Letting hearing loss fall through the cracks can have devastating consequences.
Physicians and patients alike may consider hearing loss just a normal part of aging, along with aching joints and middle-aged spread. They may feel there is little to offer in terms of management, particularly in the early stages of hearing loss. In fact, nothing could be further from the truth.
Hearing loss and dementia
The importance of early hearing loss screening and treatment was highlighted in Aug. 2020 with the publication of Dementia Prevention, Intervention, and Care by The Lancet Commission. This report identifies untreated hearing impairment in midlife, defined as ages 45 to 65, as the largest modifiable risk factor for dementia, reporting that people in midlife with hearing loss have nearly twice the risk of developing dementia, relative to those without. As the degree of hearing impairment worsens, the risk of dementia increases.
Primary care physicians should view this report as a wake-up call to include hearing loss in their routine screenings, starting early in middle age. The report is timely, given that more than half of Canadians aged 40 to 79 have at least some degree of hearing loss, according to Statistics Canada. Most of this hearing loss is unperceived, indicating a need for active screening.
Role of hearing aids
The Lancet Commission report identifies the use of hearing aids as a means of mitigating the risk of dementia. It cites a 25-year prospective study of nearly 4,000 people aged 65 and older in which dementia risk was increased among those reporting hearing loss, except in those using hearing aids.(2) A similar cross-sectional study found that hearing loss was associated with cognitive decline only among people not using hearing aids.(5) Finally, a survey of 2,040 people aged 50 and older followed for 18 years(4) found, as described in The Lancet Commission report, that “hearing aid use was the largest factor protecting from decline (regression coefficient β for higher episodic memory 1·53;
P< 0.001) adjusting for protective and harmful factors.”
“The long follow-up times in these prospective studies suggest hearing aid use is protective, rather than the possibility that those developing dementia are less likely to use hearing aids. Hearing loss might result in cognitive decline through reduced cognitive stimulation,” wrote The Lancet Commission authors.
Hearing loss develops gradually. Patients themselves may not notice it or realize the potential cost to their long-term cognition. They may have an outdated view of hearing aids, making them reluctant to start a process that they erroneously believe will lead to the use of large, conspicuous devices that never seem to properly work.
This means primary care physicians must proactively discuss hearing health. This can be as simple as asking patients whether they’ve noticed that their hearing is not as good as it once was. Are they having more difficulty following conversations? Do they find themselves turning the TV up higher and higher? For patients reluctant to admit a problem, try the whispered voice test, in which numbers or words are whispered from behind the patient after full exhalation.(3) There are also screening questionnaires, such as the Hearing Handicap Inventory for the Elderly-Screening Version (HHIE-S), or consider investing in an audioscope for visual and basic tonal screening.
Patients suspected of hearing loss, even if mild, should be referred for testing by a licensed hearing professional. Overcome occasional resistance by explaining the long-term impact that untreated hearing loss can have on cognitive function and educating patients about recent advances in hearing aid technology. Today’s hearing aids are far more discreet and effective than they were even a few years ago. In fact, with Bluetooth and other connectivity features, they’re considered lifestyle augmentation devices, not just sound amplifiers.
How HearingLife can help
HearingLife Canada has more than 250 hearing centres offering hearing assessments by licensed hearing professionals. Our five-part evaluation includes otoscopy, tympanometry, pure-tone audiometry, speech audiometry and a Quick SIN speech-in-noise test, all provided free of charge.
Early adoption of hearing aids can help people have a better quality of life, stay active, and prevent the risks of untreated hearing loss, including dementia. During 2020, we have all seen the negative consequences of social isolation, and untreated hearing loss creates an isolation of its own.
Jillian Price, M.Sc, Aud (C), Reg. CASLPO is chief audiologist at HearingLife Canada Ltd.
References
1. Livingston G, Huntley J, Sommerlad A, et al. Dementia prevention, intervention, and care: 2020 report of The Lancet Commission.
Lancet. 2020;396(10248):413-446. doi:10.1016/S0140-6736(20)30367-6
2. Amieva H, Ouvrard C, Meillon C, et al. Death, depression, disability, and dementia associated with self-reported hearing problems: a 25-year study. J Gerontol A Biol Sci Med Sci 2018; 73: 1383–89.
3. Macphee GJ, Crowther JA, McAlpine CH. A simple screening test for hearing impairment in elderly patients.
Age Ageing 1988; 17:347-351.
4. Maharani A, Dawes P, Nazroo J, et al. Longitudinal relationship between hearing aid use and cognitive function in older Americans.
J Am Geriatr Soc 2018; 66: 1130–36.
5. Ray J, Popli G, Fell G. Association of cognition and age-related hearing impairment in the English longitudinal study of ageing.
JAMA Otolaryngol Head Neck Surg 2018; 144: 876–82.