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Longitudinal Relationship Between Hearing Aid Use and Cognitive Function in Older Americans
TAKE-HOME MESSAGE
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Population-based, longitudinal data from the Health and Retirement Study were used to evaluate the effects of hearing aid use on cognitive function in 2040 older adults (≥50 years of age). Using a hearing aid was significantly associated with episodic memory scores. In addition, participants demonstrated slower decline in episodic memory scores after hearing aid use as compared with scores before using a hearing aid.
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The use of a hearing aid in later life may slow the rate of cognitive decline, thereby reducing the global prevalence of dementia.
abstract
This abstract is available on the publisher's site.
Access this abstract nowOBJECTIVES
To test whether hearing aid use alters cognitive trajectories in older adults.
DESIGN
US population-based longitudinal cohort study SETTING: Data were drawn from the Health and Retirement Study (HRS), which measured cognitive performance repeatedly every 2 years over 18 years (1996-2014).
PARTICIPANTS
Adults aged 50 and older who who took part in a minimum of 3 waves of the HRS and used hearing aids for the first time between Waves 4 and 11 (N=2,040).
MEASUREMENTS
Cognitive outcomes were based on episodic memory scores determined according to the sum of immediate and delayed recall of 10 words.
RESULTS
Hearing aid use was positively associated with episodic memory scores (β=1.53, p<.001). Decline in episodic memory scores was slower after (β=-0.02, p<.001) than before using hearing aids (β=-0.1, p<.001). These results were robust to adjustment for multiple confounders and to attrition, as accounted for using a joint model.
CONCLUSIONS
Hearing aids may have a mitigating effect on trajectories of cognitive decline in later life. Providing hearing aids or other rehabilitative services for hearing impairment much earlier in the course of hearing impairment may stem the worldwide rise of dementia.
Additional Info
Longitudinal Relationship Between Hearing Aid Use and Cognitive Function in Older Americans
J Am Geriatr Soc 2018 Apr 10;[EPub Ahead of Print], A Maharani, P Dawes, J Nazroo, G Tampubolon, N PendletonFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.
Hearing loss is the leading midlife indictor for developing dementia. Of the 34,506 participants ≥50 years in the Michigan Health and Retirement Study (HRS), 2040 who started using hearing aids during the 14 years of follow-up were evaluated with an episodic memory screen of the sum of immediate and delayed recall of 10 words. At baseline, no participants used a hearing aid or had a cognitive deficit.
Episodic memory scores declined before and after initial hearing aid use, but the rate of the decline was slower after beginning to use hearing aids (ẞ = –0.03; P < .001) than before (ẞ = –0.11; P < .001). The difference in the coefficient between those two slopes is 0.08 (P < .001). Age, depression score, and number of comorbidities have a significant association with episodic decline in memory scores.
Other risk factors for hearing loss are use of firearms (≥1000 rounds), smoking (≥20 pack-years), hypertension, and diabetes.1 Risk is increased in men almost 2-fold, noise exposure 2.4-fold, and Caucasian race 2.3-fold, as melanocytes in the cochlea are protective of damage.1,2 Risk is decreased with exercise due to the effects of better vascular health on the hair cells of the auditory tract.3,4
Treating hearing loss early is critically important to not lose the connections between the ear and the brain. If treatment is delayed too long, many patients cannot process the sounds the hearing aid produces, as it sounds different than what they are used to.
Patients with moderate to severe dementia often cannot learn to use a hearing aid. Using an assisted listening device is convenient in these cases, as the device that is connected to the headphones can be held up to the speaker or placed on the table to focus on the conversation without amplifying background sounds.
Although the USPSTF recommends against routine hearing screening in asymptomatic individuals ≥50 years old, Medicare (CMS) has made hearing evaluation a part of the annual wellness visit.5 In 2017, two laws passed that make hearing aids more affordable: the need for a physician evaluation was waived and hearing aids will become available over the counter after FDA review. Now, we have yet another argument to encourage earlier wearing of hearing aids, and patients may pay attention when we mention dementia.
References