Hearing Loss and Physical Decline in Older Adults

Most American seniors have hearing loss

Hearing aids can reverse its adverse effects

You probably wouldn’t have guessed that a 2017 study in the prestigious journal, Lancet, identified hearing loss as a leading contributor to mortality across the globe. A 2021 study showed that hearing loss predicted significant declines in objectively measured physical activity. The study used cross-sectional data from 291 participants aged 60-69 years in the National Health and Nutrition Examination Survey. Hearing was measured for four pure tones using a standard protocol. Hearing loss was defined as a loss of 25 decibels or more in the better ear.

Participants spent little time in moderate or vigorous physical activity (median of 7.7 minutes per day), much more time in light-intensity physical activity (326 minutes per day), and even more time being sedentary (518 minutes per day). Each 25 decibel decline in hearing predicted a 1.8-minute decline in moderate or vigorous physical activity. Participants with hearing loss had 4.5 fewer minutes of moderate or vigorous physical activity compared to participants with no hearing loss, reducing the median time for moderate or vigorous physical activity to 3.2 minutes per day. Hearing loss reduced daily time spent in light-intensity physical activity from 326 to 309 minutes. Researchers calculated that hearing loss corresponded to 5.8 years of aging. Hearing loss led directly to greater aging due to less physical activity and indirectly through increased social isolation, depressive symptoms, cognitive load, and fear of falling.

People with hearing impairment often exhibit diminished physical function. Another 2021 study asked if hearing impairment predicted reduced physical function, walking endurance, and faster decline in physical function of older adults. A team of researchers used data from nearly 3,000 participants in four locations across the US with an average age of 79 years in the Atherosclerosis Risk in Communities (ARIC) study. Hearing was evaluated objectively with pure tone audiomertry. The Short Physical Performance Battery (SPPB) evaluated three aspects of physical function: balance, gait speed, and chair stand. A fast-paced, two-minute walk test evaluated walking endurance.

Cross-sectional data from visit 6 of ARIC showed that participants with severe hearing loss had significantly lower composite and individual component SPPB scores than participants with normal hearing. After up to 9 years of follow-up, participants with hearing impairment showed faster declines in composite SPPB scores than participants with normal hearing. Participants with moderate or severe hearing loss had significantly lower walking endurance than participants with normal hearing.

Hearing loss is wide-spread among older people, but a relatively small proportion of people with hearing loss use hearing aids. Some studies suggest that hearing loss is associated with frailty. Australian researchers conducted a systematic review and meta-analysis of 16 studies (three observational and 13 cross-sectional) that investigated hearing loss and frailty. Included studies were confined to participants aged 50 years or older. The meta-analyses showed that hearing loss predicted significant 87 and 56 percent higher risks of frailty compared to no hearing loss for cross-sectional and longitudinal studies, respectively. The researchers cautioned that different definitions of frailty, general lack of objective evaluation of hearing loss, and publication bias may affected the results. Hearing loss might be linked to frailty via lower levels of physical activity and reduced activities of daily living.

The studies noted above beg the question: Do hearing aids diminish these adverse health outcomes? A recent study  investigated physical and psychosocial outcomes associated with both unaided and aided hearing loss. Researchers used data from 24,893 members aged 65 or older of a Medicare Supplemental Insurance Plan sponsored by United Health Care. Self-reported hearing was grouped into five categories: 1) no hearing loss, 2) unaided mild hearing loss, 3) aided mild hearing loss, 4) unaided severe hearing loss, and 5) aided severe hearing loss. A significant trend in the unhealthful direction for nine physical and psychosocial conditions appeared across the five categories from no hearing loss to aided hearing loss.

Only participants with severe unaided hearing loss reported significantly reduced self-reported health. Having a hearing aid reduced this risk to statistical insignificance. Participants with unaided mild and severe hearing loss reported significantly reduced weekly exercise, while participants with hearing aids did not. Participants with mild or severe hearing loss (unaided or aided) reported significant mobility limitations, but the associations declined in strength for participants with hearing aids. Hearing loss, especially if severe, seems to diminish aspects of health and well-being, but the adverse effects can be eliminated or reduced with hearing aids. Alas, only about half of the participants who would likely benefit for hearing aids used them.

Mitigating moderate or severe hearing loss with hearing aids may help older people reduce their rate of aging and reduce declines in physical activity, physical function, and function. If you think you might have hearing loss, have your hearing tested by an audiologist. Medicare covers the cost for seniors. Plus, the price and quality of hearing aids are rapidly improving. And Medicare coverage of hearing aids is increasing.

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