Goman Adele M, Tan Nasya, Pike James Russell, Bessen Sarah Y, Chen Ziheng Sally, Huang Alison R, Arnold Michelle L, Burgard Sheila, Chisolm Theresa H, Couper David, Deal Jennifer A, Glynn Nancy W, Gmelin Theresa, Gravens-Mueller Lisa, Hayden Kathleen M, Martinez-Amezcua Pablo, Mitchell Christine M, Pankow James S, Reed Nicholas S, Sanchez Victoria A, Schrack Jennifer A, Sullivan Kevin J, Coresh Josef, Lin Frank R
School of Health and Social Care, Edinburgh Napier University, Edinburgh, UK; Cochlear Center for Hearing and Public Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
Cochlear Center for Hearing and Public Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
Lancet Public Health. 2025 Jun;10(6):e492-e502. doi: 10.1016/S2468-2667(25)00088-X.
Hearing loss is highly prevalent among older adults and has been associated with an increased likelihood of falling. We aimed to examine the effect of a hearing intervention on falls over 3 years among older adults in a secondary analysis of the ACHIEVE study.
The Aging and Cognitive Health Evaluation in Elders (ACHIEVE) study was a 3-year, unmasked, randomised controlled trial of adults aged 70-84 years at enrolment with untreated hearing loss and without substantial cognitive impairment. Participants were recruited at four US community-based field sites from two study populations: (1) an ongoing observational study of cardiovascular health (Atherosclerosis Risk in Communities [ARIC] study), and (2) de novo from the community. Participants were randomly assigned (1:1) to a hearing intervention (audiological counselling and provision of hearing aids) or a health education control (didactic education and enrichment activities covering chronic disease prevention topics). A prespecified exploratory outcome was falls. Self-reported falls in the past 12 months were assessed at baseline and annually for 3 years, and analysed by intention to treat with covariate adjustment. The study was registered with ClinicalTrials.gov, NCT03243422, and is completed.
Between Nov 9, 2017, and Oct 25, 2019, 3004 individuals were screened for eligibility and 977 (238 [24%] from the ARIC study and 739 [76%] de novo) were randomly assigned, with 490 (50%) in the hearing intervention group and 487 (50%) in the health education control group. Overall mean age was 76·8 years (SD 4·0), 523 (54%) participants were female and 454 (46%) were male, and 112 (11%) were Black, 858 (88%) were White, and seven (1%) were other race. In adjusted analyses, the intervention group had a 27% reduction in the mean number of falls over 3 years compared with the control group (intervention group: 1·45 [95% CI 1·28 to 1·61]; control group: 1·98 [1·82 to 2·15]; mean difference: -0·54 [95% CI -0·77 to -0·31]). This 3-year effect of hearing intervention was consistent across both the ARIC and de novo study populations.
Hearing intervention versus a health education control was associated with a reduction in the mean number of falls over 3 years in older adults. Ongoing follow-up of ACHIEVE participants in a separate follow-up study (NCT05532657) will enable examination of the longer term effects of hearing intervention on falls.
US National Institutes of Health.
听力损失在老年人中非常普遍，并且与跌倒风险增加有关。在对“实现听力干预预防老年人跌倒（ACHIEVE）研究”的二次分析中，我们旨在研究听力干预对老年人3年内跌倒情况的影响。
“老年人衰老与认知健康评估（ACHIEVE）研究”是一项为期3年的、非盲法、随机对照试验，纳入的是入组时年龄在70 - 84岁、患有未经治疗的听力损失且无严重认知障碍的成年人。参与者从美国四个社区实地研究点的两个研究人群中招募：（1）一项正在进行的心血管健康观察性研究（社区动脉粥样硬化风险[ARIC]研究），以及（2）社区新招募人群。参与者被随机分配（1:1）至听力干预组（听力学咨询和提供助听器）或健康教育对照组（讲授式教育和涵盖慢性病预防主题的丰富活动）。一个预先设定的探索性结局是跌倒。在基线时以及随后3年每年评估过去12个月内自我报告的跌倒情况，并采用意向性分析方法进行协变量调整后分析。该研究已在ClinicalTrials.gov注册，注册号为NCT03243422，现已完成。
在2017年11月9日至2019年10月25日期间，3004人接受了资格筛查，977人（238人[24%]来自ARIC研究，739人[76%]为新招募）被随机分配，其中490人（50%）在听力干预组，487人（50%）在健康教育对照组。总体平均年龄为76.8岁（标准差4.0），523名（54%）参与者为女性，454名（46%）为男性，112名（11%）为黑人，858名（88%）为白人，7名（1%）为其他种族。在调整分析中，与对照组相比，干预组3年内跌倒的平均次数减少了27%（干预组：1.45次[95%置信区间1.28至1.61]；对照组：1.98次[1.82至2.15]；平均差值：-0.54次[95%置信区间-0.77至-0.31]）。听力干预的这一3年效果在ARIC研究人群和新招募研究人群中均一致。
与健康教育对照相比，听力干预与老年人3年内跌倒平均次数减少有关。在一项单独的随访研究（NCT05532657）中对ACHIEVE参与者进行的持续随访将有助于研究听力干预对跌倒的长期影响。
美国国立卫生研究院。
