Hearing Loss Magazine January/February 2013 - 33

(Not too successfully however, since only about 15 percent of them use hearing aids.) But for this population, particularly at the upper end of the age spectrum, a hearing loss is not the only condition associated with increasing age: older folks are also more likely to display some sort of cognitive decline as well, ranging from a mild cognitive impairment (MCI) to advanced Alzheimer’s disease (AD). Some sort of dementia affects five to eight percent of the population older than age 65, with the incidence doubling every five years thereafter. In short, this is not a low incidence disorder.

Research and Cognitive Issues A number of researchers have been examining the co-existence of these two conditions in an effort to uncover the relationships between age related hearing losses and some type of dementia. Does having a hearing loss exacerbate the cognitive impairment? Is there a relationship between the severity of the cognitive symptoms and the degree of hearing loss? And can the use of hearing aids possibly forestall or reduce the severity of these symptoms? According to Frank Lin, M.D., Ph.D., of the Johns Hopkins School of Medicine, the answer to these questions is: “yes” (JAMA, 307, No.11, 2012). Age-related hearing loss has been found to be associated with poorer cognitive functioning and dementia. That is, older folks with a hearing loss are more likely to exhibit symptoms of dementia. His research revealed that, “compared to people with normal hearing those with mild, moderate and severe hearing loss had a two-, three-, five-fold risk of developing dementia, respectively.” While the specific mechanisms underlying this association is unknown, he suggests that it might be related to the effects of the hearing loss on cortical processing, the resulting increase in cognitive load (it takes more effort to understand speech with a hearing loss, particularly in noise) and the occurrence of increasing social isolation. A hearing loss, in other words, while it does not directly cause dementia, can exacerbate

the appearance of its symptomology. He points out, concisely and eloquently in this excellent article, that a hearing loss is more than an “unfortunate, but inconsequential part of aging.” It can, on the contrary, impact upon cognitive performance in ways that can permeate every aspect of a person’s life. It need not be a severe hearing loss; as he found, an age-related hearing loss of even 25 dB was equivalent to the cognitive performance of someone about seven years older. These findings beg the question of whether this decline in cognitive functioning (increasing symptoms of dementia) can be arrested or reversed with an aggressive program of aural rehabilitation, particularly when intervention takes place during the early appearance of a hearing loss.

Unlike younger folks, older people need much more encouragement to try different things. It is not sufficient to just tell them what to do, like how to use hearing aids, install a TV, listening device, or use a modified telephone, etc.; many will require hands-on help, including home visits when necessary (perhaps by audiological assistants).
There’s very little direct evidence bearing on this question, but what there is suggests that treatment by hearing aids in the early stages of hearing loss might help people retain cognitive function longer than those who are fit later. There’s no suggestion here that sound amplification can “cure” dementia, only that the confounding effects of the hearing loss itself on cognitive function can be somewhat ameliorated. In short, a hearing loss in older adults needs to be taken very seriously, in much the same way the hearing losses sustained by young servicemen during WW II and the Korean conflict were taken seriously. And in much the same way that hearing aids were not presented to them as the answer to the hearing loss, so must they not be viewed as all that

is necessary for those with age-related hearing losses. The issue that must be addressed is the benign view of hearing loss in older folks. This applies even though prospective users might feel that they can get along okay and that hearing assistance is not needed. So what if the TV set is turned up too loud or all types of social engagements are refused? That’s just the way things are. Not so; people with age-related hearing loss can benefit from an aggressive program of aural rehabilitation, including wellfited hearing aids and therapeutic group encounters. Unlike younger folks, older people need much more encouragement to try different things. It is not sufficient to just tell them what to do, like how to use hearing aids, install a TV, listening device, or use a modified telephone, etc.; many will require hands-on help, including home visits when necessary (perhaps by audiological assistants). What is less helpful are hearing aids delivered by the postal service, with written instructions, the address of a website, and a disembodied voice on the telephone. More human interactions are required: these older folks are not buying some kitchen appliance, but prosthetic devices that can significantly improve the quality of their lives. If we’re to do better in the future, as a society we need to show hearing loss and hearing aids their proper respect. Mark Ross, Ph.D., is a retired audiologist and wrote a technology column for 19 years for Hearing Loss Magazine as an associate at the Rehabilitation Engineering Research Center (RERC) at Gallaudet University. He was awarded the HLAA Lifetime Achievement Award in June 2008. He and his wife, Helen, live in Storrs, Connecticut. To find more Dr. Ross articles on technology for consumers, go to www.hearingloss.org and www.hearingresearch.org.
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Hearing Loss Magazine January/February 2013

Table of Contents for the Digital Edition of Hearing Loss Magazine January/February 2013