HEARING AIDS AND LATE-LIFE DEPRESSION: A METHODS STUDY

Introduction Age-related hearing loss (AHRL) is the third most common health condition affecting older adults after heart disease and arthritis. The prevalence of clinically significant hearing impairment rises steeply with age, from 3% among adults 20-29 to 49% of adults ages 60-69 and over 80% in individuals 85 years of age and older. Initial studies suggest that remediation of hearing loss using hearing aids may decrease depressive symptoms over longitudinal follow-up. However, important limitations to these studies call for controlled trials of hearing remediation as a treatment for late-life depression (LLD). We conducted the first double-blind randomized clinical trial utilizing rigorous control groups, objective documentation of compliance of the hearing aid, enrollment of subjects with clinical depression, and incorporation of comprehensive neuropsychological assessments. Our main aims were to consider the feasibility, acceptability, tolerability of such a study, as well as ability to blind the hearing aid devices. Methods 12 individuals were recruited who were aged ≥60 years, diagnosed with a clinically significant depressive disorder, and had mild-severe hearing loss. Baseline psychiatric, audiometric, neuropsychological, and functional assessments were performed. Participants were then randomized to receive either full-amplitude active hearing aids or low-amplitude sham hearing aids over a 12-week prospective trial, either as monotherapy or as an augmentation with antidepressant medications. The sham hearing aid was programmed to a hearing threshold of 10dB, which resulted in a small volume increase without substantively improving the subject's ability to hear. The baseline evaluation was repeated at the study endpoint. Results Of the 12 subjects who completed the study, 7 received active and 5 received sham hearing aids. Acceptability of the hearing aid, evaluated as the duration of time participants wore the hearing aids between the active and sham groups, was high as all subjects used the devices for >9 hours a day and the duration was not statistically significant between groups (p = 0.05). Tolerability was measured as proportions of subjects who experienced adverse events during participation, which were acceptable and included insomnia, drowsiness, and excitement. Feasibility was also acceptable, as 86.7% of the enrolled subjects completed the 12-week study. Blind assessments were evaluated as proportions of subjects who correctly guessed whether they were wearing active or sham hearing aids and was not in effect as the majority of subjects guessed correctly (92% in sham [p Conclusions Data from this study suggests that the study design of a double-blind randomized clinical trial of hearing aids as a treatment for LLD was highly acceptable to the subjects. Future studies with larger sample sizes should investigate whether hearing remediation may be an effective therapeutic strategy for LLD. Efforts should be made to improve the ability to blind the hearing aid such as increasing the hearing threshold of the sham devices. Should future studies prove to be successful, this suggests a novel therapeutic strategy for LLD and thereby mitigate its public health burden, while also contributing to the increased recognition and treatment of ARHL more generally. This research was funded by CaMPR Phase II: Columbia University Irving Institute for Clinical and Translational Research (Rutherford [PI]) Phonak, a hearing assistance company, supplied the Audeo BR 90 hearing aid devices. PDF: http://submissions.mirasmart.com/Verify/AAGP2019/Original/AAGP2019-000298/AAGP2019-000298_Fig1.pdf PDF: http://submissions.mirasmart.com/Verify/AAGP2019/Original/AAGP2019-000298/AAGP2019-000298_Fig2.pdf