Hearing Loss, Loneliness, and Social Isolation: A Systematic Review

Caregiving Time of Unpaid Family Caregivers Assisting Older Adults With Hearing Difficulty

Objectives: We aimed to investigate the association of older adults' hearing difficulty status with caregiving time. Methods: We used data from two linked surveys of Medicare beneficiaries and family caregivers. Hearing difficulty was defined by hearing aid use and hearing capacity in functional settings. Weighted multivariable linear regression examined the association between hearing difficulty and caregiving time. Stratified analyses were conducted to investigate the moderation effects of caregiving networks and care recipient's dementia status. Results: Among 3003 caregivers, those who assisted older adults with hearing difficulty were observed to spend greater time providing care (β = 1.18, 95% Confidence Interval [CI]: 1.04, 1.32). Stronger associations in magnitude were observed among caregivers without caregiving networks (β = 1.35, 95% CI: 1.13, 1.56) and assisting older adults without dementia (β = 1.22; 95% CI = 1.06, 1.37). Discussion: Hearing difficulty may contribute to greater caregiving time and remains a potential target for caregiver support programs.

Sensory impairments and the risk of cognitive decline and dementia across sex, age, and regions: Longitudinal insights from Europe

BACKGROUND

In aging populations, understanding predictors of cognitive decline is essential. We aimed to investigate the risk of cognitive decline and dementia by sensory impairments across sex, age, and European regions, and examined the mediating role of activities of daily living (ADL), physical activity, and depressive symptoms.

METHODS

A cohort study of 72,287 Europeans aged 50+ participating in at least two waves of the Survey of Health, Ageing and Retirement in Europe. We employed mixed-effects and time-to-event models, incorporating sex interactions, and adjusting for socio-demographic factors and medical history.

RESULTS

Compared to individuals with good vision and hearing, lower cognitive function was found for people with vision impairment (VI) (males: coef. -0.70, 95 % CI -0.95; -0.46; females: coef. -1.12, 95 % CI -1.33; -0.92), hearing impairment (HI) (males: coef. -0.64, 95 % CI -0.93; -0.35; females: coef. -0.96, 95 % CI -1.27; -0.65) and dual sensory impairment (DSI, i.e. VI and HI) (males: coef. -1.81, 95 % CI -2.16; -1.46; females: coef. -2.71, 95 % CI -3.05; -2.38), particularly among females. Moreover, higher dementia risk was observed among participants with VI (hazard ratio (HR) 1.29, 95 % CI 1.17; 1.43), HI (HR 1.18, 95 % CI 1.05; 1.34), and DSI (HR 1.62, 95 % CI 1.45; 1.81) with no sex-interactions. Findings were overall consistent across age and European regions.

CONCLUSION

The results suggest the necessity of preventing sensory impairments to maintain good cognitive function. Mitigating depressive symptoms, ADL limitations, and physical inactivity could potentially reduce a significant portion of the total effect of sensory impairments on cognitive decline.

Speech-evoked cortical activities and speech recognition in adult cochlear implant listeners: a review of functional near-infrared spectroscopy studies

Cochlear implants (CIs) are the most successful neural prostheses, enabling individuals with severe to profound hearing loss to access sounds and understand speech. While CI has demonstrated success, speech perception outcomes vary largely among CI listeners, with significantly reduced performance in noise. This review paper summarizes prior findings on speech-evoked cortical activities in adult CI listeners using functional near-infrared spectroscopy (fNIRS) to understand (a) speech-evoked cortical processing in CI listeners compared to normal-hearing (NH) individuals, (b) the relationship between these activities and behavioral speech recognition scores, (c) the extent to which current fNIRS-measured speech-evoked cortical activities in CI listeners account for their differences in speech perception, and (d) challenges in using fNIRS for CI research. Compared to NH listeners, CI listeners had diminished speech-evoked activation in the middle temporal gyrus (MTG) and in the superior temporal gyrus (STG), except one study reporting an opposite pattern for STG. NH listeners exhibited higher inferior frontal gyrus (IFG) activity when listening to CI-simulated speech compared to natural speech. Among CI listeners, higher speech recognition scores correlated with lower speech-evoked activation in the STG, higher activation in the left IFG and left fusiform gyrus, with mixed findings in the MTG. fNIRS shows promise for enhancing our understanding of cortical processing of speech in CI listeners, though findings are mixed. Challenges include test-retest reliability, managing noise, replicating natural conditions, optimizing montage design, and standardizing methods to establish a strong predictive relationship between fNIRS-based cortical activities and speech perception in CI listeners.

No causal relationship serum lipids on age-related hearing loss based on Mendelian randomized evidence

OBJECTIVES

Presbycusis, or age-related hearing loss (ARHL) has been a common disability disease among the elderly population. It is particularly essential to identify the underlying role of related risk factors for ARHL diagnosis and treatment. Observational studies have shown that cardiovascular disease may be a factor in ARHL. Serum lipids are a key risk factor for cardiovascular disease. Therefore, it may be a potentially influencing factor for elderly deafness. We conduct the study to analyze the causal relationship between serum lipids and European elderly deafness.

DESIGN

Using genetic variation data related to serum lipids (total cholesterol levels [TCL], total triglycerides levels [TGL], and lipoprotein fractions, including apolipoprotein A1 levels [APOA1L], apolipoprotein B levels [APOBL], high-density lipoprotein cholesterol levels [HDL], and low-density lipoprotein cholesterol levels [LDL]) as instrumental variables, the outcome events were summarized from the genome-wide association study data of elderly deafness, and Mendelian randomization (MR) analysis was used in our analysis. The relationship between serum lipids levels and ARHL was analyzed using five methods, including inverse variance weighted, weighted mode, MR-Egger, weighted median, and simple mode. The study aims to use bidirectional MR analysis.

RESULTS

Among all 5 methods, no significant causal effects were found between serum lipids (TCL OR = 0.936, p = .488; TGL OR = 0.955, p = 0.657; APOA1L OR = 0.864, p = .061; APOBL OR = 0.979, p = .786; HDL OR = 0.998, p = .979; LDL OR = 1.089, p = .281) and presbycusis.

CONCLUSION

The findings of MR causal inference analysis did not support the causal relationship between presbycusis and serum lipids, including cholesterol, triglycerides, and lipoprotein fractions (APOA1L, APOBL, HDL and LDL).

Effect of Hearing Intervention Versus Health Education Control on Fatigue: A Secondary Analysis of the ACHIEVE Study

BACKGROUND

Fatigue is a common complaint among older adults with hearing loss. The impact of addressing hearing loss on fatigue symptoms has not been studied in a randomized controlled trial. In a secondary analysis of the Aging and Cognitive Health Evaluation in Elders (ACHIEVE) study, we investigated the effect of hearing intervention versus health education control on 3-year change in fatigue in community-dwelling older adults with hearing loss.

METHODS

Participants aged 70-84 years old with untreated hearing loss recruited across 4 study sites in the United States (Forsyth County, North Carolina; Jackson, Mississippi; Minneapolis, Minnesota; Washington County, Maryland) were randomized (1:1) to hearing intervention or health education control and followed for 3 years. Three-year change in fatigue symptoms was measured by 2 instruments (RAND-36 and PROMIS). We estimated the intervention effect as the difference in the 3-year change in fatigue between intervention and control groups using a linear mixed-effects model under the intention-to-treat principle.

RESULTS

Participants (n = 977) had a mean age (SD) of 76.8 (4.0) years, were 53.5% female and 87.8% White. Over 3 years, a beneficial effect of the hearing intervention versus health education control on fatigue was observed using the RAND-fatigue score (β = -0.12 [95% CI: -0.22, -0.02]). Estimates also suggested beneficial effect of hearing intervention on fatigue when measured by the PROMIS-fatigue score (β = -0.32 [95% CI: -1.15, 0.51]).

CONCLUSIONS

Our findings suggest that hearing intervention may reduce fatigue over 3 years among older adults with hearing loss.

Chronic tinnitus is associated with aging but not dementia

AIM

Aging is related to deterioration of bodily and neural functions, leading to various disorders and symptoms, including the development of dementia, hearing loss, or tinnitus. Understanding how these phenomena are intertwined and how aging affects those is crucial for prevention and the future development of interventions.

METHODS

We utilized the UK Biobank which includes a total of 502,382 participants between 40 and 70 years old. We used logistic regression models and cox proportional hazard models and compared hazard ratios.

RESULTS

The odds of reporting tinnitus in the older age group (i.e., older than 58 years) were increased by 53.6 % and a one decibel increase in the speech-reception thresholds enhanced the odds for tinnitus by 13.0 %. For our second analysis regarding hearing loss, the risk of dementia increased by 14.0 % with an increase by one decibel in the speech-reception threshold score. In terms of aging, each additional year increased the risk by 17.3 %. Tinnitus alone showed a significant influence with a hazard ratio of 52.1 %, however, when adding hearing loss, age and various covariates, the effect vanished.

CONCLUSION

Findings confirm that tinnitus is indeed related to aging, but presumably independent of the aging processes accompanying the development of dementia. This highlights the urge to further investigate the impact of aging on neural processes that are relevant for alterations in the auditory systems (e.g., leading to the development of tinnitus or hearing loss) as well as for increased vulnerability in terms of neurodegenerative diseases.

Hearing Loss and Alzheimer Disease

Several studies have been done to investigate the role of hearing loss (HL) in cognitive decline. A co-existence of these two conditions has been identified. Recently, thanks to the use of functional MRI and EEG it has been shown that untreated HL can expose patients with cognitive decline to a higher risk of developing Alzheimer Disease (AD). This chapter will discuss the difference between central and peripheral HL, the link between HL and cognition and the relationship between HL and AD. At the end of the chapter the available technologies to treat HL will be discussed as well as their impact on memory and cognition.

Effectiveness of the active communication education program in improving the general quality of life of older adults who use hearing aids: a randomized clinical trial

BACKGROUND

Hearing loss in older adults affects general, generic health-related and disease-specific quality of life (QoL). The conventional strategy to address it is through hearing aids, which have been shown to improve disease-specific QoL. However, the long-term results regarding general quality of life are unknown, and communication problems and stigma associated with hearing loss may persist. An effective intervention strategy to address these problems is group communication programs, most notably Active Communication Education (ACE). This program has been shown to increase communication strategies and reduce communication activity limitations and participation restrictions. These precedents allow us to hypothesize that this program could improve general QoL.

METHODS

A randomized clinical trial was conducted on 114 older adult hearing aid users. Fifty-four subjects composed the intervention group that received the ACE program, while 60 subjects composed the control group that received an informational-lectures type intervention. The WHOQOL-BREF questionnaire was used to measure general QoL. Measurements were taken before and right after the intervention, with follow-ups at 6 and 12 months. Multilevel linear mixed models were estimated, considering the WHOQOL-BREF dimension scores and total score as the outcomes, and an interaction term between time since intervention and group as the predictor. Within- and between-group comparisons were made.

RESULTS

Compared to the baseline time-point, the ACE group showed significant improvements right after the intervention, and at the 6-month and 12-month follow-ups for the dimensions of psychological health, social relationships, environment, and total score. Compared to the control group, the ACE group exhibited significantly greater improvements in the social dimension at all postintervention assessments, as well as in the environment dimension and total score at the 12-month follow-up.

CONCLUSIONS

The ACE program improved general QoL in terms of social relationships and environment dimensions, which lasted up to 12 months after the intervention. Therefore, ACE is positioned as an effective complement for HA users, enhancing and delivering new benefits related to broader aspects of QoL not necessarily tied to health.

TRIAL REGISTRATION

ISRCTN54021189 (retrospectively registered on 18/07/2023).

The prevalence of patient-reported cognitive complaints and dementia risk factors in the audiology clinic

BACKGROUND

Hearing-dementia research mainly focuses on determining the causal direction of this association. Little is known about the prevalence of cognitive problems in a representative audiology patient population.

AIM

To examine the occurrence of self-reported cognitive complaints (SCC) and dementia risk factors (RF) in an audiology patient population.

MATERIALS AND METHODS

Patients visiting audiology clinics (n = 1100, 51% female and avg. age 61yrs) were administered an online intake tool based on the International Classification of Functioning Disability and Health. Domains extracted for analyses were memory and concentration (SCC) and loneliness, depression, sleep and vision (dementia RF) and self-reported hearing problems (SHP). Prevalence rates and associations with demographic variables and SHP were examined.

RESULTS

SCC were highly prevalent, with over half of the patients reporting memory or concentration problems. Regarding dementia RF, 68% reported sleeping problems and > 50% reported sadness, anxiety or depressed mood. SHP correlated significantly with self-reported memory problems, loneliness, and vision problems.

CONCLUSION

This descriptive cohort-study suggests a high risk of cognitive issues within the audiology clinic population, indicated by the high prevalence of SCC and some dementia RF. Our findings underscore the importance of considering closer cooperation between care pathways like audiology and neurology and use of a holistic patient-centered approach.

Towards stem cell therapies for hearing loss: awareness and perspectives of Australian audiologists and their patients

Aim: Over the last two decades, numerous experimental studies have examined the feasibility of delivering stem cells into the cochlea to restore hearing. While these studies have spawned new cell therapy companies, there is little information on what patients understand or expect from these emerging therapies.Methods: This study sought to understand the awareness and perspectives of Australian audiologists and their adult patients toward stem cell therapies for treating hearing loss.Results: An anonymous survey indicated 91% of patients and 39% of audiologists were unaware of these therapies being developed. Thirty percent of audiologists reported being asked about stem cell therapies for hearing loss, but 70% were not confident answering patient queries about this and were unsure where to gather information. Primary concerns reported by patients were cost (45%) and safety of treatment (42%). Interestingly, 58% of patients were unsure of how this therapy would improve their hearing, yet 25% of these patients expected that their hearing would return to normal.Conclusion: There was strong support for development of educational materials for both patient and clinician. The increasingly important role of audiologists in providing patient counselling was reflected in overwhelming support (from both patient and clinician) for audiologists providing such information.

Applications of Augmented and Virtual Reality in Enhancing Communication for Individuals Who Are Hard of Hearing: A Systematic Review

PURPOSE

This systematic review examines the role of augmented reality (AR) and virtual reality (VR) in enhancing communication for individuals who are hard of hearing.

METHOD

Following Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines, we conducted a comprehensive search across databases including PubMed, WoS, EMBASE, and IEEE. Of the 5,981 records initially identified, 22 studies met our inclusion criteria after screening. Most of these studies (68%) focused on nonverbal communication modalities using tools such as sign language and visual cues, while the remainder focused on verbal communication. A descriptive synthesis was used due to the expected diversity in study characteristics.

RESULTS

Our assessment showed a substantial emphasis on educational impacts, speech perception, and cognitive skills development through AR and VR. The reviewed articles provide preliminary evidence on the efficacy of these technologies in teaching sign language, enhancing cognitive skills such as reasoning, and improving speech perception among the deaf or hard of hearing individuals.

CONCLUSION

This review underscores the transformative potential of AR and VR in addressing communication challenges faced by individuals who are hard of hearing, emphasizing the need for further research with diverse, larger sample sizes to investigate these technologies for broader communication support.

Spanish-speaking Patients' Experiences with Hearing Health Care

Background/introduction: Health care providers working with Spanish-speaking patients must provide culturally and linguistically appropriate care to meet the communication needs of this population. Disparities related to hearing health care access remain understudied, leaving gaps in clinical practice and guidance for audiologists. The purpose of this study was to explore the experiences of Spanish-speaking patients with hearing loss when accessing hearing health care services through a limited income hearing aid program. Methods: Six Spanish-speaking patients (three monolingual Spanish, three bilingual Spanish/English) with hearing loss from the Oklahoma City metropolitan area completed in-depth, semi-structured interviews. Results/findings: Three main themes emerged: (1) perceived barriers to service delivery (cost, language, and transportation); (2) success with hearing health care (use of interpreters and reduced cost of services and amplification); and (3) cultural factors (family, religion, and use of home remedies). Discussion/conclusion: The themes identified can provide a foundation for service delivery of patient-centered services that are culturally and linguistically appropriate to help improve access to and quality of hearing health care, particularly for this population of patients. This study identified factors that may contribute to hearing health care disparities for Spanish-speaking adults, which may not be observed in other disciplines that are less communication-focused. Suggestions for improving services for audiologists serving Spanish-speaking patients are discussed.

The Medicare annual wellness visit: An opportunity to improve health system identification of hearing loss?

BACKGROUND

Hearing loss is prevalent and consequential but under-diagnosed and managed. The Medicare Annual Wellness Visit (AWV) health risk assessment elicits patient-reported hearing concerns but whether such information affects documentation, diagnosis, or referral is unknown.

METHODS

We use 5 years of electronic medical record (EMR) data (2017-2022) for a sample of 13,776 older primary care patients. We identify the first (index) AWV indication of hearing concerns and existing and subsequent hearing loss EMR diagnoses (visit diagnoses or problem list diagnoses) and audiology referrals. For a 20% random sample of AWV notes (n = 474) we compared hearing loss EMR diagnoses to documentation of (1) hearing concerns, (2) hearing loss/aid use, and (3) referrals for hearing care.

RESULTS

Of 3845 (27.9%) older adults who identified hearing concerns (mean age 79.1 years, 57% female, 75% white) 24% had an existing hearing diagnosis recorded. Among 474 patients with AWV clinical notes reviewed, 90 (19%) had an existing hearing loss diagnosis. Clinicians were more likely to document hearing concerns or hearing loss/aid use for those with (vs. without) an existing EMR diagnosis (50.6% vs. 35.9%, p = 0.01; 68.9% vs. 37.5%, p < 0.001, respectively). EMR diagnoses of hearing loss were recorded for no more than 40% of those with indicated hearing concerns. Among those without prior diagnosis 38 (9.9%) received a hearing care referral within 1 month. Subgroup analysis suggest greater likelihood of documenting hearing concerns for patients age 80+ (OR:1.51, 95% confidence interval [CI]: 1.03, 2.19) and decreased likelihood of documenting known hearing loss among patients with more chronic conditions (OR: 0.49, 95% CI: 0.27, 0.9), with no differences observed by race.

CONCLUSION

Documentation of hearing loss in EMR and AWV clinical notes is limited among older adults with subjective hearing concerns. Systematic support and incorporation of hearing into EMR and clinical notes may increase hearing loss visibility by care teams.

Developing a prototype web-based decision aid for adults with hearing loss

OBJECTIVE

To develop a prototype of a decision aid to be used on a website for adults with hearing loss. Design: Development was guided by the International Patient Decision Aid Standards (IPDAS) and included a survey and think-aloud process.

STUDY SAMPLE

A total of 153 participants completed a survey about what to include in the decision aid (111 adults with hearing loss, 21 family members of adults with hearing loss, and 21 professionals). Six adults with hearing loss and six family members participated in a think-aloud process to provide feedback as they used an initial version of the decision aid.

RESULTS

In the survey, 26 of the 38 potential items were identified as being highest priority and were included in the initial version of the decision aid. This initial version was then tested in the think-aloud sessions and a prototype of a web-based version was developed based on participant responses related to: 1) information on the decision aid, 2) ease of use, 3) layout and orders of the items, 4) satisfaction, 5) areas for improvement (e.g., need for graphics).

CONCLUSIONS

The methodologies used in this study are recommended for developing decision aids for adults with acquired hearing loss.

Hearing Loss Interventions for Occupational Therapy Practitioners: A Scoping Review

Hearing loss can impact an individual's mental, emotional, physical, and spiritual well-being. This review identifies existing research on client-centered interventions for Deaf and Hard of Hearing (DHH) clients which occupational therapy practitioners should understand. Databases searched included CINAHL, JSTOR, ERIC, PsychINFO, and Google Scholar. Full-text articles published in English from December 2013 to December 2023 were reviewed. After data extraction and analysis, 77 articles were synthesized, and interventions were categorized by type, occupation, relevant age group, theme, and professional performing the intervention. Understanding these interventions will help occupational therapy practitioners support DHH clients across the lifespan.

Sensory Dysfunction, Microbial Infections, and Host Responses in Alzheimer's Disease

Sensory functions of organs of the head and neck allow humans to interact with the environment and establish social bonds. With aging, smell, taste, vision, and hearing decline. Evidence suggests that accelerated impairment in sensory abilities can reflect a shift from healthy to pathological aging, including the development of Alzheimer's disease (AD) and other neurological disorders. While the drivers of early sensory alteration in AD are not elucidated, insults such as trauma and infections can affect sensory function. Herein, we review the involvement of the major head and neck sensory systems in AD, with emphasis on microbes exploiting sensory pathways to enter the brain (the "gateway" hypothesis) and the potential feedback loop by which sensory function may be impacted by central nervous system infection. We emphasize detection of sensory changes as first-line surveillance in senior adults to identify and remove potential insults, like microbial infections, that could precipitate brain pathology.

"Close to My Community": A Qualitative Study of Community Health Worker-Supported Teleaudiology Hearing Aid Services

OBJECTIVES

Given well-documented disparities in rural and minority communities, alternative service delivery models that help improve access to hearing care are needed. This article reports on a study of older Latino adults with hearing loss who received hearing aid services with Community Health Workers (CHWs) providing support via teleaudiology. The present study used qualitative data to explore perceptions of this novel service delivery model.

DESIGN

Participants completed semistructured interviews related to their experiences in the intervention approximately 17 weeks after the hearing aid fitting appointment. Two coders independently coded the data, using an iterative deductive and inductive thematic analysis approach. Inter-rater reliability was good (κ = 0.80).

RESULTS

Of the 28 participants, 19 were interviewed (CHW group: n = 9, 8 females; non-CHW group: n = 10, 9 females). Both groups of participants reported experiencing barriers in access to care and reported positive experiences with teleaudiology and with hearing aids as part of the trial. CHW group participants reported interactions with patient-site facilitators that were indicative of patient-centeredness.

CONCLUSIONS

Results demonstrate the feasibility and potential effectiveness of trained CHWs as patient-site facilitators in teleaudiology-delivered hearing aid services for adults.

National Cohort Data Suggests an Association Between Serious Mental Illness and Audiometric Hearing Loss

OBJECTIVE

To explore whether there is an association between serious mental illness (SMI) and hearing loss (HL) among US Hispanic adults.

STUDY DESIGN AND SETTING

Cross-sectional epidemiological study (Hispanic Community Health Study), including multicentered US volunteers.

METHODS

Multivariable linear regressions were conducted to study the association between SMI and HL. Adjustments were made for potential confounders including age, sex, education, vascular disease (hypertension or diabetes mellitus), and cognition. SMI was defined by (1) antipsychotic medication classification and (2) the use of at least 1 antipsychotic medication specifically used to treat SMI in clinical psychiatric practice. HL was measured by pure tone audiometry.

RESULTS

A total of 7581 subjects had complete data. The mean age was 55.2 years (SD = 7.5 years) and the mean pure tone average in the better ear was 16.8 dB (SD = 10.7 dB). A total of 194 (2.6%) subjects were taking a HCHS-defined antipsychotic and 98 (1.3%) were taking at least 1 antipsychotic specifically used to treat SMI. On multivariable regression, use of HCHS's classified antipsychotics was associated with 3.75 dB worse hearing (95% confidence interval [CI] = 2.36-5.13, P < .001) and use of antipsychotics specific for SMI was associated with 4.49 dB worse hearing (95% CI = 2.56-6.43, P < .001) compared to those not using antipsychotics.

CONCLUSION

SMI, as defined by either the use of HCHS-defined antipsychotics or the use of antipsychotic medication specific for SMI, is associated with worse hearing, controlling for potential confounders. Whether SMI contributes to HL, antipsychotic medication (through ototoxicity) contributes to HL, or whether HL contributes to SMI is unknown and warrants further investigation.

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.

Risk factors associated with the Motoric Cognitive Risk syndrome: A meta-analysis of data from a cross-national study

BACKGROUND

Identifying risk factors associated with the Motoric Cognitive Risk (MCR) syndrome (a pre-dementia syndrome) can assist in developing risk reduction strategies and interventions to delay progression to dementia. Tailored interventions require comparisons of high- and middle-income countries to determine if the same or different risk factors should be targeted. We examined risk factors associated with MCR in seven Health and Retirement Studies with harmonized measures.

METHODS

Data from adults aged ≥65 years (n = 20,036, mean age 71.2(SD 6.2)-80.1(SD 4.1)) from the U.S. Health and Retirement Study, English Longitudinal Study of Aging, Survey of Health, Aging and Retirement in Europe, China Health and Retirement Longitudinal Study, Harmonized Diagnostic Assessment of Dementia for Longitudinal Aging Study in India, Mexican Health and Aging Study, and Brazilian Longitudinal Study of Aging was included. MCR was defined as the presence of cognitive complaints and slow gait (no mobility disability and dementia). Associations of demographic [education], medical [hypertension, diabetes, heart disease, obesity, stroke, Parkinson's, falls], psychological [depressive symptoms, psychiatric problems], sensorimotor [grip strength, hearing], and behavioral factors [smoking, sedentariness, sleep], with prevalent MCR were examined using age- and sex-adjusted logistic regression models. A meta-analysis was performed to compare risk factors for MCR in high- versus middle-income countries.

RESULTS

Except for depressive symptoms and weak grip strength, different risk factor clusters were associated with individual studies. Poor sleep, hearing, weak grip, and multiple falls emerged as novel associations with MCR. When grouped by income, some risk factors (i.e., education) were associated with MCR in high- and middle-income countries. Others (i.e., obesity) were specific to high-income countries.

CONCLUSIONS

This cross-sectional, cross-national study identified new, shared, and specific risk factors associated with MCR in high- and middle-income countries, providing insights to develop public health approaches and interventions to forestall the onset of dementia in those with MCR.

Preliminary Validation of Stigma Measures Among Parents of Children Who Are d/Deaf or Hard of Hearing in the United States and Ghana

OBJECTIVES

Parents are integral to the development and overall well-being of their child. Previous research has studied the emotional effects parenting experiences have on parents. However, parents caring for children with disabilities have unique parenting experiences, filled with both victories and challenges. Parenting a child with disabilities can bring additional responsibilities as parents respond to their child's special needs. Specifically, parents of children who are d/Deaf or hard of hearing (d/DHH) are required to make ongoing life-changing decisions about their child's life, including mode of communication, medical care, and education. Across the world, many adults who are d/DHH experience stigma. However, less is known about the stigma faced by children who are d/DHH and their parents. Measuring the nature and magnitude of stigma-affecting parents of children who are d/DHH could offer insights into how to additionally support these parents. Nonetheless, there is a gap in validated scales to measure stigma among parents of children who are d/DHH. In response, we developed and preliminarily validated five measures of stigma among parents of children who are d/DHH.

DESIGN

Measures were developed through a mixed-method process: (1) a scoping literature review, (2) a modified Delphi process consisting of two group discussions (n = 3, n = 4) and two individual discussions with parents of children who are d/DHH from high-income countries (HICs) and low- and middle-income countries (LMICs), (3) cognitive interviews with parents of children who are d/DHH in the United States (U.S.) (n = 5) and Ghana (n = 5), and (4) a pretest of the survey in the U.S. (n = 28) and Ghana (n = 30). Modifications to the measures were made after each stage. This article focuses on evaluating the psychometric performance of the developed measures. Parents were recruited in the U.S. (n = 100) and Ghana (n = 173). Convenience sampling was used in both countries. In Ghana, survey administration was in-person with trained interviewers collecting data on tablets. In the U.S. data were collected online through self-administered surveys.

RESULTS

The final five scales measured: (1) parental observation of stigma their child experiences (seven items), (2) parental perceptions of stigma toward their child (eight items), (3) parental secondary experienced stigma (eight items), (4) perceived parental secondary stigma (five items), and (5) parental internalized stigma (seven items). All scales performed strongly and similarly across both country samples. The scales had ordinal αs ranging from 0.864 to 0.960, indicating strong reliability.

CONCLUSIONS

This study provides a set of preliminarily validated stigma measures to capture the experience of parents of children who are d/DHH. Measuring stigma among parents is critical to understanding parental mental health, as parental well-being affects the health and development of their child. Furthermore, measuring observed stigma by parents can allow the researcher to gain an understanding of the stigma experienced by children who are d/DHH that they may not be able to communicate. Further studies testing these measures across other countries and with more diverse samples are needed.

Sensory impairment, loneliness, and the discordance between subjective and objective cognitive function among older adults: A multi-cohort study

OBJECTIVES

This study aimed to examine the association between sensory impairment and the discordance between subjective/objective cognitive function among older adults and test the mediating effect of loneliness.

METHODS

We used data from four cohort studies conducted in 16 countries (N = 19,119). Sensory impairment and subjective cognitive impairment were self-reported. Objective cognitive impairment was measured in three dimensions. Generalized estimating equations were conducted to examine the association between sensory impairment and discordance in subjective/objective cognitive function. Cross-lagged panel model and a bootstrap method with 2,000 samples were employed to verify the mediating effect.

RESULTS

Sensory impairment was related to an increased risk of subjective cognitive impairment (OR = 4.70, 95 % CI 4.33-5.10), objective impairment (OR = 1.51, 95 %CI 1.31-1.74), as well as the discordance in subjective/objective cognitive function (OR = 1.35, 95 %CI 1.06-1.71 for older adults with normal subjective cognitive function). In contrast, sensory impairment was associated with a decreased risk of discordant subjective/objective cognitive function among those with subjective cognitive impairment (OR = 0.79, 95 %CI 0.66-0.94). Moreover, loneliness mediated the association between sensory impairment and subjective cognitive impairment (standardized indirect effect = 0.002, 95 %CI 0.001-0.004), objective cognitive impairment (standardized indirect effect = 0.005, 95 %CI 0.003-0.007) as well as the discordance in subjective/objective cognitive function (standardized indirect effect = 0.001, 95 %CI 0.001-0.003 for older adults with normal subjective cognitive function).

CONCLUSIONS

Significant association between sensory impairment and discordance in subjective/objective cognitive function and the mediating role of loneliness were revealed, varying by subjective cognitive function. Early screening on sensory impairment and targeted interventions on loneliness should be considered in future policies on cognitive impairment.

Validation of the Optimal University of California Los Angeles Loneliness Scale Cutoff Score in Screening for the Prevention of Disability Occurrence Among Older Japanese Adults

OBJECTIVES

The association between loneliness and disability is a growing public health priority. While the University of California Los Angeles Loneliness Scale (UCLA-LS) has been internationally used as an indicator for assessing loneliness, its optimal cutoff point in relation to disability occurrence has not yet been examined. Therefore, we aimed to determine the optimal cutoff point of the UCLA-LS regarding future disability.

METHODS

This longitudinal cohort study was conducted in Tokai City, Aichi Prefecture, Japan. Overall, 4536 community-dwelling older adults (age: 73.8 ± 5.5 years; females: 55.2%) were followed up for 2 years. The area under the curve of the receiver operating characteristic analysis was calculated to evaluate the optimal cutoff point of the UCLA-LS in relation to future disability occurrence using the Youden index, which maximized the sensitivity and specificity of the UCLAS-LS. A survival analysis was conducted to test this cutoff value's external validity, using the presence or absence of disability occurrence as the dependent variable.

RESULTS

The cutoff score of the UCLA-LS in relation to future disability was 44 points. An association was found between new disability occurrence and loneliness based on this cutoff value (hazard ratio: 1.67, 95% confidence interval: 1.29-2.16).

CONCLUSIONS

Although cultural context should be taken into account, the optimal cutoff scores for the loneliness scale related to disability identified in this study may be a useful indicator for early recognition of loneliness as a global public health problem and for promoting social participation as one of the disability prevention strategies.

Loneliness and Mode of Social Contact in Late Life

OBJECTIVES

Social contact may alleviate loneliness, but little is known about within-person daily fluctuations in loneliness and social encounters. Older adults who feel lonely may engage in different modes of social contact (in-person, phone, digital). This study asked how different forms of contact are associated with loneliness throughout the day.

METHODS

Participants were 313 community-dwelling older adults (aged 65-90). They completed ecological momentary assessments reporting on their social encounters (e.g., type of social partner, mode of contact) and their loneliness every 3 hr for 5-6 days. We differentiated close social ties from ties not identified as close (i.e., weak ties).

RESULTS

We examined within-person effects using multilevel models. Findings revealed that momentary loneliness predicted a greater likelihood of phone contact in the next 3 hr. However, only in-person contact was associated with lower levels of loneliness. Regarding close and weak ties, momentary loneliness was associated with more in-person and phone contact with close ties, yet fewer in-person contacts with weak ties. In-person contact with both close and weak ties predicted lower levels of loneliness.

DISCUSSION

Although older adults engage in both in-person and phone contact when they feel lonely, it appears that only in-person contact may reduce loneliness. Digital contact was not widely adopted as a response to momentary loneliness among these older adults. Findings underscore older adults' willingness to maintain regular contact with close ties. Interventions addressing older adults who are lonely may consider innovative approaches to increase in-person contact.

Nanodelivery of antioxidant Agents: A promising strategy for preventing sensorineural hearing loss

Sensorineural hearing loss (SNHL), often stemming from reactive oxygen species (ROS) generation due to various factors such as ototoxic drugs, acoustic trauma, and aging, remains a significant health concern. Oxidative stress-induced damage to the sensory cells of the inner ear, particularly the non-regenerating hair cells, is a critical pathologic mechanism leading to SNHL. Despite the proven efficacy of antioxidants in mitigating oxidative stress, their clinical application for otoprotection is hindered by the limitations of conventional drug delivery methods. This review highlights the challenges associated with systemic and intratympanic administration of antioxidants, including the blood-labyrinthine barrier, restricted permeability of the round window membrane, and inadequate blood flow to the inner ear. To overcome these hurdles, the application of nanoparticles as a delivery platform for antioxidants emerges as a promising solution. Nanocarriers facilitate indirect drug delivery to the cochlea through the round and oval window membrane, optimising drug absorption while reducing dosage, Eustachian tube clearance, and associated side effects. Furthermore, the development of nanoparticles carrying antioxidants tailored to the intracochlear environment holds immense potential. This literature research aimed to critically examine the root causes of SNHL and ROS overproduction in the inner ear, offering insights into the application of nanoparticle-based drug delivery systems for safeguarding sensorineural hair cells. By focusing on the intricate interplay between oxidative stress and hearing loss, this research aims to contribute to the advancement of innovative therapeutic strategies for the prevention of SNHL.

Underlying dimensions of real-time word recognition in cochlear implant users

Word recognition is a gateway to language, linking sound to meaning. Prior work has characterized its cognitive mechanisms as a form of competition between similar-sounding words. However, it has not identified dimensions along which this competition varies across people. We sought to identify these dimensions in a population of cochlear implant users with heterogenous backgrounds and audiological profiles, and in a lifespan sample of people without hearing loss. Our study characterizes the process of lexical competition using the Visual World Paradigm. A principal component analysis reveals that people's ability to resolve lexical competition varies along three dimensions that mirror prior small-scale studies. These dimensions capture the degree to which lexical access is delayed ("Wait-and-See"), the degree to which competition fully resolves ("Sustained-Activation"), and the overall rate of activation. Each dimension is predicted by a different auditory skills and demographic factors (onset of deafness, age, cochlear implant experience). Moreover, each dimension predicts outcomes (speech perception in quiet and noise, subjective listening success) over and above auditory fidelity. Higher degrees of Wait-and-See and Sustained-Activation predict poorer outcomes. These results suggest the mechanisms of word recognition vary along a few underlying dimensions which help explain variable performance among listeners encountering auditory challenge.

Knowledge, attitudes, and practices of Australian allied hearing-healthcare professionals: survey on comorbid hearing loss and cognitive impairment

Purpose

As hearing loss is a modifiable risk factor of dementia, allied hearing-healthcare professionals (AHHPs) frequently see older patients who are affected by both conditions. However, little is known about how well Australian AHHP's understand the complexities of providing care to patients with comorbid hearing loss and dementia, as well as their associated views and practices. Thus, the current study used a survey to explore the knowledge, attitudes, and practices (KAPs) of Australian AHHPs in managing comorbid patients.

Materials and methods

A cross-sectional design was used, wherein a KAP survey was developed and distributed to eligible AHHPs via Qualtrics. Data were analysed with descriptive statistics and binary logistic regression.

Results

101 Australian AHHPs met inclusion criteria (2.5% of approximately 4,000 invited AHHPs), and participated in the study. Although participants generally possessed a high level of knowledge for the association between hearing loss and cognitive impairment, their specific knowledge and practices in relation to cognitive screening tests and referral pathways was limited. Participants also expressed mostly positive attitudes towards their role in assisting patients with comorbid hearing loss and dementia. Furthermore, our results suggested that some KAPs relevant to comorbid patients differed based on sex, qualification, and ethnicity.

Conclusion

This study identified gaps in the knowledge and practices of Australian AHHPs with regard to the complexities of addressing comorbid cognitive impairment and hearing loss. These findings will help to develop training programs to empower AHHPs to deliver optimal healthcare services to comorbid patients.

Factors Influencing Intentions of People with Hearing Impairments to Use Augmented Reality Glasses as Hearing Aids

The advent and progression of AR (augmented reality) technology, coupled with the emergence of AR hearing aid glasses, offer a novel opportunity for people with hearing impairments (PHI). This study aims to explore the intention of this population to employ AR hearing aid glasses as their choice of hearing aid device and the specific factors influencing their preference. This study utilized the partial least squares SEM (PLS-SEM) analytical method to create structural equation model for intentions of PHI to use AR glasses as hearing aids. Data were gathered from on-site experiences across multiple locations; a total of 189 valid questionnaires from individuals with varying degrees of hearing disabilities were used for statistical analysis. According to the data analysis results, we discovered that functionality quality, perceived interaction speed, and perceived usability significantly influence communication effectiveness. Further, communication effectiveness positively influences confidence and societal perception, and the latter has a positive impact on information. Both of these factors positively influence behavioral intention. Based on these findings, this study offers design recommendations for AR hearing aid glasses to cater to the specific needs of PHI, aiming to enhance their quality of life. Furthermore, this study provides pivotal insights for the prospective growth of this emerging industry.

Age-Related Hearing Loss, Cognitive Decline, and Social Interaction: Testing a Framework

PURPOSE

Aging increases risk for hearing loss, cognitive decline, and social isolation; however, the nature of their interconnection remains unclear. This study examined the interplay between age-related hearing loss, cognitive decline, and social isolation in adults by testing the ability to understand speech in background noise, a challenge frequently reported by many older adults.

METHOD

We analyzed data collected from 128 adults (20-79 years of age, Mage = 51 years) recruited as part of the Aging Brain Cohort at the University of South Carolina repository. The participants underwent testing for hearing, cognition, and social interaction, which included pure-tone audiometry, a words-in-noise (WIN) test, a hearing questionnaire (Speech, Spatial and Qualities of Hearing Scale [SSQ12]), a social questionnaire (Patient-Reported Outcomes Measurement Information System-57 Social), and the Montreal Cognitive Assessment. We used a single pure-tone average (PTA) threshold value and a single WIN threshold value for each participant because there were no differences on average between the left and right ears.

RESULTS

Poorer hearing was significantly associated with cognitive decline, through both PTA and WIN thresholds, with a stronger association observed for WIN threshold. Adults with poorer hearing also exhibited greater social isolation, as evidenced by their WIN threshold and SSQ12 score, although not through PTA. This connection was more pronounced with the WIN threshold than with the SSQ12 score. Cognition was not related to social isolation, suggesting that social isolation is affected more by the ability to understand words in noise than by cognition in a nondemented population.

CONCLUSIONS

Understanding speech in challenging auditory environments rather than mere threshold detection is strongly linked to social isolation and cognitive decline. Thus, inclusion of a word-recognition-in-noise test and a social isolation survey in clinical settings is warranted.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.26237060.

Exploring factors influencing the hearing test and hearing aid adoption among Japanese older adults: Implications of recognizing the hearing loss-dementia relationship

OBJECTIVE

The hearing aid adoption rate among older adults in Japan is lower than that in other developed countries. Herein, a survey was conducted to identify this bottleneck and develop countermeasures. This study aimed to examine whether raising awareness of the relationship between hearing loss and dementia is significant for hearing tests and adopting hearing aids.

METHODS

A questionnaire was administered to participants aged 65 or older who visited a general hospital to determine the background factors (1) for a recent history of hearing tests, (2) for the desire to visit an otolaryngologist and have a hearing test, (3) for recognizing the hearing loss-dementia relationship, and (4) for adopting hearing aids.

RESULTS

A total of 517 patients (mean age, 78.06; SD 6.97), representing 2.4% of the region's older-adult population, participated in the survey. A history of hearing tests within five years was significantly associated with recognizing the hearing loss-dementia relationship (adjusted OR 2.36, 95% CI 1.49-3.72). The desire to visit an otolaryngologist or have a hearing test was significantly associated with recognizing the hearing loss-dementia relationship (adjusted OR 1.70, 95% CI 1.02-2.85). Moreover, 39.3% were aware of the hearing loss-dementia relationship. The significant associated factors were being female (OR 2.50, 95% CI 1.64-3.81) and having interpersonal hobbies (OR 1.66, 95% CI 1.11-2.49). The significant background factors for adopting hearing aids were older age (OR 6.95, 95% CI 1.90-25.40), self-reported severe hearing impairment (OR 5.49, 95% CI 2.55-11.80), and living alone (OR 2.63, 95% CI 1.18-5.89). Recognizing the hearing loss-dementia relationship was not a significant factor.

CONCLUSION

Raising awareness of the hearing loss-dementia relationship was not associated with adopting hearing aids for self-reported hearing impairments. However, it may be associated with otolaryngology visits and hearing tests. Thus, steps like hearing screening for older adults are also essential.

A review of the literature on wellbeing and modifiable dementia risk factors

Wellbeing-defined broadly as experiencing one's life as enjoyable and fulfilling-has been associated with lower risk for Alzheimer's disease and related dementias. The mechanisms underlying this association are largely unknown. However, prior research and theory suggest that wellbeing impacts health behaviors and biological systems that are relevant to cognitive and brain health. Several of these factors have also been identified by the 2020 Lancet Commission on Dementia Prevention, Intervention, and Care as modifiable dementia risk factors. In the current review, we summarize and evaluate the evidence for associations between wellbeing and each of the 12 Lancet Commission risk factors. We found relatively consistent evidence for associations between higher wellbeing and lower levels of most of the risk factors: physical inactivity, social isolation, smoking, depression, hypertension, diabetes, hearing loss, traumatic brain injury, and air pollution. By contrast, we found evidence for only modest associations between wellbeing and education and mixed evidence for associations of wellbeing with alcohol use and body weight. Although most of the reviewed evidence was observational, longitudinal and experimental evidence suggests that many of the observed associations are likely bidirectional. These findings suggest that modifiable dementia risk factors may be mediators (i.e., intermediate steps in the causal chain) and/or confounders (i.e., variables that impact both wellbeing and dementia, and thus could induce a spurious association) of the association between wellbeing and dementia. We conclude by discussing next steps to test mediation hypotheses and to account for potential confounding in the relation between wellbeing and dementia.

Hearing Difficulties Among Farmworkers in the México-US Southwest Border Region

Migrant and seasonal farmworkers are a vulnerable population with a potentially high risk for hearing loss due to farm-related noise exposures. Occupational noise-induced hearing loss (NIHL) is permanent, and it is associated with an increased risk for injuries on the job, as well as communication difficulties, isolation, and depression. The México/US border region is one of the most productive agricultural regions in the country, however, no known studies have explored hearing loss among farmworkers in this area. This pilot study was a first step toward measuring and addressing hearing loss and noise exposure among this region's farmworkers. We conducted a cross-sectional survey to estimate the prevalence of subjective hearing difficulties among Yuma County, Arizona farmworkers. Survey interviews took place during a late-night farmworker health fair from 2 am to 6 am to accommodate local farms' labor schedules. Multivariable regression adjusted for demographic and work covariates estimated subjective hearing loss prevalence ratios. Among 132 farmworker participants, 36% reported they have or might have hearing loss, and 62% reported no hearing loss. Subjective hearing loss prevalence was lower in farmworkers who report not working in noise compared to prevalence in farmworkers who work in noise [prevalence ratio, 0.44 (95% CI 0.23-0.82)]. This report contributes to understanding the perception of hearing-related health and occupational exposures among farmworkers in the México-US Southwest border region. The information from this line of research will inform appropriate safety measures known to lower the risk of experiencing occupational NIHL.

A comparison of psychosocial health among individuals with different levels of hearing ability during the COVID-19 pandemic

OBJECTIVE

This study assessed the impact of the COVID-19 pandemic on psychosocial health among individuals with different levels of hearing ability.

DESIGN

For this cross-sectional study, adults completed an online digits-in-noise test and survey. Participants were categorised into "good", "insufficient", or "poor" hearing groups. Survey questions included topics on depression, anxiety, distress, somatisation, and loneliness levels. Multiple logistic, linear, and negative binomial regressions examined differences in psychosocial health between hearing groups. Moderation analyses identified vulnerable subgroups. Mediation analyses examined mediating effects of pandemic measures on hearing ability and psychosocial health.

STUDY SAMPLE

Eight-hundred and sixty-five adults with or without hearing impairment.

RESULTS

Individuals with poor hearing had a higher odds of having elevated anxiety levels and had higher somatisation levels compared to participants with good hearing. Chronic diseases significantly moderated the relationship between poor hearing ability and loneliness. Difficulties with communicating through facemasks, 1.5 m distance, plastic screens, and during video calls significantly mediated the relationships between hearing ability, anxiety and somatisation.

CONCLUSIONS

Results highlight the elevated anxiety and somatisation levels experienced among individuals with hearing impairment during the COVID-19 pandemic. More awareness is needed of the negative impact pandemic measures can have on psychosocial health during future health crises.

Patient Characteristics Impacting Adherence to Serial Observation for Vestibular Schwannomas

OBJECTIVE

To examine patient characteristics that impact serial observation adherence among vestibular schwannoma (VS) patients.

STUDY DESIGN

Retrospective chart review.

SETTING

Single tertiary care center.

METHODS

We selected for VS patients from 201 to 2020 who elected for serial observation as initial management. Patients under 18, with previous management, bilateral or intralabyrinthine VS, and neurofibromatosis type 2 were excluded. Demographics, tumor characteristics, and follow-up status were extracted. Single and multiple logistic regression was used to identify patient characteristics impacting follow-up.

RESULTS

We identified 507 VS patients who chose serial observation as initial management. Most were female (56.0%), white (73.0%), and married (72.8%). The mean age was 59.3 and most had private insurance (56.4%). Median Charlson Comorbidity Index was 2.00. Mean pure tone audiometry (PTA) average was 41.7 Hz. Average tumor size was 9.04 mm. Of 507 patients, 358 (70.6%) returned for at least one follow-up. On multiple logistic regression analysis, patients with private insurance (odds ratio [OR]: 0.39, confidence interval [CI]: 0.22-0.68; P = .001), racial minority background (OR: 0.54, CI: 0.35-0.83; P = .005), worse PTA averages (OR: 0.99, CI: 0.98-1.00; P = .044), and older age at diagnosis (OR: 0.97, CI: 0.95-1.00; P = .038) were less likely to follow-up.

CONCLUSION

Private health insurance, racial minority background, worse PTA average, and older age were associated with decreased follow-up among adult VS patients electing serial observation. Patients with these characteristics may require additional support to ensure serial observation adherence.

Environmental Risk Factors, Protective Factors, and Biomarkers for Hearing Loss: An Umbrella Review

OBJECTIVE

We aimed to investigate the potential environmental risk factors, protective factors, and biomarkers of hearing loss (HL), and establish a hierarchy of evidence.

DATA SOURCES

Embase, PubMed, Cochrane Library, and Web of Science electronic database from inception to June 1, 2023.

REVIEW METHODS

We included meta-analyses of observational studies of associations between HL and environmental risk factors, protective factors, or biomarkers. We calculated summary effect estimates, 95% confidence interval, heterogeneity I2 statistic, 95% prediction interval, small study effects, and excess significance biases.

RESULTS

Of the 9211 articles retrieved, 60 eligible articles were included. The 60 eligible articles identified 47 potential environmental risk and protective factors (N = 4,123,803) and 46 potential biomarkers (N = 173,701). Evidence of association was convincing (class I) for rheumatoid arthritis (RA) and every 1 cm increase in height. Evidence of association was highly suggestive (class II) for human immunodeficiency virus (HIV), diabetes, cumulative noise exposure (CNE), smoking, congenital cytomegalovirus (CMV) infection, combined exposure to organic solvents and noise, non-Gaussian noise exposure, each 1 kg increase in birth weight, noise exposure, and alopecia areata (AA).

CONCLUSION

In this umbrella review, RA, every 1 cm increase in height, HIV, diabetes, CNE, smoking, congenital CMV infection, combined exposure to organic solvents and noise, non-Gaussian noise exposure, each 1 kg increase in birth weight, noise exposure, and AA were strongly associated with HL.

Examining the Relationship Between Hearing Health Beliefs and Social Determinants of Health in Black Adults

OBJECTIVES

Hearing loss is a highly prevalent condition; however, it is widely under-treated, and Black Americans have been found to have significantly lower rates of hearing aid utilization than other ethnic/racial groups. In this exploratory study, we aimed to identify hearing health beliefs among Black adults, guided by the Health Belief Model, with social determinants of health, and examine individual differences in these perspectives.

DESIGN

The Hearing Beliefs Questionnaire (HBQ) was administered online to measure constructs of the Health Belief Model among 200 Black adults aged 18 to 75 (M = 39.14, SD = 14.24). Approximately 13% reported hearing difficulty. In addition, 11 social determinants of health questions were included. Participants were recruited from a university otolaryngology clinic and local Black congregations, meeting inclusion criteria of being 18 or older and Black/African American. Mean scores and SDs for HBQ subscales were calculated. Analysis included analysis of variance and t tests to explore relationships with demographic variables and social determinants of health. Multiple regression analyses predicted HBQ subscale scores from sociodemographic variables.

RESULTS

Mean HBQ subscale scores ranged from 3.88 (SD = 2.28) for Perceived Barriers to 6.76 (SD = 1.93) for Perceived Benefits. Positive correlations were observed between Perceived Severity, Perceived Benefits, and Perceived Self-Efficacy scores and participant educational attainment. Lower economic stability was correlated with poorer scores in Perceived Self-Efficacy, Perceived Severity, and Perceived Benefits. Black adults' willingness to purchase a hearing aid was heavily influenced by their Perceived Benefit, Perceived Severity, and Perceived Self-Efficacy scores, with lower scores correlating with unwillingness to purchase devices. Higher frequency of racism/discrimination and financial hardship correlated with increased Perceived Barriers scores for accessing hearing healthcare. In addition, hearing health beliefs between participants with self-reported hearing difficulty and those without trouble only exhibited differences in the Perceived Susceptibility subscale, with those experiencing hearing difficulty having higher scores in this subscale; no other distinctions were identified.

CONCLUSIONS

The Health Belief Model, used with social determinants of health, revealed associations, and variations, in the hearing health beliefs held by Black adults. The present investigation reveals heterogeneity within this group and pinpoints individuals at higher risk for untreated hearing loss, stemming from their negative perceptions about hearing healthcare. These beliefs are influenced by demographics and social determinants of health, underscoring areas ripe for intervention.

Opening Access but Concealing Contact: A First Study of Over-The-Counter Hearing Aid Consumer-Facing Communications

Hearing loss is a prevalent chronic health condition with approximately 40 million Americans living with mild to moderate hearing loss. Yet, only about 20% will ever pursue hearing interventions. To broaden uptake the FDA approved over the counter (OTC) hearing aid (HA) options in October 2022. A stigmatized health topic, it is both necessary and well-timed to explore how HAs are depicted in consumer-facing communications, which has not been formally studied to date. The present study examines social media posts across a one-year time frame (six months prior and six months following the FDA announcement) from the three most-followed OTC HA brands. With the shift to OTC, HA companies are responsible for communicating directly with consumers. Through the lens of Contact Theory, we explore three mechanisms by which these messages enact stigma, through contact with (1) people, (2) HA products, and (3) a larger brand community. Overall, only 22% of posts discussed OTC in any capacity. Contact was similarly limited, with only 9% of posts showing a person wearing an HA. However, following the FDA announcement, the number of posts depicting people or social relationships doubled (23% to 58% and 13% to 36%, respectively). To overcome stigma and increase uptake of these essential health products, it is important to promote contact with hearing aids and those who wear them. Timely implications for health communication research and practice are discussed.

Diabetes mellitus, hearing loss, and therapeutic interventions: A systematic review of insights from preclinical animal models

OBJECTIVES

The aim of this systematic review article is to evaluate the relationship between diabetes mellitus (DM) and sensorineural hearing loss (SNHL) utilizing preclinical animal models. The review focused on studies assessing SNHL in diabetic animal models, elucidating the mechanisms of DM-associated SNHL, and exploring the response of diabetic animal models to noise overexposure. We also discussed studies investigating the efficacy of potential therapeutic strategies for amelioration of DM-associated SNHL in the animal models.

METHODS

A protocol of this systematic review was designed a priori and was registered in the PROSPERO database (registration number: CRD42023439961). We conducted a comprehensive search on PubMed, Science Direct, Web of Science, Scopus, and EMBASE databases. A minimum of three reviewers independently screened, selected, and extracted data. The risk of bias assessment of eligible studies was conducted using the Systematic Review Center for Laboratory Animal Experimentation (SYRCLE) tool.

RESULTS

Following the screening of 238 studies, twelve original articles were included in this systematic review. The studies revealed that hyperglycemia significantly affects auditory function, with various pathological mechanisms contributing to DM-induced hearing impairment, including cochlear synaptopathy, microangiopathy, neuropathy, oxidative stress, mitochondrial abnormalities, and apoptosis-mediated cell death. Emerging interventions, such as Asiaticoside, Trigonelline, Chlorogenic acid, and Huotanquyu granules, demonstrated efficacy in providing otoprotection for preserving cochlear hair cells and hearing function.

CONCLUSIONS

Our systematic review delves into the intricate relationship between DM and hearing impairment in animal models. Future research should focus on targeted therapies to enhance cochlear mitochondrial function, alleviate oxidative stress, and regulate apoptosis. The association between SNHL and social isolation as well as cognitive decline underscores the necessity for innovative therapeutic modalities addressing yet undiscovered mechanisms. Translating findings from animal models to human studies will validate these findings, offering a synergistic approach to effectively manage DM-associated co-morbidities such as hearing impairment.

How Individuals Shape Their Acoustic Environment: Implications for Hearing Aid Comparison in Ecological Momentary Assessment

OBJECTIVES

When using ecological momentary assessment (EMA) to compare different hearing aid programs, it is usually assumed that for sufficiently long study durations similar situations will be experienced in both programs. However, conscious or subconscious adaptation of situations to one's hearing ability (e.g., asking a conversation partner to speak up, increasing TV volume)-which might be different across the time spent in different hearing aid programs-may challenge this assumption. In the present study, we investigated how test participants modify their acoustic environment and if these modifications depend on the hearing program.

DESIGN

Twenty-nine experienced hearing aid users were provided with hearing aids containing two hearing programs differing in directionality and noise reduction (NR). The hearing programs called NR-on and NR-off changed each day automatically. Over the course of 3 weeks, participants were asked to answer a questionnaire every time they encountered an acoustic situation they modified or would have liked to modify to improve the listening situation. Objective data on sound pressure level and classification of the acoustic situation were collected from the hearing aids. At the beginning of the study participants recollected modifications of the acoustic environments they typically do when using their own hearing aids and reported on the frequency of this behavior.

RESULTS

During the field trial, participants reported on average 2.3 situations per day that they modified or would have liked to modify. Modifications were usually performed quickly after the onset of the situation and significantly improved the pleasantness of the listening situation. While the number of the reported situations did not differ between the programs, modifications increasing the volume of the target signal and increasing the hearing aid volume were more frequent for the NR-on hearing program. Changes in the objective data at the time of the modification were consistent with the reported modifications. Further, the usage time as well as the distribution of the acoustic situations over the entire study period differed between the two hearing programs.

CONCLUSIONS

The large improvement in pleasantness due to the modification might explain the generally positive ratings observed in EMA studies. Furthermore, the results found here suggest that caution is needed when comparing ratings of audiological attributes in EMA, because the different modification behavior across hearing programs may lead to an underestimation of hearing problems and reduced sensitivity when comparing two technologies.

Smartphone-Facilitated In-Situ Hearing Aid Audiometry for Community-Based Hearing Testing

OBJECTIVES

Hearing loss prevalence is increasing, with an estimated 2.5 billion people affected globally by 2050. Scalable service delivery models using innovative technologies and task-shifting are World Health Organization priorities to improve access to hearing care, particularly in low- and middle-income countries. Smartphone-facilitated audiometry in the community using hearing aids covered by noise-attenuating ear cups ("in-situ") could support more accessible hearing care when provided by less trained individuals such as community health workers (CHWs). This study aimed to determine the validity of this method for potential hearing aid fitting. Study objectives included determining the maximum permissible ambient noise level (MPANL), inter-device reliability, clinical threshold accuracy, reliability, and performance in real-world settings.

DESIGN

Experiment 1: 15 normal-hearing adult participants were evaluated to determine MPANLs for circumaural Peltor 3M earcups covering Lexie Lumen hearing aids with smartphone-facilitated in-situ audiometry. MPANLs were calculated by measuring the difference in attenuation between thresholds obtained with standard headphones and in-situ hearing aids. Experiment 2: Pure-tone frequency and intensity output of 14 same-model Lexie Lumen hearing aids were measured to determine inter-device reliability. Pure-tone stimuli were measured and analyzed to determine sound pressure levels in decibels and pure-tone frequency when connected to a test box 2cc coupler. Experiment 3: 85 adult participants were tested in a sound booth to determine the accuracy of automated in-situ pure-tone audiometry (PTA) compared to clinical PTA (500, 1000, 2000, 3000, 4000, 6000 Hz) facilitated by an audiologist. The first 39 participants were tested twice to determine test-retest reliability. Experiment 4: In a community setting, 144 adult participants were tested with automated in-situ audiometry facilitated by CHWs using a smartphone app. These participants were subsequently tested with automated mobile PTA (500, 1000, 2000, 4000 Hz). An additional 44 participants were tested twice to determine test-retest reliability.

RESULTS

Experiment 1: MPANLs of the Peltor 3M earcup-covered hearing aids were higher than standard headphones across all frequencies, ranging from 24 to 47.3 dB SPL. Experiment 2: Inter-device performance reliability was high, with all inter-device differences across all intensities and frequencies less than 3 dB. Frequency output was consistent and differed less than 0.7% between devices. Experiments 3 and 4: 85.2% and 83.3% of automated in-situ audiometry thresholds were within 10 dB of thresholds obtained in the sound booth and in a community setting, respectively. Acceptable test-retest intraclass correlation coefficient (ICC) was evident across all thresholds obtained in a sound booth (ICC = 0.85 to 0.93) and in a community setting (ICC = 0.83 to 0.97).

CONCLUSIONS

Smartphone-facilitated in-situ audiometry allows for reliable and valid community-based testing. A simple smartphone user interface and automated in-situ audiometry allow CHWs with minimal training to facilitate the testing. With the additional capability to program hearing aids via the smartphone after the initial test, this approach would have the potential to support widespread access to personalized hearing aid fittings facilitated by CHWs in low- and middle-income countries. This approach also supports self-fitting options based on in-situ thresholds, enabling testing and fitting via over the counter hearing aids.

Hearing Impairment and Physical Activity and Physical Functioning in Older Adults: Baseline Results From the ACHIEVE Trial

BACKGROUND

Hearing loss is associated with restricted physical activity (PA) and impaired physical functioning, yet the relationship between severity of hearing impairment (HI) and novel PA measures in older adults with untreated HI is not well understood.

METHODS

Analyses included 845 participants aged ≥70 years (mean = 76.6 years) with a better-hearing ear pure-tone average (PTA) ≥30 and <70 dB in the Aging and Cognitive Health Evaluation in Elders (ACHIEVE) study who wore an ActiGraph accelerometer for 7 days. Physical functioning measures included grip strength and the Short Physical Performance Battery (SPPB). Linear regression models estimated the association by HI level (moderate or greater [PTA ≥ 40 dB] vs mild [PTA < 40 dB]) and continuous hearing with total daily activity counts, active minutes/day, activity fragmentation, grip strength, and gait speed. Logistic regression models estimated odds ratios (ORs) and 95% confidence intervals (CIs) of poor performance on the SPPB (≤6) and its subtests (≤2). Mixed-effects models estimated differences by HI level in activity by time of day.

RESULTS

Participants with moderate or greater HI had poorer physical functioning, particularly balance (OR = 2.17, 95% CI = 1.29-3.67), versus those with mild impairment. There was no association of HI level with activity quantities or fragmentation. For diurnal patterns of activity, participants with moderate or greater HI had fewer activity counts in the afternoon (12:00 pm -05:59 pm).

CONCLUSIONS

Older adults with worse hearing had shifted diurnal patterns and poorer balance performance. Exercise programs should be tailored to older adults with different levels of HI to maintain PA and physical functioning, particularly balance control.

Comprehensive Audiologic Analyses After Cisplatin-Based Chemotherapy

Importance

Cisplatin is highly ototoxic but widely used. Evidence is lacking regarding cisplatin-related hearing loss (CRHL) in adult-onset cancer survivors with comprehensive audiologic assessments (eg, Words-in-Noise [WIN] tests, full-spectrum audiometry, and additional otologic measures), as well as the progression of CRHL considering comorbidities, modifiable factors associated with risk, and cumulative cisplatin dose.

Objective

To assess CRHL with comprehensive audiologic assessments, including the WIN, evaluate the longitudinal progression of CRHL, and identify factors associated with risk.

Design, Setting, and Participants

The Platinum Study is a longitudinal study of cisplatin-treated testicular cancer survivors (TCS) enrolled from 2012 to 2018 with follow-up ongoing. Longitudinal comprehensive audiologic assessments at Indiana University and Memorial Sloan Kettering Cancer Center included 100 participants without audiometrically defined profound hearing loss (HL) at baseline and at least 3.5 years from their first audiologic assessment. Data were analyzed from December 2013 to December 2022.

Exposures

Factors associated with risk included cumulative cisplatin dose, hypertension, hypercholesterolemia, diabetes, tobacco use, physical inactivity, body mass index, family history of HL, cognitive dysfunction, psychosocial symptoms, and tinnitus.

Main Outcomes and Measures

Main outcomes were audiometrically measured HL defined as combined-ears high-frequency pure-tone average (4-12 kHz) and speech-recognition in noise performance measured with WIN. Multivariable analyses evaluated factors associated with risk for WIN scores and progression of audiometrically defined HL.

Results

Median (range) age of 100 participants at evaluation was 48 (25-67) years; median (range) time since chemotherapy: 14 (4-31) years. At follow-up, 78 (78%) TCS had audiometrically defined HL; those self-reporting HL had 2-fold worse hearing than TCS without self-reported HL (48 vs 24 dB HL; P < .001). A total of 54 (54%) patients with self-reported HL showed clinically significant functional impairment on WIN testing. Poorer WIN performance was associated with hypercholesterolemia (β = 0.88; 95% CI, 0.08 to 1.69; P = .03), lower-education (F1 = 5.95; P = .004), and severity of audiometrically defined HL (β̂ = 0.07; 95% CI, 0.06 to 0.09; P < .001). CRHL progression was associated with hypercholesterolemia (β̂ = -4.38; 95% CI, -7.42 to -1.34; P = .01) and increasing age (β̂ = 0.33; 95% CI, 0.15 to 0.50; P < .001). Importantly, relative to age-matched male normative data, audiometrically defined CRHL progression significantly interacted with cumulative cisplatin dose (F1 = 5.98; P = .02); patients given 300 mg/m2 or less experienced significantly less progression, whereas greater temporal progression followed doses greater than 300 mg/m2.

Conclusions and Relevance

Follow-up of cisplatin-treated cancer survivors should include strict hypercholesterolemia control and regular audiological assessments. Risk stratification through validated instruments should include querying hearing concerns. CRHL progression relative to age-matched norms is likely associated with cumulative cisplatin dose; investigation over longer follow-up is warranted.

Association of Hearing Loss Onset and Etiology with Psychosocial Outcomes Among US Older Adults

OBJECTIVE

Understand the differential association of onset and etiology of hearing loss with psychosocial outcomes among older adults.

METHODS

This is a cross-sectional cohort study based on 2017-2020 National Health and Nutrition Examination Survey. Adults aged ≥70 years who completed audiometric testing and questionnaires on onset and etiologies of hearing loss were included (n = 612). Outcomes included report of social avoidance and major depressive disorder (MDD, PHQ-9). Multivariable regression was utilized to examine differential associations of onset and etiology of hearing loss on psychosocial outcomes while adjusting for relevant factors.

RESULTS

In this nationally representative sample of US older adults with hearing loss, 20.8% [95%CI: 14.5-29.0%] reported social avoidance due to hearing loss and 7.2% [95%CI: 4.3-11.8] reported symptoms suggestive of MDD. Multivariable regression demonstrated self-reported onset of hearing loss between ages 6-19 years (OR:2.49 [95%CI: 1.52-4.10]) and 20-59 years (OR:1.95 [95%CI: 1.07-3.55]) was associated with higher avoidance of social interaction than reported onset at ≥70 years. Those with onset between 20-59 years (OR:4.28 [95%CI: 1.17-15.6]) and 60-69 years (OR:5.68 [95%CI: 1.85-17.5]) were more likely to report symptoms consistent with MDD than those with onset at ≥70. Multivariable regression did not demonstrate increased risk of avoiding social interactions or MDD due to hearing loss from noise exposure, ear infection, or ear disease versus aging alone.

CONCLUSION

There was an association between earlier hearing loss onset with social avoidance and MDD. This suggests a need for research to investigate the impact of earlier diagnosis and intervention for hearing loss on psychosocial outcomes.

LEVEL OF EVIDENCE

2b Laryngoscope, 2024.

Diabetes and long duration leading to speech-, low/mid-, and high- frequency hearing loss: current evidence from the China National Health Survey 2023

PURPOSE

To examine the effect of diabetes, duration of diabetes, and blood glucose on speech-, low/mid-, and high-frequency hearing loss.

METHODS

In this cross-sectional study, 2821 participants aged 20-87 years in the China National Health Survey were included. Diabetes was defined as valid fasting blood glucose (FBG) of ≥ 7.0 mmol/L, a self-reported history of diabetes or the use of anti-diabetic medications. Speech-(500, 1000, 2000, and 4000 Hz), low/mid- (500, 1000 and 2000 Hz), and high-frequency (4000, 6000, and 8000 Hz) hearing loss was defined as pure tone average of responding frequencies > 20 dB HL in the better ear, respectively.

RESULTS

In fully adjusted models, for speech-, low/mid-, and high-frequency hearing loss, compared with no diabetes, those with diabetes (OR[95%CI]: 1.44 [1.12, 1.86], 1.23 [0.94, 1.61], and 1.75 [1.28, 2.41], respectively) and with diabetes for > 5 years duration (OR[95%CI]: 1.63 [1.09, 2.42], and 1.63 [1.12, 2.36], 2.15 [1.25, 3.70], respectively) were at higher risk. High FBG level was associated with a higher risk of speech-, low/ mid-, and high-frequency hearing loss. And there were stronger associations between HL and diabetes, longer duration and higher in "healthier population" (no hypertension, no dyslipidemia and younger age).

CONCLUSION

Diabetes, longer duration, and higher FBG level were independently associated with hearing loss for speech-, low/mid- and high-frequency hearing loss, particularly in higher frequency and "healthier population". Paying more attention to hearing loss in those populations could lower the burden of hearing loss.

Hearing loss and psychosocial outcomes: Influences of social emotional aspects and personality

The aim of this study was to examine the effects of social isolation, loneliness, anxiety, depression, higher stress, and memory complaints interacting with personality traits as a function of hearing loss. Personality traits have previously been shown to correlate with anxiety and depression, as well as hearing loss, suggesting an effect of personality on the relationship between social emotional outcomes and hearing loss. A cross-sectional survey including validated screening measures was anonymously administered. Measures included personality (Big Five Index-2 Extra-Short Form), stress (Perceived Stress Scale), anxiety and depression (Patient Health Questionnaire for Depression and Anxiety), loneliness (Three-Item Loneliness Scale), social engagement (Lubben Social Network Scale-6), and self-perceived memory complaints (Subjective Cognitive Function). Eight hundred and ninety-one responses were obtained from adults between the ages of 18 and 90 years old (M = 50 years old). Hearing loss was positively correlated with subjective memory complaints only when not accounting for demographic variables, personality traits, psychosocial outcomes, and social emotional outcomes. There were additive effects of hearing loss and negative emotionality on increases in memory complaints in those who self-identified as maybe having hearing loss. Higher degrees of hearing loss also increased loneliness, with greater hearing loss negating the positive correlation between extraversion and social engagement. Overall, our results suggest that hearing loss significantly interacts with personality traits and other social emotional measures. Our results suggest that the impact of hearing loss on memory complaints, social isolation, and loneliness may differ across patients with hearing loss in comparison with those who think they maybe have hearing loss. Information from this study may provide insights for hearing healthcare and mental healthcare professionals to better serve persons with hearing loss who may require additional support or interventions.

Technology-forcing to reduce environmental noise pollution: a prospectus

BACKGROUND

Environmental movements of the late 20th century resulted in sweeping legislation and regulatory actions to reduce the prevalence of diverse pollutants. Although the consequences of noise pollution to public health, environment, and the economy have been recognized over the same time period, noise has received far less policy attention. Correspondingly, even while evidence of the diverse and detrimental effects of noise pollution on human health has grown, solutions and actual reductions in environmental noise remain seemingly out of reach.

OBJECTIVE

To address this shortcoming, we developed a prospectus for environmental noise reduction through technology-forcing policies. Technology-forcing describes intent to encourage technological solutions for pollution control through policy and regulations, and has been a critical component of national and global progress in reducing environmental pollutants.

METHODS

We take advantage of the unique policy history for noise in the United States - which initially enacted, but then abandoned federal noise regulation. We compare this history against outcomes from contemporaneous environmental legislation for air, water, and occupational pollution control, to demonstrate the potential for technology-forcing to reduce noise pollution. Our review then identifies promising solutions, in the form of existing technologies suitable for innovation and diffusion through technology-forcing regulations and incentives.

RESULTS

Based on this review, we outline a program for noise policy development to support efforts to reduce environmental noise pollution worldwide. The proposed program consists of three steps, which are to (i) identify dominant sources of noise pollution, (ii) combine legislative or regulatory provisions with suitable systems of enforcement and incentives, and (iii) anticipate and prepare for stages of technological change.

IMPACT STATEMENT

Analysis of noise policy often focuses on justifying the need to reduce noise pollution. In this article, we demonstrate how technology-forcing regulations could also promote much-needed innovation and diffusion of technologies to reduce environmental noise pollution. We first establish the potential for technology-forcing by comparing technology outcomes from environmental legislation passed contemporaneously to the inactive US Noise Control Act. We next review promising innovations available for diffusion in multiple sectors to reduce environmental noise. Lastly, we recommend a program to support development of technology-forcing noise policies, to help ensure that the benefits of reduced noise pollution are distributed equitably.

The Effects of Light Level and Signal-to-Noise Ratio on the Task-Evoked Pupil Response in a Speech-in-Noise Task

PURPOSE

There is increasing interest in the measurement of cognitive effort during listening tasks, for both research and clinical purposes. Quantification of task-evoked pupil responses (TEPRs) is a psychophysiological method that can be used to study cognitive effort. However, light level during cognitively demanding listening tasks may affect TEPRs, complicating interpretation of listening-related changes. The objective of this study was to examine the effects of light level on TEPRs during effortful listening across a range of signal-to-noise ratios (SNRs).

METHOD

Thirty-six adults without hearing loss were asked to repeat target sentences presented in background babble noise while their pupil diameter was recorded. Light level and SNRs were manipulated in a 4 × 4 repeated-measures design. Repeated-measures analyses of variance were used to measure the effects.

RESULTS

Peak and mean dilation were typically larger in more adverse SNR conditions (except for SNR -6 dB) and smaller in higher light levels. Differences in mean and peak dilation between SNR conditions were larger in dim light than in brighter light.

CONCLUSIONS

Brighter light conditions make TEPRs less sensitive to variations in listening effort across levels of SNR. Therefore, light level must be considered and reported in detail to ensure sensitivity of TEPRs and for comparisons of findings across different studies. It is recommended that TEPR testing be conducted in relatively low light conditions, considering both background illumination and screen luminance.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.25676538.

Hearing and Functioning in Everyday Life Questionnaire: Psychometric Evaluation and Revision

PURPOSE

The aim of the current study was to explore the construct validity and internal consistency reliability of the International Classification of Functioning, Disability and Health (ICF)-based original English version of the Hearing and Functioning in Everyday Life Questionnaire (HFEQ) and to revise the HFEQ based on the results.

METHOD

This study used a cross-sectional survey design. The data were collected using an online survey. Adults with self-reported hearing disability (n = 513) from the United States were included. The ICF components of body functions, activity and participation, and environmental factors were tested as the underlying structure of the HFEQ using confirmatory factor analysis and then adjusted by triangulation with previous content validation.

RESULTS

The results of the current study confirmed the ICF components of body functions, activity and participation, and environmental factors as underlying constructs of the HFEQ. However, after triangulation with previous content validation, fine adjustments were made. The revised version of the HFEQ includes two removed items and a fine-tuned factor structure.

CONCLUSION

The results confirm that the structure of the HFEQ aligns with the ICF, and the overall results indicate that HFEQ has acceptable construct validity and internal consistency.

Life space limitations in visually impaired older adults

SIGNIFICANCE

Future work should develop and evaluate interventional strategies to help overcome visual and health-related barriers to travel in visually impaired seniors and mitigate adverse impacts of loneliness for those who do not leave town.

PURPOSE

Life space refers to the area in which a person travels within a given time period. We explored whether demographics, vision, and/or health characteristics were related to restrictions in self-reported life space for visually impaired seniors.

METHODS

Visually impaired (n = 114) clinical trial participants aged ≥55 years learned visual assistive iPhone apps and completed the following baseline questionnaires: Life Space, 36-Item Short-Form Health Survey, University of California, Los Angeles Loneliness Scale, and New-General Self-efficacy Scale. Multiple logistic regressions evaluated associations between life space and patient factors after accounting for their distance to the next county or state.

RESULTS

During 2021 to 2023, 17%, 43%, and 70% of participants had not left their town, county, or state, respectively, in the past 3 months, or planned to in the next 3 months. Those with reduced distance best-corrected visual acuity had greater odds of not leaving the county in these time frames (odds ratio [OR] = 3.5; p=0.04). Minority race was associated with greater odds of not leaving town or the county in the past 2 weeks or future 3 months (OR = 4.3 to 6.4; p=0.009 to 0.049). Increased self-efficacy was associated with reduced odds of not leaving the state in the past 3 months, next 3 months, or past and/or future 3 months (OR = 0.54 to 0.55; p=0.02 to 0.03). Better physical function was associated with reduced odds of not leaving the state in the past 2 weeks or 3 months (OR = 0.96 to 0.98; p=0.01 to 0.04). Increased loneliness was related to greater odds of not leaving town in the past and/or future 3 months (OR = 1.8 to 2.0; p=0.007 to 0.009).

CONCLUSIONS

Minority race, reduced vision, self-efficacy, and physical health were related to life space restrictions in this cohort of visually impaired seniors, whereas loneliness was greater among those who were not leaving town.