Self-reported hearing loss, hearing aid use, and cognitive function among U.S. older adults
There has been increasing attention to the role of hearing loss as a potentially modifiable risk factor for Alzheimer’s disease and related dementias. However, more nationally-representative studies are needed to understand the co-occurring changes in hearing loss and cognitive function in older adults over time, and how hearing aid use might influence this association. The purpose of this report is to examine how age-related changes in hearing loss and hearing aid use are associated with trajectories of cognitive function in a nationally-representative sample of U.S. older adults. We used 11 waves of longitudinal data from the Health and Retirement Study (HRS) from 1998 to 2018 to examine changes in self-reported hearing loss, hearing aid use, and cognitive function in adults 65 and older by race and ethnicity. Results from mixed models showed that greater levels of hearing loss were associated with lower levels of cognitive function at age 65 in non-Hispanic White, non-Hispanic Black, and Hispanic older adults. We also found that the associations diminished across age in White and Black individuals; but remained persistent in Hispanic individuals. The use of hearing aids was not associated with cognitive function in Black older adults but appeared protective for White and Hispanic older adults. Overall, the findings from this report suggest that the timely identification of hearing loss and subsequent acquisition of hearing aids may be important considerations for reducing declines in cognitive function that manifests differently in U.S. population subgroups.
Agrawal Y, Platz EA, and Niparko JK. (2008). Prevalence of hearing loss and differences by demographic characteristics among US adults: Data from the national health and nutrition examination survey, 1999-2004. Archives of Internal Medicine, 168(14):1522- 1530. https://doi.org/10.1001/archinte.168.14.1522
Alattar AA, Bergstrom J, Laughlin GA, et al. (2019). Hearing impairment and cognitive decline in older, community-dwelling adults. The Journals of Gerontology Series A Biological Sciences and Medical Sciences, 75(3):567-573. https://doi.org/10.1093/gerona/ glz035
Babulal GM, Quiroz YT, Albensi BC, et al. (2019). Perspectives on ethnic and racial disparities in Alzheimer’s disease and related dementias: Update and areas of immediate need. Alzheimers and Dementia, 15(2):292-312.
Brenowitz WD, Kaup AR, Lin FR, et al. (2019). Multiple sensory impairment is associated with increased risk of dementia among black and white older adults. The Journals of Gerontology Series A, Biological Sciences and Medical Sciences, 74(6):890-896. https://doi.org/10.1093/gerona/gly264
Brown TH, O’Rand AM, and Adkins DE. (2012). Race-ethnicity and health trajectories: Tests of three hypotheses across multiple groups and health outcomes. Journal of Health and Social Behavior, 53(3):359-377. https://doi.org/10.1177/0022146512455333
Bugliari D, Nancy C, Chris C, et al. (2016). RAND HRS Data Documentation, Version P. Labor and Population Program: RAND Center for the Study of Aging.
CDC. (2017). Table A-6a. Age-Adjusted Percentages (with Standard Errors) of Hearing Trouble, Vision Trouble, and Absence of Teeth among Adults Aged 18 and Over, by Selected Characteristics: United States, 2017. In: Summary Health Statistics: National Health Interview Survey, 2017. U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Health Statistics. https://doi.org/10.3886/icpsr09228
Choi JS, Kari E, Friedman RA, et al. (2018). Prevalence of hearing loss and hearing care use among asian americans: A nationally representative sample. Otology and Neurotology, 39(2):158-167. https://doi.org/10.1097/mao.0000000000001668
Cloutier S, Chertkow H, Kergoat MJ, et al. (2015). Patterns of cognitive decline prior to dementia in persons with mild cognitive impairment. Journal of Alzheimer’s Disease, 47(4):901-913. https://doi.org/10.3233/jad-142910
Curhan SG, Willett WC, Grodstein F, et al. (2019). Longitudinal study of hearing loss and subjective cognitive function decline in men. Alzheimers and Dementia, 15(4):525-533. https://doi.org/10.1016/j.jalz.2018.11.004
Deal JA, Betz J, Yaffe K, et al. (2017). Hearing impairment and incident dementia and cognitive decline in older adults: The health ABC study. The Journals of Gerontology. Series A, Biological Sciences and Medical Sciences, 72(5):703-709. https://doi.org/10.1093/ gerona/glw069
Deal JA, Sharrett AR, Albert MS, et al. (2015). Hearing impairment and cognitive decline: A pilot study conducted within the atherosclerosis risk in communities neurocognitive study. American Journal of Epidemiology, 181(9):680-690. https://doi. org/10.1093/aje/kwu333
Demeester K, Topsakal V, Hendrickx JJ, et al. (2012). Hearing disability measured by the speech, spatial, and qualities of hearing scale in clinically normal-hearing and hearing-impaired middle-aged persons, and disability screening by means of a reduced SSQ (the SSQ5). Ear and Hearing, 33(5):615-616. https://doi.org/10.1097/aud.0b013e31824e0ba7
Gatehouse S and Noble W. (2004). The speech, spatial and qualities of hearing scale (SSQ). International Journal of Audiology, 43(2):85-99. https://doi.org/10.1080/14992020400050014
Gauthier S, Rosa-Neto P, Morais JA, et al. (2021). World Alzheimer Report 2021: Journey Through the Diagnosis of Dementia. London, England: Alzheimer’s Disease International.
Ge S, McConnell ES, Wu B, et al. (2021). Longitudinal association between hearing loss, vision loss, dual sensory loss, and cognitive decline. Journal of the American Geriatrics Society, 69(3):644-650. https://doi.org/10.1111/jgs.16933
Golub JS, Brickman AM, Ciarleglio AJ, et al. (2020). Audiometric age-related hearing loss and cognition in the hispanic community health study. The Journals of Gerontology. Series A, Biological Sciences and Medical Sciences, 75(3):552-560. https://doi. org/10.1093/gerona/glz119
Golub JS, Luchsinger JA, Manly JJ, et al. (2017). Observed hearing loss and incident dementia in a multiethnic cohort. Journal of the American Geriatrics Society 65(8):1691-1697. https://doi.org/10.1111/jgs.14848
Haas SA and Rohlfsen L. (2010). Life course determinants of racial and ethnic disparities in functional health trajectories. Social Science and Medicine, 70(2):240-250. https://doi.org/10.1016/j.socscimed.2009.10.003
House JS, Lepkowski JM, Kinney AM, et al. (1994). The social stratification of aging and health. Journal of Health and Social Behavior, 35(3):213-234. https://doi.org/10.2307/2137277
Kramer SE, Kapteyn TS, Festen JM, et al. (1996). The relationships between self-reported hearing disability and measures of auditory disability. Audiology, 35(5):277-287. https://doi.org/10.3109/00206099609071948
Lin FR, Metter EJ, O’Brien RJ, et al. (2011). Hearing loss and incident dementia. Archives of Neurology, 68(2):214-220.
Lin FR, Yaffe K, Xia J, et al. (2013). Hearing loss and cognitive decline in older adults. JAMA Internal Medicine, 173(4):293-299. https://doi.org/10.1001/jamainternmed.2013.1868
Lin FR. (2011). Hearing loss and cognition among older adults in the United States. The Journals of Gerontology: Series A Biological Sciences and Medical Sciences, 66(10):1131-1136. https://doi.org/10.1093/gerona/glr115
Livingston G, Sommerlad A, Orgeta V, et al. (2017). Dementia prevention, intervention, and care. The Lancet, 390(10113):2673- 2734.
Maharani A, Dawes P, Nazroo J, et al. (2018a). Longitudinal relationship between hearing aid use and cognitive function in older americans. Journal of the American Geriatrics Society, 66(6):1130-1136. https://doi.org/10.1111/jgs.15363
Maharani A, Dawes P, Nazroo J, et al. (2018b). Visual and hearing impairments are associated with cognitive decline in older people. Age and Ageing, 47(4):575-581. https://doi.org/10.1093/ageing/afy061
Maharani A, Dawes P, Nazroo J, et al. (2019). Associations between self-reported sensory impairment and risk of cognitive decline and impairment in the health and retirement study cohort. The Journals of Gerontology. Series B, Psychological Sciences and Social Sciences, 75(6):1230-1242. https://doi.org/10.1093/geronb/gbz043
McKee MM, Stransky ML, and Reichard A. (2018). Hearing loss and associated medical conditions among individuals 65 years and older. Disability and Health Journal, 11(1):122-125. https://doi.org/10.1016/j.dhjo.2017.05.007
Ofstedal MB, Fisher GG, and Herzog AR. (2005). Documentation of Cognitive Functioning Measures in the Health and Retirement Study. Ann Arbor, MI: Survey Research Center, University of Michigan. https://doi.org/10.7826/isr-um.06.585031.001.05.0010.2005
Rabe-Hesketh S and Skrondal A. (2012). Multilevel and Longitudinal Modeling Using Stata, Volume I: Continuous Responses. 3rd ed. College Station, Texas: StataCorpLP. https://doi.org/10.1177/0962280214527532
RAND Center for the Study of Aging. (2021). RAND HRS Longitudinal File 2018 (V1). Available from: https://www.rand.org/well-being/social-and-behavioral-policy/centers/aging/dataprod/hrs-data.html [Last accessed on 2022 May 25].
Simpson AN, Matthews LJ, Cassarly C, et al. (2019). Time from hearing aid candidacy to hearing aid adoption: A longitudinal cohort study. Ear and Hearing, 40(3):468-476. https://doi.org/10.1097/aud.0000000000000641
Sonnega A, Faul JD, Ofstedal MB, et al. (2014). Cohort profile: The health and retirement study (HRS). International Journal of Epidemiology, 43(2):576-585. https://doi.org/10.1093/ije/dyu067
Wallhagen MI, Strawbridge WJ, and Shema SJ. (2008). The relationship between hearing impairment and cognitive function: A 5-year longitudinal study. Research in Gerontological Nursing, 1(2):80-86. https://doi.org/10.3928/19404921-20080401-08
Wayne RV and Johnsrude IS. (2015). A review of causal mechanisms underlying the link between age-related hearing loss and cognitive decline. Ageing Research Reviews, 23(Pt B):154-166. https://doi.org/10.1016/j.arr.2015.06.002
West JS, Smith SL, and Dupre ME. (2020). Hearing loss. In: D Gu and M Dupre (eds.). Encyclopedia of Gerontology and Population Aging. Cham: Springer International Publishing. p.1-11. https://doi.org/10.1007/978-3-319-69892-2_1135-1
Whitson HE, Cronin-Golomb A, Cruickshanks KJ, et al. (2018). American geriatrics society and national institute on aging bench-to-bedside conference: Sensory impairment and cognitive decline in older adults. Journal of the American Geriatrics Society, 66(11):2052-2058. https://doi.org/10.1111/jgs.15506
Yang Y and Land KC. (2013). Age-Period-Cohort Analysis: New Models, Methods, and Empirical Applications. Boca Raton, FL: CRC Press.