Reed Nicholas S, Chen Jinyu, Huang Alison R, Pike James R, Arnold Michelle, Burgard Sheila, Chen Ziheng, Chisolm Theresa, Couper David, Cudjoe Thomas K M, Deal Jennifer A, Goman Adele M, Glynn Nancy W, Gmelin Theresa, Gravens-Mueller Lisa, Hayden Kathleen M, Mitchell Christine M, Mosley Thomas, Oh Esther S, Pankow James S, Sanchez Victoria A, Schrack Jennifer A, Coresh Josef, Lin Frank R
Optimal Aging Institute, New York University Grossman School of Medicine, New York.
Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
JAMA Intern Med. 2025 May 12. doi: 10.1001/jamainternmed.2025.1140.
Promoting social connection among older adults is a public health priority. Addressing hearing loss may reduce social isolation and loneliness among older adults.
To describe the effect of a best-practice hearing intervention vs health education control on social isolation and loneliness over a 3-year period in the Aging and Cognitive Health Evaluation in Elders (ACHIEVE) study.
DESIGN, SETTING, AND PARTICIPANTS: This secondary analysis of a multicenter randomized controlled trial with 3-year follow-up was completed in 2022 and conducted at 4 field sites in the US (Forsyth County, North Carolina; Jackson, Mississippi; Minneapolis, Minnesota; Washington County, Maryland). Data were analyzed in 2024. Participants included 977 adults (aged 70-84 years who had untreated hearing loss without substantial cognitive impairment) recruited from the Atherosclerosis Risk in Communities study (238 [24.4%]) and newly recruited (de novo; 739 [75.6%]). Participants were randomized (1:1) to hearing intervention or health education control and followed up every 6 months.
Hearing intervention (4 sessions with certified study audiologist, hearing aids, counseling, and education) and health education control (4 sessions with a certified health educator on chronic disease, disability prevention).
Social isolation (Cohen Social Network Index score) and loneliness (UCLA Loneliness Scale score) were exploratory outcomes measured at baseline and at 6 months and 1, 2, and 3 years postintervention. The intervention effect was estimated using a 2-level linear mixed-effects model under the intention-to-treat principle.
Among the 977 participants, the mean (SD) age was 76.3 (4.0) years; 523 (53.5%) were female, 112 (11.5%) were Black, 858 (87.8%) were White, and 521 (53.4%) had a Bachelor's degree or higher. The mean (SD) better-ear pure-tone average was 39.4 dB (6.9). Over 3 years, mean (SD) social network size reduced from 22.6 (11.1) to 21.3 (11.0) and 22.3 (10.2) to 19.8 (10.2) people over 2 weeks in the hearing intervention and health education control arms, respectively. In fully adjusted models, hearing intervention (vs health education control) reduced social isolation (social network size [difference, 1.05; 95% CI, 0.01-2.09], diversity [difference, 0.19; 95% CI, 0.02-0.36], embeddedness [difference, 0.27; 95% CI, 0.09-0.44], and reduced loneliness [difference, -0.94; 95% CI, -1.78 to -0.11]) over 3 years. Results were substantively unchanged in sensitivity analyses that incorporated models that were stratified by recruitment source, analyzed per protocol and complier average causal effect, or that varied covariate adjustment.
This secondary analysis of a randomized clinical trial indicated that older adults with hearing loss retained 1 additional person in their social network relative to a health education control over 3 years. While statistically significant, it is unknown whether observed changes in social network are clinically meaningful, and loneliness measure changes do not represent clinically meaningful changes. Hearing intervention is a low-risk strategy that may help promote social connection among older adults.
ClinicalTrials.gov Identifier: NCT03243422.
促进老年人的社交联系是一项公共卫生重点工作。解决听力损失问题可能会减少老年人的社会隔离和孤独感。
在老年人衰老与认知健康评估（ACHIEVE）研究中，描述最佳实践听力干预与健康教育对照在3年期间对社会隔离和孤独感的影响。
设计、背景和参与者：这项多中心随机对照试验的二次分析于2022年完成，在美国的4个实地地点（北卡罗来纳州福赛斯县；密西西比州杰克逊市；明尼苏达州明尼阿波利斯市；马里兰州华盛顿县）进行，随访3年。2024年对数据进行了分析。参与者包括977名成年人（年龄在70 - 84岁，患有未经治疗的听力损失且无严重认知障碍），其中238名（24.4%）从社区动脉粥样硬化风险研究中招募，739名（75.6%）为新招募。参与者被随机（1:1）分配到听力干预组或健康教育对照组，每6个月进行一次随访。
听力干预（由认证的研究听力学家进行4次治疗，配备助听器、咨询和教育）和健康教育对照（由认证的健康教育工作者就慢性病、残疾预防进行4次治疗）。
社会隔离（科恩社会网络指数得分）和孤独感（加州大学洛杉矶分校孤独感量表得分）是在基线、干预后6个月以及1、2和3年时测量的探索性结局。干预效果根据意向性分析原则，使用二级线性混合效应模型进行估计。
在977名参与者中，平均（标准差）年龄为76.3（4.0）岁；523名（53.5%）为女性，112名（11.5%）为黑人，858名（87.8%）为白人，521名（53.4%）拥有学士学位或更高学历。较好耳的平均（标准差）纯音平均值为39.4 dB（6.9）。在3年时间里，听力干预组和健康教育对照组中，每2周内社交网络规模的平均（标准差）人数分别从22.6（11.1）减少到21.3（11.0），从22.3（10.2）减少到19.8（10.2）。在完全调整模型中，听力干预（与健康教育对照相比）在3年内减少了社会隔离（社交网络规模[差异，1.05；95%置信区间，0.01 - 2.09]、多样性[差异，0.19；95%置信区间，0.02 - 0.36]、嵌入性[差异，0.27；95%置信区间，0.09 - 0.44]），并减少了孤独感[差异， - 0.94；95%置信区间， - 1.78至 - 0.11]。在纳入按招募来源分层的模型、按方案分析和依从者平均因果效应分析或改变协变量调整的敏感性分析中，结果基本不变。
这项随机临床试验的二次分析表明，与健康教育对照相比，患有听力损失的老年人在3年时间里其社交网络中多保留了1个人。虽然具有统计学意义，但社交网络中观察到的变化在临床上是否有意义尚不清楚，孤独感测量的变化并不代表临床上有意义的变化。听力干预是一种低风险策略，可能有助于促进老年人的社交联系。
ClinicalTrials.gov标识符：NCT03243422。
