Hearing loss and depressive symptoms in elderly patients

Aims: Hearing loss is a common disability that has a profound impact on communication and daily functioning in the elderly. The present study assesses the effects of hearing aids on mood, quality of life and caregiver burden when hearing loss, comorbidity and depressive symptoms coexist in the elderly. Methods: A total of 15 patients aged older than 70 years suffering from hearing loss and depressive mood were recruited. Comorbidity was evaluated by the Cumulative Illness Rating Scale, functional ability by the Activities of Daily Living scale and the Lawton Instrumental Activities of Daily Living scale, cognitive capacity by the Mini‐mental State Examination and the Clock Drawing Test, psychological status by the Center for Epidemiological Studies‐Depression scale, and quality of life by the Short Form (36) Health Survey. Caregiver burden was appraised by the Caregiver Burden Inventory. Testing was carried out at baseline and at 1‐, 3‐ and 6‐month intervals, assessing the use of binaural digital and programmable hearing aids. Results: Reduction in depressive symptoms and improved quality of life at statistically significant levels were observed early on with the use of hearing aids. In particular, general health (P < 0.02), vitality (P < 0.03), social functioning (P < 0.05), emotional stability (P < 0.05) and mental health (P < 0.03) all changed for the better, and were maintained for the study duration. The degree of caregiver burden also declined, remaining low throughout the study. Conclusions: The benefits of digital hearing aids in relation to depressive symptoms, general health and social interactivity, but also in the caregiver – patient relationship, were clearly shown in the study. The elderly without cognitive decline and no substantial functional deficits should be encouraged to use hearing aids to improve their quality of life. Geriatr Gerontol Int 2012; 12: 440–445.     

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.     

Relationship of Type 2 diabetes to the prevalence,incidence and progression of age‐related hearing loss

Aims Type 2 diabetes and associated microvascular abnormalities are postulated to affect hearing. Our study reports on the relationship between Type 2 diabetes and the prevalence, 5‐year incidence and progression of hearing impairment in a representative, older, Australian population. Methods The Blue Mountains Hearing Study is a population‐based survey of age‐related hearing loss conducted in a defined suburban area, west of Sydney. Hearing loss was defined as the pure‐tone average of frequencies 0.5, 1.0, 2.0 and 4.0 kHz > 25 decibels hearing level (dB HL) in the better ear (bilateral hearing loss). Type 2 diabetes was defined from reported physician‐diagnosed diabetes or fasting blood glucose ≥ 7.0 mmol/l. Results Age‐related hearing loss was present in 50.0% of diabetic participants (n = 210) compared with 38.2% of non‐diabetic participants (n = 1648), odds ratio (OR) 1.55 [95% confidence interval (CI) 1.11–2.17], after adjusting for multiple risk factors. A relationship of diabetes duration with hearing loss was also demonstrated. After 5 years, incident hearing loss occurred in 18.7% of participants with, and 18.0% of those without diabetes, adjusted OR 1.01 (CI 0.54–1.91). Progression of existing hearing loss (> 5 dB HL), however, was significantly greater in participants with newly diagnosed diabetes (69.6%) than in those without diabetes (47.8%) over this period, adjusted OR 2.71 (CI 1.07–6.86). Conclusions Type 2 diabetes was associated with prevalent, but not incident hearing loss in this older population. Accelerated hearing loss progression over 5 years was more than doubled in persons newly diagnosed with diabetes. These data explore further reported links between Type 2 diabetes and age‐related hearing loss.     

Hearing impairment affects older people's ability to drive in the presence of distracters

OBJECTIVES: To investigate the effects of hearing impairment and distractibility on older people's driving ability, assessed under real‐world conditions. DESIGN: Experimental cross‐sectional study. SETTING: University laboratory setting and an on‐road driving test. PARTICIPANTS: One hundred seven community‐living adults aged 62 to 88. Fifty‐five percent had normal hearing, 26% had a mild hearing impairment, and 19% had a moderate or greater impairment. MEASUREMENTS: Hearing was assessed using objective impairment measures (pure‐tone audiometry, speech perception testing) and a self‐report measure (Hearing Handicap Inventory for the Elderly). Driving was assessed on a closed road circuit under three conditions: no distracters, auditory distracters, and visual distracters. RESULTS: There was a significant interaction between hearing impairment and distracters, such that people with moderate to severe hearing impairment had significantly poorer driving performance in the presence of distracters than those with normal or mild hearing impairment. CONCLUSION: Older adults with poor hearing have greater difficulty with driving in the presence of distracters than older adults with good hearing.     

A comparison of the MMSE and the TICS‐m in hearing‐impaired older adults

Objective: The efficacy of telephone‐administered cognitive screening instruments used with hearing‐impaired populations is as yet unknown. Method: In a pilot study, performance of hearing‐impaired veterans (N = 46) was compared on telephone‐administered (Telephone Interview for Cognitive Status – modified; TICS‐m) and face‐to‐face administered (Mini‐Mental State Examination; MMSE) instruments. Results: Correlations between the MMSE and the TICS‐m (r = 0.39) are lower than previously reported in the literature. Participants had difficulty perceiving words from the TICS‐m on registration and thus also on later recall, regardless of whether hearing aids were worn. Further analyses revealed that when these items were removed from the TICS‐m scores, correlations with the MMSE improved significantly. Conclusions: Hearing‐impaired participants may have difficulties with telephone‐administered instruments requiring accurate hearing of words in the absence of any context. Participants’ hearing should be taken into account when administering and interpreting cognitive screens over the telephone.     

Hearing and vision loss within residential care facilities ‐the need for improved service delivery

Objective: To assess the level of hearing impairment within residential care facilities and to determine the efficacy of providing aural rehabilitation services within the facility. Method: 178 elderly residents participated in this project. The procedures included case history, pure‐tone screening, otoscopic examination, vision screening, hearing aid assessment and sentence identification. Results: Despite 87.1% of participants having a significant hearing impairment only 43.3% currently wore hearing aids. Linked to poor hearing aid use was the fact that 43.9% of hearing aids required some degree of maintenance. Otoscopic examination revealed 42.1% of ear canals to be occluded with cerumen to a degree that medical intervention was required. Sentence identification revealed the importance of aiding and access to contextual and visual cues (lip‐reading) for this population. Conclusions: This study confirms the high prevalence of hearing impairment amongst the elderly and makes a case for increased rehabilitation services being directed towards this population particularly in the areas of hearing aid maintenance, cerumen removal and delivery of communication skills training to residential care workers.     

Variation in Prostate‐Specific Antigen Screening in Men Aged 80 and Older in Fee‐for‐Service Medicare

OBJECTIVES: To determine the rate of prostate‐specific antigen (PSA) screening in men aged 80 and older in Medicare and to examine geographic variation in screening rates across the U.S. DESIGN: Retrospective cohort study of variation across hospital referral regions using administrative data. SETTING: National random sample in fee‐for‐service Medicare. PARTICIPANTS: Medicare beneficiaries aged 80 and older in 2003. MEASUREMENTS: Percentage of men aged 80 and older screened using the PSA test. RESULTS: The national rate of PSA screening in men aged 80 and older was 17.2%, but there was wide variation across regions (<2–38%). Higher PSA screening in a region was positively associated with greater total costs (correlation coefficient (r)=0.49, P<.001), greater intensive care unit use at the end of life (r=0.46, P<.001), and greater number of unique physicians seen (r=0.36, P<.001). PSA screening was negatively associated with proportion of beneficiaries using a primary care physician as opposed to a medical subspecialist for the predominance of ambulatory care (r=?0.38, P<.001). CONCLUSION: PSA screening in men aged 80 and older is common practice, although its frequency is highly variable across the United States. Its association with fragmented physician care and aggressive end‐of‐life care may reflect less reliance on primary care and consequent difficulty informing patients of the potential harms and low likelihood of benefit of this procedure.     

Hearing sensitivity in older adults: associations with cardiovascular risk factors in the health, aging and body composition study

OBJECTIVES: To examine the association between cardiovascular disease (CVD) and its risk factors and age‐associated hearing loss in a cohort of older black and white adults. DESIGN: Cross‐sectional cohort study. SETTING: The Health, Aging, and Body Composition (Health ABC) Study, a community‐based cohort study of older adults from Pittsburgh, Pennsylvania, and Memphis, Tennessee. PARTICIPANTS: Two thousand forty‐nine well‐functioning adults (mean age 77.5; 37% black). MEASUREMENTS: Pure‐tone audiometry measurement and history of clinical CVD were obtained at the fourth annual follow‐up visit. Pure‐tone averages in decibels reflecting low (250, 500, and 1,000 Hz), middle (500, 1,000, and 2,000 Hz), and high (2,000, 4,000, and 8,000 Hz) frequencies were calculated for each ear. CVD risk factors, aortic pulse‐wave velocity (PWV), and ankle–arm index (AAI) were obtained at study baseline. RESULTS: In sex‐stratified models, after adjustment for age, race, study site, and occupational noise exposure, risk factors associated with poorer hearing sensitivity in men included high triglyceride levels, high resting heart rate, and history of smoking. In women, poor hearing sensitivity was associated with high body mass index, high resting heart rate, fast PWV, and low AAI. CONCLUSION: Modifiable risk factors for CVD may play a role in the development of age‐related hearing loss.     

Hearing loss in Muckle‐Wells syndrome

Objective

Muckle‐Wells syndrome (MWS) is an inherited autoinflammatory disease characterized by fevers, rashes, arthralgia, conjunctivitis, and sensorineural hearing loss. In MWS, NLRP3 gene mutations are associated with excessive interleukin‐1 release. The aims of this study were to determine the otologic characteristics of MWS, define trajectories of hearing loss, and explore the association with distinct NLRP3 genotypes.

Methods

A prospective observational cohort study of children and adults diagnosed as having MWS was conducted at a single center. NLRP3 gene mutations were determined. Patients underwent standardized clinical, laboratory, and otologic assessments, including pure tone audiometry, vestibular organ testing, and tinnitus evaluation. Trajectories of hearing loss were defined for each genotype. The genotype‐specific risk of progression of hearing loss was determined.

Results

A total of 33 patients ages 3–75 years who were members of 5 families with 4 different NLRP3 gene mutations were included. The majority of patients (67%) experienced bilateral sensorineural hearing loss. Even in cases of profound hearing loss vestibular reactivity remained normal. Fourteen adult patients reported nondebilitating tinnitus. Overall, hearing impairment progressed with age. Patients with the T348M mutation were at highest risk of rapid progression of sensorineural hearing loss.

Conclusion

Patients with MWS are at risk of developing progressive sensorineural hearing loss without vestibular involvement. Hearing impairment starts at high frequencies and can subsequently progress to profound hearing loss. Progression is age dependent. Patients with different NLRP3 mutations had distinctly different trajectories of hearing loss, suggesting a mutation‐specific risk that should be considered when making treatment decisions.

     

Is there a risk to safety when working in the New South Wales underground coal‐mining industry while having binaural noise‐induced hearing loss?

BACKGROUND: Underground coal-mine workers suffer noise-induced hearing loss and continue working in the industry while having varying degrees of deafness. Few studies have researched the risk to safety arising from the loss of hearing. AIMS: This study is designed to investigate the possible association between hearing loss and accidents in the New South Wales underground coal-mining industry. METHODS: A study was conducted, gathering data over a 10-year period from 1994 to 2003, which identified 97 cases that have had accidents and 983 controls that have had no accidents. Hearing loss levels were noted and compared in the cases and controls. Multiple logistic regression was used to determine whether the variables were significant risk factors in the occurrence of accidents. RESULTS: Hearing loss levels in the total cohort varied from 0 to 54%. The proportion of cases with hearing loss appeared to be significantly higher in the young age group of <29 years than in the controls, but was not significantly different in the older age groups. CONCLUSIONS: This study indicates that workers who have lost up to 54% binaural high tone hearing and are older than 29 years do not appear to have an increased risk to safety when compared with workers who do not have hearing loss. However, workers in the young age group of <29 years who have high tone hearing loss may be at an increased risk of accident.     

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.     

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.     

Studies of Physician‐Patient Communication with Older Patients: How Often is Hearing Loss Considered? A Systematic Literature Review

Hearing loss is remarkably prevalent in the geriatric population: one‐quarter of adults aged 60–69 and 80% of adults aged 80 years and older have bilateral disabling loss. Only about one in five adults with hearing loss wears a hearing aid, leaving many vulnerable to poor communication with healthcare providers. We quantified the extent to which hearing loss is mentioned in studies of physician‐patient communication with older patients, and the degree to which hearing loss is incorporated into analyses and findings. We conducted a structured literature search within PubMed for original studies of physician‐patient communication with older patients that were published since 2000, using the natural language phrase “older patient physician communication.” We identified 409 papers in the initial search, and included 67 in this systematic review. Of the 67 papers, only 16 studies (23.9%) included any mention of hearing loss. In six of the 16 studies, hearing loss was mentioned only; in four studies, hearing loss was used as an exclusion criterion; and in two studies, the extent of hearing loss was measured and reported for the sample, with no further analysis. Three studies examined or reported on an association between hearing loss and the quality of physician‐patient communication. One study included an intervention to temporarily mitigate hearing loss to improve communication. Less than one‐quarter of studies of physician‐elderly patient communication even mention that hearing loss may affect communication. Methodologically, this means that many studies may have omitted an important potential confounder. Perhaps more importantly, research in this field has largely overlooked a highly prevalent, important, and remediable influence on the quality of communication.     

Management of Age Related Hearing Loss

Abstract . This paper presents some current issues relating to the management of age‐related hearing loss to reduce the effects of auditory deprivation and maximise the potential for acclimatisation during the hearing rehabilitation process. Early intervention in age‐related hearing loss affords the best chance for successful aural rehabilitation, promotes healthy communication and may reduce the effects of other serious health issues for older people. In both Australia and New Zealand the older person may be eligible for subsidised hearing aids under the Governments' Hearing Services Programmes. However, hearing aids are just the beginning of a hearing rehabilitation programme. Best practice audiological management depends on a combination of strategies.     

Hearing Handicap Predicts the Development of Depressive Symptoms After 3 Years in Older Community-Dwelling Japanese

OBJECTIVES: To examine the association between hearing handicap and depressive symptoms in older community-dwelling Japanese.
DESIGN: Community-based cohort study.
SETTING: Kurabuchi Town, Gunma Prefecture, Japan.
PARTICIPANTS: Five hundred eighty residents (261 men, 319 women) aged 65 and older without depressive symptoms.
MEASUREMENTS: In a baseline examination performed in 2005/06, participants answered the 10-item screening version of the Hearing Handicap Inventory for Elderly (HHIE-S). They were divided into two groups according to their scores: a group with no hearing handicap (HHIE-S scores of ≤8) and a hearing handicap group (HHIE-S scores of ≥10). The Geriatric Depression Scale was used to identify depressive symptoms in face-to-face home visit interviews conducted in 2008, and the association between hearing handicap and depressive symptoms was assessed using logistic regression.
RESULTS: The incidence of depressive symptoms was 19.6% in the group with a hearing handicap and 8.0% in the group without a hearing handicap. When compared with the subjects without hearing handicap, subjects with a hearing handicap had a multiadjusted odds ratio of depressive symptoms of 2.45 (95% confidence interval=1.26–4.77). The association remained significant even when hearing impairment measured with pure-tone audiometry was added to the multiadjusted model.
CONCLUSION: A hearing handicap can predict future depressive symptoms in older community-dwelling people.     

The 4Cs (Crash History,Family Concerns,Clinical Condition,and Cognitive Functions): A Screening Tool for the Evaluation of the At‐Risk Driver

OBJECTIVES: To evaluate the effectiveness of crash history, family concerns, clinical condition, and cognitive function (the 4Cs, an interview‐based screening tool for health providers working with older drivers) in identifying at‐risk older drivers. DESIGN: Retrospective cohort study. SETTING: Clinical driving evaluation program at a teaching hospital in the United States. PARTICIPANTS: One hundred sixty patients who completed comprehensive driving evaluations between 2003 and 2009. MEASUREMENTS: Medical record information was used to identify component and total 4Cs scores. Other measurements included the Trail Making Test, the Mini‐Mental State Examination, and brake reaction time. The outcome variable was performance on a 45‐minute road test. RESULTS: Fifty participants passed the road test, 67 failed, and 43 demonstrated marginal driving skills. The relationship between 4Cs scores and road test outcome was statistically significant (P<.001). The domains most strongly associated with road test outcome were cognitive function (P<.001) and family concerns (P=.01). Scores of 9 or greater‐on the 4Cs identified 84% of participants who were at risk for poor road test performance. CONCLUSION: The 4Cs, an interview based screening tool, may be a useful marker to identify at‐risk older drivers.     

A systematic model improves hepatitis C virus birth cohort screening in hospital‐based primary care

Despite national and local governing board recommendations in the United States of America to perform an HCV screening test in baby boomers, screening rates remain low. Our goal was to study the impact of an HCV screening and link‐to‐care programme with patient navigation in two New York City primary care practices. This was a 2‐year prospective study of patients born between 1945‐1965 (“baby boomers”) with encounters at two primary care practices at the Mount Sinai Hospital between November 1, 2013 and November 30, 2015. Baseline HCV screening rates were collected for four months. A multifaceted intervention was sequentially implemented involving electronic alerts, housestaff education, data feedback and patient navigation. HCV screening rates and link to care, defined as attending an appointment with a viral hepatitis specialist, were compared before and after these interventions. There were 14 642 primary care baby boomer patients of which 4419 (30.2%) were newly screened during the study. There was a significant increase in HCV screening rates from 55% to 75% (P<.01) with an HCV seropositive rate of 3.3%. Factors associated with being HCV seropositive included older age (P<.01), male sex (P<.01), African American race (P<.01) and receiving care in the housestaff practice (P<.01). With patient navigation, 78 of 84 (93%) newly diagnosed HCV‐infected persons were referred to a specialist and 60 (77%) attended their first appointment. A structured, multifaceted HCV screening programme using well‐studied principles identifies a large number of undiagnosed baby boomers within hospital‐based primary care and improves access to specialty providers in a timely manner.     

Simultaneous Compared With Sequential Blood Pressure Measurement Results in Smaller Inter‐Arm Blood Pressure Differences

There are currently few recommendations on how to assess inter‐arm blood pressure (BP) differences. The authors compared simultaneous with sequential measurement on mean BP, inter‐arm BP differences, and within‐visit reproducibility in 240 patients stratified according to age (<50 or ≥60 years) and BP (<140/90 mm Hg or ≥140/90 mm Hg). Three simultaneous and three sequential BP measurements were taken in each patient. Starting measurement type and starting arm for sequential measurements were randomized. Mean BP and inter‐arm BP differences of the first pair and reproducibility of inter‐arm BP differences of the first and second pair were compared between both methods. Mean systolic BP was 1.3±7.5 mm Hg lower during sequential compared with simultaneous measurement (P<.01). However, the first sequential measurement was on average higher than the second, suggesting an order effect. Absolute systolic inter‐arm BP differences were smaller on simultaneous (6.2±6.7/3.3±3.5 mm Hg) compared with sequential BP measurement (7.8±7.3/4.6±5.6 mm Hg, P<.01 for both). Within‐visit reproducibility was identical (both r=0.60). Simultaneous measurement of BP at both arms reduces order effects and results in smaller inter‐arm BP differences, thereby potentially reducing unnecessary referral and diagnostic procedures.     

Race and sex differences in age-related hearing loss: the Health, Aging and Body Composition Study

OBJECTIVES: To determine the prevalence of and risk factors for hearing loss in a sample of 2,052 older adults (aged 73-84; 46.9% male, 37.3% black) enrolled in the Health, Aging and Body Composition (Health ABC) Study. DESIGN: Cross-sectional analysis of a longitudinal cohort study. SETTING: Pittsburgh, Pennsylvania, and Memphis, Tennessee, areas. PARTICIPANTS: Random sample of Medicare beneficiary subjects enrolled in the Health ABC program from 1997 to 1998. They included 2,052 individuals: 660 white men (32.2%), 631 white women (30.8%), 310 black men (15.1%), and 451 black women (22.0%). Participants ranged in age from 73 to 84, with a mean age of 77.5. MEASUREMENTS: Hearing sensitivity was measured using pure-tone threshold testing. Hearing loss was defined based on two averages of hearing thresholds: 500, 1,000, and 2,000 Hz greater than 25-decibel (dB) hearing level (HL) (hearing loss); and 2,000, 4,000, and 8,000 Hz greater than 40-dB HL (high-frequency hearing loss). Potential hearing loss correlates, including demographics, medical history, ototoxic medication use, occupational noise exposure, and lifestyle factors, were collected via questionnaire. RESULTS: The prevalence of hearing loss was 59.9%; the prevalence of high-frequency hearing loss was 76.9%. Hearing loss was most common in white men, followed by white women, black men, and black women. Older age, white race, diabetes mellitus, cerebrovascular disease, smoking, poorer cognitive status, occupational noise exposure, and ear surgery were associated with hearing loss after multivariable adjustment. Race- and sex-specific risk factors included higher blood pressure and occupational noise exposure (white men), poorer cognitive status and smoking (black women), and low total hip bone mineral density (black men). Possible protective factors included salicylate use (overall sample, black men) and moderate alcohol intake (black women). CONCLUSION: Hearing loss was extremely common in this population. Because many of the identified hearing loss risk factors are modifiable, some of the burden associated with hearing loss in older people should be preventable.     

Hearing impairment is associated with cognitive function in community-dwelling older adults: A cross-sectional study

BackgroundHearing impairment (HI) is associated with dementia. However, the cognitive screening tasks effective in older community dwellers presenting with HI are unclear.MethodsWe retrospectively and cross-sectionally investigated the associations between HI and cognitive function assessed with screening tasks using data from two healthcare check-up programs for community dwellers ≥65 years old in 2018. We examined demographics, risk factors, cognitive function, hearing condition, lifestyles, and self-care levels. Cognitive function was assessed using the clock drawing task and the delayed three words recall task. Hearing condition was assessed using questionnaires on the use of hearing aids and HI during conversation situations. Multivariate analysis was used to identify independent associations between HI and cognitive assessment tasks.ResultsWe analyzed 1602 eligible participants (61.9% women; 74.3 ± 6.5 years old). Hearing aid users (n = 90) were older (80 vs. 73 years, respectively; p < 0.001) and less likely to draw the clock correctly (71.1% vs. 80.1% years, respectively; p = 0.044) than non-hearing aid users. Multivariate logistic regression analysis showed that HI was associated with inability to draw the clock correctly (odds ratio 1.60, 95% confidence interval 1.12–2.26; p = 0.011), independent of age, living alone, memory impairment, and impaired self-care levels.ConclusionHearing impairment is independently associated with cognitive decline assessed by the clock drawing task. The clock drawing task may be useful for identifying an increased risk of dementia in older subjects presenting with HI.