Investigating the Relationship Between Age-Related Hearing Loss and Loneliness Among Community-Dwelling Older Adults

建议书摘要 意义：鉴于越来越多的证据表明，孤独已成为公共卫生的当务之急 如果得不到解决，就会出现疾病，包括阿尔茨海默病和相关痴呆的风险增加 (ADRD)。据估计，超过40%的老年人遭受孤独之苦，这进一步突显了这种压力 需要学习。2020年2月，美国国家科学院建议对已知风险因素进行更多研究 为新的筛查和干预策略提供信息。一个特殊的危险因素，听力损失(HL)， 影响到美国三分之二的70岁以上的成年人，预计将增加 估计在接下来的40年里会有70%。HL的增殖可加重ADRD等远端预后 与孤独联系在一起。目前的孤独干预措施显示出有限的效果，而且 大多数人没有明确地解决HL问题。作为一个潜在的可改变的危险因素，研究HL与 孤独将增加证据基础，并有助于开发有效的解决方案。这份培训方案 支持申请者通过提高对听力的理解来促进健康老龄化的长期目标 健康及其在促进健康社会关系方面的作用。这项提议将为一项计划奠定基础 以美国国立卫生研究院干预发展阶段模型为指导框架建立的研究。 具体目标：通过顺序解释性混合方法设计，我们的目标是：(1)考察纯音 听力测量作为调节因素与孤独和听力障碍的关联，(2A)描述知觉和 患有HL的老年人的孤独和听力障碍的经历，以及(2B)整合AIMS的数据 1-2A解释HL和听力障碍对孤独感的作用。 方法：目标1涉及多变量调整后的Logistic回归模型，检验加法和 通过对该协会的验证调查报告的听力障碍分数的乘性交互作用 在HL(听力测试)和孤独(加州大学洛杉矶分校三项孤独)的黄金标准之间。方法 包括对以社区为基础、种族/族裔和区域多样化人口数据的二次分析 更老的样本。目标2A涉及通过建议的定性描述指南进行的分析 从理论指导下对居住在社区的老年人进行有目的抽样的访谈收集的数据。 目标2B涉及使用排列定量和定性数据的联合展示来解释专题调查结果。 奖学金培训：作为约翰·霍普金斯护理学院博士项目的第一位听力学专家，建议的 跨学科培训将通过严格的课程作业、专业发展为申请人做好准备 活动和有指导的研究经验，以成功完成本提案的目标并推动 这些发现转化为随后作为临床医生、科学家和老年学领导者的创新翻译。

PROPOSAL SUMMARY Significance: Loneliness has become a public health imperative given mounting evidence of associated morbidities when it is not addressed, including increased risks for Alzheimer's disease and related dementias (ADRD). Over 40% of older adults are estimated to suffer from loneliness, further underscoring the pressing need for study. In February 2020, the National Academies recommended more research into known risk factors of loneliness to inform novel screening and intervention strategies. One particular risk factor, hearing loss (HL), affects two-thirds of all adults over the age of 70 years in the United States and is projected to increase by an estimated 70% over the next four decades. The proliferation of HL can exacerbate distal outcomes like ADRD that are associated with loneliness. Current loneliness interventions have shown limited efficacy, and the vast majority do not clearly address HL. As a potentially modifiable risk factor, studying HL's relationship with loneliness will add to the evidence base and contribute to developing effective solutions. This training proposal supports the applicant's long-term goals to promote healthy aging through improving understanding of hearing health and its role in facilitating healthy social connections. The proposal will lay the groundwork for a program of research established using the NIH Stage Model for Intervention Development as a guiding framework. Specific Aims: Through a sequential explanatory mixed methods design, we aim to: (1) Examine pure tone audiometry's association with loneliness and hearing handicap as a moderator, (2A) Describe perceptions and experiences of loneliness and hearing handicap among older adults with HL, and (2B) Integrate data from aims 1-2A to explain the contributing roles of HL and hearing handicap to loneliness. Approach: Aim 1 involves multivariable adjusted logistic regression models examining additive and multiplicative interactions from hearing handicap scores reported through a validated survey on the association between a gold standard measure of HL (audiometry) and loneliness (Three-Item UCLA Loneliness). Methods include secondary analyses of population data from a community-based, racially/ethnically and regionally diverse older sample. Aim 2A involves analyses conducted via recommended guidelines for Qualitative Description with data collected from theoretically-guided interviews with purposively sampled community-dwelling older adults. Aim 2B involves using joint displays arraying quantitative and qualitative data to explain thematic findings. Fellowship Training: As the first audiologist in the PhD program at Johns Hopkins Nursing, the proposed transdisciplinary training will prepare the applicant through rigorous coursework, professional development activities, and mentored research experiences to successfully complete the aims of this proposal and advance the findings into subsequent innovative translations as a clinician scientist and leader in gerontology.