Mick Paul, Pichora-Fuller M Kathleen
1Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada; 2Kelowna General Hospital, Kelowna, British Columbia, Canada; 3Department of Psychology, University of Toronto, Toronto, Ontario, Canada; 4Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada; and 5Rotman Research Institute, Toronto, Ontario, Canada.
Ear Hear. 2016 May-Jun;37(3):e194-201. doi: 10.1097/AUD.0000000000000267.
Hearing screening programs may benefit adults with unacknowledged or unaddressed hearing loss, but there is limited evidence regarding whether such programs are effective at improving health outcomes. The objective was to determine if poorer audiometric hearing thresholds are associated with poorer cognition, social isolation, burden of physical or mental health, inactivity due to poor physical or mental health, depression, and overnight hospitalizations among older American adults with unacknowledged or unaddressed hearing loss.
The authors performed a cross-sectional population-based analysis of older American adults with normal hearing or unacknowledged or unaddressed hearing loss. Data was obtained from the 1999 to 2010 cycles of the National Health and Nutrition Examination Survey. Participants with a pure-tone average (PTA in the better hearing ear of thresholds at 0.5, 1, 2, and 4 kHz) > 25 dB HL who self-reported their hearing ability to be "good" or "excellent" were categorized as having "unacknowledged" hearing loss. Those who had a PTA > 25 dB HL and who self-reported hearing problems but had never had a hearing test or worn a hearing aid were categorized as having "unaddressed" hearing loss. Multivariate regression was performed to account for confounding due to demographic and health variables.
A 10 dB increase in PTA was associated with a 52% increased odds of social isolation among 60- to 69-year-olds in multivariate analyses (p = 0.001). The average Digit Symbol Substitution Test score dropped by 2.14 points per 10 dB increase in PTA (p = 0.03), a magnitude equivalent to the drop expected for 3.9 years of chronological aging. PTA was not associated significantly with falls, hospitalizations, burden of physical or mental health, or depression, or social isolation among those ages 70 years or older in these samples.
Unacknowledged or unaddressed hearing loss was associated with a significantly increased risk of social isolation among 60- to 69-year-olds but not those 70 years or older. It was also associated with lower cognitive scores on the Digit Symbol Substitution Test among 60- to 69-year-olds. This study differs from prior studies by focusing specifically on older adults who have unacknowledged or unaddressed hearing loss because they are the most likely to benefit from pure-tone hearing screening. The finding of associations between hearing loss and measures of social isolation and cognition in these specific samples extends previous findings on unrestricted samples of older adults including those who had already acknowledged hearing problems. Future randomized controlled trials measuring the effectiveness of adult hearing screening programs should measure whether interventions have an effect on these measures in those who have unacknowledged or unaddressed pure-tone hearing loss.
听力筛查项目或许能使未被察觉或未得到治疗的听力损失的成年人受益，但关于此类项目是否能有效改善健康状况的证据有限。目的是确定在美国未被察觉或未得到治疗的听力损失的老年成年人中，较差的听力阈值是否与较差的认知、社会隔离、身心健康负担、因身心健康不佳导致的活动减少、抑郁以及过夜住院有关。
作者对听力正常或有未被察觉或未得到治疗的听力损失的美国老年成年人进行了基于人群的横断面分析。数据来自1999年至2010年的国家健康和营养检查调查周期。纯音平均听阈（在较好耳中0.5、1、2和4千赫频率的阈值）>25分贝听力级且自我报告听力能力为“良好”或“优秀”的参与者被归类为有“未被察觉”的听力损失。纯音平均听阈>25分贝听力级且自我报告有听力问题但从未进行过听力测试或佩戴过助听器的参与者被归类为有“未得到治疗”的听力损失。进行多变量回归以解释人口统计学和健康变量造成的混杂影响。
在多变量分析中，纯音平均听阈每增加10分贝，60至69岁人群中社会隔离的几率增加52%（p = 0.001）。纯音平均听阈每增加10分贝，数字符号替换测试平均得分下降2.14分（p = 0.03），这一下降幅度相当于按实际年龄计算3.9年预期的下降幅度。在这些样本中，纯音平均听阈与70岁及以上人群的跌倒、住院、身心健康负担、抑郁或社会隔离无显著关联。
未被察觉或未得到治疗的听力损失与60至69岁人群中社会隔离风险显著增加有关，但与70岁及以上人群无关。它还与60至69岁人群在数字符号替换测试中的较低认知得分有关。本研究与先前研究的不同之处在于特别关注有未被察觉或未得到治疗的听力损失的老年人，因为他们最有可能从纯音听力筛查中受益。在这些特定样本中发现听力损失与社会隔离和认知指标之间的关联扩展了先前对包括那些已承认有听力问题的老年人在内的无限制样本的研究结果。未来测量成人听力筛查项目有效性的随机对照试验应测量干预措施对那些有未被察觉或未得到治疗的纯音听力损失的人的这些指标是否有影响。
