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Applied Longitudinal Data Analysis Modeling Change And Event Occurrence

Background:Whetherhearinglossisindependentlyassociatedwithacceleratedcognitivedeclineinolderadults is unknown. Methods:Westudied1984olderadults(meanage,77.4 years) enrolled in the Health ABC Study, a prospective observational study begun in 1997-1998. Our baseline cohort consisted of participants without prevalent cognitive impairment (Modified Mini-Mental State Examination [3MS] score, 80) who underwent audiometric testinginyear5.Participantswerefollowedupfor6years. Hearing was defined at baseline using a pure-tone average of thresholds at 0.5 to 4 kHz in the better-hearing ear. Cognitive testing was performed in years 5, 8, 10, and11andconsistedofthe3MS(measuringglobalfunction) and the Digit Symbol Substitution test (measuring executive function). Incident cognitive impairment was definedasa3MSscoreoflessthan80oradeclinein3MS score of more than 5 points from baseline. Mixedeffects regression and Cox proportional hazards regression models were adjusted for demographic and cardiovascular risk factors. Results: In total, 1162 individuals with baseline hearing loss (pure-tone average 25 dB) had annual rates of declinein3MSandDigitSymbolSubstitutiontestscoresthat were41%and32%greater,respectively,thanthoseamong individuals with normal hearing. On the 3MS, the annual score changes were 0.65 (95% CI, 0.73 to 0.56) vs 0.46(95%CI,0.55to0.36)pointsperyear(P=.004). On the Digit Symbol Substitution test, the annual score changes were 0.83 (95% CI, 0.94 to 0.73) vs 0.63 (95% CI, 0.75 to 0.51) points per year (P=.02). Comparedtothosewithnormalhearing,individualswithhearing loss at baseline had a 24% (hazard ratio, 1.24; 95% CI, 1.05-1.48) increased risk for incident cognitive impairment. Rates of cognitive decline and the risk for incident cognitiveimpairmentwerelinearlyassociatedwiththeseverity of an individual’s baseline hearing loss.

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Hearing loss and cognitive decline in older adults

Objective To determine whether hearing loss is associated with incident all-cause dementia and Alzheimer disease (AD). Design Prospective study of 639 individuals who underwent audiometric testing and were dementia free in 1990 to 1994. Hearing loss was defined by a pure-tone average of hearing thresholds at 0.5, 1, 2, and 4 kHz in the better-hearing ear (normal, 70 dB [n = 6]). Diagnosis of incident dementia was made by consensus diagnostic conference. Cox proportional hazards models were used to model time to incident dementia according to severity of hearing loss and were adjusted for age, sex, race, education, diabetes mellitus, smoking, and hypertension. Setting Baltimore Longitudinal Study of Aging. Participants Six hundred thirty-nine individuals aged 36 to 90 years. Main Outcome Measure Incident caces of all-cause dementia and AD until May 31, 2008. Results During a median follow-up of 11.9 years, 58 cases of incident all-cause dementia were diagnosed, of which 37 cases were AD. The risk of incident all-cause dementia increased log linearly with the severity of baseline hearing loss (1.27 per 10-dB loss; 95% confidence interval, 1.06-1.50). Compared with normal hearing, the hazard ratio (95% confidence interval) for incident all-cause dementia was 1.89 (1.00-3.58) for mild hearing loss, 3.00 (1.43-6.30) for moderate hearing loss, and 4.94 (1.09-22.40) for severe hearing loss. The risk of incident AD also increased with baseline hearing loss (1.20 per 10 dB of hearing loss) but with a wider confidence interval (0.94-1.53). Conclusions Hearing loss is independently associated with incident all-cause dementia. Whether hearing loss is a marker for early-stage dementia or is actually a modifiable risk factor for dementia deserves further study.

/pdf/hearing-loss-and-incident-dementia-b27jtj7wgy.pdf

Hearing Loss and Incident Dementia

Purpose: The authors investigate the impact of hearing loss on quality of life in a large population of older adults. Design and Methods: Data are from the 5-year follow-up Epidemiology of Hearing Loss Study, a population-based longitudinal study of agerelated hearing impairment conducted in Beaver Dam, WI. Participants (N ¼ 2,688) were 53–97 years old (mean ¼ 69 years) and 42% were male. Difficulties with communication were assessed by using the Hearing Handicap for the Elderly—Screening version (HHIE-S), with additional questions regarding communication difficulties in specific situations. Health-related quality of life was assessed by using measures of activities of daily living (ADLs), instrumental ADLs (IADLs) and the Short Form 36 Health Survey (SF-36). Hearing loss measured by audiometry was categorized on the basis of the puretone average of hearing thresholds at 0.5, 1, 2, and 4 kHz. Results: Of participants, 28% had a mild hearing loss and 24% had a moderate to severe hearing loss. Severity of hearing loss was significantly associated with having a hearing handicap and with self-reported communication difficulties. Individuals with moderate to severe hearing loss were more likely than individuals without hearing loss to have impaired ADLs and IADLs. Severity of hearing loss was significantly associated with decreased function in both the Mental Component Summary score and the Physical Component Summary score of the SF-36 as well as with six of the eight individual domain scores. Implications: Severity of hearing loss is associated with reduced quality of life in older adults.

http://web.clas.ufl.edu/users/mcolburn/Web-links/SPA4321/Impact%20of%20HL%20on%20QOL.pdf

The Impact of Hearing Loss on Quality of Life in Older Adults

There are no recent population-based data on the prevalence of hearing loss in older adults using standard audiometric testing. The population-based Epidemiology of Hearing Loss Study was designed to measure the prevalence of hearing loss in adults aged 48-92 years, residing in Beaver Dam, Wisconsin. Hearing thresholds were measured with standardized protocols using pure-tone air- and bone-conduction audiometry in sound-treated booths. The examination also included an otoscopic evaluation, screening tympanogram, and a questionnaire on hearing-related medical history, noise exposure, other potential risk factors, and self-perceived hearing handicap. Of the 4,541 eligible people, 3,753 (82.6%) participated in the hearing study (1993-1995). The average age of participants was 65.8 years, and 57.7% were women. The prevalence of hearing loss was 45.9%. The odds of hearing loss increased with age (odds ratio (OR) = 1.88 for 5 years, 95% confidence interval (CI) 1.80-1.97) and were greater for men than women (OR = 4.42, 95% CI 3.73-5.24). The male excess of hearing loss remained statistically significant after adjusting for age, education, noise exposure, and occupation (OR = 3.65). These results demonstrate that hearing loss is a very common problem affecting older adults. Epidemiologic studies are needed to understand the genetic, environmental, and sex-related determinants of age-related hearing loss and to identify potential intervention strategies.

/pdf/prevalence-of-hearing-loss-in-older-adults-in-beaver-dam-3ni7vgsq22.pdf

Prevalence of Hearing Loss in Older Adults in Beaver Dam, Wisconsin The Epidemiology of Hearing Loss Study

Context.—Clinical studies have suggested that cigarette smoking may be associated
with hearing loss, a common condition affecting older adults.Objective.—To evaluate the association between smoking and hearing loss.Design.—Population-based, cross-sectional study.Setting.—Community of Beaver Dam, Wis.Participants.—Adults aged 48 to 92 years. Of 4541 eligible subjects, 3753 (83%) participated
in the hearing study.Main Outcome Measures.—The examination included otoscopy, screening tympanometry, and pure-tone
air-conduction and bone-conduction audiometry. Smoking history was ascertained
by self-report. Hearing loss was defined as a pure-tone average (0.5, 1, 2,
and 4 kHz) greater than 25-dB hearing level in the worse ear.Results.—After adjusting for other factors, current smokers were 1.69 times as
likely to have a hearing loss as nonsmokers (95% confidence interval, 1.31-2.17).
This relationship remained for those without a history of occupational noise
exposure and in analyses excluding those with non–age-related hearing
loss. There was weak evidence of a dose-response effect. Nonsmoking participants
who lived with a smoker were more likely to have a hearing loss than those
who were not exposed to a household member who smoked (odds ratio, 1.94; 95%
confidence interval, 1.01-3.74).Conclusions.—These data suggest that environmental exposures may play a role in age-related
hearing loss. If longitudinal studies confirm these findings, modification
of smoking habits may prevent or delay age-related declines in hearing sensitivity.

https://jamanetwork.com/journals/jama/articlepdf/187596/joc72066.pdf

Cigarette Smoking and Hearing Loss The Epidemiology of Hearing Loss Study

Context Hearing impairment affects many older adults, but the incidence is unknown. Objective To determine the 5-year incidence and progression of hearing impairment. Design A longitudinal, population-based study of adults aged 48 to 92 years at baseline examination. Hearing sensitivity was measured twice, 5 years apart. Setting Testing was conducted at the Beaver Dam Community Hospital, Beaver Dam, Wis. Participants A total of 1636 participants without hearing loss and 1085 participants with hearing loss at the baseline examination in 1993-1995 were reexamined in 1998-2000. Main Outcome Measure The examinations included otoscopy, screening tympanometry, and tone air- and bone-conduction audiometry. Incidence of hearing impairment was defined as a pure-tone average (PTA) of thresholds at 500, 1000, 2000, and 4000 Hz (PTA0.5, 1, 2, and 4 kHz) greater than 25 dB HL (hearing level) in either ear at follow-up among those without hearing loss at baseline. Progression was defined as a change of more than 5 dB in the PTA0.5, 1, 2, and 4 kHzamong those with hearing loss at baseline. Results The 5-year incidence of hearing impairment was 21%. More than half of those with hearing loss at baseline experienced a decline in hearing. Age was an important risk factor for both incidence and progression.Male sex, occupation, and education were associated with the incidence of hearing loss after adjusting for age. Conclusions Older adults have a high risk of developing hearing loss. Among those with hearing loss, most experience further declines in hearing sensitivity over time. These data indicate that hearing impairment is an important public health problem and underscore the need for appropriate hearing screening and treatment.

https://jamanetwork.com/journals/jamaotolaryngology/articlepdf/483974/ooa20172.pdf

The 5-year incidence and progression of hearing loss: the epidemiology of hearing loss study.

OBJECTIVES: To measure the prevalence of hearing aid use among older adults with hearing loss and to identify factors associated with those currently using hearing aids.

DESIGN: Population-based cohort study.

SETTING: The south-central Wisconsin community of Beaver Dam.

PARTICIPANTS: A total of 1629 adults, aged 48 to 92 years, who have hearing loss and are participating in the Epidemiology of Hearing Loss Study and the Beaver Dam Eye Study.

MEASUREMENTS: A hearing-related risk factor and medical history questionnaire, the Hearing Handicap Inventory for the Elderly (screening version), screening tympanometry, pure-tone air- and bone-conduction audiometry, and word recognition tests were administered by trained examiners using standard protocols.

RESULTS: The prevalence of current hearing aid use among those with a hearing loss (pure-tone average > 25 decibels hearing level over 500, 1000, 2000, and 4000 Hertz, worse ear) was 14.6%. The prevalence was 55% in a subset of the most severely affected participants. In univariate analyses, current hearing aid use was associated with age, severity of loss, word recognition scores, self-reported hearing loss, self-perceived hearing handicap, and history of noise exposure. Factors associated with current hearing aid use in multivariate logistic regression models were age, severity of loss, education, word recognition scores, Hearing Handicap Inventory for the Elderly (screening version) score, and self-report of a hearing loss.

CONCLUSIONS: Few older adults with hearing loss are currently utilizing hearing aids. Improved screening and intervention programs to identify older adults who would benefit from amplification are needed to improve hearing-related quality of life for this large segment of the population.

Low Prevalence of Hearing Aid Use Among Older Adults with Hearing Loss: The Epidemiology of Hearing Loss Study

Tinnitus (ringing or buzzing in the ear or head) can range from barely noticeable to debilitating . Although a few studies have estimated the prevalence of this condition in adult populations, we know of no population-based estimates of incidence. As part of a population-based study of hearing loss in adults aged 48 to 92 years at baseline in Beaver Dam, Wisconsin, self-reported data on tinnitus were obtained at the baseline examination (1993-1995 ; N = 3753) and again 5 years later (1998-2000 ; N = 2800) . A person was classified as having tinnitus if their tinnitus was at least moderate in severity or caused difficulty in falling asleep. The prevalence of tinnitus at baseline was 8 .2 percent. The 5-year incidence of tinnitus among the 2513 participants at risk was 5.7 percent. Risk factors for prevalent and incident tinnitus were evaluated. The results suggest that tinnitus is a common problem for older adults and is associated with some modifiable risk factors.

Ted S. Tweed

Papers

Prevalence of Hearing Loss in Older Adults in Beaver Dam, Wisconsin The Epidemiology of Hearing Loss Study

Cigarette Smoking and Hearing Loss The Epidemiology of Hearing Loss Study

The 5-year incidence and progression of hearing loss: the epidemiology of hearing loss study.

Low Prevalence of Hearing Aid Use Among Older Adults with Hearing Loss: The Epidemiology of Hearing Loss Study

Prevalence and 5-Year Incidence of Tinnitus among Older Adults : The Epidemiology of Hearing Loss Study