Association between hearing impairment and the quality of life of elderly individuals

Hearing impairment is one of the most common chronic health problems of elderly Americans. Although adverse effects on quality of life are thought to be considerable, they have not been rigorously evaluated. This study was designed to identify the types and extent of dysfunction experienced by elderly individuals with hearing loss, and to define the most appropriate measures for assessing this dysfunction. Elderly male veterans attending a primary care clinic were screened for hearing loss and had their quality of life assessed with a comprehensive battery of disease-specific and generic measures. Of 472 people who had their hearing tested, 106 had hearing loss. Hearing loss was associated with significant emotional (P = .0001), social (P = .0001), and communication (P = .02) dysfunction. Most individuals (66%) perceived these dysfunctions as severe handicaps even though audiologic loss revealed only mild to moderate impairment (pure tone average loss, 27-55 dB). Adverse effects were best detected with disease-specific rather than generic functional status measures. We conclude that hearing impairment is associated with important adverse effects on the quality of life of elderly individuals, and that these effects are perceived as severe handicaps even by individuals with only mild to moderate degrees of hearing loss.     

Reducing a barrier to diabetes education: identifying hearing loss in patients with diabetes

PURPOSE: Recent research suggests that hearing loss, a frequent problem for aging adults, is more prevalent in people with diabetes. Hearing impairment affects a patient's learning. This article reviews the anatomy and physiology involved in hearing, describes common causes of hearing loss in people with diabetes, and describes how hearing loss is diagnosed and treated. Two simple tests the diabetes educator can use to screen for hearing loss are described, and interventions that improve communication with patients with difficulty hearing are explained. CONCLUSIONS: Hearing loss can negatively affect a patient's ability to actively participate in diabetes education. Diabetes educators have a responsibility to learn how to communicate better with their patients who have a hearing impairment. Diabetes educators are uniquely positioned to improve the health status of their patients by identifying persons who need referral for further evaluation of their hearing.     

Visual and hearing impairment among rural elderly of south India: A community‐based study

Aim: Of India's population, 76.6 million (7.2%) are aged above 60 years. Increasing age is associated with increasing disability and functional impairments such as low vision, loss of mobility and hearing impairment. Hence, the purpose of this paper is to study the prevalence of hearing and visual impairment among a rural elderly population in South India and its association with selected variables. Methods: This was a cross‐sectional study of elderly persons in two villages of Bangalore District, Karnataka, South India. Elderly persons identified were administered a questionnaire for assessment of demographic details, health and function related information. Visual acuity was checked using Snellen's E chart for distant vision. Hearing was assessed using pure tone audiometry. Results: Two hundred and fifty‐seven (12.2%) of the population were elderly in these two villages. Seventy‐two (32.4%) of the elderly persons were facing problems completely or partially in at least one of the activities and 10 (4.5%) elderly persons had cognitive impairment. Sixty‐two (35.4%) of the elderly had low vision and 22 (12.6%) were blind. On assessment with pure tone audiometry, 117 (66.9%) of the elderly persons had some degree of hearing impairment. Forty‐three (24.6%) of the elderly had disabling hearing impairment. Forty‐seven (26.9%) of the elderly had combined low vision associated with hearing impairment and 18 (10.2%) had combined blindness along with hearing impairment. As age advanced there was a significant increase in visual, hearing and combined impairments. Conclusion: Visual and hearing impairment are important health problems among elderly persons in rural areas of South India. Geriatr Gerontol Int 2012; 12: 116–122.     

Mechanisms of age-related hearing loss and strategies for protection and restoration of hearing

Hearing impairment is the most frequent disability in elderly individuals; however, we have limited options for treatment of age-associated hearing loss. To establish novel strategies for the treatment of age-associated hearing loss, it is crucial to elucidate the mechanisms of age-associated hearing loss. Studies on animal models and human temporal bones have indicated a close relationship between degeneration of the spiral ganglion neurons and stria vascularis and age-associated hearing loss. We have developed a drug delivery system using biodegradable gel for the inner ear to protect inner ears against aging. In addition, recent studies on cell therapy for the inner ear have suggested the efficacy of cell transplantation for restoration of hearing.     

Quality of life determinants and hearing function in an elderly population: Osservatorio Geriatrico Campano Study Group

BACKGROUND: Hearing impairment (HI) is a very common condition in elderly people and the epidemiology together with hearing-related problems is still poorly investigated. Moreover, the cognitive status may be impaired in relation to hearing function. OBJECTIVE: The goal of the study was to evaluate: (a) the prevalence of HI in a random sample of elderly people aged 65 and over (n = 1,750) living in Campania, a region of southern Italy; (b) the cross-sectional relationship between hearing function and cognitive status and also depressive symptomatology and disability, and (c) to assess the role of hearing aids on depressive symptomatology. METHODS: Cross-sectional study on a random sample of elderly population. RESULTS: The overall participation rate in the study was 74.8% (n = 1,332, mean age was 74.2 +/- 6.4 years). The prevalence rate of HI (evaluated by questionnaire) was 27.2%, cognitive impairment prevalence (evaluated by the Mini-Mental State Examination (MMSE)) was 27.9%, mean depressive symptomatology score (evaluated by Geriatric Depression Scale (GDS)) was 11.4 +/- 6.6, while disability assessed by Activity of Daily Living (ADL) was present in 7.0% of the whole population. A strong relationship was found between both decreasing hearing function and MMSE decline, independently by the effect of age and education (r = 0.97; p < 0.01). A positive relationship (r = 0.85; p < 0.01) between GDS score and hearing function was also found. Moreover, at an increased level of hearing loss, a lower ADL score was recorded (r = 0.98; p < 0.01). Finally, the use of hearing aids reduced GDS score. In logistic regression analysis, gender, age and educational level indicate that hearing loss risk increased with age (odds ratio 1.60; 95% confidence interval 1.53-1.71), whereas education plays a protective role (odds ratio 0.75; 95% confidence interval 0.72-0.80). CONCLUSION: HI is very prevalent among elderly people and is associated with either cognitive impairment and/or depression and reduction of functional status. This study suggests that hearing aids may protect against cognitive impairment and disability, improving quality of life of aged people. Copyrightz1999S.KargerAG,Basel     

Validation of the use of self-reported hearing loss and the Hearing Handicap Inventory for elderly among rural Indian elderly population

Hearing loss is a potentially disabling problem among elderly leading to physical and social dysfunction. Though audiometric assessment of hearing loss is considered as gold standard, it is not feasible in community settings. Several questionnaires measuring hearing handicap have been developed. Knowledge regarding applicability of these questionnaires among rural elderly is limited, hence a study was planned to validate single question and Shortened Hearing Handicap Inventory for Elderly (HHIE-S) in detecting hearing loss against pure tone-audiometry among rural Indian elderly. A single question 'do you feel you have a hearing loss?' and the HHIE-S was administered to 175 elderly in two rural areas. Hearing ability was assessed using pure tone audiometry. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of both screening tools were compared with pure tone averages (PTAs) greater than 25, 40 and 55dB hearing level (mild, moderate and severe hearing loss, respectively). The single question yielded low sensitivity (30.9%) and high specificity (93.9%) for mild hearing loss. Similarly HHIE-S yielded a sensitivity of 26.2% and specificity of 95.9%. Sensitivity with single question increased to 76.2% and specificity decreased to 83.1% with severe hearing loss. Sensitivity with HHIE-S also increased to 76.2% and specificity decreased to 87.7% with severe hearing loss. These hearing screening questionnaires will be useful in identifying more disabling hearing losses among rural elderly which helps in rehabilitation services planning.     

Hearing impairment as a determinant of function in the elderly

This clinical, practice-based study explores the research question: Is there a relationship between hearing loss and functional disturbance in elderly patients? We analyzed the impact of hearing impairment on 153 patients over 65 years of age screened in primary care practice. Functional and psychosocial impairment were measured using the Sickness Impact Profile (SIP), a standardized measure for assessing sickness related dysfunction. Hearing level was determined with pure tone audiometry. Multiple linear regression was used to adjust for patient case-mix differences and other clinical variables. After adjustment, a 10 dB increase in hearing loss was found to result in a 2.8 point increase in Physical SIP scores (95% confidence interval = 1.8–3.8), a 2.0 point increase in psychosocial SIP scores (95% confidence interval = 0.8–3.2) and a 1.3 point increase in overall SIP scores (95% confidence interval = 0.1–2.5). Poor hearing was associated with higher SIP scores and increased dysfunction. Thus, hearing impairment is an important determinant of function in the elderly.     

The effects of improving hearing in dementia

BACKGROUND: audiological function is impaired in people with dementia and poor hearing is known to exaggerate the effects of cognitive deficits. OBJECTIVE: the objective of this study was to assess the effects of increasing auditory acuity by providing hearing aids to subjects with dementia who have mild hearing loss. METHOD: subjects were screened for hearing impairment and fitted with a hearing aid according to standard clinical practice. Measures of cognition and psychiatric symptoms, activities of daily living, and burden on carers were made over 6 months. Hearing aid diaries were kept to record the acceptability of the hearing aids to the subjects. RESULTS: more than 10% of eligible subjects were excluded as removal of wax restored hearing. Subjects showed a decline in cognitive function, no change in behavioural or psychiatric symptoms over the study period. Forty-two percent of subjects showed an improvement on an independently rated measure of change. The hearing aids were well accepted. Both carers and subjects reported overall reduction in disability from hearing impairment. CONCLUSIONS: all patients with hearing impairment require thorough examination. The presence of dementia should not preclude assessment for a hearing aid as they are well tolerated and reduce disability caused by hearing impairment. Hearing aids do not improve cognitive function or reduce behavioural or psychiatric symptoms. There is evidence that patients improved on global measures of change.     

Effects of hearing aids on cognitive functions and depressive signs in elderly people

With the physical, emotional and cognitive effects of senility, elderly people, especially those with impaired hearing, need rehabilitation for improving their life conditions. Hearing aids are frequently used to improve their daily life communications and activities. The aim of this study was to report the cognitive and psychological benefits of using hearing aids by the elderly people, over the age of 65. This was a prospective, single-arm interventional study in 34 elderly subjects with hearing impairment who answered the geriatric depression scale-short form (GDS) questionnaire and the mini mental state examination (MMSE) test, prior to, and 3 months following the use of hearing aid, after obtaining the patients’ consent to participate in study. Patients with evidence of focal neurological loss with clinical examination, a confusional state, sudden hear loss and severe tinnitus were not included in the study. Scores of the effects of hearing aids on mood and cognitive functions were compared for each subject, before and after, and between males and females. After 3 months of using a hearing aid, all patients showed a significant improvement of the psychosocial and cognitive conditions, and all of them showed betterment of their problems, i.e., the social communication and exchanging information. In conclusion, for the elderly people with the effects of hearing aids in presbycusis and due to the significant improvement in psychological state and mental functions, using and being adaptable to hearing aids is a good solution.     

Sensory impairments and subjective well-being among aged African American persons

The limited number of studies concerning the prevalence of hearing loss and vision impairment and their causes, and the lack of strategies to prevent or treat the deleterious effects of hearing loss and vision impairment, point to a significant gap in the knowledge base concerning aged minority populations. This cross-sectional study evaluated the relationship between vision and hearing impairment and psychological well-being among a sample of 988 elderly African American persons. Fair or poor vision or hearing was reported for 36.5% and 26% of our sample, respectively. Reported prevalence rates for these impairments are considerably higher than rates previously documented in comparable studies of elderly people conducted in general (i.e., predominantly White) populations. Eighty-four percent of our study participants attempted to improve their vision through the use of eyeglasses. By contrast, only 4.3% of individuals in the study who described their hearing as poor reported using hearing aids. Using multivariate analysis and other related variables that have previously been identified as common predictors of psychological well-being, the findings of this study suggest that poor vision is independently associated with a lower level of psychological well-being among aged African Americans even after adjusting for sociodemographic characteristics, functional limitations, perceived health status, and cognition. Poor hearing was also found to be associated with a lower level of psychological well-being; however, this relationship was not independent but was mediated by the effect of hearing on functional status. These data indicate considerable potential for improved psychological well-being for African American elderly people through visual and audiological rehabilitation.     

中国老年性耳聋的研究与干预进展

老年性耳聋已成为影响我国老年人生活质量的最主要的慢性病之一。助听器是目前帮助听力损失的老年人克服交流障碍的主要手段。在我国,数字助听器已逐渐取代模拟助听器并且体现出了更好的效果。但是老年听力损失患者中使用助听器的比例仍然很小。人工耳蜗植入也已被应用在老年患者中。我国针对老年人的听力康复服务还有较长的路要走。     

Effects of hearing impairment on use of health services among the elderly

OBJECTIVES. To assess the effects of hearing impairment on health-service use in an elderly population, controlling for factors associated with hearing difficulties known to affect utilization. METHODS. Diagnoses of hearing impairment, depression, and chronic illnesses were used in hierarchical regression procedures to predict the volume and probability of any service use among 1,436 randomly selected 65-year-old health maintenance organization members. RESULTS. Hearing impairment substantially increased the likelihood of making at least one visit to a health care provider (OR = 3.31, 95%; CI = 1.55-7.06). Among those who made such visits, however, hearing impairment did not lead to use of additional services despite expectations to the contrary. DISCUSSION. Further research should explore whether underutilization of services exists, and, if so, whether it stems from clinician or patient attitudes about the seriousness of hearing impairment, from a paucity of available treatment strategies, or from some combination of these and other factors.     

Hearing loss is a risk factor of disability in older adults: A systematic review

Background and ObjectivesHearing loss (HL) is a public health problem affecting older adults. HL is not only a health condition but also a complex, dynamic phenomenon related to disability. Previous studies identified associations between HL and undesirable outcomes; however, their correlation remains inconclusive. Hearing loss can have profound impact on daily life in the elderly, and an understanding of how HL contributes to disability is needed. A systematic review was conducted to comprehensively examine current evidence and determine the association between HL and disability regarding impairment, activity and participation in older adults.Research Design and MethodsThe Meta-analysis Of Observational Studies in Epidemiology (MOOSE) guidelines were applied in this systematic review. Quality assessment was conducted using the Newcastle-Ottawa Scale for longitudinal studies and the Joanna Briggs Institute (JBI) Critical Appraisal Checklist for cross-sectional studies.ResultsIn this systematic review of 20 studies, HL was associated with mobility limitation, activity limitation and participation restriction. The severity of HL was associated with impaired mobility and physical performance, but the association was only found in persons with severe/major HL. HL was also associated with activities of daily living (ADL) dependency, however these findings were mainly based on cross-sectional studies.Discussion and ImplicationsHL is related to disability by impairment, activity limitations or participation restrictions in older adults. Future studies should include participation restrictions as a mediation factor to better understand this association. Consistent and accurate hearing measurements and hearing loss criteria are also required to determine the impact of HL on disability.     

Comprehensive Geriatric Assessment for outpatients is important for the detection of functional disabilities and depressive symptoms associated with sensory impairment as well as for the screening of cognitive impairment

Background:   The Comprehensive Geriatric Assessment (CGA) for inpatients is very useful to improve the outcomes of elderly patients. However, most of the elderly patients are provided their care by general practitioners in primary care settings without comprehensive assessment. Concise and practical assessment is necessary for the detection of geriatric problems and sufficient care in the outpatient clinic.
Methods:   The CGA was introduced in the outpatient clinic for elderly people in Kyoto University Hospital and 309 patients participated in the study, where cognitive impairment, depressive symptoms, activities of daily living, and self-reported hearing and visual impairment were assessed.
Results:   In the patients studied, the most prevalent chief complaint was memory loss (19%). Among the patients complaining of memory loss, two-thirds of the patients were diagnosed as cognitively impaired by the Mini-Mental State Examination. Multiple logistic regression analysis showed that hearing and visual impairment was significantly associated with functional disabilities and that hearing impairment was significantly associated with depressive symptoms.
Conclusions:   Thus, the CGA for outpatients is useful for the detection of functional disabilities and depressive symptoms by asking about their sensory impairment as well as for the detection of cognitive impairment in elderly patients. Therefore, concise and practical assessment should be introduced in the primary care settings to improve the quality of life of elderly people.     

Functional status of elderly people with hearing loss

The objective is to determine the prevalence of hearing loss in people over 65 years of age, to describe the functional status of people with hearing loss and to identify the need for hearing aid use. In a cross-sectional study, a random sample of 1387 people aged 65 years and over was selected. The primary study variables were: hearing level by audiometric assessment, self-perceived hearing loss, screening for hypoacusia using the Hearing Handicap Inventory for the Elderly-Screening (HHIE-S) and physical, cognitive and emotional functional status. Using the HHIE-S it was determined that 11.3% of the subjects had severe hearing handicap. According to the Ventry/Weinstein criteria 43.6% had hearing handicap. When asked about the use of hearing aids, 4.5% of the study subjects said they used them, although 41.9% had hearing loss of 35 dB or more in their better ear. The variables associated with the need for a hearing aid were age >75 years (odds ratio=OR=3.2), ADL dependence (OR=2.7), cognitive impairment (OR=2.0), multiple health problems (OR=1.8), male sex (OR=1.6) and single/widowed (OR=1.5). In conclusion, there is a high prevalence of hearing loss associated with other functional limitations. Of those people who would benefit from a hearing aid (more than a third of people over 65 years old), 89.3% do not own one. The screening of hearing loss needs to be improved.     

老年人听力功能与认知功能关系的探讨

目的：探讨老年听力下降患者认知功能与听力的关系。方法以90名年龄≥60岁上海地区军队离退休干部为研究对象。根据其听力情况分为3组（ A组为听力正常组,B组为听力下降助听器辅助治疗组,C组为听力下降未治疗组）,每组30名受试者。对入选患者进行认知功能量表测定,比较各组认知功能情况,分析老年认知功能与听力水平的关系。结果3组受试者认知功能使用四分位数描述,简易智力状态量表结果分别为：26.00（22.00,28.00）、25.00（21.00,28.00）、22.00（16.00,24.00）;蒙特利尔认知评估量表结果：27.00（26.00,28.00）、26.00（25.00,27.00）、22.00（19.00,23.00）;画钟测试结果：4.00（3.50,4.00）、4.00（3.00,4.00）、2.00（1.00,3.00）;日常生活能力量表结果：20.00（19.75,21.25）、21.00（19.50,24.25）、24.50（22.00,28.00）。采用非参数检验统计,3组间比较各量表差异有统计学意义（P＜0.001）;两两组间比较各量表得分,A组与B组比较,P＞0.05;A组与C组比较,P＜0.001;B组与C组比较,P＜0.001。结论认知功能在听力障碍未治疗组患者中明显下降,听力障碍是老年认知功能障碍的重要相关因素之一,助听器辅助治疗对认知功能有改善作用。     

Molecular and hereditary mechanisms of sensorineural hearing loss with focus on selected endocrinopathies

Hearing loss is one of the most widespread sensory disorders. The incidence of deafness in general population is 1:1000 newborns. About one half of the cases of the congenital sensorineural hearing loss (SNHL) is inherited. Recessive mutations in the gap junction beta 2 (GJB2) gene are the most common genetic causes of the nonsyndromic SNHL. The GJB2 encodes a?protein connexin 26 which forms a?subunit of gap junction essential for the correct function of the inner ear. The syndromic SNHL is associated with a?wide range of other symptoms, which encompass also dysfunctions of endocrine organs. The Pendred syndrome associated with the hearing impairment is characterized by a?prelingual, bilateral sever to profound SNHL, goiter, and iodine organification defect. It is an autosomal recessive disorder, which develops due to mutations in pendrin, an anion channel encoded by SLC26A4 gene. Another important type of syndromic hearing loss is the Maternally Inherited Diabetes and Deafness syndrome, which is caused by several mitochondrial DNA mutations. These mutations are clinically manifested by a?hearing impairment with development of the diabetes in the adult age. Hearing impairment occurs during puberty when sensation of high frequency tones is affected following with further progress to profound bilateral sensorineural hearing impairment in the whole frequency range. This review deals with the molecular mechanisms of common genetic causes of the hereditary SNHL along with the selected endocrinopathies emphasizing that the DNA analyses along with the functional studies significantly contribute to the early SNHL diagnosis followed by personalized therapy and genetic counseling. Keywords: hearing impairment, inner ear, connexin, Pendred syndrome, diabetes.     

Hearing Acuity as a Predictor of Walking Difficulties in Older Women

OBJECTIVES: To examine whether hearing acuity correlates with walking ability and whether impaired hearing at baseline predicts new self‐reported walking difficulties after 3 years. DESIGN: Prospective follow‐up. SETTING: Research laboratory and community. PARTICIPANTS: Four hundred thirty‐four women aged 63 to 76. MEASUREMENTS: Hearing was measured using clinical audiometry. A person was defined as having a hearing impairment if a pure‐tone average of thresholds at 0.5 to 4 kHz in the better ear was 21 dB or greater. Maximal walking speed was measured over 10 m (m/s), walking endurance as the distance (m), covered in 6 minutes and difficulties in walking 2 km according to self‐report. RESULTS: At baseline, women with hearing impairment (n=179) had slower maximal walking speed (1.7 ± 0.3 m/s vs 1.8 ± 0.3 m/s, P=.007), lower walking endurance (520 ± 75 m vs 536 ± 75 m, P=.08), and more selfreported major difficulties in walking 2 km (12.8% vs 5.5%, P=.02) than those without hearing impairment. During follow‐up, major walking difficulties developed for 33 participants. Women with hearing impairment at baseline had a twice the age‐adjusted risk for new walking difficulties as those without hearing impairment (odds ratio=2.04, 95% confidence interval=0.96–4.33). CONCLUSION: Hearing acuity correlated with mobility, which may be explained by the association between impaired hearing and poor balance and greater risk for falls, both of which underlie decline in mobility. Prevention of hearing loss is not only important for the ability to communicate, but may also have more wide‐ranging influences on functional ability.     

The Effect of Sensory Impairment on the Lifestyle Activities of Older People

Objective : To evaluate the relative effects of hearing and vision impairments on the lifestyle activities of older people. Method : The sample was drawn from the Australian Longitudinal Study of Ageing, and consisted of 1,052 participants aged 70 years and over. Lifestyle activities were assessed using the Adelaide Activities Profile. Hearing and vision impairments were determined on the basis of clinical assessments using pure tone audiometry and a Snellen chart respectively. Self-report measures of the effect of sensory impairment on activities were recorded. Results : Respondents with either a hearing or vision impairment were likely to report that their hearing or vision affected their activities. Indeed, vision impairment was associated with an objective reduction in lifestyle activities in domestic chores and household maintenance. Among males vision impairment was also associated with reduced social activities. Hearing impairment had no direct effect on lifestyle activities, nor was there any significant joint effect of hearing and vision impairment. Conclusions : Vision impairments are more likely to lead to reductions in activities than hearing impairments, particularly when the activities are physically demanding or optional. However, age may be a more important determinant of reduced activities than sensory impairment.