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

摘要

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.