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What are the consequences of hearing loss for older adults?

Posted Sep 15th, 2015

Frank R. Lin, M.D. Ph.D.


Associate Professor, Division of Otology, Neurotology and Skull Base Surgery, Department of Otolaryngology-Head & Neck Surgery, Johns Hopkins School of Medicine
Associate Professor, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health
Associate Professor, Division of Geriatric Medicine,  Department of Medicine, Johns Hopkins School of Medicine
Associate Professor, Department of Mental Health, Johns Hopkins Bloomberg School of Public Health
Core Faculty Member, Johns Hopkins Center on Aging and Health

Clinical Office:        Department of Otolaryngology- Head and Neck Surgery
                               Johns Hopkins University School of Medicine
                               601 N. Caroline Street, 6th Floor
                               Baltimore, MD 21287
1. What are the consequences of hearing loss for older adults?

The basis of this research starts with the concept of what characterizes healthy aging—namely maintaining optimal cognitive and physical functioning as we age. Intuitively, many people would assume that hearing loss is only related to our cognitive and physical abilities because of some shared pathologic process. For example, as your body ages you’re more likely to lose your hearing and have poorer memory, or if you smoke or have diabetes, you’re also more likely to have hearing loss and have poorer cognitive abilities. But, if only a shared pathologic process links hearing loss with these broader outcomes then this relationship isn't very interesting because it means that treating hearing loss wouldn't have an impact on these other outcomes. We’re beginning to understand now, though, that there are likely mechanistic pathways through which hearing loss contributes to accelerated declines in the cognitive and physical functioning of older adults.

Much of our research over the last few years has focused on investigating whether hearing loss is independently associated with cognition and dementia. We have collaborated with other aging researchers and have analyzed observational epidemiologic data from the Baltimore Longitudinal Study of Aging, the Health, Aging, and Body Composition Study (HealthABC), and the National Health and Nutritional Examination Surveys (NHANES). Through these studies, we have shown that hearing loss is independently associated with poorer cognitive functioning on non-verbal tests of memory and executive function, accelerated cognitive decline, the risk of developing dementia, and accelerated rates of brain atrophy. Currently, we're also beginning to study how hearing loss is associated with declines in physical functioning, frailty, health care utilization, and occupational status.

2. How can hearing loss be most effectively addressed in the community?

This is a hugely important question and extends well beyond the epidemiologic and clinical studies that are the dominant focus of my research group. Currently, there is really only one current model for hearing rehabilitative care—namely repeated clinic-based audiologic visits. While this will always remain the gold standard to some extent, there clearly needs to be other alternative models of care when nearly 2 out of every 3 adults over 70 has a clinically-significant hearing loss. The most important perspective to keep in mind, though, is that the goal of hearing treatment is NOT to simply fit a hearing aid but instead to ensure that the individual can communicate effectively in all settings. While hearing aids serve as the building block of this treatment paradigm, far more is involved—namely adequate counseling and training in the use of devices, public health education and messaging, widespread availability of hearing loop systems, other assistive listening devices, etc. Our work on this front involves myriad approaches including:

Collaboration with the Hearing Loss Association of America (HLAA) on advocacy efforts to address hearing loss as a public health problem
Collaboration with pharmaceutical companies and venture capital firms actively exploring, testing, or developing drugs for the treatment of hearing loss
Collaboration with the hearing industry to develop devices and ultimately (hopefully) open wireless standards for universal connectivity between hearing aids and other devices (e.g. phones, TVs, sound systems in theaters, churches, etc.)
 Active promotion and advocacy for the installation of hearing loop systems in all public spaces in collaboration with the HLAA, David Myers, Linda Remensnyder, Juliette Sterkens, and Richard Einhorn
Collaboration with start-up companies (e.g. Conversion Sound) actively looking to develop novel, audiologically-sound approaches toward self-fit, low cost, and easily accessible hearing devices.

3. What is the impact of treating hearing loss on older adults?

The question of whether treating hearing loss could potentially delay declines in cognitive and physical functioning remains completely unknown. We are currently conducting an ongoing prospective observational study of adults who get hearing aids or cochlear implants at Johns Hopkins. In this study, the Studying Multiple Outcomes after Aural Rehabilitative Treatment (SMART) study, we are measuring the neurocognitive, social, and physical functioning of patients before and after hearing loss treatment. Most recently, in collaboration with Mark Laudenslager’s lab at the University of Colorado, we are also beginning to measure salivary and hair cortisol as biomarkers of stress and inflammation before and after hearing loss treatment. Finally, working with cognitive aging and audiology colleagues at Johns Hopkins, the University of South Florida, and with investigators in the Atherosclerosis Risk in Communities - Neurocognitive Study (ARIC-NCS), we are also now planning a definitive randomized controlled trial of whether comprehensive hearing loss treatment in older adults can reduce the risk of cognitive decline and dementia.

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