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Original Investigation
September 6, 2018

Association of Cognition and Age-Related Hearing Impairment in the English Longitudinal Study of Ageing

Author Affiliations
  • 1Regional Department of Neurotology, Ear Nose and Throat Department, Sheffield Teaching Hospitals, Glossop Road, Sheffield, United Kingdom
  • 2Department of Economics, University of Sheffield, Sheffield, United Kingdom
  • 3Sheffield City Council, Sheffield, United Kingdom
JAMA Otolaryngol Head Neck Surg. 2018;144(10):876-882. doi:10.1001/jamaoto.2018.1656
Key Points

Question  Does untreated hearing loss and social isolation explain the link between age-related hearing loss and cognitive decline?

Findings  In this cohort study of persons 50 years or older from the United Kingdom, hearing loss had a negative association with cognition; however, this association was observed only in the individuals with untreated hearing loss. Evidence suggests that social isolation acts as a mediating factor.

Meaning  Cognitive decline associated with age-related hearing loss is probably preventable by early hearing rehabilitation and opportunistic screening of persons older than 50 years.

Abstract

Importance  Evidence has linked age-related hearing impairment (ARHI) with cognitive decline; however, very few studies (none in the United Kingdom) explore this link in large well-characterized groups of community-dwelling individuals.

Objective  To investigate the link between ARHI and cognitive decline using a cohort of elderly individuals from the United Kingdom and explore untreated hearing loss and social isolation as potential explanations for the observed link.

Design, Setting, and Participants  This cross-sectional analysis of wave 7 (June 2014 through May 2015) of the English Longitudinal Study of Ageing (ELSA) sampled men and women 50 years or older and living in the United Kingdom in a community setting. Those with a diagnosis of dementia, Alzheimer disease, or Parkinson disease or with ear infections and cochlear implants were excluded. Data were analyzed from August 1, 2017, through May 25, 2018.

Main Outcomes and Measures  Memory and executive function as measures of cognitive function and hearing acuity derived from the HearCheck screener device (Siemens).

Results  Of a cohort of 9666 members in wave 7 of ELSA, 7385 were eligible for analysis after applying exclusion criteria (55.1% women; mean [SD] age, 67.4 [9.4] years). Of these, 3056 (41.4%) had mild hearing loss and 755 (10.2%) had severe hearing loss; 834 (11.3%) used a hearing aid; and 7155 (96.9%) were white. Hearing loss had a negative association with cognition; for those with moderate to severe loss, the score on memory assessment was a full 1 point less (−1.00; 95% CI, −1.24 to −0.76), ceteris paribus, relative to those with no hearing loss. However, this association was seen only in the individuals with untreated hearing loss (ie, those who did not use hearing aids) (−1.16; 95% CI, −1.45 to −0.87). Evidence suggests that social isolation acts as a mediating factor.

Conclusions and Relevance  Although hearing loss and cognition are linked, untreated hearing loss drives the association. Social isolation is a mediating factor in the link for those who have untreated hearing loss. Cognitive decline associated with ARHI is probably preventable by early rehabilitation and increased opportunistic screening for the elderly.

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