The Lancet Public Health: Hearing aids may protect against a higher risk of dementia associated with hearing loss, study suggests
Peer-reviewed / Observational study / People
The Lancet Public Health: Hearing aids may protect against a higher risk of dementia associated with hearing loss, study suggests
- Study of 437,704 people suggests those experiencing hearing loss and not using hearing aids may have a higher risk of dementia than people without hearing loss. Those using hearing aids did not appear to be at an increased risk of dementia.
- After adjusting for other factors, study analysis suggests a 1.7% risk of dementia in people with hearing loss who are not using hearing aids, compared to 1.2% among those without hearing loss or who are experiencing hearing loss but using hearing aids.
- Authors call for greater public awareness of the potential protective effects of hearing aids against dementia, increased accessibility to hearing aids by reducing cost and more support for primary care workers to screen for hearing impairment, raise awareness, and deliver treatment such as fitting hearing aids.
People experiencing hearing loss who are not using a hearing aid may have a higher risk of dementia than people without hearing loss, suggests a new study published in The Lancet Public Health journal. However, using a hearing aid may reduce this risk to the same level as people without hearing loss.
Dementia and hearing loss are common conditions among older adults. The Lancet Commission on dementia prevention, intervention, and care, published in 2020, suggested that hearing loss may be linked to around 8% of worldwide dementia cases [1], therefore, addressing hearing impairment could be a crucial way to reduce the global burden of dementia.
“The evidence is building that hearing loss may be the most impactful modifiable risk factor for dementia in mid-life, but the effectiveness of hearing aid use on reducing the risk of dementia in the real world has remained unclear. Our study provides the best evidence to date to suggest that hearing aids could be a minimally invasive, cost-effective treatment to mitigate the potential impact of hearing loss on dementia,” says corresponding author Prof. Dongshan Zhu, Shandong University (China). [2]
The researchers looked at data from 437,704 people who were part of the UK Biobank database [3]. Information on the presence of hearing loss and use of hearing aids was collected via self-reported questionnaires, and dementia diagnoses were determined using hospital records and death register data. The average age of study participant at recruitment was 56 years old, and the average follow-up time was 12 years.
Around three-quarters of the participants (325,882/437,704) had no hearing loss, and the remaining one-quarter (111,822) had some level of hearing loss. Among those with hearing loss, 11.7% (13,092 / 111,822) used hearing aids.
After controlling for other factors, the study suggests that, compared to participants with normal hearing, people with hearing loss not using hearing aids had a 42% higher risk of all-cause dementia, while no increased risk was found in people with hearing loss who used hearing aids.
This is approximately equivalent to a 1.7% risk of dementia in people with hearing loss who are not using hearing aids, compared to 1.2% among those without hearing loss or who are experiencing hearing loss but using hearing aids.
“Close to four-fifths of people experiencing hearing loss do not use hearing aids in the UK [4]. Hearing loss may begin early in one’s 40s, and there is evidence that gradual cognitive decline before a dementia diagnosis can last 20 to 25 years. Our findings highlight the urgent need for the early introduction of hearing aids when someone starts to experience hearing impairment. A group effort from across society is necessary, including raising awareness of hearing loss and the potential links with dementia, increasing accessibility to hearing aids by reducing cost, and more support for primary care workers to screen for hearing impairment, raise awareness, and deliver treatment such as fitting hearing aids,” says Dongshan Zhu. [2]
The researchers also analysed how other factors, including loneliness, social isolation, and depressive symptoms, might impact the association between hearing loss and dementia. The study analysis suggests that less than 8% of the association between hearing aid use and decreased dementia risk could be removed by improving psychosocial problems. The authors say this indicates the association between hearing aid use and protection from increased dementia is likely mostly due to direct effects from hearing aids rather than the investigated indirect causes.
“The underlying pathways which may link hearing aid use and reduced dementia risk are unclear. Further research is needed to establish a causal relationship and the presence of underlying pathways,” says study author Dr Fan Jiang, Shandong University (China). [2]
The authors acknowledge some limitations to the study, including that self-reporting is at risk of bias and that, as this study is observational, the association between hearing loss and dementia might be due to reverse causation through neurodegeneration or other shared mechanisms. Additionally, although many cofactors were accounted for, there might be unmeasured factors, such as those who used hearing aids potentially also taking more care of their health than those who did not. Lastly, most UK Biobank participants are white, and very few participants were born deaf or experienced hearing loss before acquiring spoken language, which may limit the generalisability of the findings to other ethnicities and people with limited hearing using sign language.
Writing in a Linked Comment, Prof Gill Livingston and Dr Sergi Costafreda, University College London, who were not involved in this research, said: “With the addition of Jiang and colleagues’ work, the evidence that hearing aids are a powerful tool to reduce the risk of dementia in people with hearing loss, is as good as possible without randomised controlled trials, which might not be practically possible or ethical because people with hearing loss should not be stopped from using effective treatments. Dementia is not only an illness that affects the individual and their family but can also be expensive. However, using hearing aids to prevent dementia has been found to be cost-effective and cost-saving. In the USA, hearing aids have become available to purchase over the counter, thus making them more accessible. The evidence is compelling that treating hearing loss is a promising way of reducing dementia risk. This is the time to increase awareness of and detection of hearing loss, as well as the acceptability and usability of hearing aids.”
NOTES TO EDITORS
This study was funded by the National Natural Science Foundation of China and Shandong Province, Taishan Scholars Project, China Medical Board and China Postdoctoral Science Foundation. See the Article for a full list of author affiliations.
The labels have been added to this press release as part of a project run by the Academy of Medical Sciences seeking to improve the communication of evidence. For more information, please see: http://www.sciencemediacentre.org/wp-content/uploads/2018/01/AMS-press-release-labelling-system-GUIDANCE.pdf if you have any questions or feedback, please contact The Lancet press office pressoffice@lancet.com
[1] https://www.thelancet.com/article/S0140-6736(20)30367-6/fulltext
[2] Quote direct from author and cannot be found in the text of the Article.
[3] https://www.ukbiobank.ac.uk/learn-more-about-uk-biobank/about-us
[4] https://pubmed.ncbi.nlm.nih.gov/30664127/
The labels have been added to this press release as part of a project run by the Academy of Medical Sciences seeking to improve the communication of evidence. For more information, please see: http://www.sciencemediacentre.org/wp-content/uploads/2018/01/AMS-press-release-labelling-system-GUIDANCE.pdf if you have any questions or feedback, please contact The Lancet press office pressoffice@lancet.com
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JOURNAL
The Lancet Public Health
METHOD OF RESEARCH
Observational study
SUBJECT OF RESEARCH
People
ARTICLE TITLE
Association between hearing aid use and all-cause and cause-specific dementia: an analysis of the UK Biobank cohort
ARTICLE PUBLICATION DATE
13-Apr-2023
COI STATEMENT
AO has received consulting fees from Medical Network Systems (MNES) and payment from Kyowa Kirin, outside the submitted work. All other authors declare no competing interests.
Sensor system could decrease fall risk
for older adults
Lower health care costs, greater patient autonomy are goals of project
Reports and ProceedingsIMAGE: (FROM LEFT) THREE SEASONS TEAM MEMBERS FADEEL KHAN, CHARLIE GORTON, VANESSA GARLEPP, AHALYA LETTENBERGER AND CHRIS HEUSER. view more
CREDIT: PHOTO BY BRANDON MARTIN/RICE UNIVERSITY
HOUSTON – (April 13, 2023) – Knowing how to avoid falls could help adults 65 and older fend off costly health care bills and live in their homes longer.
A team of Rice University engineering students designed a fall-risk assessment system that enables doctors to create personalized risk-management strategies for patients based on their individual movement patterns at home.
The Three Seasons team — “because with us, there is no fall,” said member Vanessa Garlepp — is one of more than 110 competing in this year’s Oshman Engineering Design Kitchen showcase April 13 at the Ion. Charlie Gorton, Chris Heuser, Fadeel Khan and Ahalya Lettenberger round out the team.
Falls are the leading cause of injury — and death caused by injury — for adults 65 and older, according to the Centers for Disease Control and Prevention . A quarter of the nearly 56 million adults over 65 in the U.S. experience a fall each year , and 1 in 5 falls results in serious injury such as a broken bone or head trauma.
With the population of older adults expected to reach over 85 million by 2050, the team’s fall-risk assessment system could have a significant impact in terms of reducing fall-associated health care costs and increasing patient autonomy.
The system includes a wearable device, a home-mapping and movement-monitoring component and an artificial intelligence-mediated data-processing element.
“Our wearable device tracks location with an ultrawideband sensor, it tracks movement with an accelerometer, it tracks time with a real-time clock and it has a user-input button that they can press if they are dizzy, for instance,” Garlepp said. “Lastly, everything is written to a micro SD card. That is all happening in the wearable itself. Then, the data is post-processed.”
Garlepp said she was drawn to the sensing aspect of the project: “To me, that was really cool — how the sensors would interface with each other and how everything would integrate together.
“This is also personal for me,” she added. “My grandfather actually passed away because of a fall. So I was also drawn to the project for that reason, as well as to just help prevent the same thing from happening to other families.”
The system includes a lidar scanner mounted on a tripod that can map the layout of a room, including the furniture.
“The lidar scanner sends out a signal and detects where the walls are,” Heuser said. “With the tripod, you can raise and lower it. For instance, I used it to scan my living room at different heights — 7 feet, 5 feet, 4 feet and 2 feet. And you can see features like my couch, which you can tell by the uneven line that is the cushions. Combined with the ultrawideband location sensing, this can provide physicians with a map of how a patient moves in their home and help them find the riskiest locations.”
“Our device is not only detecting falls in the home, but also detecting everything surrounding the fall ⎯ what they were doing before the fall, where they were in their home when they fell, etc.,” Lettenberger said.
“A lot of times when older people fall, they can't remember why they fell,” Gorton said. “This device gives the physician details about the fall event that a patient might otherwise forget.”
“When we spoke to our clients who are physicians, they said that most patients experience some form of either (pre-fall) activity or dizzy spell within a certain time period,” Khan said. “A patient would have to wear the device for that recommended time, because a shorter amount of time might not give you any meaningful data.”
The team’s mentors are Catherine Ambrose, a professor in the Department of Orthopedic Surgery at McGovern Medical School at UTHealth Houston and an adjunct associate professor in biomedical engineering at Rice; Dr. Nahid Rianon, a professor in family medicine and geriatric medicine at McGovern Medical School at UTHealth; David Trevas, a mechanical engineering lecturer at Rice; Sabia Abidi, a bioengineering assistant teaching professor at Rice; and Kaira Lujan, a graduate student in Rice’s Global Medical Innovations program.
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The wearable device and integrated in-home monitoring system aim to help doctors identify fall risk factors for individual patients.
CREDIT
Photo by Brandon Martin/Rice University
Video URL:
https://youtu.be/UCcuCCG8THM
(Video by Brandon Martin)
Image downloads:
https://news-network.rice.edu/news/files/2023/04/230411_Three_Seasons_Team1_LG.jpg
CAPTION: (From left) Three Seasons team members Fadeel Khan, Charlie Gorton, Vanessa Garlepp, Ahalya Lettenberger and Chris Heuser. (Photo by Brandon Martin/Rice University)
https://news-network.rice.edu/news/files/2023/04/230411_Three_Seasons_Team2_LG.jpg
CAPTION: Chris Heuser (front) holds the wearable device developed together with his team, (from left) Fadeel Khan, Charlie Gorton, Vanessa Garlepp and Ahalya Lettenberger. (Photo by Brandon Martin/Rice University)
https://news-network.rice.edu/news/files/2023/04/230411_Three_Seasons_device_LG.jpg
CAPTION: The wearable device and integrated in-home monitoring system aim to help doctors identify fall risk factors for individual patients. (Photo by Brandon Martin/Rice University)
Located on a 300-acre forested campus in Houston, Rice University is consistently ranked among the nation’s top 20 universities by U.S. News & World Report. Rice has highly respected schools of Architecture, Business, Continuing Studies, Engineering, Humanities, Music, Natural Sciences and Social Sciences and is home to the Baker Institute for Public Policy. With 4,552 undergraduates and 3,998 graduate students, Rice’s undergraduate student-to-faculty ratio is just under 6-to-1. Its residential college system builds close-knit communities and lifelong friendships, just one reason why Rice is ranked No. 1 for lots of race/class interaction and No. 1 for quality of life by the Princeton Review. Rice is also rated as a best value among private universities by Kiplinger’s Personal Finance.
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