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Psychosocial Impact of Hearing Loss

Psychosocial Impact of Hearing Loss in Adults

Deafness vs. Hearing Loss

  • Deafness:
    • Individuals born Deaf may identify as part of a cultural group.
    • They may not consider themselves disabled.
    • They communicate using sign language.
  • Acquired Hearing Loss:
    • Can be sudden or gradual.
    • Involves the loss of a crucial sense for connecting with others.

Acquired Hearing Loss: Direct Losses

  • Connection with Others:
    • Difficulty understanding speech.
    • Challenges with speech in noisy environments.
    • Inability to perceive subtlety in communication.
  • Awareness:
    • Reduced social awareness.
    • Diminished environmental awareness.
  • Enjoyment:
    • Loss of enjoyment of pleasant sounds.
    • Reduced appreciation of music.

Acquired Hearing Loss: Indirect Losses

  • Confidence: Decreased self-assurance in social and professional situations.
  • Social Contact: Reduced interaction and engagement with others, leading to isolation.
  • Mental Health: Increased risk of emotional distress, depression and anxiety.
  • Physical Health: Hearing loss is related to reduced physical activity and overall well being.
  • Cognitive Ability: Potential link between hearing loss and decline in cognitive functions.
    • Gopinath, B., Hickson, L., Schneider, J., McMahon, C. M., Burlutsky, G., Leeder, S. R., & Mitchell, P. (2012). Hearing-impaired adults are at increased risk of experiencing emotional distress and social engagement restrictions five years later. Age and Ageing, 41(5), 618-623.

You Gain

  • Tinnitus:
    • Perception of ringing or buzzing in the head or ears.
    • Considered a phantom sound.
    • Analogous to phantom limb pain.

Hearing Loss in Old Age & Cognitive Decline

  • Most acquired hearing loss happens in old age.
    • Presbyacusis: Accounts for 5/6 of hearing loss cases internationally.
  • Cognitive ability also generally declines with age.
  • Other sensory abilities decline (vision, balance).

Cognitive Ability Declines with Age

  • Older people (>$65 years) were followed up over six years.
  • A range of cognitive measures were used.
  • Wilson, R. S., Beckett, L. A., Barnes, L. L., Schneider, J. A., Bach, J., Evans, D. A., & Bennett, D. A. (2002). Individual differences in rates of change in cognitive abilities of older persons. Psychology and Aging, 17(2), 179-193.

Initial Measures Showed:

  • Older people tended to have poorer cognitive scores.
  • Wilson, R. S., Beckett, L. A., Barnes, L. L., Schneider, J. A., Bach, J., Evans, D. A., & Bennett, D. A. (2002). Individual differences in rates of change in cognitive abilities of older persons. Psychology and Aging, 17(2), 179-193.

Decline with Age

  • There tended to be decline with age, the decline was heterogenous.
  • Wilson, R. S., Beckett, L. A., Barnes, L. L., Schneider, J. A., Bach, J., Evans, D. A., & Bennett, D. A. (2002). Individual differences in rates of change in cognitive abilities of older persons. Psychology and Aging, 17(2), 179-193.

Age-Related Cognitive Ability & Sensory Functioning

  • Age-related cognitive ability is predicted by sensory functioning.
  • "Sensory functioning" included hearing, vision, and balance.
  • Lindenberger, U., & Baltes, P. B. (1997). Intellectual functioning in old and very old age: Cross-sectional results from the Berlin Aging Study. Psychology and Aging, 12(3), 410-432.

Hearing Loss & Cognitive Ability

  • Hearing loss is associated with poorer cognitive ability in older people.
  • Lin, F. R., Yaffe, K., Xia, J., Xue, Q.-L., Harris, T. B., Purchase-Helzner, E., . . . Hlth, A. B. C. S. G. (2013). Hearing Loss and Cognitive Decline in Older Adults. Jama Internal Medicine, 173(4), 293-299.

Causality Question

  • Is hearing loss causal of cognitive decline?
  • If so, can we prevent or reverse cognitive decline by treating hearing loss?

Potential Mechanisms Linking Hearing Loss & Cognitive Decline

  • Hearing Loss May Cause Cognitive Decline:
    • Cognitive Load: The person is overworked trying to understand sounds, lacking resources for other cognition.
    • Cascade: Loss of sensory input causes withdrawal, reduced brain stimulation and atrophy.
  • Or the Association May Be Non-Causal:
    • Common Cause: Hearing loss and cognitive decline are both caused by some other aspect of the person (poor blood circulation).
    • Overdiagnosis: Cognitive decline is not real but appears to be present due to a person not hearing the instructions for the tests.
    • Uchida, Y., Sugiura, S., Nishita, Y., Saji, N., Sone, M., & Ueda, H. (2019). Age-related hearing loss and cognitive decline - The potential mechanisms linking the two. Auris, Nasus, Larynx, 46(1), 1-9.

Cognitive Load Hypothesis

  • Losing hearing means that more cognitive effort is required to understand what has been said.
  • That cognitive load reduces the resources available to work out the meaning.
  • Cognitive Load: The amount of cognitive effort to complete a task.
  • Uchida, Y., Sugiura, S., Nishita, Y., Saji, N., Sone, M., & Ueda, H. (2019). Age-related hearing loss and cognitive decline - The potential mechanisms linking the two. Auris, Nasus, Larynx, 46(1), 1-9.

Cascade Hypothesis

  • Loss of sound input may lead to reduced stimulation:
    • Loss of social input.
    • Loss of environmental input.
  • Mental health issues and brain atrophy may lead to a reduction in cognitive ability.
  • Uchida, Y., Sugiura, S., Nishita, Y., Saji, N., Sone, M., & Ueda, H. (2019). Age-related hearing loss and cognitive decline - The potential mechanisms linking the two. Auris, Nasus, Larynx, 46(1), 1-9.

Common Cause Hypothesis

  • There may be an underlying factor that tends to increase with age and that influences both hearing and cognition.
  • For example, if blood vessels become blocked, this may impair the blood supply to both the ear and the brain.
  • Uchida, Y., Sugiura, S., Nishita, Y., Saji, N., Sone, M., & Ueda, H. (2019). Age-related hearing loss and cognitive decline - The potential mechanisms linking the two. Auris, Nasus, Larynx, 46(1), 1-9.

Overdiagnosis Hypothesis

  • There may be no direct decline in cognition.
  • Instead, there may appear to be one due to a person failing to understand the instructions given to them.
  • Uchida, Y., Sugiura, S., Nishita, Y., Saji, N., Sone, M., & Ueda, H. (2019). Age-related hearing loss and cognitive decline - The potential mechanisms linking the two. Auris, Nasus, Larynx, 46(1), 1-9.

Developmental Effects

  • The effects may be due to developmental effects observed in children.
  • Welch, D., & Dawes, P. J. D. (2007). Variation in the normal hearing threshold predicts childhood IQ, linguistic, and behavioral outcomes. Pediatric Research, 61(6), 737-744.
  • Lin et al, 2013

Can Hearing Aids Reverse/Prevent Cognitive Decline?

  • Mixed evidence.
  • Desjardins 2016:
    • Single-subject design.
    • Effects were detected with hearing aids.
    • Often returned to baseline after removing hearing aids.
    • Suggests that effects mediated by cognitive load/information pathway.
    • Desjardins, J. L. (2016). Analysis of Performance on Cognitive Test Measures Before, During, and After 6 Months of Hearing Aid Use: A Single-Subject Experimental Design. American Journal of Audiology, 25(2), 127-141

Randomised-Controlled Trial

  • 977 participants.
  • Randomly assigned to hearing aid or no hearing aid treatment.
  • Overall, no difference in cognitive decline over three years.
  • But in a subgroup of 238 people with cardiovascular risk factors, there was an effect.
  • Lin, F. R., Pike, J. R., Albert, M. S., Arnold, M., Burgard, S., Chisolm, T., . . . Coresh, J. (2023). Hearing intervention versus health education control to reduce cognitive decline in older adults with hearing loss in the USA (ACHIEVE): a multicentre, randomised controlled trial. The Lancet, 402(10404), 786-797.

Other Impacts of Hearing Loss

  • Financial cost.
  • Impact on others.
    • Third-party disability.

Financial Burden of Hearing Loss

  • Hearing Aids:
    • Hearing aid replacements every 3-5 years [$2000-$5000 per ear].
    • Consumables (batteries, earmoulds).
  • Cochlear Implants:
    • ˜NZ50k for surgery and rehabilitation.
    • Ongoing service and upgrades.
  • Loss of work and training opportunities.
  • Underemployment of deaf adults widely reported.

Third-Party Disability

  • "…… the disability of family members due to the health condition of their significant other and was identified as a direction for future development by the World Health Organization in 2001"
  • Scarinci, L Worrall & L Hickson (2009). The ICF and third-party disability: Its application to spouses of older people with hearing impairment. Disabil Rehabil 21:1-13.