The role of social engagement in the association of self-reported hearing loss and health-related quality of life

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.

Association between depression status and hearing loss among older adults: The role of outdoor activity engagement

BACKGROUND

More than half of Chinese older adults over 60 are suffering from hearing loss, which might increase the risk of depression. Outdoor activity engagement is a key factor to alleviate depression symptoms. This study is conducted to analyze the associations between hearing loss and depression, and explore the role of outdoor activity engagement on depression.

METHODS

This study was based on the Chinese Longitudinal Healthy Longevity Survey (CLHLS), which collected the health and demographic information of elderly people in 23 provinces in China. In total, 12,333 older adults over 60 were recruited in the final analysis. Participants' risk of depressive symptoms was assessed using the 10-item Center for Epidemiologic Studies Depression Scale (CESD-10). The relationship between self-reported hearing loss and depression in older adults was tested using logistic regression models.

RESULTS

The findings suggested a significant relationship between self-reported hearing loss and depressive symptoms (OR = 1.513, 95%CI = 1.391-1.646, P < 0.001). In addition, outdoor activity engagement have a moderation effect on self-reported hearing loss, among which entertainment and physical activities can better reduce the risk of depression.

CONCLUSION

Evidence from this study suggests that older adults with self-reported hearing loss can perform appropriate outdoor activities. Early recognition and intervention in hearing loss may reduce the risk of depression.

Association of social integration with cognitive function trajectories among Chinese older adults: evidence from the China health and retirement longitudinal study (CHARLS)

Background

The prevalence of cognitive impairment among older adults remains high. It has been proven that social integration is related to cognitive function. However, limited research has examined the association of social integration and its different dimensions with cognitive function trajectories of older adults.

Methods

The data were from the China Health and Retirement Longitudinal Study (CHARLS) spanning 2013 (T1) to 2018 (T3). A total of 3,977 older adults were included in the final analysis. Cognitive function was measured with items from an adapted Chinese version of the Mini-Mini-Mental Mental State Examination (MMSE), while the measurement of social integration included three dimensions: economic integration, relational integration and community integration. A group-based trajectory model (GBTM) was used to identify cognitive trajectory groups among participants and an unordered multinomial logistic regression was employed to explore the association of baseline social integration and its three dimensions with cognitive function trajectories.

Result

Three cognitive function trajectory groups were identified: low-decline group (24.1%), medium-decline group (44.2%) and high-stable group (31.7%). Comparing to the medium-decline trajectory group, older adults with higher social integration scores were more likely to be in the high-stable trajectory group (OR = 1.087, 95%CI: 1.007 ~ 1.174), while less likely to be in the low-decline group (OR = 0.806, 95%CI: 0.736 ~ 0.882). Among the different dimensions of social integration, older adults with higher community integration scores were more likely to be in the high-stable trajectory group (OR = 1.222, 95%CI: 1.026 ~ 1.456); Older adults with higher relational integration scores were less likely to be in the low-decline trajectory group (OR = 0.816, 95%CI: 0.734 ~ 0.906). The economic integration was not found to correlate with the cognitive function trajectories. Stratified analyses revealed that the association between community integration and cognitive trajectories was only significant among older adults aged 60 to 69, and the association between relational integration and cognitive trajectories was only significant among older adults who was agricultural household registration.

Conclusion

The developmental trajectories of cognitive function among Chinese older adults are heterogeneous. Social integration is significantly related to the trajectories of cognitive function in Chinese older adults. Measures should be taken to promote social integration of Chinese older adults to reduce the decline of cognitive function.

Relationship between intrinsic capacity and health-related quality of life among community-dwelling older adults: the moderating role of social support

PURPOSE

To examine how social support might moderate the relationship between intrinsic capacity and health-related quality of life (HRQoL) based on the buffering model of social support.

METHODS

This was a cross-sectional study with a sample of 1181 Chinese community-dwelling older adults aged ≥ 60 years in 2016. Social support was assessed using the Social Support Rating Scale. Intrinsic capacity was assessed using the revised integrated care for older people screening tool. HRQoL was measured by the 12-item Short Form Health Survey. Hierarchical linear regression analysis was implemented to test the moderating effect of social support.

RESULTS

Support utilization attenuated the relationship between lower intrinsic capacity and poor physical HRQoL while subjective support attenuated the relationship between lower intrinsic capacity and poor mental HRQoL. However, objective support had no significant moderating effect on the relationship between intrinsic capacity and specific domains of HRQoL.

CONCLUSION

The moderating effects of social support on the association between intrinsic capacity and HRQoL vary by support types. Effective interventions should target the perception and utilization of available support among older adults with lower intrinsic capacity to maintain their physical and mental HRQoL.

Prevalence and risk factors of hearing loss among the middle-aged and older population in China: a systematic review and meta-analysis

PURPOSE

This paper was aimed at estimating the prevalence and risk factors of hearing loss (HL) among the middle-aged and elderly in China.

METHODS

Databases including the CQVIP (VIP) Database, Chinese National Knowledge Infrastructure (CNKI), China Biology Medicine disc (CBMdisc), Wanfang, PubMed, Web of Science, Excerpta Medica Database (Embase) and the Cochrane Library were comprehensively searched. In this review, random-effect models were used for pooling the prevalence of HL and the odds ratios (ORs) of potential risk factors.

RESULTS

34 studies were included in the meta-analysis. HL among the middle-aged and elderly in China had a pooled prevalence of 45% (95% confidence interval (CI) 40-51%). There were significant differences in the prevalence of HL between males and females (47% vs. 42%), between different screening methods by self-report and pure-tone audiometry (44% vs. 46%), between the middle-aged and the elderly (18% vs. 52%), and between the uneducated and the educated (49% vs. 36%). In urban areas, the prevalence was slightly higher than that in rural areas (50% vs. 48%). The findings suggested that the middle-aged and elderly in the South Central China region (61%, 95% CI 45-78%) and Northwest China (57%, 95% CI 55-58%) were more likely to develop HL. In addition, it was confirmed that advanced age, being male, noise exposure history, hypertension and hyperglycemia were related to a higher prevalence of HL among middle-aged and older adults.

CONCLUSION

The prevalence of HL among the middle-aged and older population in China is 45%, nearly half of the total population. It is urgent to take great efforts to raise people's awareness of HL prevention and early hearing screening.

Hearing and sociality: the implications of hearing loss on social life

Hearing is essential to the formation of social relationships and is the principal afferent of social life. Yet hearing loss, which is one of the most prevalent forms of sensory disability worldwide and is critical for social development, has received little attention from the social interventionalist perspective. The purpose of this mini-review is to describe the basic neurobiological principles of hearing and to explore the reciprocal relationships between social support, hearing loss, and its psychosocial comorbidities. We also discuss the role of social enrichment in sensorineural recovery and identify open questions within the fields of hearing physiology and social networks.

Effect of Determinants of Health on the Hearing Care Framework: An Economic Perspective

Hearing care is expanding accessibility to consumers through new service delivery channels and methods of technology distribution (see Brice et al, this issue). This diversification has the potential to overcome longstanding consumer disparities (e.g., health, socioeconomic, psychological, environmental) in receiving care and provider constraints (e.g., accessibility, geography, direct access) to delivering care that adversely impacts quality of life (e.g., social isolation, depression, anxiety, self-esteem). In this article, the reader is provided with an overview of health outcomes factors (i.e., determinants of health)-in the context of an economic framework (i.e., supply, demand)-and their effect on consumer behavior and provider preferences toward hearing healthcare services. This overview also affords readers with strategic business insights to assess and integrate future hearing care services and technology to consumers in their local markets.

Audiological benefit, quality of life, and factors associated with functional gain in elderly hearing aid users in a developing country between 2017 and 2020: a pre-post-study

BACKGROUND

Sensorineural hearing loss (SNHL) is the most common auditory deficit in older adults and may lead to quality-of-life deterioration. However, few studies have been performed in low/middle-income countries, particularly in Latin America. This study aimed to assess the audiological benefit, quality of life, and factors associated with functional gain in elderly hearing aid users in the Fundación Santa Fe de Bogotá and UNIMEQ-ORL, two otology referral centers in Colombia.

DESIGN

Pre-post study that included hearing aid users at the otology consult of the Fundación Santa Fe de Bogotá and UNIMEQ-ORL between June 2017 and December 2020. Glasgow Benefit Inventory (GBI) and Abbreviated Profile of Hearing Aid Benefit (APHAB) questionnaires were applied. Audiometric (0,5 kHz to 4 kHz) and speech audiometry results were collected.

RESULTS

A total of 75 participants (132 ears) were included. The mean age was 70.73 years (SD: 12.66). The median hearing aid use in years was 0.71 (IQR: 0.64-0.90). Mean change in speech audiometry was - 26.53dB (95%CI: -28.09, -24.97; p < 0.001), in functional gain was - 21.75dB (-23.81, -19.68; p < 0.001). The mean changes in the APHAB domains were Ease of Communication: -37.85 (95%CI: -43.01; -32.7), Background Noise: -3.51 (-6.06; -0.95), and Aversiveness of Sounds: -6.9 (-2.04; 11.77). The GBI assessment of quality of life showed improvement in 100% of the population after the use of hearing aids. The number of years of hearing aids use was associated with functional gain.

CONCLUSION

The number of years of hearing aids use may impact on the functional gain in these populations. A significant clinical benefit was found in terms of quality of life, communication, and reverberation related to the use of hearing aids. Access to hearing aids should be granted, and public health strategies are needed to grant the access to hearing rehabilitation in these populations.

TRIAL REGISTRATION

Fundación Santa Fe de Bogotá (Protocol Number: CCEI-12666-2020).

Functional Hearing Impairment, Psychological Resilience, and Social Well-Being Among Chinese Older Adults in Low-Income Households

PURPOSE

Hearing loss (HL) is prevalent and relates to social health in old age. This study aims to examine the association between functional HL and social well-being (SWB) in older adults and to investigate whether psychological resilience mediates this association.

METHOD

The analytical sample of 4,531 older adults aged ≥ 60 years was from the Sample Survey on Vulnerable Populations from Poor Families in Urban/Rural China (2018). SWB was measured by social networks and social engagement using the Lubben Social Network Scale and Index of Social Engagement Scale, respectively. Functional hearing impairment was defined by a dichotomized measure of self-perceived hearing difficulty. Psychological resilience was assessed by a 25-item Connor-Davidson Resilience Scale. Structural equation modeling was performed to determine associations of HL with SWB and the mediating roles of psychological resilience.

RESULTS

Functional HL was associated with reduced SWB among older adults living in low-income households. Hearing-impaired individuals were more likely to be socially isolated and less socially engaged compared to those with normal hearing. The association persisted in gender subsamples and in non-low-income households but not in older adults aged ≥ 70 years. Psychological resilience partially mediated the association of hearing impairment with SWB, accounting for 50.9% of the variance in the change of SWB.

CONCLUSIONS

Functional hearing impairment may be a modifiable risk factor for social restrictions and downstream older adults' health. Promotion of hearing health care and accessibility to coping resources including psychological support may improve social wellness among the older adults and benefit healthy aging.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.22750736.

Effects of Language, Age, and Hearing Loss on Health-Related Quality of Life

Objective

To understand the effect of age on health-related quality of life (HRQoL) in patients with hearing loss and determine how primary language mediates this relationship.

Study Design

Cross-sectional study.

Setting

General otolaryngology clinic in Los Angeles.

Methods

Demographics, medical records, and HRQoL data of adult patients presenting with otology symptoms were reviewed. HRQoL was measured using the Short-Form 6-Dimension utility index. All patients underwent audiological testing. A path analysis was performed to generate a moderated path analysis with HRQoL as the primary outcome.

Results

This study included 255 patients (mean age = 54 years; 55% female; 27.8% did not speak English as a primary language). Age had a positive direct association with HRQoL (p < .001). However, the direction of this association was reversed by hearing loss. Older patients exhibited significantly worse hearing (p < .001), which was negatively associated with HRQoL (p < .05). Primary language moderated the relationship between age and hearing loss. Specifically, patients who did not speak English as a primary language had significantly worse hearing (p < .001) and therefore worse HRQoL (p < .01) than patients who spoke English as a primary language with hearing loss. Increasing age was associated with bilateral hearing loss compared to unilateral hearing loss (p < .001) and subsequently lower HRQoL (p < .001). Polypharmacy (p < .01) and female gender (p < .01) were significantly associated with lower HRQoL.

Conclusion

Among otolaryngology patients with otology symptoms, older age and not speaking English as a primary language were associated with worse hearing and subsequently lower HRQoL.

Health-related quality of life associated with sensory impairment in Chinese middle-aged and older adults: a cohort study

BACKGROUND

The impact of sensory impairment (SI) on individual multidimensional health has not been adequately explored in developing countries. This study examined the association of hearing or/and visual impairment with health-related quality of life (HRQoL) in the Chinese middle-aged and older population, and further explored potential discrepancies in associations by gender and rural-urban residence.

METHODS

This cohort study used four-wave data during 2011-2018 from the China Health and Retirement Longitudinal Study, and enrolled 13 342 community-dwelling adults aged 45 years or older. We employed linear mixed effects models to estimate the longitudinal associations between SI and HRQoL, and conducted interaction tests to assess gender or rural-urban differences in above associations.

RESULTS

Hearing impairment (HI) and visual impairment (VI) were separately and jointly associated with deteriorated overall HRQoL and decreased physical/mental component of HRQoL (all β<0, all p<0.05), and in particular, dual sensory impairment (DSI) exhibited greater impacts on HRQoL than either HI or VI alone. The impacts of SI on HRQoL were more evident among women or rural population than their counterparts (all p for interaction<0.05).

CONCLUSION

This study observed decreased HRQoL in association with SI. The greater impact of DSI underlines the need for integrated care for comorbid sensory conditions. Our findings also indicate the necessity to reduce the burden of SI among more vulnerable populations such as females and rural adults.

The impact of hearing loss on cognitive impairment: The mediating role of depressive symptoms and the moderating role of social relationships

Background

Given the potentially negative effects of hearing loss on mental health and cognitive function, it is critical to gain a better understanding of the mechanisms underlying the link between hearing loss and cognitive impairment. This study aimed to investigate the moderating effects of social relationships, including their components in the role of depressive symptoms as a mediator between hearing loss and cognitive impairment.

Methods

Cross-sectional analyses were conducted with 8,094 Chinese older adults (aged ≥65 years) from the Chinese Longitudinal Healthy Longevity Survey in 2018. Simple mediation analysis and moderated mediation analysis were conducted to examine the roles of depressive symptoms and social relationships in the association between hearing loss and cognitive impairment.

Results

There is a significant correlation between hearing loss, depressive symptoms, social relationships, and cognitive function. Depressive symptoms partially mediated the association between hearing loss and cognitive function [standardized regression B-coefficient (B) = -0.114; 95% confidence interval (CI): (-0.158, -0.076)]. Social relationships moderated the effect of hearing loss on cognitive function through both path b (depressive symptoms - cognitive function) [B = 0.021; 95% CI: (0.008, 0.034)], and path c' (hearing loss-cognitive function) [B = 0.597; 95% CI: (0.463, 0.730)]. Furthermore, social activities and social networks moderated both the direct and indirect effects of moderated mediation. However, there appeared to be no moderated effect of social support for both the direct and indirect paths.

Conclusion

Social relationships moderated both the direct and indirect effects of depressive symptoms on the association between hearing loss and cognitive impairment. These findings shed light on the mechanisms underlying the relationship between hearing loss and cognitive impairment in Chinese older adults. It might be worthwhile to recommend multidimensional health and social interventions aimed at improving mental health and social inclusion among older adults with hearing loss.

Factors associated with health-related quality of life among home-dwelling older adults aged 75 or older in Switzerland: a cross-sectional study

BACKGROUND

HRQoL is an indicator of individuals' perception of their overall health, including social and environmental aspects. As a multidimensional concept, HRQoL can be influenced by a multitude of factors. Studies of HRQoL and factors associated with it among home-dwelling older adults have often been limited to inpatient settings or to a sub-population with a chronic disease. Studying HRQoL and its correlating factors among this population, by providing an ecological lens on factors beyond the individual level, can provide a better understanding of the construct and the role of the environment on how they perceive their HRQoL. Thus, we aimed to assess the HRQoL and investigate the correlates of HRQOL among home-dwelling older adults, guided by the levels of the ecological model.

METHODS

This is a cross-sectional population survey conducted in 2019 in Canton Basel-Landschaft, in northwestern Switzerland, and includes a sample of 8786 home-dwelling older adults aged 75 and above. We assessed HRQoL by using the EQ-index and the EQ-VAS. The influence of independent variables at the macro, meso and micro level on HRQoL was tested using Tobit multiple linear regression modelling.

RESULTS

We found that having a better socio-economic status as denoted by higher income, having supplementary insurance and a higher level of education were all associated with a better HRQoL among home-dwelling older adults. Furthermore, being engaged in social activities was also related to an improved HRQoL. On the other hand, older age, female gender, presence of multimorbidity and polypharmacy as well as social isolation and loneliness were found to all have a negative impact on HRQoL.

CONCLUSIONS

Understanding factors related to HRQoL by using an ecological lens can help identify factors beyond the individual level that impact the HRQoL of home-dwelling older adults. Our study emphasises the importance of social determinants of health and potential disparities that exists, encouraging policymakers to focus on policies to reduce socio-economic disparities using a life-course approach, which consequently could also impact HRQoL in later stages of life.

Does Hearing Impairment Affect Mental Health Among Chinese Older Adults? Evidence from the Chinese Longitudinal Healthy Longevity Survey

Background and Aim

Hearing impairment is a commonly reported chronic condition among older adults. Hearing impairment is significantly associated with reduced quality of life and diminished function status. This study aimed to investigate the association between hearing impairment and mental health among Chinese older adults, with a focus on exploring the moderating effects of social participation and exercise on this association.

Methods

The data of this study were obtained from the 2018 wave of Chinese Longitudinal Healthy Longevity Survey (CLHLS). We employed ordinary least squares regression models to analyze the effect of hearing impairment on mental health. Propensity score matching (PSM) and doubly robust estimation were employed to conduct robustness checks.

Results

Hearing impairment produced an adverse effect on Mini-Mental State Examination (MMSE) score (coefficient = -1.4073, p < 0.001), while it had a positive effect on depression score (coefficient = 0.8682, p < 0.001). Further analyses using PSM and doubly robust estimation reported similar results. Moreover, social participation (coefficient = 0.9424, p < 0.001) and exercise (coefficient = 0.7001, p < 0.01) moderated the association between hearing impairment and MMSE score. Social participation (coefficient = -0.5991, p > 0.05) and exercise (coefficient = 0.7806, p > 0.05) did not moderate the association between hearing impairment and depression score.

Conclusion

We provide robust evidence indicating that hearing impairment had significantly negative effects on the cognitive function and depression status of older adults. Furthermore, we find that social participation and exercise relieved the negative effect of hearing impairment on cognitive function.

Sensorineural hearing dysfunction after discharge from critical care in adults: A retrospective observational study

Background

Patients undergoing intensive care are exposed to risk factors for hearing impairment. This study assessed the worse changes in pure tone average (PTA) thresholds after intensive care and identified the factors associated with worse hearing function.

Methods

We conducted a single-centre retrospective study, and included adult patients admitted to the intensive care unit (ICU) of Kurashiki Central Hospital between January 2014 and September 2019, who had regular pure tone audiometry performed before and after ICU admission. Correlations between changes in PTA threshold and patient characteristics, were evaluated. The included ears were classified as those with worse hearing (>10 dB increase in the PTA threshold) and those without worse hearing, and the baseline characteristics were compared.

Results

During the study period, 125 ears of 71 patients (male:female ratio, 35:36; mean age, 72.5 ± 12.3 years) met the eligibility criteria. Age, sex, and the use of furosemide were not correlated with changes in PTA threshold. Univariate analysis showed that ears with worse hearing were associated with a lower serum platelet count than ears without worse hearing (153 ± 85 × 10⁹/L vs. 206 ± 85 × 10⁹/L, respectively; P = 0.010), and the rate of planned ICU admission (elective surgery) was higher in the worse hearing group (57.1% vs. 28.8%, respectively; p = 0.011).

Conclusions

Age, sex, and the use of furosemide did not have adversely affect hearing function. Low serum platelet count and planned admission appear to be risk factors for worse hearing.