Falls Related Injuries and Hearing Loss: Understanding the role of hearing healthcare intervention

摘要 在老年人中，福尔斯和与跌倒相关的损伤导致大量的发病率、死亡率和残疾。 最近，感音神经性听力损失和听力障碍已被确定为独立的危险因素， 福尔斯。有一个既定的剂量效应，其中增加听力损失的严重程度和/或更大的感知 听力损失会增加跌倒的几率。目前尚不清楚福尔斯是否可以通过治疗 使用助听器或人工耳蜗造成的听力损失。长期目标是确定和了解 调节福尔斯和听力损失之间联系的机制，以努力开发干预措施 这将改变该患者人群中的福尔斯风险。目前的目标是确定放大是否会改变 老年人跌倒相关损伤的几率。为实现当前目标，将实现以下具体目标： 1）确定放大是否会改变老年人遭受跌倒相关损伤的几率， 听力损失将采用历史前瞻性队列设计，合并现有的当地听力测定 以及助听器数据库，其中包含本地电子医疗记录数据和Medicare数据， 因福尔斯摔倒而寻求治疗。考虑到患者可能存在残余听力困难， 中度或重度听力损失患者仅使用助听器进行放大，将进行子分析， 确定放大的类型（即，助听器与人工耳蜗）改变了跌倒相关的几率 我们假设那些中度或重度听力损失的人， 听觉受益于人工耳蜗植入，因此跌倒的几率较低。2)进行一次 对老年听力损失患者进行的探索性研究，以确定患者报告的听力结果是否存在差异 (e.g.,听力努力，空间意识，听力障碍），患者报告的放大结果，认知 心理社会因素与福尔斯风险有关。将使用经过验证的问卷调查， 按扩增状态分层的跌倒者和非跌倒者之间在这些领域的差异（使用者与非使用者）， 用户）和类型（助听器与人工耳蜗）。目前的建议是创新的，因为这项工作将 确定听力干预是否会影响老年人跌倒受伤的风险，并寻求解决 听力损失严重程度和福尔斯之间的剂量依赖性关系。此外，它将确定候选人 这些机制将进一步阐明福尔斯和听力损失之间的联系。这些贡献将是 重要的是，他们将确定听力损失是否是适当的干预目标，以减少听力损失。 福尔斯和跌倒相关损伤的社会和医疗负担。

ABSTRACT Falls and falls-related injuries result in substantial morbidity, mortality, and disability among older adults. Recently, sensorineural hearing loss and hearing handicap have been identified as independent risk factors for falls. There is an established dose-effect, in which increasing hearing loss severity and/or greater perceived handicap from hearing loss increases the odds of falling. It is unclear if falls can be mitigated by treatment of hearing loss with hearing aids or a cochlear implant. The long-term goal is to identify and understand the mechanisms that mediate the association between falls and hearing loss in an effort to develop interventions that will modify falls risk in this patient population. The current objective is to determine if amplification modifies the odds of falls-related injury in older adults. To address the current objective, the following specific aims will be pursued: 1) Determine if amplification modifies the odds of suffering a falls-related injury in older adults with hearing loss. A historical prospective cohort design will be employed that merges existing local audiometric and hearing aid databases with local electronic medical record data and Medicare data to identify individuals seeking medical treatment for falls in. Given the potential for residual hearing difficulties in patients with moderate or greater hearing loss who are amplified with a hearing aid only, a sub-analysis, will be performed to determine if type of amplification (i.e., hearing aid versus cochlear implant) modifies the odds of a fall-related injury in this subgroup We hypothesize that those with moderate or greater hearing loss receive greater auditory benefit from cochlear implantation and therefore, have lower odds of falling. 2) To conduct an exploratory study of older adults with hearing loss to identify if differences in patient-reported hearing outcomes (e.g., listening effort, spatial awareness, hearing handicap), patient-reported amplification outcomes, cognitive and psychosocial factors are associated with falls risk. Validated questionnaires will be used to examine differences in these domains between fallers and non-fallers stratified by amplification status (user versus non- user) and type (hearing aid versus cochlear implant). The current proposal is innovative as the work will determine if hearing intervention influences the risk of falls-injury in older adults and seeks to address the dose-dependent associations between hearing loss severity and falls. Moreover, it will identify candidate mechanisms that will further clarify the link between falls and hearing loss. These contributions will be significant as they will determine if hearing loss may be an appropriate target for intervention to reduce the societal and healthcare burden of falls and falls-related injury.