title: Is Hearing Loss Associated with Poorer Health in Older Adults Who Might Benefit from Hearing Screening?
abstract: Hearing screening programs may benefit adults with unacknowledged or unaddressed hearing loss, but there is limited evidence regarding whether such programs are effective at improving health outcomes. The objective was to determine if poorer audiometric hearing thresholds are associated with poorer cognition, social isolation, burden of physical or mental health, inactivity due to poor physical or mental health, depression, and overnight hospitalizations among older American adults with unacknowledged or unaddressed hearing loss.
  
  
  
  The authors performed a cross-sectional population-based analysis of older American adults with normal hearing or unacknowledged or unaddressed hearing loss. Data was obtained from the 1999 to 2010 cycles of the National Health and Nutrition Examination Survey. Participants with a pure-tone average (PTA in the better hearing ear of thresholds at 0.5, 1, 2, and 4 kHz) > 25 dB HL who self-reported their hearing ability to be "good" or "excellent" were categorized as having "unacknowledged" hearing loss. Those who had a PTA > 25 dB HL and who self-reported hearing problems but had never had a hearing test or worn a hearing aid were categorized as having "unaddressed" hearing loss. Multivariate regression was performed to account for confounding due to demographic and health variables.
  
  
  
  A 10 dB increase in PTA was associated with a 52% increased odds of social isolation among 60- to 69-year-olds in multivariate analyses (p = 0.001). The average Digit Symbol Substitution Test score dropped by 2.14 points per 10 dB increase in PTA (p = 0.03), a magnitude equivalent to the drop expected for 3.9 years of chronological aging. PTA was not associated significantly with falls, hospitalizations, burden of physical or mental health, or depression, or social isolation among those ages 70 years or older in these samples.
  
  
  
  Unacknowledged or unaddressed hearing loss was associated with a significantly increased risk of social isolation among 60- to 69-year-olds but not those 70 years or older. It was also associated with lower cognitive scores on the Digit Symbol Substitution Test among 60- to 69-year-olds. This study differs from prior studies by focusing specifically on older adults who have unacknowledged or unaddressed hearing loss because they are the most likely to benefit from pure-tone hearing screening. The finding of associations between hearing loss and measures of social isolation and cognition in these specific samples extends previous findings on unrestricted samples of older adults including those who had already acknowledged hearing problems. Future randomized controlled trials measuring the effectiveness of adult hearing screening programs should measure whether interventions have an effect on these measures in those who have unacknowledged or unaddressed pure-tone hearing loss.
authors.affiliation: 1Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada; 2Kelowna General Hospital, Kelowna, British Columbia, Canada; 3Department of Psychology, University of Toronto, Toronto, Ontario, Canada; 4Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada; and 5Rotman Research Institute, Toronto, Ontario, Canada.
authors.forename: Paul
authors.initials: P
authors.lastname: Mick
authors.forename: M Kathleen
authors.initials: MK
authors.lastname: Pichora-Fuller
mesh_terms: D000058:Accidental Falls / Q000706:statistics & numerical data*; D000367:Age Factors; D000368:Aged; D001301:Audiometry, Pure-Tone; D060825:Cognitive Dysfunction / Q000453:epidemiology* / Q000523:psychology; D017281:Cost of Illness; D003430:Cross-Sectional Studies; D003863:Depression / Q000453:epidemiology* / Q000523:psychology; D005260:Female; D006304:Health Status; D034381:Hearing Loss / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D016014:Linear Models; D016015:Logistic Models; D008297:Male; D008403:Mass Screening; D008603:Mental Health; D008875:Middle Aged; D015999:Multivariate Analysis; D009749:Nutrition Surveys; D000073222:Patient Health Questionnaire; D057566:Self Report; D012934:Social Isolation / Q000523:psychology*; D014481:United States / Q000453:epidemiology