Prevalence of Subclinical Hearing Loss in the United States

OBJECTIVE

Current definitions of hearing loss (HL) may be insufficiently strict, as subclinical hearing loss (SCHL; >0 and ≤25 dB hearing level) has been associated with deleterious age-related conditions. SCHL prevalence and mean age of HL onset in the United States has not been characterized.

STUDY DESIGN

A cross-sectional epidemiologic prevalence study.

SETTING

US Community.

METHODS

We analyzed cross-sectional audiometric data in the US National Health and Nutrition Examination Survey (2005-2012, 2015-2018, n = 15,649). Results were scaled to the current population using weighting.

RESULTS

79.6% of participants (227.32 million Americans) had SCHL. The mean age of HL onset at thresholds of 25, 20, and 15 dB was 74, 66, and 55 years, respectively, for the 4-frequency pure-tone average, and 48, 44, and 35 years for the high-frequency pure-tone average.

CONCLUSION

We present SCHL prevalence and define HL onset by various sensitive definitions. These results inform ongoing public health efforts to increase hearing aid utilization, particularly given the arrival of over-the-counter hearing aids.

The Association Between Self-Reported Hearing Loss and Loss of Usual Source of Health Care Among Older Medicare Beneficiaries: Evidence From the National Health and Aging Trends Study

Background and Objectives

The purpose of the study is to investigate the association of hearing loss (HL) with maintaining a usual source of care (USOC).

Research Design and Methods

In this study we implemented a time-to-event analysis using data from the National Health and Aging Trends Study (NHATS), a nationally representative study of older Medicare beneficiaries in the United States. The study sample included 2 114 older adults, aged 65+ years, 58.9% female, 20.4% Black, who reported having a USOC during the baseline round of NHATS and who remained community-dwelling during the 2011-2018 study period. Based on self-report measures at baseline, individuals' hearing status was classified into 3 categories: no HL, treated HL (hearing aids users), and untreated HL (nonhearing aid users who reported having hearing difficulties). Time-to-event was computed as the time elapsed between baseline and the study round in which the respondent first reported no longer having a USOC. Discrete-time proportional hazard models were estimated.

Results

In fully adjusted models, untreated HL at baseline was associated with a hazard ratio (HR) for losing one's USOC 1.60 (95% confidence interval: 1.01, 2.56) times higher than that of participants with no HL. We found no HR differences between the treated- and no-HL group.

Discussion and Implications

Untreated HL at baseline was associated with a higher probability of losing one's USOC over time. Noninvasive interventions such as hearing aids may be beneficial for maintaining a USOC.

MIDLIFE PHYSICAL ACTIVITY AND HEARING IMPAIRMENT IN LATE LIFE: ATHEROSCLEROSIS RISK IN COMMUNITIES (ARIC) STUDY

Background

Cardiovascular risk factors are associated with worse hearing, but the role of mid-life physical activity (PA) on hearing loss at older ages is yet to be investigated.

Methods

Among 3,198 participants of the Atherosclerosis Risk in Communities study, we investigated the association between self-reported mid-life PA (meets PA recommendations [≥150 minutes of moderate-to-vigorous PA/week] vs. not) and hearing loss (audiometric battery [pure-tone and speech-in-noise]) at older ages. We estimated differences in hearing between those who met and did not meet PA recommendations at mid-life and at late life adjusting for demographics, medical conditions, and noise exposure.

Results

43.3% participants met PA recommendations at mid-life. These participants, compared to those who did not meet recommendations, had lower better hearing by 1.51 (0.46, 2.55) decibels, and 0.37 (0.01, 0.74) more words identified in the speech-in-noise test.

Conclusions

Meeting PA recommendations in mid-life was associated with better hearing at older ages.

OLDER ADULTS LEAVING THE WORKFORCE: SENSORY LOSS, RETIREMENT, AND DISABILITY

Hearing loss (HL), vision loss (VL), and their combination (dual sensory loss, DSL) are common among older adults. Sensory loss impacts labor productivity which might result in departures from the workforce. Whether older adults leave due to retirement or a disability, and how these responses are associated with sensory loss remains unexplored. Using the 2004-2018 rounds of the Health and Retirement Study, self-reported sensory loss (No Impairment/HL/VL/DSL) at baseline, and reason for leaving the workforce (retirement or disability) were observed. Competing risk models models for departures from the workforce treating retirement or disability as a competing risk were estimated. Among 5,201 adults employed at baseline, ages 50-94, 3,436 reported retirement, and 4254 reported a disability as a reason for not working. In Fine-Gray models, treating retirement as a competing risk and adjusting for sociodemographic and clinical characteristics, we found that compared to older adults without impairments, DSL was associated with a 50% increase in the rate of departures from the labor force due to disability among adults in the in the risk group (SHR=1.51; 95% CI=1.09,2.11). In contrast, when treating disability as the competing risk, HL was associated with a 22% increase in the rate of departures labor force due to retirement (SHR=1.22; 95% CI=1.10,1.36) among adults in the risk group when compared to those without impairments. In sample of older adults, we provide evidence that the presence of sensory impairments is associated with departures from the workforce. Our results highlight differences in the type of departures by sensory loss.

ADVANCING HEARING HEALTH EQUITY FOR OLDER ADULTS: FINDINGS FROM THE HEARS RCT

Hearing loss is highly prevalent but disparities exist in hearing care. Delivering care in partnership with community health workers (CHWs) is an established approach to addressing disparities but has not been robustly studied in hearing care. We recruited older adults with hearing loss from community sites in Baltimore, MD. The 2-hour intervention consists of fitting a low-cost amplification device and counseling.151 participants were randomized. The primary outcome was change in communication function (Hearing Handicap Inventory for the Elderly-Screening [HHIE-S]; range 0-40; higher scores indicate poorer function). Communication function significantly improved in the intervention group, with an intention to treat estimated average treatment effect of a -12.98 point change (95% CI: -15.52, -10.42). In the first randomized control trial of a CHW-delivered hearing care intervention for older adults using low-cost amplification devices, participants receiving the intervention demonstrated a treatment effect comparable to prior studies of conventional hearing aids fit by audiologists.

HEARING LOSS, HEARING AID USE, AND NEUROPSYCHIATRIC SYMPTOMS IN DEMENTIA: FINDINGS FROM NACC

Hearing loss is highly prevalent among persons living with dementia (PWD) and associated with an increased risk of neuropsychiatric symptoms (NPS), while hearing aid use may be protective. We analyzed data from the National Alzheimer’s Coordinating Center’s (NACC) uniform data set. We estimated the association between hearing loss and number or severity of NPS in a negative binomial regression adjusting for demographic and clinical characteristics. In the subsample with hearing loss, we estimated the association between hearing aid use and number or severity of NPS.10,054 participants were included with a mean age of 75 years. 2,416 (24%) self-reported hearing loss with 71% reporting 2+ NPS. In PWD and hearing loss, 1,325 (54.8%) reported hearing aid use. After a well-balanced matching, in adjusted models, hearing aid use was associated with fewer (IRR=0.82; 95%CI=0.77,0.87) and less severe NPS (IRR=0.74; 95%CI=0.69,0.80). Hearing aid use may represent an underutilized, non-pharmacological intervention to address NPS.

Working while Caring for Older Adults with Hearing Impairment and Dementia: Evidence from the NSOC

Age-related hearing loss (HL) and dementia are common among older adults. The implications of caregiving for older adults with dementia is documented. Whether the presence of HL modifies these association is unknown. We used data from the 2011 NHATS/NSOC. Hearing loss and dementia were identified among care recipients (CR). Our outcomes included: hours of care provided, and caregiver’s work activities. Among 1,013 caregivers, 456 assisted individuals without HL or dementia (HL-/D-), 229 with dementia (D+), 193 with HL, and 135 with HL and dementia (HL+/D+). In fully adjusted models, as compared to caregivers of HL-/D-, caregivers of D+ spent 39.1 hours more (95% CI: 13.6,64.6) in caregiving, caregivers of HL+/D+ spent 56.6 more hours (95% CI: 25.1,88.1). We found no differences in work activities between CR groups. The presence of HL increases the caregiving needs of adults with dementia. The additional time does not affect the labor participation of caregivers.

Neuropsychiatric Symptoms and Hearing Loss in Dementia: Unmet Need and Opportunity for Intervention

Hearing loss is one of the most common comorbidities among persons with dementia, with prevalence of 60->90%. Most go untreated and disparities exist. However, sensory impairment may influence the health of individuals and care partners. We will share findings from a clinic-based cohort of persons with dementia (n=101). Controlling for demographic and clinical factors, we found that every 10 decibel increase in hearing loss was associated with nearly an additional neuropsychiatric symptom (b = 0.7 per 10 dB; p = 0.01) and 1.3-point increase in severity (b = 1.3 per 10 dB; p = 0.04). These findings provide the first estimates that utilize objective audiometry. Furthermore, hearing aid use appeared to be protective. Hearing care may represent an additional, but underutilized, non-pharmacological intervention. We will discuss these findings in the context of the epidemiology of hearing loss in dementia and highlight new opportunities for managing hearing loss through community-based approaches.

Hearing Loss and Preventable Hospitalizations

Nearly half of all adults over the age of 60 years have hearing loss. Recent research suggests adults with hearing loss experience increased health care expenditures and hospitalization. However, little is known about whether these are preventable hospitalizations which may indicate poorer healthcare system engagement. In this cross-sectional analysis, we examined data from combined 2016-2018 Medicare Current Beneficiary Survey (MCBS) datasets. Participants are asked to describe their self-perceived trouble hearing. Preventable hospitalizations were defined and generated from administrative claims files based on the Agency for Healthcare Research and Quality identified conditions that should be manageable in ambulatory care settings. Multivariate regression models adjusted for demographic/socioeconomic characteristics and general health determinants were used to explore the association between trouble hearing and outcomes. The combined 2016-2018 MCBS administrative claims files included 18,814 participant-years, 49.8% reported no trouble hearing, 43.4% reported a little trouble and 6.8% a lot of trouble hearing, respectively. A higher proportion of those with a lot of trouble hearing (6.8%) experienced at least one preventable hospitalization compared to those with a little trouble hearing (3.4%) and no trouble hearing (2.5%). In a fully adjusted logistic regression model, hearing loss was associated with 1.35 times the odds of experiencing at least one preventable hospitalization per year (OR=1.35; 95% CI=1.03-1.77). Medicare beneficiaries with hearing loss experience higher rates of preventable hospitalizations. This may be due to avoidance of care due to communication barriers. Further work is needed to understand underlying reasons and whether addressing hearing loss modifies the observed association.

Early Retirement and Sensory Impairments: The Modifying Effect of Total Assets

Sensory impairments are common among older adults. Little is known on the association between sensory impairments, which impact labor productivity, and the effect modification of wealth. We used the 2006-2018 rounds of the Health and Retirement Study. Hearing (HI) and vision (VI) impairments (self-report) at baseline, and working status throughout the study period was observed. Logistic regression models, adjusted for demographic, socioeconomic, and health characteristics, were used to characterize the association of sensory impairment and early retirement (i.e., before age 65). Secondary analysis stratified by assets. Among 1,688 adults ages 53-64, 1,350 had no impairment, 140 had HI only, 141 VI only, and 57 had dual sensory impairment (DSI). Only adults with HI had higher odds of early retirement (Odds Ratio [OR]: 1.6; 95% Confidence Interval [CI]: 1.0,2.5) relative to those without sensory impairment. Among those with large assets, those with HI had higher odds (OR:2.6, 95% CI: 1.4,5.2) and those with VI had lower odds (OR. 0.37; 95% CI: 0.2,0.8) of early retirement. Among the low asset group, we found no differences across impairment groups for the odds of retirement. In sample of older adults, we provide evidence that the presence of hearing impairment is associated early retirement. Secondary analyses suggest wealth may modify this association which highlights the wealth disparities faced by people with sensory impairments.

Sensory Loss and Delirium Among Medicare Beneficiaries

Sensory impairment is prevalent among older adults and may increase risk for delirium via mechanisms including sensory deprivation and poor communication which may result in confusion and agitation. In the Medicare Current Beneficiary Study (MCBS), delirium was measured using a validated algorithm of claims data. Sensory impairment was defined as any self-reported trouble hearing or seeing, with the use of aids, and was categorized as no impairment, hearing impairment only (HI), vision impairment only (VI), and dual sensory impairment (DSI). Among, 3,240 hospitalized participants in 2016-2017, 346 (10.7%) experienced delirium. In a model adjusted for socio-demographic and health characteristics, those with HI only, VI only, and DSI had 0.84 (95% CI: 0.6-1.3), 1.1 (95% CI 0.7-1.7), and 1.5 (95% CI 1.0-2.1) times the odds of experiencing delirium compared to those without sensory impairment. Future research should focus on mechanisms underlying association and determine the impact of treatment of sensory loss.

Trends in Hearing Aid Use Among Older Adults in the United States, 2011-2018

Hearing loss among older adults is prevalent and associated with dementia and health care utilization. However, cross-sectional data suggest less than 20% of adults with hearing loss use hearing aids. There is a paucity of studies examining trends in hearing aid ownership over time. This study analyzed data from the 2011, 2015, and 2018 cycles of the National Health Aging and Trends Study (NHATS), a nationally-representative longitudinal study of Medicare Beneficiaries. Participants were asked “in the last month, [have you/has [he/she]] use a hearing aid or other hearing device?” (“yes” or “no”). Among a weighted sample of Medicare Beneficiaries 70 years and older (26.47 million in 2011; 29.70 million in 2015; and 33.28 in 2018), the overall proportion who own and use hearing aids rose from 14.96% in 2011 to 16.90% in 2015 to 18.45% in 2018. As age increased so did the proportion of older adults who used hearing aids. A smaller proportion of Black Americans used hearing aids across time and experienced a smaller overall increase in the proportion in hearing aid ownership over the 8-year period compared to White Americans (+0.78% vs. +4.30%). Black women had the lowest rates of hearing aids use across the 8-year period. Notably, older adults at less than 100% of the federal poverty level experienced an overall decrease in proportion of hearing aid ownership and use. This study lays the groundwork to examine the impact of the Over-the-Counter Hearing Aid Act of 2017 across subpopulations when it takes effect in 2021.

The Association of Sensory Impairment With Incident Disability-Related Cessation of Employment in Older Adults

Sensory impairment (SI) is common among older adults, and it is an increasingly important public health challenge as the population ages. We evaluated the association between SI and incident disability-related cessation of employment in older adults using the population-based Health and Retirement Study. Participants employed in 2006 completed biennial interviews until self-reported incident disability-related cessation of employment. Participants were censored at loss to follow-up, retirement, or 2018. Participants rated their vision and hearing, using eyeglasses or hearing aids if applicable, on a Likert scale (poor, fair, good, very good, excellent). SI was defined as poor or fair ability, and SI was categorized as neither SI (NSI), vision impairment alone (VI), hearing impairment alone (HI), and dual SI (DSI). Cox proportional hazard regression assessed the association between SI and incident disability-related cessation of employment, adjusting for demographic and health covariates. Overall, 4726 participants were included: 421 (8.9%) were with VI, 487 (10.3) with HI, and 203 (4.3%) with DSI. Mean age was 61.0 ± 6.8 years, 2488 (52.6%) were women, and 918 (19.4) were non-White. In the fully adjusted model, incident disability-related cessation of employment over the 12-year follow-up period was higher in VI (Hazard Ratio (HR)=1.30, 95% confidence interval (CI)=0.92, 1.85), HI (HR=1.60, CI=1.16, 2.22), and DSI (HR=2.02, CI=1.38, 2.96). These findings indicate that employed older adults with SI are at increased risk of incident disability-related cessation of employment, and that older adults with DSI are particularly vulnerable. Addressing SI in older adults may lengthen their contribution to the workforce.