Welcome to PracticeUpdate! We hope you are enjoying temporary access to this content.
Please register today for a free account and gain full access
to all of our expert-selected content.
Already Have An Account? Log in Now
Hearing Loss and Peripheral Neuropathy and Associations With Balance, and Survival in Older Primary Care Patients
TAKE-HOME MESSAGE
- This large retrospective cohort study evaluated the association of age-associated hearing loss and peripheral neuropathy with mortality among older adults in the primary care setting and found that both hearing loss and neuropathy were independently associated with increased mortality risk (HR, 1.36 and 1.32, respectively). The combination of hearing loss and peripheral neuropathy was associated with an even greater risk of mortality (OR, 1.55).
- Among the elderly, age-associated hearing loss and peripheral neuropathy diagnosed in primary care are significantly associated with an increased risk of mortality. This association is likely mediated by decreased balance and increased risk of falls.
abstract
This abstract is available on the publisher's site.
Access this abstract nowBACKGROUND
Both age-associated hearing loss (AAHL) and peripheral neuropathy (PN) are common in older patients, and both are associated with impaired balance, falls, and premature mortality. The objectives of this study were to document the prevalence and severity of AAHL in older primary care patients, and to explore associations between AAHL, PN, balance, falls, and mortality.
METHODS
We analyzed information obtained in 1999 from 793 primary care patients recruited from practices participating in the Oklahoma Longitudinal Assessment of the Health Outcomes of Mature Adults (OKLAHOMA) Studies. Available data included demographic and health information, history of falls and hospitalizations, audiometry, balance testing, examination of the peripheral nerves, 50 foot timed gait, and dates of death up to 22 calendar years and 8106 person-years of follow-up. Proportionate hazards (PH) and structural equation modeling (SEM) were used to examine associations between AAHL, PN, balance, gait time, and mortality.
RESULTS
501 of the 793 participants (63%) had AAHL. Another 156 (20%) had low frequency and 32 (4%) had unilateral deficits. Those with moderate or severe AAHL and the 255 (32%) with PN had impaired balance (p < 0.0001), increased gait time (p = 0.0001), and reduced survival time (p < 0.0001). In the PH model, both AAHL and PN were associated with earlier mortality (H.Rs. [95% C.I.]: 1.36 [1.13-1.64] and 1.32 [1.10-1.59] respectively). The combination of moderate or severe AAHL and PN, present in 24% of participants, predicted earlier mortality than predicted by either deficit alone (O.R. [95% C.I.I] 1.55 [1.25-1.92]). In the SEM models, the impacts of both moderate or severe AAHL and PN on survival were mediated, in part, through loss of balance.
CONCLUSIONS
Hearing loss and PN, both common in older patients, appear to be independently and additively associated with premature mortality. Those associations may be mediated in part by impaired balance. The Mechanisms are likely multiple and complex.
Additional Info
Disclosure statements are available on the authors' profiles:
Associations between hearing loss, peripheral neuropathy, balance, and survival in older primary care patients
J Am Geriatr Soc 2024 Aug 14;[EPub Ahead of Print], JW Mold, FH Lawler, X Liao, DE BardFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.
In this study, 83% of 793 community-living older adults aged 64 years or older had some level of hearing loss, and this finding was associated with age and peripheral neuropathy (PN). Less than half of the individuals with audiographic hearing deficits reported difficulty hearing or wore a hearing aid. Hearing loss was also associated with a significant physical functioning deficit, impaired balance, increased gait time, and a 36% increased mortality rate but not with social or emotional health, reported falls, or hospitalizations.
The increased mortality rate may be associated with impaired balance and the development of dementia, which was not measured in the study. However, the association between hearing loss and dementia is strong, and this association supports the theory of overall neuronal loss due to hypertension, diabetes mellitus, systemic inflammation, and ototoxic and neurotoxic chemicals (eg, medications, cigarette smoke metabolites, and alcohol) in addition to noise exposure.
The key is prevention starting in midlife and ongoing, through lifestyle, and avoiding noise pollution. With noise-canceling headphones, we have technology that can help. In addition, earplugs should be used for intermittent loud noise. Peripheral neuropathy (PN) was present in 32% of patients, and 24% had both PN and hearing loss. PN was associated with a 27% increase in gait time and impaired balance and 32% reduced survival, with the combination reducing survival by 51%.
Neuropathy can be caused by diabetes, heavy metals, vitamin B12 deficiency, excess alcohol use, impaired absorption through celiac disease, bariatric surgery, and medications that block vitamin B12 absorption, such as metformin, proton pump inhibitors, colchicine, etc. For patients on any of these medications, we should recommend vitamin B12 supplementation. With the recommendation of a plant-based diet, we take in less vitamin B12 and absorption decreases with age. When patients report symptoms of neuropathy, the damage is often irreversible.
We must have a high index of suspicion for vitamin B12 deficiency as it is preventable. I routinely check sensation with a 256-Hz tuning fork and have found no vitamin B12 deficiency in individuals with intact toe sensation. However, most of my older adults have absent vibratory sense, and most are usually vitamin B12–deficient. The recommendation is to replace vitamin B12 when levels are below 350 pg/mL, as that is when methylmalonic acid levels rise significantly, the metabolite that builds up in B12 deficiency.1
Reference