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Original Investigation
February 11, 2021

Association Between Central and Peripheral Age-Related Hearing Loss and Different Frailty Phenotypes in an Older Population in Southern Italy

Author Affiliations
  • 1Population Health Unit, Salus in Apulia Study, National Institute of Gastroenterology Saverio de Bellis, Research Hospital, Castellana Grotte, Bari, Italy
  • 2Center for Neurodegenerative Diseases and the Aging Brain, Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari Aldo Moro, Bari, Italy
  • 3Department of Orofacial Pain and Dysfunction, Academic Centre for Dentistry Amsterdam, University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
  • 4Geriatric Unit and Laboratory of Gerontology and Geriatrics, Department of Medical Sciences, Aging Network of Italian Research Hospitals, Casa Sollievo della Sofferenza, San Giovanni Rotondo, Foggia, Italy
  • 5Hematology and Stem Cell Transplant Unit, Vito Fazzi Hospital, ASL Lecce, Lecce, Italy
  • 6Department of Clinical Research in Neurology, Pia Fondazione Cardinale G. Panico, Tricase, Lecce, Italy
  • 7Cesare Frugoni Internal and Geriatric Medicine and Memory Unit, University of Bari Aldo Moro, Bari, Italy
  • 8Otolaryngology Unit, Department of Basic Medical Science, Neuroscience and Sense Organs, University of Bari Aldo Moro, Bari, Italy
  • 9Longitudinal Studies Section, Translational Gerontology Branch, National Institute on Aging, National Institutes of Health, Baltimore, Maryland
JAMA Otolaryngol Head Neck Surg. Published online February 11, 2021. doi:10.1001/jamaoto.2020.5334
Key Points

Question  Are physical frailty or cognitive frailty phenotypes associated with age-related hearing loss in an older community-dwelling population?

Findings  In this population-based cross-sectional study of 1929 community-dwelling older individuals in southern Italy, the prevalence of peripheral age-related hearing loss and age-related central auditory processing disorder (CAPD) was higher in physical and cognitive frailty groups than in the nonfrail group. Age-related CAPD was associated only with cognitive frailty.

Meaning  In this study, age-related CAPD was independently associated with cognitive frailty, suggesting that management of age-related hearing loss may be associated with development of different frailty phenotypes.


Importance  The association between age-related hearing loss (ARHL) and physical or cognitive frailty has been poorly explored. These associations could define new perspectives for delaying frailty-related processes in older age.

Objective  To examine whether peripheral ARHL and age-related central auditory processing disorder (CAPD) are independently associated with physical or cognitive frailty.

Design, Setting, and Participants  This cross-sectional study analyzed registry data from December 31, 2014, on 1929 older (≥65 years) participants of the Salus in Apulia Study (Southern Italy) who underwent audiologic, physical, and neuropsychological assessment. Data analysis was performed from December 12, 2019, to January 4, 2020.

Main Outcomes and Measures  Prevalence of peripheral ARHL in older individuals with physical and/or cognitive frailty and those without frailty assessed using the Fried criteria (physical) and the Mini-Mental State Examination (cognitive). Multivariable logistic regression models were used to assess associations of audiologic variables with frailty phenotype.

Results  Data from 1929 participants (mean [SD] age, 73.6 [6.3] years; 974 male [50.5%]) were eligible for the analyses. The prevalence of peripheral ARHL was higher in the physical frailty group (96 [26.6%]) than in the nonfrail group (329 [21.0%]) (difference, 5.61 percentage points; 95% CI, 0.63-10.59 percentage points) and in the cognitive frailty group (40 [38.8%]) than in the nonfrail group (385 [21.1%]) (difference, 17.75 percentage points; 95% CI, 8.2-27.3 percentage points). Age-related CAPD was more prevalent in the physical frailty group (62 [17.2%]) than in the nonfrail group (219 [14.0%]) (difference, 3.21 percentage points; 95% CI, −1.04 to 7.46 percentage points) and in the cognitive frailty group (28 [27.2%]) than in the nonfrail group (253 [13.9%]) (difference, 13.33 percentage points; 95% CI, 4.10-22.21 percentage points). In the multivariable models, age-related CAPD was associated with cognitive frailty in the fully adjusted model (odds ratio [OR], 1.889; 95% CI, 1.094-3.311). There was also an inverse association between the unitary increase in Synthetic Sentence Identification With the Ipsilateral Competitive Message scores, indicating a lower likelihood of this disorder, and cognitive frailty (OR, 0.989; 95% CI, 0.988-0.999). Peripheral ARHL was associated with cognitive frailty only in the partially adjusted model (OR, 1.725; 95% CI, 1.008-2.937).

Conclusions and Relevance  In this cross-sectional study of 1929 participants, age-related CAPD was independently associated with cognitive frailty. Whether the management of ARHL may help prevent the development of different frailty phenotypes or improve their clinical consequences should be addressed in longitudinal studies and, eventually, well-designed randomized clinical trials.

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