recommendations for actions. It should be customizable to individual needs. These results will form the basis for a prototype. Iterative development and validation will aim to make LiSA accessible in the public domain as a reliable tablet-based system for self-assessment.

Dual Sensory Impairment and Functional Status in a Prospective Cohort Study

Objective

To examine the impact of visual impairment, hearing impairment, and dual sensory impairment (DSI) on functional status in older adults.

Methods

Secondary analysis of the Manitoba Health and Aging Study, a population-based cohort study of 1751 adults age 65+. Data were collected from 1991 to 1992 (Time 1), with follow-up five years later (Time 2). Vision and hearing were self-reported. Functional status was measured using the Older Americans Resource and Services (OARS). Logistic regression models were constructed to assess functional status at both Time 1 and Time 2.

Results

Dual sensory impairment (DSI) at Time 1 predicted poor functional status at both Time 1 and Time 2. The adjusted odds ratios (OR; 95% confidence interval [CI]) for poor functional status at Time 1 for those with only hearing impairment was 1.74 (1.25, 2.44) for visual impairment was 2.95 (2.19, 3.98), and for DSI was 3.58 (2.58, 4.95). At Time 2, the adjusted ORs for poor functional status for those with only hearing impairment was 1.32 (0.86, 2.03), for visual impairment was 1.63 (1.05, 2.52), and for DSI was 2.61 (1.54, 4.40).

Conclusions

DSI is associated with lower functional status, but the effect of visual impairment is more pronounced than hearing impairment.

Associations of Dietary Intake With Self-Reported Hearing Loss: Findings From the Survey of the Health of Wisconsin

PURPOSE

The purpose of this study was to evaluate associations of dietary intake components with hearing loss.

METHOD

Participants were from the population-based Survey of the Health of Wisconsin. The Block food frequency questionnaire measured dietary intake of carbohydrates, fiber, protein, free (added) sugars, fruits, vegetables, saturated and trans fats, and glycemic index. Intake was categorized into quintiles (Q). Hearing loss was self-reported. Logistic regression models were used to evaluate associations of dietary determinants with hearing loss. Results are presented as odds ratios (ORs) with corresponding 95% confidence intervals (95% CIs). Final models were adjusted for age, sex, total energy intake, race/ethnicity, education, smoking, and regular physical activity.

RESULTS

There were 2,839 participants (56% women; M_age = 48.2 [SD = 14.5] years) included. Higher consumption of trans fat (Q5: OR = 1.83, 95% CI [1.27, 2.64]) and higher glycemic index (Q5: OR = 1.34, 95% CI [1.00, 1.80]) were associated with increased odds of hearing loss. Hearing loss was associated with fruit, saturated- and trans-fat intake in women, and trans-fat intake and glycemic index in men.

CONCLUSIONS

Dietary intake was associated with self-reported hearing loss. Research on mechanistic pathways of associations and public health interventions to prevent hearing loss is needed.

Sex-Linked Biology and Gender-Related Research Is Essential to Advancing Hearing Health

There is robust evidence that sex (biological) and gender (behavioral/social) differences influence hearing loss risk and outcomes. These differences are noted for animals and humans-in the occurrence of hearing loss, hearing loss progression, and response to interventions. Nevertheless, many studies have not reported or disaggregated data by sex or gender. This article describes the influence of sex-linked biology (specifically sex-linked hormones) and gender on hearing and hearing interventions, including the role of sex-linked biology and gender in modifying the association between risk factors and hearing loss, and the effects of hearing loss on quality of life and functioning. Most prevalence studies indicate that hearing loss begins earlier and is more common and severe among men than women. Intrinsic sex-linked biological differences in the auditory system may account, in part, for the predominance of hearing loss in males. Sex- and gender-related differences in the effects of noise exposure or cardiovascular disease on the auditory system may help explain some of these differences in the prevalence of hearing loss. Further still, differences in hearing aid use and uptake, and the effects of hearing loss on health may also vary by sex and gender. Recognizing that sex-linked biology and gender are key determinants of hearing health, the present review concludes by emphasizing the importance of a well-developed research platform that proactively measures and assesses sex- and gender-related differences in hearing, including in understudied populations. Such research focus is necessary to advance the field of hearing science and benefit all members of society.

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.

Association of nocturnal sleep duration and midday napping with subjective poor hearing among middle-aged and older adults in China

Background

Hearing loss has occurred as a critical concern for aging and health. However, it remains unknown whether nocturnal sleep and midday napping duration are associated with hearing loss in middle-aged and older adults.

Methods

The study comprised 9,573 adults from China Health and Retirement Longitudinal Study, who have completed the survey for sleep characteristics and subjective functional hearing. We collected self-reported nocturnal sleep duration (<5, 5 to <6, 6 to <7, 7 to <9, ≥9 h/night) and midday napping duration (≤5, 5 to ≤30, and >30 min). The sleep information was classified into different sleep patterns. The primary outcome was self-reported hearing loss events. Multivariate Cox regression models and restricted cubic splines were used to investigate the longitudinal association of sleep characteristics with hearing loss. We applied Cox generalized additive models and bivariate exposure-response surface diagrams to visualize the effects of different sleep patterns on hearing loss.

Results

We confirmed 1,073 cases of hearing loss (55.1% female) during the follow-up. After adjusting for demographic characteristics, lifestyle factors and health condition, nocturnal sleep with < 5 h was positively associated with hearing loss [hazard ratio (HR): 1.45, 95% confidence interval [CI]: 1.20, 1.75]. Individuals with napping for 5 to ≤30 min had a 20% (HR: 0.80, 95%CI: 0.63, 1.00) lower risk of hearing loss compared with those with napping ≤ 5 min. Restrictive cubic splines showed the reverse J-shaped association between nocturnal sleep and hearing loss. Moreover, we found significant joint effects of sleeping < 7 h/night and midday napping ≤ 5 min (HR: 1.27, 95% CI: 1.06, 1.52) on hearing loss. Bivariate exposure-response surface diagrams also reflected the finding that short sleep without napping existed the highest risk of hearing loss. Compared with persistently sleeping moderately (7-9 h/night), those who persistently slept < 7 h/night or shifted from < 7 h/night to moderate or > 9 h/night had higher risks of hearing loss.

Conclusion

Inadequate nocturnal sleep was associated with an elevated risk of poor subjective hearing in middle-aged and older adults, while moderate napping decreased the risk of hearing loss. Keeping sleep stable within recommendation duration may be a useful strategy for preventing poor hearing loss.

Prevalence of sensory impairments in home care and long-term care using interRAI data from across Canada

BACKGROUND

In the general population, sensory impairments increase markedly with age in adults over 60 years of age. We estimated the prevalence of hearing loss only (HL), vision loss only (VL), and a combined impairment (i.e., dual sensory loss or DSL) in Canadians receiving home care (HC) or long-term care (LTC).

METHODS

Annual cross-sectional analyses were conducted using data collected with one of two interRAI assessments, one used for the HC setting (n = 2,667,199), and one for LTC (n = 1,538,691). Items in the assessments were used to measure three mutually exclusive outcomes: prevalence of VL only, HL only, or DSL. Trends over time for each outcome were examined using the Cochran-Armitage trend test. A negative binomial model was used to quantify the trends over time for each outcome while adjusting for age, sex and province.

RESULTS

In HC, there was a significant trend in the rate for all three outcomes (p < 0.001), with a small increase (roughly 1%) each year. In HC, HL was the most prevalent sensory loss, with a rate of roughly 25% to 29%, while in LTC, DSL was the most prevalent impairment, at roughly 25% across multiple years of data. In both settings, roughly 60% of the sample was female. Males in both HC and LTC had a higher prevalence of HL compared to females, but the differences were very small (no more than 2% in any given year). The prevalence of HL differed by province after adjusting for year, age and sex. Compared to Ontario, Yukon Territory had a 26% higher rate of HL in HC (relative rate [RR] = 1.26; 95% confidence interval [CI]:1.11, 1.43), but LTC residents in Newfoundland and Labrador had a significantly lower rate of HL (RR: 0.57; CI: 0.43, 0.76).When combined, approximately 60% of LTC residents, or HC clients, had at least one sensory impairment.

CONCLUSIONS

Sensory impairments are highly prevalent in both HC and LTC, with small sex-related differences and some variation across Canadian provinces. The interRAI assessments provide clinicians with valuable information to inform care planning and can also be used to estimate the prevalence of these impairments in specific population sub-groups.

Self-Reported Sensory Decline in Older Adults Is Longitudinally Associated With Both Modality-General and Modality-Specific Factors

Background and Objectives

Self-reported sensory data provide important insight into an individual's perception of sensory ability. It remains unclear what factors predict longitudinal change in self-reported sensory ability across multiple modalities during healthy aging. This study examined these associations in a cohort of older adults for vision, hearing, taste, and smell.

Research Design and Methods

Data on self-report sensory ability were drawn from 5,065 participants of The Irish Longitudinal Study on Ageing (mean age at baseline = 61.6, SD = 9.5, range 32-93 years; 59% female; resident in the Republic of Ireland) across 6 waves of data collection (2009-2021). Covariates included demographics, lifestyle factors, and measures of sensory, physical, mental, and cognitive health. Independent discrete survival analyses were performed for each sensory modality.

Results

A transition to self-reported fair/poor hearing was most prevalent (21% of the sample), followed by fair/poor vision (19%), smell (11%), and taste (6%). Participants who self-reported fair/poor function in one sensory modality were likely to report fair/poor ability in another sensory modality, although not for all pairings. Only self-rated fair/poor health was associated with increased odds of self-reported fair/poor ability across all sensory modalities. Age was associated with increased odds of self-reported fair/poor hearing, smell, and taste, as was current smoker status (vision, smell, and taste). Several other sensory (e.g., eye disease, hearing aid use) and nonsensory covariates (e.g., education, depression) were associated with the odds of self-reported fair/poor ability in one or two sensory modalities only.

Discussion and Implications

Over time, older adults perceive associations in fair/poor ability for multiple sensory modalities, albeit somewhat inconsistently. Both modality-general and modality-specific factors are associated with a transition from normal to fair/poor sensory ability. These results suggest the need for more routine testing of multiple senses with increasing age.

Objective and Subjective Hearing Difficulties Are Associated With Lower Inhibitory Control

OBJECTIVE

Evidence suggests that hearing loss increases the risk of cognitive impairment. However, the relationship between hearing loss and cognition can vary considerably across studies, which may be partially explained by demographic and health factors that are not systematically accounted for in statistical models.

DESIGN

Middle-aged to older adult participants (N = 149) completed a web-based assessment that included speech-in-noise (SiN) and self-report measures of hearing, as well as auditory and visual cognitive interference (Stroop) tasks. Correlations between hearing and cognitive interference measures were performed with and without controlling for age, sex, education, depression, anxiety, and self-rated health.

RESULTS

The risk of having objective SiN difficulties differed between males and females. All demographic and health variables, except education, influenced the likelihood of reporting hearing difficulties. Small but significant relationships between objective and reported hearing difficulties and the measures of cognitive interference were observed when analyses were controlled for demographic and health factors. Furthermore, when stratifying analyses for males and females, different relationships between hearing and cognitive interference measures were found. Self-reported difficulty with spatial hearing and objective SiN performance were better predictors of inhibitory control in females, whereas self-reported difficulty with speech was a better predictor of inhibitory control in males. This suggests that inhibitory control is associated with different listening abilities in males and females.

CONCLUSIONS

The results highlight the importance of controlling for participant characteristics when assessing the relationship between hearing and cognitive interference, which may also be the case for other cognitive functions, but this requires further investigations. Furthermore, this study is the first to show that the relationship between hearing and cognitive interference can be captured using web-based tasks that are simple to implement and administer at home without any assistance, paving the way for future online screening tests assessing the effects of hearing loss on cognition.

Prevalence of Self-Reported Hearing Loss and Associated Risk Factors: Findings From the Survey of the Health of Wisconsin

PURPOSE

The purpose of this study was to determine the prevalence of self-reported hearing loss and associated risk factors in a representative population-based study of Wisconsin residents.

METHOD

Survey of the Health of Wisconsin participants with data on self-reported hearing loss were included. We reported prevalence of self-reported hearing loss with corresponding 95% confidence intervals (CIs), overall, and stratified by age and sex. Age- and sex-adjusted and multivariable logistic regression models were used to evaluate determinants of self-reported hearing loss, and results are presented as odds ratios with corresponding 95% CIs.

RESULTS

There were 2,767 participants (50.7% men) with a mean age of 46 years (range: 21-74) in this study. Prevalence of self-reported hearing loss was 26.8% (24.4, 28.4) and was higher in men (30.3% [27.1, 33.4]) than in women (22.5% [19.9, 25.0]). Prevalence increased with age. After multivariable adjustment, age (per +1 year increase; 1.05 [1.04, 1.06]), male sex (1.57 [1.18, 2.08]), having two chronic diseases (vs. 0; 1.93 [1.16, 3.23]), occupational (2.47 [1.91, 3.19]) and recreational (1.58 [1.22, 2.04]) noise exposure, and poor diet (1.88 [1.28, 2.78]) were associated with higher odds of self-reported hearing loss.

CONCLUSIONS

Hearing loss is a highly prevalent public health concern and may be at least partially modifiable via interventions to reduce noise exposure and promote health. Statewide prevalence and risk factor data can be used to inform public health practice and promote hearing loss prevention.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.19661130.

Understanding Self-reported Hearing Disability in Adults With Normal Hearing

OBJECTIVES

Despite a diagnosis of normal hearing, many people experience hearing disability (HD) in their everyday lives. This study assessed the ability of a number of demographic and auditory variables to explain and predict self-reported HD in people regarded as audiologically healthy via audiometric thresholds.

DESIGN

One-hundred eleven adults (ages 19 to 74) with clinically normal hearing (i.e., audiometric thresholds ≤25 dB HL at all octave and interoctave frequencies between 0.25 and 8 kHz and bilaterally symmetric hearing) were asked to complete the 12-item version of the Speech, Spatial, and Qualities of Hearing Scale (SSQ12) as a measure of self-reported HD. Patient history and a number of standard and expanded measures of hearing were assessed in a multivariate regression analysis to predict SSQ12 score. Patient history included age, sex, history of noise exposure, and tinnitus. Hearing-related measures included audiometry at standard and extended high frequencies, word recognition, otoacoustic emissions, auditory brainstem response, the Montreal Cognitive Assessment, and FM detection threshold.

RESULTS

History of impulse noise exposure, speech-intelligibility index, and FM detection threshold accurately predicted SSQ12 and were able to account for 40% of the SSQ12 score. These three measures were also able to predict whether participants self-reported HD with a sensitivity of 89% and specificity of 86%.

CONCLUSIONS

Although participant audiometric thresholds were within normal limits, higher thresholds, history of impulse noise exposure, and FM detection predicted self-reported HD.

Bidirectional associations of vision loss, hearing loss, and dual sensory loss with depressive symptoms among the middle-aged and older adults in China

BACKGROUND

Most studies on the relationship between sensory loss and depression focus on the unidirectional association between sensory loss and the risk of depression based on cross-sectional designs. The present study aimed to explore the bidirectional longitudinal associations of vison loss (VL), ¹ hearing loss (HL), ² and dual sensory loss (DSL)³ with depressive symptoms among Chinese population.

METHODS

A longitudinal study was conducted among 13,690 participants aged 45 years and older over four years. VL, HL, and DSL were identified through self-reporting, and depressive symptoms were assessed using a 10-item Center for Epidemiologic Studies Depression Scale. Multivariable Cox proportional hazards regression models were constructed to estimate the bidirectional associations of VL, HL, and DSL with depressive symptoms.

RESULTS

Participants with self-reported VL (HR: 1.14, 95%CI: 1.04-1.24), HL (HR: 1.22, 95%CI: 1.07-1.37), and DSL (HR: 1.27, 95%CI: 1.08-1.49) were associated with higher risk of developing depressive symptoms, compared with those without VL, HL, and DSL, respectively. In comparison with those without depressive symptoms, participants with depressive symptoms in the baseline had higher risk of developing VL (HR: 1.43, 95%CI: 1.33-1.54), HL (HR: 1.49, 95%CI: 1.36-1.63), and DSL (HR: 1.76, 95%CI: 1.59-1.95).

LIMITATIONS

Sensory loss was defined only based on participants' self-report.

CONCLUSIONS

Significant bidirectional associations exist between self-reported VL, HL, or DSL and depressive symptoms. The mental health of people with VL and HL should be focused on, and regular assessments of vision and hearing in people with depressive symptoms are recommended.

Accuracy of self- and proxy-rated hearing among older adults with and without cognitive impairment

BACKGROUND

Hearing loss is highly prevalent among older adults with cognitive impairment and may exacerbate neuropsychiatric symptoms and affect interactions with others. Although audiometry is the gold standard for measuring hearing, it is not always used in research or clinical settings focused on the care of individuals with cognitive impairment. Subjective assessments of hearing, both self- and proxy-rated, are widespread but may not adequately capture the presence of hearing loss as compared to audiometry. This study investigates the concordance between subjective and objective hearing assessments among older adults with and without cognitive impairment and evaluates factors associated with concordance.

METHODS

Participants were a subset of the Atherosclerosis Risk in Communities Neurocognitive Study (ARIC-NCS), a prospective cohort study representing four US communities with adjudicated cognitive diagnoses and audiometric data, totaling 3326 self-rated and 520 proxy-rated hearing assessments. Sensitivity and specificity were calculated, and multivariable logistic regression estimated the magnitude of the association between the concordance of hearing assessments and variables of interest.

RESULTS

Sensitivity and specificity for self-rated hearing status were 71.2% and 85.9% among cognitively normal older adults, 61.1% and 84.9% among persons with MCI, and 52.6% and 81.2% among persons with dementia, respectively. For proxy-rated hearing, sensitivity and specificity were 65.7% and 83.3% for persons with MCI and 73.3% and 60.3% for persons with dementia, respectively. Female sex was positively associated with concordance for self-rated hearing assessments.

CONCLUSIONS

The low sensitivity of self- and proxy-rated hearing assessments compared to audiometry suggests that hearing loss among older adults with cognitive impairment may go underreported and unaddressed in subjective assessments. Clinicians and researchers should recognize the limitations of using self- and proxy-rated hearing assessments as measures of hearing status and incorporate objective audiometric evaluation whenever possible.