Age-related hearing impairment in older adults associated with decreased physical functioning

1. Cross-sectional analysis in this study demonstrated reduced physical functioning and walking endurance in those with hearing impairment compared to those without one.

2. Longitudinal analysis of those with hearing impairment demonstrated a more rapid decline in physical functioning than those with normal hearing.

Evidence Rating Level: 2 (Good)

Study Rundown: Hearing impairment (HI) is prevalent among adults over 70 years old (approximately 2/3 of adults in this population are affected) and is associated with various poor functional outcomes. HI is often modifiable and treatable, which makes it an ideal target for intervention. This cross-sectional and longitudinal cohort study assessed whether there is an association between HI and physical functioning, walking endurance, and rate of physical decline. Physical function was assessed using the Short Physical Performance Battery (SPPB), which measures balance, gait speed, and chair stands. Walking endurance was evaluated using a fast-paced 2-minute walk (TMW) test. For each progress 10 dB HL, there was a corresponding decreased SPPB score and slowed gait speed. When HI was categorized into mild, moderate, and severe, all three categories were significantly associated with lower SPPB composite scores and slower gait speeds compared to those with normal hearing. Chair stand test was not significantly different between HI cohorts and the normal hearing cohort. When assessing walking endurance with the TMW test, each 10 dB HL increase was significantly associated with reduced distance walked during the test. Furthermore, in the longitudinal analysis, those with moderate or severe HI had a significantly quicker rate of physical decline than those with normal hearing within the first five years. From year five until the end of study follow-up, those with mild or moderate HI had a significantly quicker decline in physical function than those with normal hearing. Overall, this study demonstrated that HI in older adults was associated with greater physical decline, a higher rate of physical decline, and reduced walking endurance. One limitation of this study, however, is that the severe HI cohort was much smaller than the normal hearing cohort (973 vs.121 participants) which reduces statistical power in comparing these two groups.

Click to read the study in JAMA

Click to read an accompanying editorial in JAMA

Relevant Reading: Association of hearing impairment with declines in physical functioning and the risk of disability in older adults

In-Depth [cross-sectional study/prospective cohort]: This cohort study included 2956 participants (973 [33%] normal hearing, 1170 [40%] mild HI, 692 [23%] moderate HI, 121 [4%] severe HI) from the Atherosclerosis Risk in Communities study between 2011 to 2019. Participants were categorized into hearing categories based on pure tone audiometry, which calculated better-hearing ear pure tone average (BPTA); higher BPTA indicates reduced hearing function. The outcomes were physical functioning (assessed with the SPPB) and walking endurance (assessed with the TMW test). SPPB is composed of balance, gait speed, and chair stands. Every 10 dB HL increase in BPTA had an odds ratio (OR) for a low SPPB composite score of 1.18 (95% CI: 1.09-1.29), including 1.21 (95% CI: 1.13-1.30) for balance, 1.18 (95% CI: 1.06-1.31) for gait speed, and 1.10 (95% CI: 1.03-1.17) for chair stands. Furthermore, for every 10 dB HL increase in BPTA, there was a 0.98 m (95% CI: 0.26-1.69) reduction in distance walked. When comparing HI categories to normal hearing participants, the mild HI cohort walked -2.10 m (95% CI: -4.24 to -0.04) less, the moderate HI cohort walked -2.81 m (95% CI: -5.45 to -0.17) less, and the severe HI cohort walked -5.31 m (95% CI: -10.20 to -0.36) less than the normal hearing cohort. Those with reduced hearing declined quicker in SPPB scores over time than those with normal hearing.

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