Hearing Aids as Cognitive Health Aids

Doctor looking into her patients ears with an instrument

Caroline Dombrowski

As we continue to hurtle toward the projected date when one in every five Americans will be over 65 years of age (the US Census estimates that to happen in 20301), working with older adults to prolong healthy years takes on increasing importance. One of the challenges besetting this population is hearing loss: approximately one in eight Americans have impaired hearing in both ears when tested using standard means; one in five has unilateral or bilateral hearing loss.2

Huge Opportunity for Health Promotion

Hearing loss is highly correlated with an increased later risk of dementia and depression.3-5 Why is that so important? It’s estimated that only 12% of adults follow up with hearing aids once diagnosed with hearing loss.5

Yet, in one study, those who did obtain a hearing aid had an 18% decreased risk of dementia or Alzheimer’s disease diagnosis, and an 11% decreased risk for anxiety and depression. Furthermore, the risk of fall-related injuries dropped by 13%.5 This represents an enormous opportunity for health promotion by primary care clinicians. The likelihood of hearing loss increases dramatically with age—90% of adults over 80 years of age have clinically significant hearing loss2—which provides a ready datapoint for stratifying patients by risk.

To protect the cognitive health of these patients, asking about hearing assessments and explaining the importance of hearing aids may help to prevent the enormous burden of cognitive decline in older populations. Even in older adults with dementia, hearing loss treatment has a high likelihood of improving symptoms related to dementia as well as communication difficulties.6

Protecting Patients From Hearing Loss

For younger patients who have a history of cognitive decline and/or hearing loss, emerging research suggests that nutrition may play a critical protective role. In one study of women, adhering to a healthier dietary pattern (specifically, the alternate Mediterranean diet or the Dietary Approaches to Stop Hypertension (DASH) diet) reduced the chance of self-reported hearing loss by approximately 30%.7

The mechanisms by which nutrition likely affects hearing are likely many and varied, including insulin resistance, adiponectin decline, dyslipidemia, and more.8

Conclusion

For the many patients with hearing loss who have not yet taken the important step of hearing loss treatment (fully 88% of those with hearing loss!), clear explanation from a clinician of the benefits of this treatment may make all the difference. Of course, the patient-practitioner relationship is a cornerstone of Functional Medicine, and loss of hearing can compromise that relationship, as well as the patient’s other personal relationships, which makes addressing their hearing loss all the more important. Attending to each patient’s sensory needs has the potential to benefit all of our patients.

References

  1. US Census. Older people projected to outnumber children for first time in U.S. history. Release Number CB18-41. Published March 13, 2018. Accessed September 5, 2019. https://www.census.gov/newsroom/press-releases/2018/cb18-41-population-projections.html
  2. Lin FR, Niparko JK, Ferrucci L. Hearing loss prevalence in the United States. Arch Intern Med. 2011;171(20):1851-1852. doi:11001/archinternmed.2011.506
  3. Deal JA, Reed NS, Kravetz AD, et al. Incident hearing loss and comorbidity: a longitudinal administrative claims study. JAMA Otolaryngol Head Neck Surg. 2019;145(1):36-43. doi:1001/jamaoto.2018.2876
  4. Lin FR, Yaffe K, Xia J, et al. Hearing loss and cognitive decline in older adults. JAMA Intern Med. 2013;173(4):293-299. doi:1001/jamainternmed.2013.1868
  5. Mahmoudi E, Basu T, Langa K, et al. Can hearing aids delay time to diagnosis of dementia, depression, or falls in older adults? J Am Geriatr Soc. Published online September 4, 2019. doi:1111/jgs.16109
  6. Mamo SK, Reed NS, Price C, et al. Hearing loss treatment in older adults with cognitive impairment: a systematic review. J Speech Lang Hear Res. 2018;61(10):2589-2603. doi:1044/2018_JSLHR-H-18-0077
  7. Curhan SG, Wang M, Eavey RD, Stampfer MJ, Curhan GC. Adherence to healthful dietary patterns is associated with lower risk of hearing loss in women. J Nutr. 2018;148(6):944-951. doi:1093/jn/nxy058
  8. Tang TH, Hwang JH, Yang TH, Hsu CJ, Wu CC, Liu TC. Can nutritional intervention for obesity and comorbidities slow down age-related hearing impairment? Nutrients. 2019;11(7):E1668. doi:3390/nu11071668