New Study links hearing impairment to increased risk of death
Findings of a team from John Hopkins University School of Medicine in Baltimore, MD, show that the greater a person's hearing impairment, the greater their risk of death.
In an age-adjusted model, the researchers found participants with moderate or more severe HI had a 54% increased risk of death, while those with mild HI had a 27% increased risk of death, compared with those free of HI.
The potential mechanisms for these findings, the authors say, include causal connections of HI with cognitive, mental and physical function.
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Thank you Sharmi. Here is a link to an earlier study that suggested a similar link between hearing loss and mortaility. This large epidemiological study concluded that older men with hearing impairment or dual-sensory impairment (hearing and vision) had a greater risk of dying from any cause and particularly cardiovascular causes within a median period of 5 years.
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Many of these studies don't really make it clear, but it looks like the hearing loss/dementia relation is in reference to adults who don't develop hearing loss until later in life. Is that correct? I can't imagine this being true of adults who were deaf or hard of hearing since birth or early childhood. What is the average age of hearing loss onset in these studies?
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In some good news, a new study has found that hearing aid usage can reduce cognitive decline associated with hearing loss. The study, published in the Journal of the American Geriatric Society, found no difference in the rate of cognitive decline between hearing aid users and a control group of people without hearing loss over a 25 year period.
More information on the study here: http://www.oticon.com/about/press/2015/pressrelease-reduce-risk-of-cognitive-decline
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I am a 73 year old female who has lived with adult onset hearing loss for most of my life. Although I grew up with normal hearing, I was diagnosed with progressive bilateral sensorineural hearing loss when I was in my early 20s. I was also told, at that time, by medical professionals who diagnosed this, that hearing aids would never help me. Consequently, I did not even try hearing instruments until I was in my mid 30s when I was desperate enough to try anything. The ‘advice’ I received helped me embrace every stigma that has ever been attached to hearing loss. I felt ‘doomed’ to say the least. As my loss progressed, I gave up my teaching career and found my social life deteriorating. People did not understand me, and I did not understand myself. I had no idea how to help myself, nor did I know how to get help. It was extremely lonely for a person who was, by nature, a social being. Had I not discovered Self Help for Hard of Hearing People, Inc. (SHHH) (Now The Hearing Loss Assn. of America, Inc. HLAA), in 1984, I often wonder what I would have happened to me in spite of having a helpful, loving family. Through SHHH/HLAA, I met other people like me. Together we battled this invisible malady and learned more about what was happening to us. Over its relatively short life span, SHHH/HLAA, has touched thousands of lives by answering questions, promoting the development of better technologies, medical research, and by making hearing loss an issue of concern. Peer support is a major part of the ongoing mission of HLAA. And yet, people who learn about HLAA support, often quite by accident, nearly always ask why they have not heard of this remarkable organization from hearing healthcare professionals or via the media. Why is this topic so boring to those who publicize success stories and solutions? Often there is focus on the fascination with manual communication in interesting situations; but rarely any coverage on solutions to partial deafness that can be helped with different technologies. This goes back to the stigmas attached and the invisibility of the disability.
These recent studies on the relationship of hearing loss to dementia, falling, and now death, are interesting. However, they add to the stigma problem. They frighten people into further denial of the problem and prevent many from seeking help. It seems to me that these studies should clearly define the difference between treated and untreated hearing loss. There should be more focus on the ‘success stories’, etc. Thirty plus years of personal experience with ‘treated' hearing loss, has proved to me (and many others whom I know through my involvement in SHHH/HLAA), that there is high quality life to be had in spite of having poor hearing. My first hearing aids ‘helped’. I was shocked to find that out after having been so discouraged, and given no hope on diagnosis. As I’ve moved through the advancements in technology, things got better and better. My first major leap was discovering audio loops, telecoils, amplified phones, and add on technologies that worked with direct audio input in my hearing aids that I didn’t even know I had. I learned about these things because of SHHH/HLAA, not from professionals in the field! Then, after watching the progress of many comrades in SHHH/HLAA receive cochlear implants, I decided the time was right for me in 2005. That was another major leap. Today I function bimodally, and continue to embrace assistive technology that works well with my personal devices. I cannot imagine who or where I’d be without the benefit of technology! Conclusion: Living WELL with hearing loss takes more than a professional fit of hearing instruments. It takes aural rehabilitation that includes peer support. If providers cannot or will not hire hearing loss support specialists, who personally experience hearing loss, in their practices, they should enthusiastically recommend that their clientele seek out or even start HLAA chapters and/or other groups that share common experiences. I understand that stigma and denial will cause many to ignore that kind of support and recommendation, but promoting it with enthusiasm is a beginning. Will scare tactics related to things like dementia, falling and even death work? Only if there is some way to focus on ‘treating hearing loss’ as a solution. Perhaps by promoting research on success stories we will find a way to move away from the ‘doom and gloom’ theories. NOTE: I appreciate the fact and reality that there may be, and probably are, correlations between falling (which relates to balance and hearing), and dementia and death. All tend to occur during the aging process, along with myriad other issues.
Julie M Olson MS
Past President SHHH National Board of Trustees (1995-1996)
HLAA Advocate & Educator
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Yesterday, by sheer chance, I came across an incredible story that helps to illustrate why current research approaches that do not differentiate between those who use hearing technology and those who do is clearly missing a crucial variable. It concerns two of my clients.
Every couple of months I see several women who just so happen to live in the same nursing home. One of the women I saw told me how another of my clients there had recently saved her life.
For some unknown reason Mrs D had been accidentally locked out of the home. She had been getting colder and colder and had tried pressing the alarm bell she wears but it wouldn't work. Being in a wheelchair and crippled by arthritis meant she had limited scope for movement, either to find help or to keep warm.
So she began to call out for help.
She doesn't have a particularly strong voice. Miss M heard her from her room upstairs and pressed the alerting call that brings staff to her room, saying "I think I can hear someone calling for help outside."
The staff checked on all the residents and found that Mrs D was missing and went searching for her. They found her outside, brought her in and put her straight into bed to warm her up and made sure she was alright.
But you know what the most amazing part of the this story for me is?
It's that Miss M has a severe mixed hearing loss and can only use a hearing aid in one ear. She spends all her time in her room, is wheelchair bound, and chooses not to interact with the other residents for reasons known only to her.
Yet when the moment counted, Miss M saved Mrs D's life. Because she heard. She heard even though she has a severe hearing loss. She heard because she was using hearing technology – in one ear only. But that was enough to connect her – and her sharp mind – to the moment. It was a crucial moment that saved a human life.
I ask you, how can an incident like that be captured in our current approach to research?
Because if we break down this single event:
- Miss M had to be wearing a hearing aid that enabled her to "hear as expected". And not for "rehab reasons" (as some advocate the primary purpose of hearing technology) but to maximise and maintain the brain's 24/7 moment-by-moment connection to the world.
- Mrs D had to have at least hoped that someone was available to hear her calls (i.e. expectation of a shared communication process made possible through the universality of hearing).
- Miss M doesn't leave her room, so the only means she had of rousing help was through the home's alerting system, which is based on audio-visual signalling. The audio is important because it "interrupts attention" even if someone isn't sat in front of the signalling board waiting for lights to randomly appear. So hearing connects us omnidirectionally to meaningful information across distances, even when our attention is elsewhere.
- Miss M had to be able to convey her concerns about what she heard quickly and efficiently, and the staff had to ask questions to clarify so they knew had to act. Transient communication in this manner is best suited to "aural" language.
That's four accounts involving a minimum of three people interconnected through "hearing as expected". One of whom was using hearing technology, and it resulted in saving a woman's life. Hearing technology decreased the risk of death.
But it woudn't have shown up that way in any study...
Because almost every study that is carried out on hearing loss focuses on the individual's hearing (e.g. Mrs D would have died with hearing loss = "correlation"). But hearing is about the interconnectedness of humans and the connectedness to the moment. And that needs other research approaches, such as the analysis of Complex Adaptive Systems.
I have not made this story up. I simply find I'm becoming far more aware of the role hearing plays in people's lives because I've started thinking about why the studies are so unreflective of the success stories that people using hearing technology have, and how we can put things right.
As a final, beautiful account of what happened next, Mrs D wanted to thank Miss M the following day but was told by staff that she doesn't see anyone. But Mrs D was so grateful that she wheeled up outside Miss M's door, knocked and shouted thank you for saving her life. Miss M. heard her and actually did something she never does: she opened the door and let Mrs D in and I'm told they had a wonderful conversation.
Hearing had brought people together. And their hearing technology enabled them to connect.
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Curtis - you're absolutely right about the challenge caused by the many studies showing "correlation" between hearing loss and "this and that", and mostly no causality. In this respect I am looking very much forward to an upcoming article by Prof. Hélène Amieva from Bordeaux who seems to state outright that "hearing aids put cognitive decline on hold". She apparently moves one step further than Frank Lin & Co.
Second, you're also right about the importance of how we ask our questions (re: feeling "lonely", etc). That's why in our EuroTrak surveys we use questions taken from the PHQ-2 (Patient Health Questionnaire) test which seems to be broadly used world-wide. At least then we hope to get the questions right. Then comes the analysis of the results - and the discussion about causality.
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"I hope someone forwards this kind of research to the Clinical Commissioning Group in North Staffordshire...."
Alas the problem we have in convincing commissioning groups and policy makers is that we still can't conclusively demonstrate that using hearing technology actually mitigates this risk. For example, this particular study – as it stands – shows that hearing impairment increases the risk regardless of whether or not someone is using hearing technology (and assuming it's fitted appropriately, with the appropriate support/rehabilitation).
The studies that have attempt to show that intervention using hearing technology reduces certain risks tend to be ambiguous in their findings.
For example, this recent study by Dawes et al (2015):
…demonstrates that hearing aid use is linked with better cognition, but doesn't show causation, only correlation. As the authors say, it could also be interpreted that more cognitively able people tend to get hearing aids!
Also their study wasn't able to demonstrate that social isolation is reduced if someone uses hearing technology. Rather, they found the opposite: that someone with hearing aids was more likely to experience (what the authors classed as) social isolation! Which of course doesn't make logical make sense to those of us in the hearing care community! Using hearing technology surely increases social interaction!
However, the question the authors relied upon was "Do you often feel lonely?"
In the literature loneliness is considered to be different from (though related to) social isolation which is better measured as "having a small social network, being unmarried, participating in few activities with others" (Wilson et al, 2007).
Also, from what I can tell, the study didn't account for whether someone was "feeling lonely" because of recent bereavement, losing contact with friends due to ageing, or whether intervention with hearing technology after reaching a point of desperation after the social networks had already been disrupted by the effects of the unsupported hearing loss.
So this is our problem:
- Hearing is so tightly woven into human experience that there are so many variables that confuse the data. How do you convincingly extract one from the other?
- Hearing aids tend to be a reactive intervention (which some see as subservient to a rehabilitation process, which by definition implies a life has already been dramatically impacted), fitted after several years of hearing loss, often when a point of desperation has been reached. During this time changes will have occured in the brain and in their lifestyles. Does fitting hearing technology automatically undo these changes? Unlikely. So those changes are likely to still influence any data.
So unfortunately it's no good us showing that hearing loss causes XYZ, because that doesn't prove the need for hearing technology. We have to demonstrate how using hearing technology decreases any risk. Otherwise we make it more difficult for someone to take action.
For example, I have clients/patients that have been caused distress by articles saying things like "hearing loss increases risk of dementia" because they believe it means there is no escape… if you have a hearing loss, you are now "doomed", which reflects on their behaviour:
"If I have my hearing checked, I may find out I'm "one of the doomed". And if I get hearing aids, it will prove (to myself) I have a hearing loss, which increases my risk of XYZ. Therefore I won't get my hearing checked (or hearing aids), because there's probably some another reason why I'm having these difficulties hearing that isn't linked to increasing my risk. For example, people speak quicker these days – that's down to them, not me! I'm safe! I'm master of my own destiny again!"
May sounds like flawed logic to us, but see the literature on Terror Management Theory and it's application to health behaviour promotion.
How do we move forward on this?
I have my thoughts, but would be interested to hear from others.
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Hi Curtis and Søren
It is in the JAMA Otolaryngology - Head & Neck Surgery.
Enclosed is the link to the news article:
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I hope someone forwards this kind of research to the Clinical Commissioning Group in North Staffordshire....
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Hi Sharmi. Do you have a link for this?