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.     

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.     

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。     

Quality-of-life changes and hearing impairment. A randomized trial

OBJECTIVE: To assess whether hearing aids improve the quality of life of elderly persons with hearing loss. SETTING: Primary care clinics at a Bureau of Veterans Affairs hospital. PATIENTS: One hundred and ninety-four elderly veterans who were identified as being hearing impaired from a screening survey involving 771 consecutive clinic patients. Of the original 194, 188 (97%) completed the trial. INTERVENTION: Subjects were randomly assigned to either receive a hearing aid (n = 95) or join a waiting list (n = 99). MAIN ENDPOINTS: A comprehensive battery of disease-specific and generic quality-of-life measures were administered at baseline, 6 weeks, and 4 months. MEASUREMENTS AND MAIN RESULTS: Persons assigned to the two groups were similar in age, ethnicity, education, marital status, occupation, and comorbid diseases. At baseline, 82% of subjects reported adverse effects on quality of life due to hearing impairment, and 24% were depressed. At follow-up, a significant change in score improvements for social and emotional function (34.0; 95% CI, 27.3 to 40.8; P less than 0.0001), communication function (24.2; CI, 17.2 to 31.2; P less than 0.0001), cognitive function (0.28; CI, 0.08 to 0.48; P = 0.008), and depression (0.80; CI, 0.09 to 1.51; P = 0.03) was seen in subjects who received hearing aids compared with those assigned to the waiting list. Six drop-outs (three per group), no crossovers, and no significant changes in cointerventions were seen. Average, self-reported, daily aid use in the hearing aid group was 8 hours. CONCLUSION: Hearing loss is associated with important adverse effects on the quality of life of elderly persons, effects which are reversible with hearing aids.     

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.     

Geriatric hearing loss: myths, realities, resources for physicians

The recommended protocol for receiving a hearing aid is: a hearing evaluation to determine candidacy for a hearing aid and/or ALD; an examination by a physician to rule out medical contraindication to hearing aid use; hearing aid selection and fitting by a dispensing audiologist or a hearing aid dealer; hearing aid orientation/counseling. It is well accepted that sensorineural hearing loss is one of the most frequent by-products of the aging process, with prevalence ranging from 30 to 50%. The hearing loss and resulting difficulty understanding speech can have a negative effect on the quality of one's daily activities and, hence, can interfere with the enjoyment of an elderly individual's remaining years. The myths of "hearing loss as an inevitable part of aging" no longer prevail, however. Advances in biomedical technology have enabled the development of smaller hearing aids with wide fitting ranges, making hearing aids a realistic option for the majority of elderly hearing-impaired individuals. To maximize benefit from hearing aids, the elderly must be identified early via routine hearing screening and referred to an audiologist for evaluation and management.     

Association between self-reported hearing impairment,use of a hearing aid and performance of instrumental activities of daily living

Background and purposeAge-related hearing loss is a prevalent condition among the growing elderly population, which has been associated with both cognitive decline and decreased daily functioning. Decreased functioning is linked to lower performance, predominantly regarding instrumental activities of daily living (IADLs). The present study aims to explore the association between hearing loss and impairment in IADLs.MethodsThis is a secondary analysis of The Health, Well-Being, and Aging Colombia study, performed in 2015. Participants were classified into three groups: 1) without hearing loss, 2) hearing loss corrected through the use of a hearing aid, and 3) hearing loss without a hearing aid. Bivariate and adjusted multivariate analyses were performed. The measured outcome was IADLs.Results and discussionInformation from a total of 23,694 community-dwelling Colombian older adults (age ≥ 60 years) was used. The prevalence of hearing impairment was 23.4%, 1.8% out of those reported the use of hearing aids. Independent associations were found for having impaired IADLs when comparing participants with hearing loss without a hearing aid and those with normal hearing. However, there was no statistical significance with respect to IADLs when comparing hearing loss corrected by hearing aids versus participants with normal hearing. Participants using hearing aids have better functioning evaluated by IADLs when compared with participants with hearing impairment and no hearing aids.ConclusionThis study evidences a positive association between hearing impairment and performance in the IADLs. This association is not significant in older adults using hearing aids     

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     

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.     

Lack of effect of 1 year intake of a high-dose vitamin and mineral supplement on cognitive function of elderly women.

OBJECTIVE: To determine if long-term, high-vitamin supplementation could reverse cognitive malfunction in old people. METHODS: We performed a longitudinal study relating the 12-month outcome to baseline values. Twenty non-vitamin-deficient elderly females with a Folstein mini mental state examination score indicating cognitive malfunctions were recruited to ascertain if feeding a high-dose vitamin-mineral supplement for 1 year could, by mass vitamin action, reverse some existing cognitive malfunctions. Ten females were fed a high-dose vitamin-mineral supplement pill with each of three daily meals for 1 year; the other 10 did not receive this supplementation. Twelve blood vitamin analyses and a Folstein mini mental state examination were performed for each of the 20 subjects before and after 1 year; each subject served as its own control. RESULTS: No improvement in cognitive malfunction was noted despite elevation of blood vitamins. CONCLUSION: Feeding of a high-dose vitamin and mineral supplement for 1 year did not improve cognitive malfunction in non-vitamin-deficient elderly in this study.     

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.     

Presbycusis

The inevitable deterioration in hearing ability that occurs with age--presbycusis--is a multifactorial process that can vary in severity from mild to substantial. Left untreated, presbycusis of a moderate or greater degree affects communication and can contribute to isolation, depression, and, possibly, dementia. These psychological effects are largely reversible with rehabilitative treatment. Comprehensive rehabilitation is widely available but underused because, in part, of social attitudes that undervalue hearing, in addition to the cost and stigma of hearing aids. Remediation of presbycusis is an important contributor to quality of life in geriatric medicine and can include education about communication effectiveness, hearing aids, assistive listening devices, and cochlear implants for severe hearing loss. Primary care physicians should screen and refer their elderly patients for assessment and remediation. Where hearing aids no longer provide benefit, cochlear implantation is the treatment of choice with excellent results even in octogenarians.     

Hearing aids

Hearing impairment is a common problem that becomes increasingly prevalent with age. It can have a major impact on quality of life, can lead to social isolation and often magnifies other health problems. There are many different hearing aid treatment options available that can help improve hearing in suitable individuals with hearing impairment. For those working with older people, it is important to understand hearing aids in order to maximise effective communication and facilitate social independence in these individuals. In this article, I describe the different hearing aid types and technologies available and provide a guide to their function and how to manage common problems with hearing aids.     

Hearing impairment in elderly persons

Hearing impairment is a common problem in elderly people that produces significant personal morbidity and isolation. Hearing impairment in elderly people often has a treatable cause. Presbycusis is only one cause of hearing loss, and may coexist with other causes. The clinical examination, if performed correctly and corroborated by caregivers, is probably adequate screening for hearing loss. However, formal testing should be administered if doubt remains. Hearing aids, although expensive, are helpful for most patients, but they are only part of a total program of aural rehabilitation. Patients, family, and health care provides can all benefit from improvement of communication skills.     

Reading and solving arithmetic problems improves cognitive functions of normal aged people: a randomized controlled study

The relationship between mental exercise and mental aging is a controversial issue. People generally believe the so-called mental-exercise hypothesis, that is, the age-related decline in cognitive function is less pronounced for people who are mentally active, yet there is insufficient scientific evidence supporting this hypothesis. Previous randomized controlled trial studies showed convincing beneficial effects of cognitive training on directly targeted cognitive functions. In this study, we performed a single-blind, randomized controlled trial on cognitive intervention in 124 community-dwelling seniors (age range, 70 to 86) and estimated the beneficial effects of non-targeted cognitive functions. As for cognitive intervention, the subjects were asked to solve systematized basic problems in reading and arithmetic every day for 6 months. Neuropsychological measures were determined prior to and 6 months after the intervention (post-test) by mini-mental state examination (MMSE), frontal assessment battery at bed side (FAB), and digit-symbol substitution test (DST) of WAIS-R. The FAB and DST scores showed a statistically significant (p<0.001 and p<0.01, respectively) improvement in the post-test compared with the pre-test, such improvement was maintained up to 6 months of follow-up tests in only the experimental group. The transfer effect of cognitive intervention by reading and solving arithmetic problems on non-targeted cognitive functions was demonstrated in this study. This study shows that daily mental training can improve cognitive functions in normal adults. Although general interests in brain training have been increasing in the public, evidence for its beneficial effects, particularly the positive transfer effect on non-targeted cognitive function still remains insufficient. Here, we introduce a new cognitive intervention program for normal aged people, the concept of which is derived from the knowledge of both brain science and clinical studies. We performed a carefully designed single-blind, randomized controlled study, and the results of this study showed convincing evidence that cognitive training provides the beneficial transfer effect.     

The effects of different types of physical exercise on physical and cognitive function in frail institutionalized older adults with mild to moderate cognitive impairment. A randomized controlled trial

BackgroundThe continuous increase in the life expectancy of older adults (elderly people) has generated interest in research into frail-aged people and their physical and mental well-being.ObjectivesTo verify the different effects of two programs of physical exercise (strength training-TG, and callisthenic training-MG) on the cognitive state, functionality, stability and general health of frail-aged institutionalized older adults.DesignThis study was a block randomized controlled trial.SettingThe study was conducted in geriatric units of the San Rosendo Foundation.ParticipantsA total of 77 institutionalized frail-aged people (70.1% female, aged 84.8±7.9) took part.InterventionsThe TG carried out a strength program with therabands®; The MG performed an exercise program of multi-callisthenics, and the CG did not carry out any physical exercise.MeasurementsThe following measurements were used: Minimental test, Pfeiffer test, SF-12, Barthel test, Five times sit-to-stand and a pressure platform.ResultsThe TG program generated some improvement in cognitive state and functional independence, while in the physical and mental component of the S-12, significant improvement was generated. The program undertaken by MG demonstrated a tendency to the stabilization of the above mentioned parameters, while the GC demonstrated a tendency to deterioration.ConclusionPhysical exercise, whether it be the strength program, or the multi-calisthenics program, is an effective method for improving and maintaining health, cognitive state, functional independence and stability in frail-aged institutionalized people.     

Cognitive impairment in old people living in the community

Cognitive impairment has a high prevalence in the elderly, especially in the oldest old, and it is a major concern for autonomous old people living in the community and their families. Any possible intervention will benefit from early detection of cognitive decline related signs. The Portuguese version of the mini-mental state examination (MMSE) was used to assess cognitive impairment in a sample of 1266 old community-dwellers in Portugal, mean age 70.3 ± 8.7 years. A standard questionnaire was also used including measures on social network, psychological distress, functionality, perceived health status, and socio-demographic variables. We recorded education levels and illiteracy by using different cut points to select people with and without cognitive impairment and results showed a 9.6% prevalence of positive cases. In general, cognitive impairment is higher in women, older people, widows(ers), and people with negative self-perception of health and with difficulties in basic and in instrumental activities of daily living (ADL and IADL). Cognitive impairment was found to be predicted by gender, age and psychological distress, explaining 18% of variance. Findings are discussed considering available literature and possible interventions for community residents.     

Physical, mental and social factors affecting self-rated verbal communication among elderly individuals

Background:   Satisfactory verbal communication is necessary to improve the quality of life in elderly individuals. However, few studies have directly analyzed the factors that influence the ability to achieve satisfactory verbal communication. The purpose of the present study was to identify the physical, mental and social factors that affect self-rated verbal communication.
Methods:   A cross-sectional survey was used to obtain the required data from 197 elderly (75.5 ± 8.3 years of age) individuals in the southern area of Japan who independently carried out basic activities of daily living. Subjective evaluation on verbal communication, general health status, oral function and hearing ability were assessed using a self-administered questionnaire. Age, sex, instrumental activities of daily living, intellectual activity, social activity, cognitive status, the number of present teeth, maximum phonetic time and status regarding the use of dentures and hearing aids were also evaluated.
Results:   In bivariate analyses, self-rated verbal communication ability was significantly related to age, instrumental activities of daily living, intellectual activity, social activity, cognitive function, maximum phonation time, the number of present teeth, the wearing of dentures, self-rated general health and oral function. However, self-rated hearing ability and the wearing of hearing aids were not significantly related to self-rated verbal communication. The backward logistic regression analysis was refined until it included only two independent variables: social activity and self-rated general health status.
Conclusion:   These results suggest that social activity and self-rated general health status are the most influential factors of satisfactory verbal communication in the present model, and that self-rated verbal communication is not related to hearing factors.     

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.     

Comprehensive geriatric assessment: a useful tool for prevention of acute situations in the elderly

Comprehensive geriatric assessment is a useful complement to the standard clinical examination of elderly people. It focuses on a systematic evaluation of functional status, dependency, cognitive functions, psychological status, continence, nutritional status and social way of life, administered by a multidisciplinary team. Standardized test, well-validated in the elderly, are used. Most studies have demonstrated the efficacy of geriatric assessment programs in outpatients, hospitalized patients or in emergency unit patients. Mostly useful in frail elderly patients, geriatric assessment results in a decrease in morbidity and dependency, shorter hospital stays and fewer referrals to nursing homes. By introducing adequate medical and social interventions, comprehensive geriatric assessment, even in very old people, is useful in preventing acute situations leading to emergency referrals.