Is Hearing Loss Associated with Poorer Health in Older Adults Who Might Benefit from Hearing Screening?
Is Hearing Loss Associated with Poorer Health in Older Adults Who Might Benefit from Hearing Screening?
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DOI：
10.1097/aud.0000000000000267
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发表时间：
2016-05-01
期刊：
影响因子：
3.7
通讯作者：
Pichora-Fuller, M. Kathleen
中科院分区：
文献类型：
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作者：
Mick, Paul;Pichora-Fuller, M. Kathleen
目的：听力筛查计划可能会使未被承认或未解决的听力损失的成年人受益，但关于这些计划是否能有效改善健康状况的证据有限。目的是确定听力阈值较差是否与认知能力较差、社会隔离、身体或精神健康负担、因身体或精神健康状况不佳而不活动、抑郁症以及未承认或未解决听力损失的美国老年人住院过夜有关。设计：作者对听力正常或未承认或未解决的听力损失的美国老年人进行了一项基于人群的横断面分析。数据来自1999年至2010年的国家健康和营养调查周期。纯音平均值（在0.5、1、2和4 kHz阈值的听力较好的耳朵中的PTA）> 25 dB HL的参与者，自我报告其听力能力为“良好”或“优秀”，被归类为“未被承认的”听力损失。那些有PTA > 25 dB HL和自我报告听力问题但从未进行过听力测试或佩戴助听器的人被归类为“未解决”听力损失。进行多变量回归，以解释由于人口统计学和健康variables.Results的混淆：一个10分贝的PTA增加与52%的几率增加社会隔离之间的60- 69岁的多变量分析（p = 0.001）。PTA每增加10 dB，平均数字符号替代测试评分下降2.14分（p = 0.03），这一幅度相当于3.9年实足老化的预期下降幅度。PTA是没有显着相关的福尔斯，住院治疗，身体或心理健康的负担，或抑郁症，或社会孤立的那些年龄在70岁或以上的这些samples.Conclusion：未承认或未解决的听力损失与社会孤立的风险显着增加60至69岁的人，但不是那些70岁或以上。它还与60至69岁的人在数字符号替代测试中的认知得分较低有关。这项研究与以往的研究不同，特别关注那些患有未被承认或未被解决的听力损失的老年人，因为他们最有可能从纯音听力筛查中受益。在这些特定样本中，听力损失与社会隔离和认知措施之间的关联扩展了先前对老年人（包括那些已经承认听力问题的人）的非限制性样本的研究结果。未来的随机对照试验测量成人听力筛查计划的有效性，应该测量干预措施是否对那些未承认或未解决的纯音听力损失的人有影响。
Objectives: Hearing screening programs may benefit adults with unacknowledged or unaddressed hearing loss, but there is limited evidence regarding whether such programs are effective at improving health outcomes. The objective was to determine if poorer audiometric hearing thresholds are associated with poorer cognition, social isolation, burden of physical or mental health, inactivity due to poor physical or mental health, depression, and overnight hospitalizations among older American adults with unacknowledged or unaddressed hearing loss.Design: The authors performed a cross-sectional population-based analysis of older American adults with normal hearing or unacknowledged or unaddressed hearing loss. Data was obtained from the 1999 to 2010 cycles of the National Health and Nutrition Examination Survey. Participants with a pure-tone average (PTA in the better hearing ear of thresholds at 0.5, 1, 2, and 4 kHz) > 25 dB HL who self-reported their hearing ability to be "good" or "excellent" were categorized as having "unacknowledged" hearing loss. Those who had a PTA > 25 dB HL and who self-reported hearing problems but had never had a hearing test or worn a hearing aid were categorized as having "unaddressed" hearing loss. Multivariate regression was performed to account for confounding due to demographic and health variables.Results: A 10 dB increase in PTA was associated with a 52% increased odds of social isolation among 60- to 69-year-olds in multivariate analyses (p = 0.001). The average Digit Symbol Substitution Test score dropped by 2.14 points per 10 dB increase in PTA (p = 0.03), a magnitude equivalent to the drop expected for 3.9 years of chronological aging. PTA was not associated significantly with falls, hospitalizations, burden of physical or mental health, or depression, or social isolation among those ages 70 years or older in these samples.Conclusion: Unacknowledged or unaddressed hearing loss was associated with a significantly increased risk of social isolation among 60- to 69-year-olds but not those 70 years or older. It was also associated with lower cognitive scores on the Digit Symbol Substitution Test among 60- to 69-year-olds. This study differs from prior studies by focusing specifically on older adults who have unacknowledged or unaddressed hearing loss because they are the most likely to benefit from pure-tone hearing screening. The finding of associations between hearing loss and measures of social isolation and cognition in these specific samples extends previous findings on unrestricted samples of older adults including those who had already acknowledged hearing problems. Future randomized controlled trials measuring the effectiveness of adult hearing screening programs should measure whether interventions have an effect on these measures in those who have unacknowledged or unaddressed pure-tone hearing loss.