Hearing Aids Reduce Risk of Dementia

Researchers are learning how hearing loss can change the brain

Hearing aids may help older citizens with more than just hearing with greater clarity. A study found that people that use hearing aids to help overcome hearing loss are less likely to have depression or develop dementia. Those suffering from a hearing loss are affected with changes within their brain. Those cognitive changes may affect the ability to form new memories. A University of Michigan Medical Center study found that older adults diagnosed with hearing loss and using a hearing aid, have a lower risk for getting a diagnosis of dementia, depression, or anxiety for the first 3 years.

They also have a decreased chance of experiencing fall-related injuries compared to those who don’t use hearing aids, according to the study in the Journal of the American Geriatrics Society.

About 40 million Americans have some type of hearing loss, the Centers for Disease Control and Prevention reports. This isn’t the first piece of research to confirm health benefits associated with hearing aid use. That said, there’s no evidence of a causal link between hearing aid use and preventing these health conditions.

“Older people with hearing loss who wear hearing aids may be better educated or may socialize more, factors which are also associated with a reduced risk of dementia,” said Dr. David Loughrey, a research psychologist specializing in hearing and cognition.

Of those with a diagnosis of hearing loss, only 12 percent of people under 69 use hearing aids. Even if they have insurance to cover all or some of the cost, most people don’t use the devices.

We must understand the hearing aid users

The study found gaps among who will use hearing aids based on gender, ethnicity, and location. Researchers used data from nearly 115,000 people over the age of 66 who had hearing loss and insurance coverage through a large, private insurance company between 2008 and 2016.

The team tracked participants 1 year before their diagnosis and 3 years after. Men with hearing loss were more likely to get a hearing aid. In fact, 13.3 percent of men got hearing aids, while 11.3 percent of women did the same. And 6.5 percent of people with Latino heritage got a hearing aid, while 9.8 percent of African Americans and 13.6 percent of white people did the same.

According to location, almost 37 percent of people with hearing loss who used hearing aids lived in the north-central part of the country, compared to 5.9 percent of people in the mountain states.

The risk of getting a dementia diagnosis (including Alzheimer’s disease) within 3 years of a hearing loss diagnosis was 18 percent lower in those using hearing aids. The risk of getting a diagnosis of depression or anxiety by the end of 3 years was 11 percent lower for hearing aid users, while the chance of being treated for fall-related injuries was 13 percent lower. People with hearing loss had significantly higher rates of dementia, depression, and fall injuries compared to the general population.

“We already know that people with hearing loss have more adverse health events and more coexisting conditions, but this study allows us to see the effects of an intervention and look for associations between hearing aids and health outcomes,” Dr. Elham Mahmoudi, a health economist and lead author, said in a statement.

The researchers plan to continue studying the population to assess future outcomes.

The hardships of hearing loss can be explained

Multiple studies have reported that age-related hearing loss is associated with changes in the brain, Loughrey says. Loss of stimulation may lead to parts of the brain responsible for memory or regulating mood becoming less active and inefficient. There’s also evidence that the brain undergoes changes after hearing loss to compensate and to help maintain understanding of speech.

“Difficulties in following conversation in noisy environments may cause adults with hearing loss to withdraw and become more socially isolated, which is associated with a higher risk of depression and dementia,” Loughrey said.

Hearing aids make sounds louder, which forces damaged cells in the ear to relay the sounds to the brain in a way that couldn’t happen without the hearing aid, says Dr. Kelly Tremblay, PhD, CCC-A FAAA a retired professor and Founder of Lend an Ear Consulting.

“Physically this is good, because it keeps the brain stimulated and neural networks flowing,” Tremblay explained.

Some research points to a loss of neurons in the brainstem and cortex following hearing loss, but the medical community doesn’t fully understand all of the mechanisms involved.

“When we are born with normal hearing, the brain develops over a lifetime using sound as part of its neural networks,” Tremblay said. “When we lose our sense of sound, the networks we once used don’t get activated. And, if we don’t use them, we lose them.”

“Lack of hearing can definitely be isolating if one cannot follow what is being said around them,” agreed Nancy Gilston, Au.D., an audiologist at the New York Eye and Ear Infirmary of Mount Sinai.

Not all hearing issues are the same. Some people may benefit from amplification, while others with impaired cochleas still don’t hear clearly with sound amplification, Gilston says.

“Some people with hearing loss are not necessarily [needing] hearing aids, as they may need other intervention, such as a cochlear implant,” added Dr. Asri Maharani, a researcher at The University of Manchester.

There is hesitation in using hearing aids

The high cost of hearing aids may deter some people from getting them, but Gilston says it’s a wise investment.

“Patients perceive hearing aids as a sign of aging, and they are resistant to address their symptoms simply because they are fearful of how it will look to the outside world,” Gilston said.

“By hearing what is being said, you bring less attention to yourself than by asking for endless repetition,” she said.

Hearing aids can help in preventing falls

The American Academy of Audiology recently presented recommendations to a U.S. Senate committee, urging it to give Medicare beneficiaries direct access to audiologist services. They referenced research from Johns Hopkins University School of Medicine that found people with untreated mild hearing loss were nearly three times more likely to have a history of falling. In 2016, approximately 3 million older adults went to the emergency room as a result of a fall. Fall-related injuries in older adults cost about $50 billion annually, the committee noted.

Next year, over-the-counter hearing aids approved by the Food and Drug Administration will be available to treat those with mild to moderate hearing loss. This could make hearing aids more accessible, and therefore result in more users. Though it’s hard to think insurers will cover the cost, Gilston says insurers should consider the welfare of their patients’ ability to be more successful in daily activities as an incentive to retain more patients.

“Less expensive hearing aids and mobile hearing technology are emerging in the marketplace, so the hope is that more people will have access to affordable hearing help,” Tremblay added.

Sounds Can Directly Affect Balance

What people hear and do not hear can have a direct effect on their balance, according to new research from the New York Eye and Ear Infirmary of Mount Sinai (NYEE). The research, published in the March 12 issue of JAMA Otolaryngology-Head & Neck Surgery, provides a better understanding of the relationship between hearing loss and why people fall, especially in the elderly population. The findings could lead doctors to screen for hearing loss in patients at high risk for falls, detect hearing loss in its early stages, and treat it quickly.

Falls are the leading cause of deadly injuries in the US

In this study, a team of researchers from Mount Sinai and New York University’s Steinhardt School of Culture conducted a comprehensive analysis of all published research since inception (PubMed, Cochran Database of Scopus) that investigated the association between sound and standing balance. They looked at 28 medical articles involving more than 700 patients. Many of the studies focused on fields that clinicians who treat falls would not typically encounter, such as sound engineering, computer science, physics, and psychology. The authors combined all of the studies and looked for trends in the data.

The studies analyzed mostly healthy adults, but also looked at patients with congenital blindness, vestibular loss (damage to the inner ear causing balance and eye issues, including vertigo), and different levels of hearing loss. All research examined how sounds affected someone’s ability to keep their balance while standing still, often with their eyes closed and when standing on a pliable, squishy surface. They also looked at how wearing noise-canceling headphones (a complete lack of sound) affected balance. Some studies played white noise or static, while others used environmental sounds such as cocktail party chatter or running water. They found that people had more difficulty staying balanced or standing still on an uneven surface when it was quiet, but had better balance while listening to sounds.

The authors found that the type of sound was important when it comes to balance. More specifically, continuous background noise (usually static) was the most helpful for subjects to keep their center of gravity. Some types of sounds actually caused poor balance; for example, some people who listened to sound jumping back and forth through headphones (i.e. beeping that went from left to right) had difficulty standing upright.

The authors believe this may be because sound can act as an “auditory anchor.” More specifically, people use sounds like white noise to help unconsciously create a mental image of the environment to keep ourselves grounded. The research analysis also showed that sound became more important for balance when the subjects were given difficult balancing tasks (e.g., standing on a moving floor) or if the patients had pre-existing sensory issues. When people with vision loss, hearing loss, or balance problems heard stationary sounds, their posture dramatically improved. This suggests people rely more on hearing when other senses are impaired.

The analysis highlighted large gaps in research on hearing loss and balance. Future studies are needed that look at different levels of hearing loss, and how hearing aids and cochlear implants affect balance. The researchers added that more studies using everyday sounds like traffic or shopping malls or airports are necessary to understand more about fall risks in people with hearing loss. Also, more studies focused on older adults need to be conducted.

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Materials provided by The Mount Sinai Hospital / Mount Sinai School of MedicineNote: Content may be edited for style and length.

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