听力损失、助听器和功能状态。

Hearing Loss, Hearing Aids, and Functional Status.

机构信息

Cochlear Center for Hearing and Public Health, Johns Hopkins University, Baltimore, Maryland.

Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.

出版信息

JAMA Otolaryngol Head Neck Surg. 2024 Aug 1;150(8):705-712. doi: 10.1001/jamaoto.2024.1716.

DOI:10.1001/jamaoto.2024.1716

PMID:38958950

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11223052/

Abstract

IMPORTANCE

Hearing loss may contribute to poor functional status via cognitive impairment and social isolation. Hearing aids may play a protective role by attenuating these downstream outcomes. However, population-based evidence is lacking.

OBJECTIVE

To examine the association of hearing loss and hearing aids with functional status.

DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional (2016-2017) and longitudinal (2016-2022) analysis of data from the Atherosclerosis Risk in Communities cohort study included older, community-dwelling adults with complete data. Data were analyzed from June to December 2023.

EXPOSURES

The better-hearing ear's pure tone average (BPTA) at speech frequencies (0.5-4 kHz) was modeled categorically (no [BPTA ≤25 dB], mild [26-40 dB], and moderate or greater hearing loss [>40 dB]). Hearing aid use was self-reported.

MAIN OUTCOMES AND MEASURES

Difficulties in activities of daily living (ADLs; eg, dressing and eating), instrumental activities of daily living (IADLS; eg, household chores and meal preparation), and heavier tasks (eg, walking a quarter of a mile) were self-reported at visit 6. The ability to perform usual activities, walk a half mile, walk up and down stairs, and do heavy housework without help were collected in follow-up surveys. Linear and logistic regression models were used that were adjusted for sociodemographic and health covariates.

RESULTS

Among 3142 participants (mean [SD] age, 79.3 [4.6] years; 1828 women [58.2%]), 1013 (32.2%) had no hearing loss, 1220 (38.8%) had mild hearing loss, and 909 (29.0%) had moderate or greater hearing loss. Moderate or greater hearing loss was cross-sectionally associated with difficulty in 1 or more ADLs (odds ratio [OR], 1.27; 95% CI, 1.02-1.58), IADLs (OR, 1.34; 95% CI, 1.05-1.71), and heavier tasks (OR, 1.29; 95% CI, 1.04-1.62) compared with no hearing loss. Over time (mean [SD] follow-up, 1.9 [1.8] years), moderate or greater hearing loss was associated with a faster decline in the number of activities participants were able to do (β = -0.07 per year; 95% CI, -0.09 to -0.06) and greater odds of reporting inability to do 1 or more of the 4 activities (OR, 1.14; 95% CI, 1.05-1.24). Hearing aid users and nonusers did not differ.

CONCLUSIONS AND RELEVANCE

The results of this study suggest that moderate or greater hearing loss was associated with functional difficulties and may contribute to a faster decline in function longitudinally independent of sociodemographic and health covariates. Hearing aids did not change the association among those with hearing loss.

摘要

重要性

听力损失可能通过认知障碍和社会隔离导致较差的功能状态。助听器可能通过减轻这些下游结果发挥保护作用。然而，缺乏基于人群的证据。

目的

研究听力损失和助听器与功能状态的关系。

设计、地点和参与者：本横断面（2016-2017 年）和纵向（2016-2022 年）分析了社区动脉粥样硬化风险队列研究的数据，包括年龄较大、居住在社区的成年人，且这些人有完整的数据。数据分析于 2023 年 6 月至 12 月进行。

暴露

言语频率（0.5-4 kHz）的较好耳朵纯音平均听力（BPTA）以分类形式建模（无听力损失[BPTA≤25 dB]、轻度[26-40 dB]和中度或更严重听力损失[>40 dB]）。助听器使用情况为自我报告。

主要结局和测量指标

日常生活活动（ADL；例如，穿衣和吃饭）、工具性日常生活活动（IADL；例如，家务和准备膳食）和较重任务（例如，走四分之一英里）的困难程度在第 6 次就诊时自我报告。在后续调查中收集了进行日常活动、走半英里、上下楼梯和不借助帮助做重家务的能力。使用线性和逻辑回归模型，调整了社会人口统计学和健康协变量。

结果

在 3142 名参与者（平均[标准差]年龄，79.3[4.6]岁；1828 名女性[58.2%]）中，1013 名（32.2%）无听力损失，1220 名（38.8%）有轻度听力损失，909 名（29.0%）有中度或更严重听力损失。与无听力损失相比，中度或更严重的听力损失与 1 项或多项 ADL（优势比[OR]，1.27；95%置信区间[CI]，1.02-1.58）、IADL（OR，1.34；95% CI，1.05-1.71）和较重任务（OR，1.29；95% CI，1.04-1.62）的困难有关。随着时间的推移（平均[标准差]随访时间，1.9[1.8]年），中度或更严重的听力损失与参与者能够完成的活动数量下降更快有关（β=−0.07/年；95% CI，−0.09 至−0.06），以及报告无法完成 4 项活动中 1 项或多项活动的几率更高（OR，1.14；95% CI，1.05-1.24）。助听器使用者和非使用者之间没有差异。