Ageing, Hearing Loss, Dementia and Hearing Care

Nov 17 2021

The Power of Hearing

Everyone has different reasons for putting off seeking help for hearing loss, from price issues and vanity concerns to preconceived and often outdated ideas of how hearing aids perform.

Today's hearing aids - like all high-tech devices–have come a long way in terms of looks and performance. And independent research shows that hearing aid usage has a positive effect on:

• Earning power
• Communication in relationships
• Intimacy and warmth in family relationships
• Ease in communication
• Emotional stability
• Sense of control over life events
• Perception of mental functioning
• Physical health

The first step is making an appointment to be examined by an audiologist, who will identify the extent and type of your hearing problem. The assessment is conducted by a skilled clinician and takes about 30 minutes.

Audiologists are health-care professionals who evaluate, diagnose, treat and manage hearing loss, tinnitus and balance disorders in newborns, children and adults. An audiologist is a clinician who has completed an undergraduate university degree and a two-year master's degree in audiology.

Auditory Deprivation & Brain Deterioration

Declining Brain Function

Studies have shown that the effects of hearing loss are cumulative. Just as muscles grow weak from lack of use, the brain loses its ability to process sounds and recognize speech without regular auditory stimulation. By the time you finally acknowledge that your hearing loss is real, you may have already lost the full appreciation of sounds and the music you once enjoyed.

Most hearing loss occurs very slowly in both ears over a long period of time. Unless regularly tested, people tend not to notice this decline but gradually withdraw socially. They may well smile and nod their heads, but not actually hear or understand what is being said to them. Eventually they stop going into noisy environments where they can't cope with what the brain interprets as noise (not conversation) and consequently they slowly lose their cognitive ability to process sounds and separate speech from noise.

"The brain isn't being kept stimulated and gradually loses its ability to recognise certain sounds and words and language."
(Auditory Deprivation & Brain Deterioration)

Social Isolation

"The idea that 'hearing loss causes dementia' is a commonly used scare tactic to pressure hearing loss sufferers into the purchase of hearing aids; however, it is more so that hearing loss causes changes in your ability to communicate and socialise. You tend to be more isolated when you have a hearing loss, and this can cause your brain to atrophy a little quicker or allow dementia and cognitive decline to take hold a little bit faster."

WHO - World Report on Hearing

On the 3rd of March 2021 (World Hearing Day), the World Health Organisation (WHO) launched the World Report on Hearing.

The WHO concluded:

• Hearing loss is the largest potentially modifiable risk factor for age-related dementia.
• Adult hearing screening and early intervention becomes even more relevant given the links between hearing loss and dementia.
• Addressing hearing through hearing devices may have a positive influence on an individual's cognition.
• The use of hearing aids can also protect against cognitive decline and dementia.
• The use of hearing devices is shown to be cost-effective in different economic settings.

Study - Ageing, Neuropsychology and Cognition

The results of a "Hearing loss, cognition, and risk of neurocognitive disorder" study of older adult Australians was published in 2020. The study used data from 1,037 Australian subjects who took part in the Sydney Memory and Ageing Longitudinal Study.

Hearing Loss and the level of hearing loss was based on self-report. From the total group, 424 (41%) - mean age 79 years - self-reported hearing difficulties and 613 (59%) - mean age 78 years - self-reported normal hearing.

An expert panel defined the level of Mild Cognitive Impairment (MCI) and Dementia for each subject-:

• Mild hearing difficulties were not associated with an increased risk for the neurocognitive disorder compared to subjects self-reporting normal hearing. Hazard Ratio - HR = 0.93
• Moderate-severe hearing difficulties were associated with an increased risk for the neurocognitive disorder compared to subjects self-reporting normal hearing Hazard Ratio - HR = 1.84
• Significant hearing difficulties for subjects with healthy cognition at baseline, emerged as a significant risk factor for MCI during the follow-up period Hazard Ratio - HR = 1.59

The conclusions from this study provide further evidence of the impact of hearing loss on cognitive abilities as well as risks for MCI and dementia in older adults.
(P. Strutt et al, 2020. Cited in Hearing Care Industry Association, AustraliaWhite Paper, March 2021)

Hearing Aids: Cost - Benefit Analysis

Data used to estimate the economic benefits of Hearing Aids to reduce symptoms of dementia come from the National Alzheimer's Coordinating Center (NACC) USA. This data set has been running since 2005 and includes demographic, clinical, diagnostic, and neuropsychological information on participants with normal cognition, mild cognitive impairment, and dementia.

Data on 37,544 subjects between 2005 and 2017 were extracted for use in the study.

• The lifetime total benefits of purchasing and wearing Hearing Aids are: US$248,425.
• The lifetime Hearing Aid costs are: US $8,499.
• This results in a benefit - cost ratio of 29.

The study results confirm the findings in the literature that hearing aids reduce the symptoms of dementia. Reducing the symptoms of dementia with improved hearing due to wearing hearing aids, increases a client's quality of life and financial position.

The total benefits (mainly coming from the direct benefits) were close to a quarter of a million US dollars. This is very large, relative to the costs of hearing aids, with a benefit–cost ratio of 29.

The indirect benefits were also sizeable in that, even if they were the only category of benefits, they alone would be sufficient to cover the hearing aid costs.
(from R. Brent.A cost–benefit analysis of hearing aids, including the benefits of reducing the symptoms of dementia, 2019)

Early Hearing Care Intervention

A White Paper, Saving Australia's Minds, was prepared by Mark Laureyns for the Hearing Care Industry Association, Australia(HCIA) in March 2021. The paper provides"compelling peer-reviewed evidence for early hearing care intervention to prevent dementia."

Laureyns is the current co-chair of the World Hearing Forum ‘Make Listening Safe Workgroup', an initiative of the WHO. He is the President of the European Association of Hearing Aid Professionals and works in Hearing Aid Fitting at the Thomas More University College, Department of Audiology in Antwerp. Laureynsis a highly experienced and qualified Audiologist and Speech Pathologist

The HCIA White Paper aims to draw the attention of policy makers to the urgency in addressing age-related hearing loss to avoid much greater healthcare burdens - specifically dementia.

The 2018 Australian Royal Commission into Aged Care Quality and Safety - Care, Dignity and Respect - also raised the increasing challenges faced by the Aged Care sector in relation to Dementia.

• Dementia is now the second leading cause of death in Australia and the leading cause of death among women.
• It is a highly visible disease, with over 472,000 people with dementia in Australia.
• This number is expected to grow to 590,000 in the next seven years and pass 1,000,000 in 2058.
• It is also currently estimated that over half of all aged care residents in Australia have dementia.
• The process of ageing need not be associated with decreased quality of life, depression or cognitive decline to a point of dementia.
• Hearing loss in mid-life is the largest modifiable risk factor for age-related dementia.

The Saving Australia's Minds White Paper once again highlights the scientific link between hearing loss and cognitive decline, and the positive impact early intervention through access to appropriate hearing aids and associated services can have on reducing the risk of dementia.

Source: Laureyns.Saving Australia's Minds - White Paper.HCIA, 2021.

• 1 in 10 over 65's in Australia have dementia costing the economy more than $15 billion
• Unaddressed hearing loss was identified as responsible for more dementia among older adults than other risk factors including alcohol overconsumption, traumatic brain injury, obesity and hypertension combined
• Hearing loss in mid-life is the largest modifiable risk factor for age-related dementia
• The benefits of reducing the symptoms of dementia relative to the total cost of hearing aids is a ratio of around 30:1

The white paper concludes:
The data presents policy makers with a critical choice relating to early hearing treatment intervention and reducing the impact of dementia.

Deferring hearing care treatment until well into old age is often too late. The cognitive decline and deficit are often well established, and they result in greater difficulties for an aged person to effectively and confidently adapt physically and psychologically to any hearing care support.

In the context of an ageing population and increasing costs of providing aged care, now is the time to seize the opportunity for a preventative hearing health strategy that will address the link between age-related hearing loss and dementia.
(from Dementia, Hearing Loss and Hearing Care: White Paper. Saving Australia's Minds. Hearing Care Industry Association, Australia March 2021) https://hcia.com.au

Holistic Approach to Dementia Prevention

A three-year Ageing and Cognitive Health Evaluation in Elders (ACHIEVE)study began as a randomized controlled trial in January 2018 at Johns Hopkins Bloomberg School of Public Health, USA.

The "Ageing Cognitive Decline" study uses the treatment of "successful ageing education and other hearing interventions".

Nicholas Reed, AuD, assistant professor in the Departments of Epidemiology at Johns Hopkins University works in the ACHIEVE study exploring the causal effect that may exist between hearing loss and dementia.

Like his peers, Reed also maintains:

"The largest attributable risk to dementia is hearing loss and that makes it the largest modifiable risk factor of any other risk factors.If you eliminated all hearing loss in the world, you would eliminate 8% of dementia in the world."

The 977 participants enrolled in the ACHIEVE study, consisting of 70-84 year-old cognitively normal older adults with hearing loss,are randomized 1:1 with either-:

• the hearing intervention - hearing needs assessment, fitting of hearing devices, education/counselling

or

• successful ageing interventions - individual sessions with a health educator covering healthy ageing topics.

Following the baseline study, participants are being followed twice annually for 3 years. Outcomes will include assessments of -:

• cognition
• social functioning
• physical functioning
• quality of life

"While Hearing Loss is the #1 modifiable-risk factor in dementia prevention,hearing loss can also exacerbate and/or contribute to the other modifiable-risk factors such as social isolation, lack of [health] education, over consumption of alcohol, physical inactivity, obesity, smoking and depression. These modifiable-risk factors should be treated in combination with hearing care initiatives as a total approach to dementia prevention."

Reed also hints strongly that other modifiable-risks in dementia prevention should be addressed through counselling in conjunction with the early fitting of hearing aids-:

"when you see that sort of sales tactic of "protect yourself from dementia, get a hearing aid", it's sort of not true… I think it's more of "get a hearing aid and get all the best practices that go along with it... get that counselling, get that whole... holistic approach to hearing-based communication... how can we address hearing loss to improve your overall quality of life?" And that's a bigger question."

Researched, Compiled, Composed, Edited by Dr Steven Gration. November 2021.

Sources and References

Australian Royal Commission into Aged Care Quality and Safety - Final Report. Care, Dignity and Respect. Australian Government, March 2021.
https://agedcare.royalcommission.gov.au/publications/final-report

Dr S. Gration. Auditory Deprivation & Brain Deterioration, 2019.
https://www.hearingaidprices.com.au/Hearing-Aids/news/NewsArticle.jsp?News_ID=26

Dr Steven Gration. PhD Griffith University, Queensland, Australia. Research Writer. www.goldcoastlogin.com.au

Dr Nicholas Reed. ACHIEVE Study. John Hopkins University, 2018.
https://www.hearingaidprices.com.au/Hearing-Aids/news/NewsArticle.jsp?News_ID=31

Mark Laureyns. Dementia, Hearing Loss and Hearing Care: White Paper. Saving Australia's Minds. Hearing Care Industry Association, Australia March 2021.
https://hcia.com.au

P. Strutt et al. Ageing, Neuropsychology, and Cognition - Hearing loss, cognition, and risk of neurocognitive disorder: evidence from a longitudinal cohort study of older adult Australians. Macquarie University,2020.
https://researchers.mq.edu.au/en/publications/hearing-loss-cognition-and-risk-of-neurocognitive-disorder-eviden

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