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.