Abstract Aims Hearing impairment (HI) is prevalent among middle‐aged and older adults, but few studies have examined its mental health consequences in China. This study investigated the association of HI with depressive symptoms and whether family financial support moderated the association among adults aged 45 in China. Methods Data were obtained from three waves of the China Health and Retirement Longitudinal Study (2011, 2013 and 2015). Hearing impairment was defined as a self‐reported hearing problem in one or both ears. Depressive symptoms were measured with CESD‐10. Associations between HI and depressive symptoms were modeled using fixed‐effect models. Results People with self‐reported hearing loss were more likely than those without hearing loss to have depressive symptoms, with an odds ratio of 1.25 [1.07–1.47]. The association remained significant after adjusting for socio‐demographic characteristics, lifestyle behaviors, and health conditions. Family financial support moderated this association. Among those with HI, adults with a higher level of family financial support tend to have better performance on symptoms of depression. Conclusions HI was positively associated with depressive symptoms among adults aged ≥45 in China, and family financial support played a buffering role in the relationship between HI and depressive symptoms.
Abstract Background Hearing loss is a risk factor for dementia; whether the association is causal or due to a shared pathology is unknown. We estimated the association of brain β-amyloid with hearing, hypothesizing no association. As a positive control, we quantified the association of hearing loss with neurocognitive test performance. Methods Cross-sectional analysis of Atherosclerosis Risk in Communities-Positron Emission Tomography study data. Amyloid was measured using global cortical and temporal lobe standardized uptake value ratios (SUVRs) calculated from florbetapir-positron emission tomography scans. Composite global and domain-specific cognitive scores were created from 10 neurocognitive tests. Hearing was measured using an average of better-ear air conduction thresholds (0.5–4 kHz). Multivariable-adjusted linear regression estimated mean differences in hearing by amyloid and mean differences in cognitive scores by hearing, stratified by race. Results In 252 dementia-free adults (72–92 years, 37% Black race, and 61% female participants), cortical or temporal lobe SUVR was not associated with hearing (models adjusted for age, sex, education, and APOE ε4). Each 10 dB HL increase in hearing loss was associated with a 0.134 standard deviation lower mean global cognitive factor score (95% CI: −0.248, −0.019), after adjustment for demographic and cardiovascular factors. Observed hearing-cognition associations were stronger in Black versus White participants. Conclusions Amyloid is not associated with hearing, suggesting that pathways linking hearing and cognition are independent of this pathognomonic Alzheimer’s-related brain change. This is the first study to show that the impact of hearing loss on cognition may be stronger in Black versus White adults.
Abstract INTRODUCTION Sensory impairment (SI) is linked to cognitive decline, but its association with early cognitive impairment (ECI) is unclear. METHODS Sensory functions (vision, hearing, vestibular function, proprioception, and olfaction) were measured between 2012 and 2018 in 414 Baltimore Longitudinal Study of Aging (BLSA) participants (age 74 ± 9 years; 55% women). ECI was defined as 1 standard deviation below age‐, sex‐, race‐, and education‐specific mean performance in Card Rotations or California Verbal Learning Test immediate recall. Log binomial models (cross‐sectional analysis) and Cox regression models (time‐to‐event analysis) were used to examine the association between SI and ECI. RESULTS Cross‐sectionally, participants with ≥3 SI had twice the prevalence of ECI (prevalence ratio = 2.10, p = 0.02). Longitudinally, there was no significant association between SI and incident ECI over up to 6 years of follow‐up. DISCUSSION SI is associated with higher prevalence, but not incident ECI. Future studies with large sample sizes need to further elucidate the relationship between SI and ECI. Highlights Sensory impairment is associated with high prevalence of early cognitive impairment Multisensory impairment may pose a strong risk of early changes in cognitive function Identifying multisensory impairment may help early detection of dementia
Abstract Hearing loss is highly prevalent and associated with adverse health outcomes but undertreated among individuals with cognitive impairment, particularly African Americans. The incorporation of community health worker (CHW)-partnered models may increase access and reduce disparities. The HEARS intervention is a hearing care intervention delivered by CHWs that provides a low-cost amplification device. This pre-specified subgroup analysis based within the HEARS randomized controlled trial (RCT) aims to assess whether cognitive impairment modified the effect of the HEARS intervention among community-dwelling older adults. The analysis was stratified by cognitive status using the total Montreal Cognitive Assessment (MoCA) score (□25: cognitive impairment; post hoc sensitivity analysis using □22). Among 149 randomized participants with MoCA data, 100 individuals were cognitively impaired (Mean adjusted MoCA: 21(SD 3.5; 52% African American; 70% low-income). At 3-months post-intervention, communication function significantly improved among individuals with cognitive impairment compared with control, with an estimated average treatment effect of -13.92 HHIE-S change (95% CI:-16.84,-10.86), comparable to those without cognitive impairment (-11.47; 95% CI:-18.04,-4.17). Post hoc sensitivity analysis using a □22 MoCA cut-off for cognitive impairment yielded similar findings. Among individuals with cognitive impairment, the HEARS intervention, compared with waitlist control, significantly improved communication function. The improvements were comparable to participants without cognitive impairment and similar in magnitude to improvements documented for older adults who received conventional hearing care. To the authors’ knowledge, this trial was the largest trial to date of a hearing care intervention in the U.S. of African American older adults and low-income older adults with cognitive impairment.
Click to increase image sizeClick to decrease image size FundingThis work was supported in part by NIH K23DC011279 (F. Lin), the Eleanor Schwartz Charitable Foundation (F. Lin), a Triological Society/American College of Surgeons Clinician Scientist Award (F. Lin), and NIA P50-AG005146 (M. Albert).DisclosuresDr Lin reports being on the scientific advisory board of Pfizer and Autifony Therapeutics, a consultant to Cochlear Ltd, and a speaker for Med El and Amplifon. Dr Albert reports being a consultant to Agenebio, Genentech, Eisai and Eli Lilly.
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Objectives: Investigate rates of long‐term use of cochlear implants (CI) in a large, consecutive case series of older adults (≥ 60 years) and characteristics associated with continuing CI use. Methods: From 1999‐2011, 447 individuals ≥60 years received their first CI at Johns Hopkins, and we successfully contacted 397 individuals (89%) to ascertain data on the individual's daily CI use averaged over the past 4 weeks. Regular CI use was defined as ≥8 hours/d. We investigated the time from implantation to the date when an individual reported discontinuing regular CI use with Kaplan‐Meier and Cox proportional hazard analyses. Results: The overall rate of regular CI use at 13.5 years of follow‐up was 82.6% (95% confidence interval: 72.5‐89.3%). Individuals who received a CI at 60‐74 years had significantly higher rates of regular CI use at 13.5 years of follow‐up (91.1%, [95% confidence interval: 83.2‐95.4%], n = 251) than individuals who received a CI at ≥75 years (55.7%, [95% confidence interval: 24.9‐78.1%], n = 146). The rate of discontinuing regular CI use (<8 hours per day) increased on average by 7.8% (95% confidence interval: 3.0‐12.8%) per year of age at implantation. Conclusions: Rates of long‐term CI use in older adults at >10 years of follow‐up exceed 80%. The rate of discontinuing regular CI use was strongly associated with older age at implantation. These results suggest that the earlier implantation of older adults, once critically low levels of speech recognition are present, is associated with greater usage of the device.
Community leaders collaborated with human-centered design practitioners and academic researchers to co-develop a community health worker (CHW) training program for delivering community-based hearing care to fellow older adults. When implemented by CHWs, clients' communication function improved comparably with outcomes following professional interventions. Community-based models offer opportunities to advance hearing health.
Abstract Age-related hearing loss is independently associated with adverse health outcomes, but the use of hearing aids by older adults is low and disparities exist. The incorporation of community health worker (CHW)-partnered models can reduce barriers and address disparities. The HEARS (Hearing health Equity through Accessible Research & Solutions) intervention is a hearing care intervention delivered by CHWs that incorporates a low-cost amplification device and education on age-related hearing loss. The efficacy of the HEARS intervention was assessed through a randomized controlled trial (RCT) (JAMA, 2022) that demonstrated the intervention significantly improved communication function. The RCT was the first of a CHW-delivered hearing care intervention designed for older adults that included provision of amplification. As a community-engaged trial, the trial was also one of the largest hearing-related trials in the U.S. of African American older adults and low-income older adults with hearing loss and provides a unique opportunity to advance understanding of hearing care among communities not traditionally represented within research. This symposium presents secondary analyses from the HEARS RCT that inform the continued expansion of hearing care, including among individuals with cognitive impairment and those with limited technology use. The symposium also shares findings from community-engaged hearing screening efforts (K-HEARS Screen) in partnership with Korean American ethnic churches and provides the first estimates of hearing health behaviors among older Korean Americans. Together, the symposium shares lessons in partnering with CHWs and community organizations to optimize the development and testing of interventions to advance hearing health equity across diverse communities.
