Hearing Aids May Lead to Lower Rates of Dementia, Depression, and Anxiety

Hearing Aids May Lead to Lower Rates of Dementia, Depression, and Anxiety

 

According to a report, hearing Aids May Lead to Lower Rates of Dementia, Depression, and Anxiety

 

This article appeared September 2019 in the Hearing review

 

Older adults who get a hearing aid for a newly diagnosed hearing loss have a lower risk of being diagnosed with dementia, depression, or anxiety in the following three years, and a lower risk of suffering fall-related injuries, than those who leave their hearing loss uncorrected, a new study finds. A summary of the study’s findings were published on the University of Michigan’s website.

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Yet only 12% of those who have a formal diagnosis of hearing loss actually get the devices—even when they have insurance coverage for at least part of the cost, the study shows. It also reveals gaps in hearing aid use among people of different racial and ethnic backgrounds, geographic locations, and genders.

The findings, made by a University of Michigan team using data from nearly 115,000 people over age 66 with hearing loss and insurance coverage through a Medicare HMO between 2008 and 2016, are published in the Journal of the American Geriatrics Society.

Unlike traditional Medicare, Medicare HMOs typically cover some hearing aid costs for members diagnosed with hearing loss by an audiologist.

Elham Mahmoudi, MBA, PhD, the U-M Department of Family Medicine health economist who led the study, says it confirms what other research has shown among patients studied at a single point in time—but the new findings show differences emerging as time goes on.

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“We already know that people with hearing loss have more adverse health events, and more co-existing conditions, but this study allows us to see the effects of an intervention and look for associations between hearing aids and health outcomes,” she says.

“Though hearing aids can’t be said to prevent these conditions, a delay in the onset of dementia, depression, and anxiety, and the risk of serious falls, could be significant both for the patient and for the costs to the Medicare system.”

Long-term Tracking

Mahmoudi and her colleagues at the U-M Institute for Healthcare Policy and Innovation looked at anonymous insurance data to perform the study, and looked at the data for each person with hearing loss one year before their diagnosis, and three years after, so they could see only newly diagnosed dementia, depression, anxiety, and fall injuries.

They intend to keep studying further data from this population, to see if the differences in health outcomes continue beyond three years.

The study shows that men with hearing loss were more likely to receive a hearing aid—13.3% compared with 11.3% of women. Only 6.5% of people of Latino heritage received a hearing aid for their hearing loss, compared with 9.8% of African-Americans and 13.6% of whites.

Nearly 37% of people with hearing loss who lived in the north-central part of the country, as designated by the Census Bureau, used a hearing aid, compared with just 5.9% of people in the mountain states.

Differences in Diagnosis

When the researchers looked at the path that patients who received hearing aids took over three years, compared with those who didn’t get the devices, significant differences emerged.

In all, the relative risk of being diagnosed with dementia, including Alzheimer’s disease, within three years of a hearing loss diagnosis was 18% lower for hearing aid users. The risk of being diagnosed with depression or anxiety by the end of three years was 11% lower for hearing aid users, and the risk of being treated for fall-related injuries was 13% lower.

The study also confirms previous studies’ findings that people with hearing loss had much higher rates of dementia, depression, and fall injuries than the general population.

The reasons for this are complicated, and can include loss of social interaction, loss of independence, loss of balance, and less stimulation to the brain. Some researchers also believe that the loss of nerve impulses from the ear to the brain, and loss of cognitive ability leading to dementia, could be part of the same ageing process.

What’s to Come

The study only included individuals who billed their insurance company for part of the cost of their hearing aid, Mahmoudi notes. The coming of FDA-approved over-the-counter hearing aids in 2020 for people with mild to moderate hearing loss could make the devices much more accessible for many people.

But those new devices could also complicate researchers’ ability to study the effects of hearing aids on other health outcomes, if people don’t use insurance coverage and researchers can’t tell if they have one.

“Correcting hearing loss is an intervention that has evidence behind it, and we hope our research will help clinicians and people with hearing loss understand the potential association between getting a hearing aid and other aspects of their health,” says Mahmoudi.

She notes that Medicaid in the state of Michigan is now covering hearing aid testing, fitting, and purchase, since a policy change in 2018, and that it will be important to study impacts in this population as well.

In addition to Mahmoudi, the new study’s authors are IHPI statisticians Tanima Basu, MS and Neil Kamdar, MA, and IHPI members Kenneth Langa, MD, PhD, Michael M. McKee, MD, MPH, Phillip Zazove, MD, and Neil Alexander, MD. Langa and Alexander are professors in the U-M Department of Internal Medicine; McKee and Zazove are assistant professor and chair, respectively, of the U-M Department of Family Medicine. Langa also holds faculty positions in the U-M Institute for Social Research and the VA Ann Arbor Center for Clinical Management Research.

Original Paper: Mahmoudi E, Basu T, Langa K, et al. Can hearing aids delay time to diagnosis of dementia, depression, or falls in older adults? Journal of the American Geriatrics Society. 2019. DOI: https://doi.org/10.1111/jgs.16109

Source: University of Michigan, Journal of the American Geriatrics Society

Depression and Hearing loss

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Depression and Hearing loss. Honiton hearing Blog

 

Depression and Hearing Loss

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Depression and its connection to hearing loss seems pretty logical and self-evident, especially if you’re a dispensing professional who experiences daily the difference that amplification can make in a person’s life. In fact, many clinicians find themselves explaining the connection as follows: a person’s hearing loss and related communication problems can lead to gaffes and social faux pas; leading to embarrassment, anxiety, and loss of self-esteem; leading to gradual withdrawal from social situations and physical activity; leading to social isolation and loneliness; and eventually bringing them down the path to depression.

Karl Strom_photo

While this is probably an adequate description for some cases, a recent webinar1 by Victor Bray, PhD, associate professor and former dean of Salus University’s Osborne College of Audiology, points to more recent scientific literature that paints a far more complex picture of hearing loss and its association with depression—one we all should be aware of. The utility of hearing aids, cochlear implants, and assistive devices is made no less important by this complexity; however, it’s vital to understand who might be most at risk for depression in your patient population, how best to administer simple screening tools (ie, the PHQ-2 or PHQ-9), and why it’s important to refer patients to a medical doctor or psychologist, when indicated. 

Depression, also known as major depressive disorder (MDD), is present in 5-10% of the general population (up to 40% in some groups), and is a serious medical illness that negatively affects feelings, thoughts, and actions. The primary risk factors for depression are co-morbid chronic medical conditions (hearing loss is a pervasive chronic condition, especially among seniors) and recent stressful events. And, as with cognitive decline and dementia—the subject of my editorial last month—the stakes in treating depression are high for society and healthcare professionals. As Hsu and colleagues (2016) pointed out:

Depression is a common mental disorder, which affects 350 million people in the world. Unipolar depressive disorders and adult-onset hearing loss, the most common neuropsychiatric conditions, and sense organ disorder, respectively, are the first and second leading nonfatal causes of year loss due to disability among adults in high-income countries.2

Several of the studies reviewed by Dr Bray tend to suggest that the odds ratio for acquiring depression increases by a factor of about two if you have untreated hearing loss. However, a lot of the studies also show that a variety of chronic illnesses—ranging from cirrhosis to diabetes mellitus—can be associated with depression, so there could be some underlying neurophysiological common cause in hearing loss and other health problems that hasn’t been discovered yet. Dr Bray also looks at some very intriguing research about how dual-sensory loss (ie, hearing and vision loss) and sudden sensorineural hearing loss (particularly among young people) can greatly increase the risk for depression, as well as studies that are shedding light on how treated hearing loss might positively affect those suffering from anxiety, loneliness, and depression. 

As Dr Bray explains, the linkage of hearing loss to depression could come from both a social (downstream) effect, as described at the beginning of this article, and a biological/neurological (upstream) effect, as proposed in a model by Rutherford et al.3 If that were the case, an effective treatment plan could involve therapy and/or medication from a psychologist, in coordination with a hearing device and/or auditory and cognitive retraining from a hearing care professional. 

Dr Bray’s webinar was sponsored by Hamilton CapTel, and the company also sponsored an exceptionally interesting and well-viewed webinar last year about hearing loss and associated co-morbidities (including depression) by Harvey Abrams, PhD.4,5 When viewed together, they put an exclamation point on the fact that hearing loss isn’t just about the ears, it’s about health, the brain, quality of life, healthy aging, and so much more—while underscoring the crucial role of the hearing care professional in general healthcare.

To see Dr Bray’s webinar, visit https://bit.ly/2Lpt4AW

Citation for this article: Strom KE. Depression and hearing loss. Hearing Review. 2018;25(8):6.

References

1. Bray V. Depression, hearing loss, and treatment with hearing aids [Webinar]. July 13, 2018. Available at: http://www.hearingreview.com/2018/07/new-webinar-depression-hearing-loss-treatment-hearing-aids

2. Hsu W-T, Hsu C-C, Wen M-H, et al. Increased risk of depression in patients with acquired sensory hearing loss: A 12-year follow-up study. Medicine. 2016;95(44):e5312.

3. Rutherford BR, Brewster K, Golub JS, Kim AH, Roose SP. Sensation and psychiatry: Linking age-related hearing loss to late-life depression and cognitive decline. Am J Psychiatry. 2017;175(3):215-224.

4. Abrams H. Hearing loss and associated comorbidities: What do we know [Webinar]? May 31, 2017. Available at: http://www.hearingreview.com/2017/05/new-webinar-hearing-loss-associated-comorbidities-know/

5. Abrams H. Hearing loss and associated comorbidities: What do we know? Hearing Review. 2017;24(12):32-35. Available at: http://www.hearingreview.com/2017/11/hearing-loss-associated-comorbidities-know/