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Huang AR, Reed NS, Deal JA, Arnold M, Burgard S, Chisolm T, Couper D, Glynn NW, Gmelin T, Goman AM, Gravens-Mueller L, Hayden KM, Mitchell C, Pankow JS, Pike JR, Schrack JA, Sanchez V, Coresh J, Lin FR. Depression and Health-Related Quality of Life Among Older Adults With Hearing Loss in the ACHIEVE Study. J Appl Gerontol 2024; 43:550-561. [PMID: 38016096 PMCID: PMC10981564 DOI: 10.1177/07334648231212291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2023] Open
Abstract
Hearing loss is associated with cognitive/physical health; less is known about mental health. We investigated associations between hearing loss severity, depression, and health-related quality of life among older adults with unaided hearing loss. Data (N = 948) were from the Aging and Cognitive Health Evaluation in Elders Study. Hearing was measured by pure-tone average (PTA), Quick Speech-in-Noise (QuickSIN) test, and the Hearing Handicap Inventory for the Elderly (HHIE-S). Outcomes were validated measures of depression and health-related quality of life. Associations were assessed by negative binomial regression. More severe hearing loss was associated with worse physical health-related quality of life (ratio: .98, 95% CI: .96, 1.00). Better QuickSIN was associated with higher mental health-related quality of life (1.01 [1.00, 1.02]). Worse HHIE-S was associated with depression (1.24 [1.16, 1.33]) and worse mental (.97 [.96, .98]) and physical (.95 [ .93, .96]) health-related quality of life. Further work will test effects of hearing intervention on mental health.
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Affiliation(s)
- Alison R. Huang
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Cochlear Center for Hearing and Public Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Nicholas S. Reed
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Cochlear Center for Hearing and Public Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Jennifer A. Deal
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Cochlear Center for Hearing and Public Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Michelle Arnold
- College of Science and Mathematics, University of South Florida Sarasota - Manatee, Sarasota, FL, USA
| | - Sheila Burgard
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Theresa Chisolm
- College of Science and Mathematics, University of South Florida Sarasota - Manatee, Sarasota, FL, USA
| | - David Couper
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Nancy W. Glynn
- Department of Epidemiology, University of Pittsburgh School of Public Health, Pittsburgh, PA, USA
| | - Theresa Gmelin
- Department of Epidemiology, University of Pittsburgh School of Public Health, Pittsburgh, PA, USA
| | - Adele M. Goman
- School of Health and Social Care, Edinburgh Napier University, UK
| | - Lisa Gravens-Mueller
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Kathleen M. Hayden
- Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Christine Mitchell
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - James S. Pankow
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, MN, USA
| | - James Russell Pike
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Jennifer A. Schrack
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Victoria Sanchez
- College of Science and Mathematics, University of South Florida Sarasota - Manatee, Sarasota, FL, USA
| | - Josef Coresh
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Frank R. Lin
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Cochlear Center for Hearing and Public Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Huang AR, Rebok GW, Swenor BK, Deal JA. Vision and hearing difficulty and effects of cognitive training in older adults. Alzheimers Dement (Amst) 2024; 16:e12537. [PMID: 38595912 PMCID: PMC11002773 DOI: 10.1002/dad2.12537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 12/22/2023] [Accepted: 12/28/2023] [Indexed: 04/11/2024]
Abstract
BACKGROUND Cognitive training is delivered visually and aurally. It is unknown whether self-reported sensory difficulty modifies the effects of cognitive training on cognition. METHODS Participants (N = 2788) in the Advanced Cognitive Training for Independent and Vital Elderly Study were randomized to training in memory, reasoning, speed of processing, or control. Differences in the 10-year effect of cognitive training on cognition by self-reported vision and hearing difficulty were assessed using linear mixed effect models. RESULTS Benefit (intervention vs. control) of reasoning training was smaller among participants with versus without vision difficulty (difficulty: -0.25, 95% confidence interval: [-0.88, 0.39], no difficulty: 0.58 [0.28, 0.89]). Benefit of memory training was greater for participants with versus without hearing difficulty (difficulty: 0.17 [-0.37, 0.72], no difficulty: -0.20 [-0.65, 0.24]). DISCUSSION Older adults with sensory loss have increased risk for cognitive decline; benefits of cognitive training may be greater for these individuals. Sensory loss should be considered in training design. Highlights Memory training was more beneficial for participants with hearing loss.Participants with vision difficulties did not benefit as much from reasoning training.Low accessibility in design and learned compensation strategies may contribute.Consideration of sensory impairment in study design is needed.Inclusion of older adults with sensory impairment in cognitive training is needed.
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Affiliation(s)
- Alison R. Huang
- Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
- Cochlear Center for Hearing and Public HealthJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
| | - George W. Rebok
- Department of Mental HealthJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
| | - Bonnielin K. Swenor
- Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
- Disability Health Research CenterJohns Hopkins Bloomberg UniversityBaltimoreMarylandUSA
- The Wilmer Eye InstituteJohns Hopkins UniversityBaltimoreMarylandUSA
- Johns Hopkins School of NursingBaltimoreMarylandUSA
| | - Jennifer A. Deal
- Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
- Cochlear Center for Hearing and Public HealthJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
- Disability Health Research CenterJohns Hopkins Bloomberg UniversityBaltimoreMarylandUSA
- Department of Otolaryngology‐Head and Neck SurgeryJohns Hopkins School of MedicineBaltimoreMarylandUSA
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Huang AR, Cudjoe TKM, Rebok GW, Swenor BK, Deal JA. Hearing and vision impairment and social isolation over 8 years in community-dwelling older adults. BMC Public Health 2024; 24:779. [PMID: 38475742 DOI: 10.1186/s12889-024-17730-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 01/10/2024] [Indexed: 03/14/2024] Open
Abstract
BACKGROUND Little is known about the long-term impact of hearing and vision impairment on social isolation. This study quantifies the association between hearing, vision, and concurrent hearing and vision impairment (dual sensory impairment) and social isolation over 8 years among older adults. METHODS Data were from the National Health and Aging Trends Study (NHATS), a cohort study (2011 - 2019) of U.S. Medicare beneficiaries aged 65 years and older. Social isolation was measured by a binary indicator incorporating four domains: living arrangement, core discussion network size, religious attendance, and social participation. Hearing, vision, and dual sensory impairments were measured by self-report and modeled categorically (no impairment [ref.], hearing impairment only, vision impairment only, dual sensory impairment). Associations between sensory impairments and odds of social isolation over 8 years were assessed using multivariate generalized logistic mixed models and adjusted for demographic and health characteristics. RESULTS Among 5,552 participants, 18.9% self-reported hearing impairment, 4.8% self-reported vision impairment, and 2.3% self-reported dual sensory impairment. Over 8 years, hearing impairment only was associated with 28% greater odds of social isolation. Participants with hearing impairment only were more likely to live alone and have limited social participation. CONCLUSION Greater clinical awareness of hearing impairment as a risk factor for social isolation can increase opportunities to identify and aid older adults who may benefit from resources and interventions to increase social connection and mitigate social isolation.
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Affiliation(s)
- Alison R Huang
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21202, USA.
- Cochlear Center for Hearing and Public Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Thomas K M Cudjoe
- Division of Geriatric Medicine and Gerontology, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - George W Rebok
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Bonnielin K Swenor
- Cochlear Center for Hearing and Public Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Disability Health Research Center, Johns Hopkins Bloomberg University, Baltimore, MD, USA
- The Wilmer Eye Institute, Johns Hopkins University, Baltimore, MD, USA
- Johns Hopkins School of Nursing, Baltimore, MD, USA
| | - Jennifer A Deal
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21202, USA
- Cochlear Center for Hearing and Public Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, MD, USA
- Disability Health Research Center, Johns Hopkins Bloomberg University, Baltimore, MD, USA
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Huang AR, Lin FR. Hearing loss and dementia in older adults: A narrative review. J Chin Med Assoc 2024; 87:252-258. [PMID: 38112446 DOI: 10.1097/jcma.0000000000001042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2023] Open
Abstract
The prevalence of hearing loss is high among older adults; globally, 65% of adults over 60 years have hearing loss. Over the past decade, evidence from epidemiologic studies has linked hearing loss to nearly two times greater risk of dementia. The hypothesized mechanistic pathways through which hearing loss could contribute to increased dementia risk include the effects of hearing on greater cognitive load, changes in brain structure and function, and decreased social engagement. These mechanistic pathways may be modified by management of hearing loss using existing intervention (eg, hearing aids). Hearing treatment may be an effective intervention for slowing cognitive decline in some older adults. In this review, we update existing reviews of the current epidemiologic research on the association between hearing loss and dementia risk and discuss hypothesized mechanisms of this association. We also discuss management of hearing loss as a potential intervention for slowing cognitive decline and reducing dementia risk.
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Affiliation(s)
- Alison R Huang
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Cochlear Center for Hearing and Public Health, Department of Epidemiology, Johns Hopkins Bloomberg School of Public health, Baltimore, Maryland, USA
| | - Frank R Lin
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Cochlear Center for Hearing and Public Health, Department of Epidemiology, Johns Hopkins Bloomberg School of Public health, Baltimore, Maryland, USA
- Department of Otolaryngology-Head & Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
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Kolberg ER, Morales EEG, Thallmayer TW, Arnold ML, Burgard S, Chisolm TH, Coresh J, Couper D, Hayden KM, Huang AR, Lin FR, Mitchell CM, Mosley TH, Gravens‐Mueller L, Owens TA, Pankow JS, Pike JR, Reed NS, Sanchez V, Schrack JA, Deal JA, Goman AM. Hearing loss and cognition: A protocol for ensuring speech understanding before neurocognitive assessment. Alzheimers Dement 2024; 20:1671-1681. [PMID: 38081140 PMCID: PMC10947954 DOI: 10.1002/alz.13552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 10/06/2023] [Accepted: 10/22/2023] [Indexed: 01/13/2024]
Abstract
INTRODUCTION Many neurocognitive evaluations involve auditory stimuli, yet there are no standard testing guidelines for individuals with hearing loss. The ensuring speech understanding (ESU) test was developed to confirm speech understanding and determine whether hearing accommodations are necessary for neurocognitive testing. METHODS Hearing was assessed using audiometry. The probability of ESU test failure by hearing status was estimated in 2679 participants (mean age: 81.4 ± 4.6 years) using multivariate logistic regression. RESULTS Only 2.2% (N = 58) of participants failed the ESU test. The probability of failure increased with hearing loss severity; similar results were observed for those with and without mild cognitive impairment or dementia. DISCUSSION The ESU test is appropriate for individuals who have variable degrees of hearing loss and cognitive function. This test can be used prior to neurocognitive testing to help reduce the risk of hearing loss and compromised auditory access to speech stimuli causing poorer performance on neurocognitive evaluation.
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Affiliation(s)
- Elizabeth R. Kolberg
- Cochlear Center for Hearing and Public HealthJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
- Department of Otolaryngology‐Head and Neck SurgeryJohns Hopkins School of MedicineBaltimoreMarylandUSA
| | - Emmanuel E. Garcia Morales
- Cochlear Center for Hearing and Public HealthJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
- Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
| | - Tara W. Thallmayer
- Cochlear Center for Hearing and Public HealthJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
| | - Michelle L. Arnold
- Department of Communication Sciences and DisordersUniversity of South FloridaTampaFloridaUSA
| | - Sheila Burgard
- Collaborative Studies Coordinating CenterUniversity of North CarolinaChapel HillNorth CarolinaUSA
| | - Theresa H. Chisolm
- Department of Communication Sciences and DisordersUniversity of South FloridaTampaFloridaUSA
| | - Josef Coresh
- Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
- George W. Comstock Center for Public Health Research and PreventionJohns Hopkins Bloomberg School of Public HealthHagerstownMarylandUSA
- Department of General Internal MedicineJohns Hopkins School of MedicineBaltimoreMarylandUSA
| | - David Couper
- Collaborative Studies Coordinating CenterUniversity of North CarolinaChapel HillNorth CarolinaUSA
| | - Kathleen M. Hayden
- Department of Social Sciences and Health PolicyWake Forest School of MedicineWinston‐SalemNorth CarolinaUSA
| | - Alison R. Huang
- Cochlear Center for Hearing and Public HealthJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
- Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
| | - Frank R. Lin
- Cochlear Center for Hearing and Public HealthJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
- Department of Otolaryngology‐Head and Neck SurgeryJohns Hopkins School of MedicineBaltimoreMarylandUSA
- Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
- Department of Mental HealthJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
| | - Christine M. Mitchell
- Cochlear Center for Hearing and Public HealthJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
- Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
| | - Thomas H. Mosley
- Memory Impairment and Neurodegenerative Dementia CenterUniversity of Mississippi Medical CenterJacksonMississippiUSA
| | - Lisa Gravens‐Mueller
- Collaborative Studies Coordinating CenterUniversity of North CarolinaChapel HillNorth CarolinaUSA
| | - Tiffany A. Owens
- Memory Impairment and Neurodegenerative Dementia CenterUniversity of Mississippi Medical CenterJacksonMississippiUSA
| | - James S. Pankow
- Division of EpidemiologyUniversity of Minnesota School of Public HealthMinneapolisMinnesotaUSA
| | - James Russell Pike
- Collaborative Studies Coordinating CenterUniversity of North CarolinaChapel HillNorth CarolinaUSA
- Department of BiostatisticsGillings School of Global Public HealthChapel HillNorth CarolinaUSA
| | - Nicholas S. Reed
- Cochlear Center for Hearing and Public HealthJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
- Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
| | - Victoria Sanchez
- Department of Communication Sciences and DisordersUniversity of South FloridaTampaFloridaUSA
| | - Jennifer A. Schrack
- Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
| | - Jennifer A. Deal
- Cochlear Center for Hearing and Public HealthJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
- Department of Otolaryngology‐Head and Neck SurgeryJohns Hopkins School of MedicineBaltimoreMarylandUSA
- Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
| | - Adele M. Goman
- Cochlear Center for Hearing and Public HealthJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
- Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
- School of Health and Social CareEdinburgh Napier UniversityEdinburghUK
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Huang AR, Reed NS, Deal JA, Arnold M, Burgard S, Chisolm T, Couper D, Glynn NW, Gmelin T, Goman AM, Gravens-Mueller L, Hayden KM, Mitchell C, Pankow JS, Pike JR, Sanchez V, Schrack JA, Coresh J, Lin FR. Loneliness and Social Network Characteristics Among Older Adults With Hearing Loss in the ACHIEVE Study. J Gerontol A Biol Sci Med Sci 2024; 79:glad196. [PMID: 37578190 PMCID: PMC10809043 DOI: 10.1093/gerona/glad196] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Indexed: 08/15/2023] Open
Abstract
BACKGROUND Hearing loss is linked to loneliness and social isolation, but evidence is typically based on self-reported hearing. This study quantifies the associations of objective and subjective hearing loss with loneliness and social network characteristics among older adults with untreated hearing loss. METHODS This study uses baseline data (N = 933) from the Aging and Cognitive Health Evaluation in Elders (ACHIEVE) study. Hearing loss was quantified by the better ear, speech-frequency pure tone average (PTA), Quick Speech-in-Noise test, and hearing-related quality of life. Outcomes were validated measures of loneliness and social network characteristics. Associations were assessed by Poisson, negative binomial, and linear regression adjusted for demographic, health, and study design characteristics. RESULTS Participants were mean of 76.8 (4.0) years, 54.0% female, and 87.6% White. Prevalence of loneliness was 38%. Worse PTA was associated with a 19% greater prevalence of moderate or greater loneliness (prevalence ration [PR]: 1.19.95% CI: 1.06, 1.33). Better speech-in-noise recognition was associated with greater social network characteristics (eg, larger social network size [IRR: 1.04, 95% CI: 1.00, 1.07]). Worse hearing-related quality of life was associated with a 29% greater prevalence of moderate or greater loneliness (PR: 1.29, 95% CI: 1.19, 1.39) and worse social network characteristics (eg, more constricted social network size [IRR: 0.96, 95% CI: 0.91, 1.00]). CONCLUSIONS Results suggest the importance of multiple dimensions of hearing to loneliness and social connectedness. Hearing-related quality of life may be a potentially useful, easily administered clinical tool for identifying older adults with hearing loss associated with greater loneliness and social isolation.
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Affiliation(s)
- Alison R Huang
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Cochlear Center for Hearing and Public Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Nicholas S Reed
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Cochlear Center for Hearing and Public Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Jennifer A Deal
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Cochlear Center for Hearing and Public Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Michelle Arnold
- College of Science and Mathematics, University of South Florida Sarasota–Manatee, Sarasota, Florida, USA
| | - Sheila Burgard
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Theresa Chisolm
- College of Science and Mathematics, University of South Florida Sarasota–Manatee, Sarasota, Florida, USA
| | - David Couper
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Nancy W Glynn
- Department of Epidemiology, University of Pittsburgh School of Public Health, Pittsburgh, Pennsylvania, USA
| | - Theresa Gmelin
- Department of Epidemiology, University of Pittsburgh School of Public Health, Pittsburgh, Pennsylvania, USA
| | - Adele M Goman
- School of Health and Social Care, Edinburgh Napier University, Edinburgh, UK
| | - Lisa Gravens-Mueller
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Kathleen M Hayden
- Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Christine Mitchell
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - James S Pankow
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, Minnesota, USA
| | - James Russell Pike
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Victoria Sanchez
- College of Science and Mathematics, University of South Florida Sarasota–Manatee, Sarasota, Florida, USA
| | - Jennifer A Schrack
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Josef Coresh
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Frank R Lin
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Cochlear Center for Hearing and Public Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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Sanchez VA, Arnold ML, Betz JF, Reed NS, Faucette S, Anderson E, Burgard S, Coresh J, Deal JA, Eddins AC, Goman AM, Glynn NW, Gravens-Mueller L, Hampton J, Hayden KM, Huang AR, Liou K, Mitchell CM, Mosley TH, Neil HN, Pankow JS, Pike JR, Schrack JA, Sherry L, Teece KH, Witherell K, Lin FR, Chisolm TH. Description of the Baseline Audiologic Characteristics of the Participants Enrolled in the Aging and Cognitive Health Evaluation in Elders Study. Am J Audiol 2024; 33:1-17. [PMID: 38166200 PMCID: PMC11001432 DOI: 10.1044/2023_aja-23-00066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 09/01/2023] [Accepted: 10/04/2023] [Indexed: 01/04/2024] Open
Abstract
PURPOSE The Aging and Cognitive Health Evaluation in Elders (ACHIEVE) study is a randomized clinical trial designed to determine the effects of a best-practice hearing intervention versus a successful aging health education control intervention on cognitive decline among community-dwelling older adults with untreated mild-to-moderate hearing loss. We describe the baseline audiologic characteristics of the ACHIEVE participants. METHOD Participants aged 70-84 years (N = 977; Mage = 76.8) were enrolled at four U.S. sites through two recruitment routes: (a) an ongoing longitudinal study and (b) de novo through the community. Participants underwent diagnostic evaluation including otoscopy, tympanometry, pure-tone and speech audiometry, speech-in-noise testing, and provided self-reported hearing abilities. Baseline characteristics are reported as frequencies (percentages) for categorical variables or medians (interquartiles, Q1-Q3) for continuous variables. Between-groups comparisons were conducted using chi-square tests for categorical variables or Kruskal-Wallis test for continuous variables. Spearman correlations assessed relationships between measured hearing function and self-reported hearing handicap. RESULTS The median four-frequency pure-tone average of the better ear was 39 dB HL, and the median speech-in-noise performance was a 6-dB SNR loss, indicating mild speech-in-noise difficulty. No clinically meaningful differences were found across sites. Significant differences in subjective measures were found for recruitment route. Expected correlations between hearing measurements and self-reported handicap were found. CONCLUSIONS The extensive baseline audiologic characteristics reported here will inform future analyses examining associations between hearing loss and cognitive decline. The final ACHIEVE data set will be publicly available for use among the scientific community. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.24756948.
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Affiliation(s)
- Victoria A. Sanchez
- Department of Otolaryngology–Head and Neck Surgery, University of South Florida, Tampa
- Department of Communication Sciences and Disorders, University of South Florida, Tampa
| | - Michelle L. Arnold
- Department of Communication Sciences and Disorders, University of South Florida, Tampa
| | - Joshua F. Betz
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
- Cochlear Center for Hearing and Public Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Nicholas S. Reed
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
- Cochlear Center for Hearing and Public Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Sarah Faucette
- The MIND Center, The University of Mississippi Medical Center, Jackson
- Department of Otolaryngology–Head and Neck Surgery, The University of Mississippi Medical Center, Jackson
| | | | - Sheila Burgard
- Department of Biostatistics, The University of North Carolina at Chapel Hill
| | - Josef Coresh
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
- Cochlear Center for Hearing and Public Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Jennifer A. Deal
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
- Cochlear Center for Hearing and Public Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Ann Clock Eddins
- Department of Communication Sciences and Disorders, University of South Florida, Tampa
| | - Adele M. Goman
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
- Cochlear Center for Hearing and Public Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Nancy W. Glynn
- Department of Epidemiology, School of Public Health, University of Pittsburgh, PA
| | | | - Jaime Hampton
- Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston-Salem, NC
| | - Kathleen M. Hayden
- Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston-Salem, NC
| | - Alison R. Huang
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
- Cochlear Center for Hearing and Public Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Kaila Liou
- Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston-Salem, NC
| | - Christine M. Mitchell
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
- Cochlear Center for Hearing and Public Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Thomas H. Mosley
- The MIND Center, The University of Mississippi Medical Center, Jackson
| | - Haley N. Neil
- Department of Otolaryngology–Head and Neck Surgery, University of South Florida, Tampa
| | - James S. Pankow
- Minneapolis Field Center, University of Minnesota
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis
| | - James R. Pike
- Department of Biostatistics, The University of North Carolina at Chapel Hill
| | - Jennifer A. Schrack
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
- Center on Aging and Health, Johns Hopkins University, Baltimore, MD
| | - Laura Sherry
- Cochlear Center for Hearing and Public Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | | | | | - Frank R. Lin
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
- Cochlear Center for Hearing and Public Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Theresa H. Chisolm
- Department of Communication Sciences and Disorders, University of South Florida, Tampa
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Reed NS, Gravens‐Mueller L, Huang AR, Goman AM, Mitchell CM, Arnold ML, Bolton S, Burgard S, Chisolm TH, Couper D, Deal JA, Evans J, Faucette S, Glynn NW, Gmelin T, Hayden KM, Miller E, Minotti M, Mosley T, Naylor S, Pankow JS, Pike JR, Sanchez VA, Schrack JA, Coresh J, Lin FR. Recruitment and baseline data of the Aging and Cognitive Health Evaluation in Elders (ACHIEVE) study: A randomized trial of a hearing loss intervention for reducing cognitive decline. Alzheimers Dement (N Y) 2024; 10:e12453. [PMID: 38356470 PMCID: PMC10865776 DOI: 10.1002/trc2.12453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 12/29/2023] [Accepted: 01/12/2024] [Indexed: 02/16/2024]
Abstract
INTRODUCTION Hearing loss is highly prevalent among older adults and independently associated with cognitive decline. The Aging and Cognitive Health Evaluation in Elders (ACHIEVE) study is a multicenter randomized control trial (partially nested within the infrastructure of an observational cohort study, the Atherosclerosis Risk in Communities [ARIC] study) to determine the efficacy of best-practice hearing treatment to reduce cognitive decline over 3 years. The goal of this paper is to describe the recruitment process and baseline results. METHODS Multiple strategies were used to recruit community-dwelling 70-84-year-old participants with adult-onset hearing loss who were free of substantial cognitive impairment from the parent ARIC study and de novo from the surrounding communities into the trial. Participants completed telephone screening, an in-person hearing, vision, and cognitive screening, and a comprehensive hearing assessment to determine eligibility. RESULTS Over a 24-month period, 3004 telephone screenings resulted in 2344 in-person hearing, vision, and cognition screenings and 1294 comprehensive hearing screenings. Among 1102 eligible, 977 were randomized into the trial (median age = 76.4 years; 53.5% female; 87.8% White; 53.3% held a Bachelor's degree or higher). Participants recruited through the ARIC study were recruited much earlier and were less likely to report hearing loss interfered with their quality of life relative to participants recruited de novo from the community. Minor differences in baseline hearing or health characteristics were found by recruitment route (i.e., ARIC study or de novo) and by study site. DISCUSSION The ACHIEVE study successfully completed enrollment over 2 years that met originally projected rates of recruitment. Substantial operational and scientific efficiencies during study startup were achieved through embedding this trial within the infrastructure of a longstanding and well-established observational study. Highlights The ACHIEVE study tests the effect of hearing intervention on cognitive decline.The study is partially nested within an existing cohort study.Over 2 years, 977 participants recruited and enrolled.Eligibility assessed by telephone and in-person for hearing, vision, and cognitive screening.The ACHIEVE study findings will have significant public health implications.
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Affiliation(s)
- Nicholas S. Reed
- Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
- Cochlear Center for Hearing and Public HealthJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
| | - Lisa Gravens‐Mueller
- Department of BiostatisticsGillings School of Global Public HealthUniversity of North CarolinaChapel HillNorth CarolinaUSA
| | - Alison R. Huang
- Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
- Cochlear Center for Hearing and Public HealthJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
| | - Adele M. Goman
- Cochlear Center for Hearing and Public HealthJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
- School of Health and Social CareEdinburgh Napier UniversityEdinburghUK
| | - Christine M. Mitchell
- Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
| | - Michelle L. Arnold
- College of Science and MathematicsUniversity of South Florida Sarasota ‐ ManateeSarasotaFloridaUSA
| | - Spencer Bolton
- George W. Comstock Center for Public Health Research and PreventionJohns Hopkins Bloomberg School of Public HealthHagerstownMarylandUSA
| | - Sheila Burgard
- Department of BiostatisticsGillings School of Global Public HealthUniversity of North CarolinaChapel HillNorth CarolinaUSA
| | - Theresa H. Chisolm
- Department of Communication Sciences and DisordersUniversity of South FloridaTampaFloridaUSA
| | - David Couper
- Department of BiostatisticsGillings School of Global Public HealthUniversity of North CarolinaChapel HillNorth CarolinaUSA
| | - Jennifer A. Deal
- Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
- Cochlear Center for Hearing and Public HealthJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
| | - Joshua Evans
- Department of Social Sciences and Health PolicyWake Forest University School of MedicineWinston‐SalemNorth CarolinaUSA
| | - Sarah Faucette
- The MIND CenterUniversity of Mississippi Medical CenterJacksonMississippiUSA
| | - Nancy W. Glynn
- Department of EpidemiologyUniversity of Pittsburgh School of Public HealthPittsburghPennsylvaniaUSA
| | - Theresa Gmelin
- Department of EpidemiologyUniversity of Pittsburgh School of Public HealthPittsburghPennsylvaniaUSA
| | - Kathleen M. Hayden
- Department of Social Sciences and Health PolicyWake Forest University School of MedicineWinston‐SalemNorth CarolinaUSA
| | - Elizabeth Miller
- Division of Epidemiology and Community HealthUniversity of Minnesota School of Public HealthMinneapolisMinnesotaUSA
| | - Melissa Minotti
- George W. Comstock Center for Public Health Research and PreventionJohns Hopkins Bloomberg School of Public HealthHagerstownMarylandUSA
| | - Thomas Mosley
- The MIND CenterUniversity of Mississippi Medical CenterJacksonMississippiUSA
| | - Stacee Naylor
- The MIND CenterUniversity of Mississippi Medical CenterJacksonMississippiUSA
| | - James S. Pankow
- Division of Epidemiology and Community HealthUniversity of Minnesota School of Public HealthMinneapolisMinnesotaUSA
| | - James Russell Pike
- Department of BiostatisticsGillings School of Global Public HealthUniversity of North CarolinaChapel HillNorth CarolinaUSA
| | - Victoria A. Sanchez
- Department of Otolaryngology‐Head and Neck SurgeryUniversity of South FloridaTampaFloridaUSA
| | - Jennifer A. Schrack
- Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
| | - Josef Coresh
- Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
| | - Frank R. Lin
- Cochlear Center for Hearing and Public HealthJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
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9
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Lin FR, Pike JR, Albert MS, Arnold M, Burgard S, Chisolm T, Couper D, Deal JA, Goman AM, Glynn NW, Gmelin T, Gravens-Mueller L, Hayden KM, Huang AR, Knopman D, Mitchell CM, Mosley T, Pankow JS, Reed NS, Sanchez V, Schrack JA, Windham BG, Coresh J. Hearing intervention versus health education control to reduce cognitive decline in older adults with hearing loss in the USA (ACHIEVE): a multicentre, randomised controlled trial. Lancet 2023; 402:786-797. [PMID: 37478886 PMCID: PMC10529382 DOI: 10.1016/s0140-6736(23)01406-x] [Citation(s) in RCA: 41] [Impact Index Per Article: 41.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Revised: 06/26/2023] [Accepted: 07/03/2023] [Indexed: 07/23/2023]
Abstract
BACKGROUND Hearing loss is associated with increased cognitive decline and incident dementia in older adults. We aimed to investigate whether a hearing intervention could reduce cognitive decline in cognitively healthy older adults with hearing loss. METHODS The ACHIEVE study is a multicentre, parallel-group, unmasked, randomised controlled trial of adults aged 70-84 years with untreated hearing loss and without substantial cognitive impairment that took place at four community study sites across the USA. Participants were recruited from two study populations at each site: (1) older adults participating in a long-standing observational study of cardiovascular health (Atherosclerosis Risk in Communities [ARIC] study), and (2) healthy de novo community volunteers. Participants were randomly assigned (1:1) to a hearing intervention (audiological counselling and provision of hearing aids) or a control intervention of health education (individual sessions with a health educator covering topics on chronic disease prevention) and followed up every 6 months. The primary endpoint was 3-year change in a global cognition standardised factor score from a comprehensive neurocognitive battery. Analysis was by intention to treat. This trial was registered at ClinicalTrials.gov, NCT03243422. FINDINGS From Nov 9, 2017, to Oct 25, 2019, we screened 3004 participants for eligibility and randomly assigned 977 (32·5%; 238 [24%] from ARIC and 739 [76%] de novo). We randomly assigned 490 (50%) to the hearing intervention and 487 (50%) to the health education control. The cohort had a mean age of 76·8 years (SD 4·0), 523 (54%) were female, 454 (46%) were male, and most were White (n=858 [88%]). Participants from ARIC were older, had more risk factors for cognitive decline, and had lower baseline cognitive scores than those in the de novo cohort. In the primary analysis combining the ARIC and de novo cohorts, 3-year cognitive change (in SD units) was not significantly different between the hearing intervention and health education control groups (-0·200 [95% CI -0·256 to -0·144] in the hearing intervention group and -0·202 [-0·258 to -0·145] in the control group; difference 0·002 [-0·077 to 0·081]; p=0·96). However, a prespecified sensitivity analysis showed a significant difference in the effect of the hearing intervention on 3-year cognitive change between the ARIC and de novo cohorts (pinteraction=0·010). Other prespecified sensitivity analyses that varied analytical parameters used in the total cohort did not change the observed results. No significant adverse events attributed to the study were reported with either the hearing intervention or health education control. INTERPRETATION The hearing intervention did not reduce 3-year cognitive decline in the primary analysis of the total cohort. However, a prespecified sensitivity analysis showed that the effect differed between the two study populations that comprised the cohort. These findings suggest that a hearing intervention might reduce cognitive change over 3 years in populations of older adults at increased risk for cognitive decline but not in populations at decreased risk for cognitive decline. FUNDING US National Institutes of Health.
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Affiliation(s)
- Frank R Lin
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Cochlear Center for Hearing and Public Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Department of Otolaryngology-Head & Neck Surgery, Johns Hopkins School of Medicine, Baltimore, MD, USA; Center on Aging and Health, Johns Hopkins University, Baltimore, MD, USA.
| | - James R Pike
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Marilyn S Albert
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Michelle Arnold
- Department of Communication Sciences & Disorders, College of Behavioral & Community Sciences, University of South Florida, Tampa, FL, USA
| | - Sheila Burgard
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Theresa Chisolm
- Department of Communication Sciences & Disorders, College of Behavioral & Community Sciences, University of South Florida, Tampa, FL, USA
| | - David Couper
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Jennifer A Deal
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Cochlear Center for Hearing and Public Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Department of Otolaryngology-Head & Neck Surgery, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Adele M Goman
- School of Health and Social Care, Edinburgh Napier University, Edinburgh, UK
| | - Nancy W Glynn
- Department of Epidemiology, University of Pittsburgh School of Public Health, Pittsburgh, PA, USA
| | - Theresa Gmelin
- Department of Epidemiology, University of Pittsburgh School of Public Health, Pittsburgh, PA, USA
| | - Lisa Gravens-Mueller
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Kathleen M Hayden
- Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Alison R Huang
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Cochlear Center for Hearing and Public Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - David Knopman
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | - Christine M Mitchell
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Thomas Mosley
- The MIND Center, University of Mississippi Medical Center, Jackson, MS, USA
| | - James S Pankow
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, MN, USA
| | - Nicholas S Reed
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Cochlear Center for Hearing and Public Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Department of Otolaryngology-Head & Neck Surgery, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Victoria Sanchez
- Department of Otolaryngology-Head & Neck Surgery, Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | - Jennifer A Schrack
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Center on Aging and Health, Johns Hopkins University, Baltimore, MD, USA
| | - B Gwen Windham
- The MIND Center, University of Mississippi Medical Center, Jackson, MS, USA
| | - Josef Coresh
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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10
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Smith JR, Huang AR, Lin FR, Reed NS, Deal JA. The Population Attributable Fraction of Dementia From Audiometric Hearing Loss Among a Nationally Representative Sample of Community-Dwelling Older Adults. J Gerontol A Biol Sci Med Sci 2023; 78:1300-1306. [PMID: 37139951 PMCID: PMC10329222 DOI: 10.1093/gerona/glad117] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Indexed: 05/05/2023] Open
Abstract
BACKGROUND The population attributable fraction (PAF) of dementia from hearing loss (HL) in the United States is ~2% when incorporating self-reported HL measures. However, self-report might underestimate clinically significant audiometric HL among older adults. Here, we quantified PAFs of dementia from audiometric HL overall and by age, sex, and race/ethnicity groups among a nationally representative sample of community-dwelling older adults in the United States. METHODS We used cross-sectional data from Round 11 (2021) of the National Health and Aging Trends Study, a prospective cohort study representing the U.S. Medicare population aged 65+ years (N = 2 470). We estimated model-adjusted PAFs of prevalent dementia by audiometric HL (pure-tone averages: normal hearing, <26 dB HL; mild HL, 26-40 dB HL; moderate or greater HL, ≥41 dB HL). RESULTS Among eligible participants (34.8% aged ≥80 years; 55.3% female; 82.4% non-Hispanic White), 37.5% had mild, and 28.8% had moderate or greater HL. Dementia prevalence overall was 10.6%, with the PAF predominately driven by moderate or greater HL (PAF = 16.9%; 95% confidence interval [CI]: 4.1-28.7%). The PAF from any degree of HL was larger but with a wider CI (PAF = 18.7%, 95% CI: -5.3% to 40.1%). There was evidence associations differed by sex but not age or race/ethnicity; moderate or greater HL exhibited stronger associations among males (PAF = 40.5%; 95% CI: 19.5% to 57.2%) than females (PAF = 3.2%; 95% CI: -12.7% to 17.9%). CONCLUSIONS In a nationally representative sample of community-dwelling older adults in the United States, 17% of dementia cases were attributable to moderate or greater audiometric HL, an estimate that is eightfold higher relative to studies relying on self-reported hearing measures only.
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Affiliation(s)
- Jason R Smith
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Cochlear Center for Hearing and Public Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Alison R Huang
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Cochlear Center for Hearing and Public Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Frank R Lin
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Cochlear Center for Hearing and Public Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Nicholas S Reed
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Cochlear Center for Hearing and Public Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Jennifer A Deal
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Cochlear Center for Hearing and Public Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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11
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Reed NS, Garcia-Morales EE, Myers C, Huang AR, Ehrlich JR, Killeen OJ, Hoover-Fong JE, Lin FR, Arnold ML, Oh ES, Schrack JA, Deal JA. Prevalence of Hearing Loss and Hearing Aid Use Among US Medicare Beneficiaries Aged 71 Years and Older. JAMA Netw Open 2023; 6:e2326320. [PMID: 37505496 PMCID: PMC10383002 DOI: 10.1001/jamanetworkopen.2023.26320] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/29/2023] Open
Abstract
Importance National prevalence estimates are needed to guide and benchmark initiatives to address hearing loss. However, current estimates are not based on samples that include representation of the oldest old US individuals (ie, aged ≥80 years), who are most at-risk of having hearing loss. Objective To estimate the prevalence of hearing loss and hearing aid use by age and demographic covariates in a large, nationally representative sample of adults aged 71 years and older. Design, Setting, and Participants In this cohort study, prevalence estimates of hearing loss by age, gender, race and ethnicity, education, and income were computed using data from the 2021 National Health Aging and Trends Study. Survey weights were applied to produce nationally representative estimates to the US older population. Data were collected from June to November 2021 and were analyzed from November to December 2022. Main Outcomes and Measures Criterion-standard audiometric measures of hearing loss and self-reported hearing aid use. Results In this nationally representative sample of 2803 participants (weighted estimate, 33.1 million individuals) aged 71 years or older, 38.3% (95% CI, 35.5%-41.1%) were aged 71 to 74 years, 36.0% (95% CI, 33.1%-38.8%) were aged 75 to 79 years, 13.8% (95% CI, 12.6%-14.9%) were aged 80 to 84 years, 7.9% (95% CI, 7.2%-8.6%) were aged 85 to 89 years, and 4.0% (95% CI, 3.5%-4.6%) were aged 90 years or older; 53.5% (95% CI, 50.9%-56.1%) were female and 46.5% (95% CI, 43.9%-49.1%) were male; and 7.5% (95% CI, 6.2%-8.7%) were Black, 6.5% (95% CI, 4.4%-8.7%) were Hispanic, and 82.7% (95% CI, 79.7%-85.6%) were White. An estimated 65.3% of adults 71 years and older (weighted estimate, 21.5 million individuals) had at least some degree of hearing loss (mild, 37.0% [95% CI, 34.7%-39.4%]; moderate, 24.1% [95% CI, 21.9%-26.4%]; and severe, 4.2% [95% CI, 3.3%-5.3%]). The prevalence was higher among White, male, lower-income, and lower education attainment subpopulations and increased with age, such that 96.2% (95% CI, 93.9%-98.6%) of adults aged 90 years and older had hearing loss. Among those with hearing loss, only 29.2% (weighted estimate, 6.4 million individuals) used hearing aids, with lower estimates among Black and Hispanic individuals and low-income individuals. Conclusions and Relevance These findings suggest that bilateral hearing loss is nearly ubiquitous among older US individuals, prevalence and severity increase with age, and hearing aid use is low. Deeper consideration of discrete severity measures of hearing loss in this population, rather than binary hearing loss terminology, is warranted.
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Affiliation(s)
- Nicholas S Reed
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland
- Cochlear Center for Hearing and Public Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Emmanuel E Garcia-Morales
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Cochlear Center for Hearing and Public Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Clarice Myers
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland
- Cochlear Center for Hearing and Public Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Alison R Huang
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Cochlear Center for Hearing and Public Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Joshua R Ehrlich
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor
- Institute for Social Research, University of Michigan, Ann Arbor
| | - Olivia J Killeen
- Cochlear Center for Hearing and Public Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Julie E Hoover-Fong
- Department of Genetic Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Frank R Lin
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland
- Cochlear Center for Hearing and Public Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Michelle L Arnold
- Department of Communication Sciences and Disorders, University of South Florida, Tampa
| | - Esther S Oh
- Cochlear Center for Hearing and Public Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Jennifer A Schrack
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Jennifer A Deal
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland
- Cochlear Center for Hearing and Public Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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12
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Huang AR, Rebok GW, Swenor BK, Reed N, Griswold M, Zhu X, Deal JA. Concurrent hearing and vision impairment and 8-year memory decline in community-dwelling older adults. Alzheimers Dement 2023; 19:2307-2316. [PMID: 36462211 PMCID: PMC10238672 DOI: 10.1002/alz.12887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 10/18/2022] [Accepted: 10/27/2022] [Indexed: 12/07/2022]
Abstract
BACKGROUND Hearing and vision impairments are risk factors for cognitive decline; less is known about dual sensory impairment. This study quantifies the association between dual sensory impairment and 8-year change in memory among older adults. METHODS Data (N = 5552) were from the National Health and Aging Trends Study. Memory (immediate/delayed word recall, subjective memory) was measured annually (2011 to 2019). Hearing and vision impairments were measured by self-report. Association between dual sensory impairment and 8-year change in memory was assessed using multivariate linear mixed effect models and generalized logistic mixed models. RESULTS Rate of memory decline was most accelerated among participants with dual sensory impairment. For example, 8-year decline in delayed word recall was -1.03 (95% confidene interval: -1.29, -0.77) for dual sensory impairment versus -0.79 (-0.92, -0.67) for single and -0.56 (-0.63, -0.48) for no impairment. CONCLUSION Older adults with dual sensory impairment may be at particularly higher risk for cognitive decline.
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Affiliation(s)
- Alison R. Huang
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
- Cochlear Center for Hearing and Public Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - George W. Rebok
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Bonnielin K. Swenor
- Cochlear Center for Hearing and Public Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
- Disability Health Research Center, Johns Hopkins Bloomberg University, Baltimore, MD
- The Wilmer Eye Institute, Johns Hopkins University, Baltimore, MD
- Johns Hopkins School of Nursing, Baltimore, MD
| | - Nicholas Reed
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
- Cochlear Center for Hearing and Public Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, MD
| | | | - Xiaoqian Zhu
- University of Mississippi Medical Center, Jackson, MS
| | - Jennifer A. Deal
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
- Cochlear Center for Hearing and Public Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, MD
- Disability Health Research Center, Johns Hopkins Bloomberg University, Baltimore, MD
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13
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Huang AR, Roth DL, Cidav T, Chung SE, Amjad H, Thorpe RJ, Boyd CM, Cudjoe TK. Social isolation and 9-year dementia risk in community-dwelling Medicare beneficiaries in the United States. J Am Geriatr Soc 2023; 71:765-773. [PMID: 36628523 PMCID: PMC10023331 DOI: 10.1111/jgs.18140] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 09/26/2022] [Accepted: 10/26/2022] [Indexed: 01/12/2023]
Abstract
BACKGROUND Social isolation can influence whether older adults develop dementia. We examine the association between social isolation and incident dementia among older adults in a nationally representative sample of community dwelling older adults in the United States (U.S.). We also investigate whether this association varies by race and ethnicity. METHODS Data (N = 5022) come from the National Health and Aging Trends Study, a longitudinal and nationally representative cohort of older adults in the U.S. A composite measure of social isolation was used to classify older adults as socially isolated or not socially isolated at baseline. Demographic and health factors were measured at baseline via self-report. Dementia was measured at each round of data collection. Discrete-time proportional hazard time-to-event models were used to assess the association between social isolation and incident dementia over 9 years (2011-2020). RESULTS Of 5022 older adults, 1172 (23.3%) were socially isolated, and 3850 (76.7%) were not socially isolated. Adjusting for demographic and health factors, being socially isolated (vs. not socially isolated) was associated with a 1.28 (95% CI: 1.10-1.49) higher hazard of incident dementia over 9 years. There was no statistically significant difference by race and ethnicity. CONCLUSION Social isolation among older adults is associated with greater dementia risk. Elucidating the pathway by which social isolation impacts dementia may offer meaningful insights for the development of novel solutions to prevent or ameliorate dementia across diverse racial and ethnic groups.
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Affiliation(s)
- Alison R. Huang
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - David L. Roth
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Tom Cidav
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Shang-En Chung
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Halima Amjad
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Roland J. Thorpe
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Cynthia M. Boyd
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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14
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Abstract
This study assesses the association of audiometric hearing loss and hearing aid use with dementia among community-dwelling older US Medicare beneficiaries.
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Affiliation(s)
- Alison R. Huang
- Cochlear Center for Hearing and Public Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Kening Jiang
- Cochlear Center for Hearing and Public Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Frank R. Lin
- Cochlear Center for Hearing and Public Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Jennifer A. Deal
- Cochlear Center for Hearing and Public Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Nicholas S. Reed
- Cochlear Center for Hearing and Public Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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15
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Kuo PL, Huang AR, Ehrlich JR, Kasper J, Lin FR, McKee MM, Reed NS, Swenor BK, Deal JA. Prevalence of Concurrent Functional Vision and Hearing Impairment and Association With Dementia in Community-Dwelling Medicare Beneficiaries. JAMA Netw Open 2021; 4:e211558. [PMID: 33739429 PMCID: PMC8601132 DOI: 10.1001/jamanetworkopen.2021.1558] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
IMPORTANCE Impairments in vision or hearing are common and have been independently linked to higher risk of dementia in older adults. There is a limited understanding of the prevalence of concurrent functional vision and hearing impairment (dual sensory impairment) and its contribution to dementia risk. OBJECTIVE To examine the age-specific prevalence of functional dual sensory impairment among older adults, and to investigate the cross-sectional and 7-year longitudinal associations between functional dual sensory impairment and dementia. DESIGN, SETTING, AND PARTICIPANTS This cohort study of 7562 older adults used data from the US National Health and Aging Trends Study (NHATS), a nationally representative cohort study of community-dwelling, Medicare beneficiaries aged 65 years and older in the US. Participants in the study with complete data on hearing, vision, and dementia were included in analysis. Data were collected between 2011 and 2018, and between March 2018 and May 2020. EXPOSURES Self-reported functional sensory impairments (ie, no sensory impairment, functional vision impairment only, functional hearing impairment only, and functional dual sensory impairment). MAIN OUTCOMES AND MEASURES Age-specific prevalence of functional sensory impairments was calculated. Generalized linear regression with a complementary log-log link and a discrete time proportional hazards model with a complementary log-log link were used to assess the cross-sectional and 7-year longitudinal hazard of dementia. RESULTS Of 7562 participants, 3073 (40.7%) were ages 80 years or older and 4411 (58.3%) were women. Overall, 5.4% (95% CI, 4.7%-6.1%) of participants reported functional vision impairment only, 18.9% (95% CI, 18.9%-17.8%) reported functional hearing impairment only, and 3.1% (95% CI, 2.7%-3.5%) reported functional dual sensory impairment (prevalence estimates are weighted). Participants reporting sensory impairments were older (no impairment: age ≥90 years, 2.12% [95% CI, 1.79%-2.46%] vs functional dual sensory impairment: age ≥90 years, 20.06% [95% CI, 16.02%-24.10%]), had lower education (no impairment: <high school, 19.05% [95% CI, 17.27%-20.83%] vs functional dual sensory impairment: <high school, 46.15% [95% CI, 38.38%-53.92%]), and greater disease burden (eg, heart disease: no impairment, 15.30% [95% CI, 14.04%-16.55%] vs functional dual sensory impairment, 25.49% [95% CI, 19.96%-31.02%]). Compared with no impairment, functional vision impairment (adjusted hazard ratio [aHR], 1.89; 95% CI, 1.57-2.28), functional hearing impairment (aHR, 1.14; 95% CI, 1.00-1.31), and functional dual sensory impairment (aHR, 2.00; 95% CI, 1.57-2.53) were associated with a higher cross-sectional hazard of dementia. Over 7 years, functional vision impairment (aHR, 1.40; 95% CI, 1.12-1.74), functional hearing impairment (aHR, 1.09; 95% CI, 0.95-1.24), and functional dual sensory impairment (aHR, 1.50; 95% CI, 1.12-2.02) were associated with a higher hazard of incident dementia compared with no impairment. CONCLUSIONS AND RELEVANCE In this cohort study of US Medicare beneficiaries, dual sensory impairment was prevalent in older adults and associated with increased risk of dementia. These findings suggest that sensory rehabilitative interventions for multiple impairments may be an additional resource in efforts to reduce dementia risk.
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Affiliation(s)
- Pei-Lun Kuo
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Cochlear Center for Hearing and Public Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Alison R. Huang
- Cochlear Center for Hearing and Public Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Joshua R. Ehrlich
- Department of Ophthalmology and Visual Sciences, University of Michigan Medical School, Ann Arbor
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
| | - Judith Kasper
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Frank R. Lin
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Cochlear Center for Hearing and Public Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Department of Otolaryngology–Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Michael M. McKee
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
- Department of Family Medicine, University of Michigan Medical School, Ann Arbor
| | - Nicholas S. Reed
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Cochlear Center for Hearing and Public Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Department of Otolaryngology–Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland
- Disability Health Research Center, Johns Hopkins Bloomberg University, Baltimore, Maryland
| | - Bonnielin K. Swenor
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Cochlear Center for Hearing and Public Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Disability Health Research Center, Johns Hopkins Bloomberg University, Baltimore, Maryland
- The Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland
| | - Jennifer A. Deal
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Cochlear Center for Hearing and Public Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Department of Otolaryngology–Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland
- Disability Health Research Center, Johns Hopkins Bloomberg University, Baltimore, Maryland
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Huang AR, Deal JA, Rebok GW, Pinto JM, Waite L, Lin FR. Hearing Impairment and Loneliness in Older Adults in the United States. J Appl Gerontol 2020; 40:1366-1371. [DOI: 10.1177/0733464820944082] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Hearing impairment impacts fluidity of communication and social interactions and thus may contribute to loneliness. We investigated the cross-sectional association between hearing impairment and loneliness in community-dwelling older U.S. adults using data from the National Social Life, Health, and Aging Project ( N = 3,196). Individuals reporting fair/poor hearing had 50% (95% confidence interval [CI] = [1.09–2.05]) higher odds of any loneliness compared with those reporting excellent hearing after adjusting for comorbidity index, functional and cognitive ability, self-reported health, and demographic characteristics. Test for trend suggests a dose–response relationship over levels of hearing impairment. Hearing impairment is highly prevalent and may be an important target for consideration in interventions to reduce loneliness. Further investigation of whether treatment of hearing impairment alleviates loneliness and its disabling effects is also needed.
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Affiliation(s)
- Alison R. Huang
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Jennifer A. Deal
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - George W. Rebok
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | | | - Frank R. Lin
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Johns Hopkins School of Medicine, Baltimore, MD, USA
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Lapham SJ, Huang AR, Strombotne KL, Lyter Achorn D, Mokyr Horner E. OVERVIEW OF THE PROJECT TALENT-MEDICARE LINKED DATA (PT-MED). Innov Aging 2018. [DOI: 10.1093/geroni/igy023.2047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- S J Lapham
- American Institutes for Research, Washington, District of Columbia, United States
| | - A R Huang
- American Institutes for Research, Washington, DC, USA
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Abstract
A major challenge with surveying physicians is low response. In this article, we present results of an experiment conducted to determine the optimal monetary incentive amount for gaining response from physicians to a short screener survey. Sampled physicians were randomly assigned to three prepaid cash incentive conditions (US$2, US$5, US$10) compared to a control (US$0). This study found using any incentive increased response versus no incentive. The US$10 incentive produced the highest response and was significantly greater than the US$2 incentive group. However, we did not find a statistical difference between the $5 and US$10 incentives or between the US$2 and US$5 incentives. In addition, any incentive amount increased the likelihood of early response compared to no incentive. This study builds on previously mixed results about the effects of various incentive amounts and effect on early survey response. These findings provide practical advice for researchers surveying physicians.
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Abstract
IMPORTANCE Low early-life cognitive ability is a potential early marker of dementia risk in later life. Previous studies use only global measures of general intelligence and/or study this relationship in gender-specific samples. The contribution of early-life performance on specific cognitive abilities, such as language, reasoning, and visualization aptitudes, to indicating future dementia risk is unknown. OBJECTIVES To investigate the association between adolescent cognitive ability and Medicare-recorded Alzheimer disease and related disorders (ADRD) using both general and specific measures of cognitive ability and to explore these associations separately in men and women. DESIGN, SETTING, AND PARTICIPANTS Population-based cohort study from the Project Talent-Medicare linked data set, a linkage of adolescent sociobehavioral data collected from high school students in 1960 to participants' 2012 to 2013 Medicare Claims and expenditures data. The association between adolescent cognitive ability and risk of ADRD in later life was assessed in a diverse sample of 43 014 men and 42 749 women aged 66 to 73 years using a series of logistic regressions stratified by sex, accounting for demographic characteristics, adolescent socioeconomic status, and regional effects. Data analysis was conducted from November 2017 to March 2018. MAIN OUTCOMES AND MEASURES Presence of Medicare-reported ADRD. RESULTS Overall, 1239 men (2.9%) and 1416 women (3.3%) developed ADRD. Lower mechanical reasoning was associated with increased odds of ADRD in men (odds ratio, 1.17; 95% CI, 1.05-1.29), and lower memory for words in adolescence was associated with increased odds of ADRD in women (odds ratio, 1.16; 95% CI, 1.05-1.28). Lower performance on several other language, reasoning, visualization, and mathematic aptitudes in adolescence showed prominent, but weaker, associations with odds of ADRD. CONCLUSIONS AND RELEVANCE This work contributes to the understanding of early-life origins of ADRD risk. The results suggest specific measures of cognitive ability may contribute to very early identification of at-risk subgroups who may benefit from prevention or intervention efforts.
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Nazerali N, Freter S, Windholz S, Morais J, Bacher Y, Jones S, Kuyumjian J, Huang AR. Caring for an aging population. CMAJ 1998; 159:647-8; author reply 649-50. [PMID: 9780960 PMCID: PMC1229687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023] Open
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McLeod PJ, Huang AR, Tamblyn RM, Gayton DC. Defining inappropriate practices in prescribing for elderly people: a national consensus panel. CMAJ 1997; 156:385-91. [PMID: 9033421 PMCID: PMC1226961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
OBJECTIVE To develop a consensus-based list of inappropriate practices in prescribing for elderly people. DESIGN Mail survey of a 32-member national panel. SETTING Academic medical centres across Canada. PARTICIPANTS Thirty-two specialists selected arbitrarily, including 7 clinical pharmacologists, 9 geriatricians, 8 family practitioners and 8 pharmacists. OUTCOME MEASURES Consensus that the practice would introduce a substantial and significant increase in the risk of serious adverse effect and is common enough that its curtailment would decrease morbidity among elderly people, ranking of clinical importance of the risk, and availability of equally or more effective and less risky alternative therapy. RESULTS The 32-member national panel developed a list of 71 practices in prescribing for elderly people and rated the clinical significance of each on a scale of 1 (not significant) to 4 (highly significant). The practices in prescribing identified fell into 3 categories: drugs generally contraindicated for elderly people, drug-disease interactions and drug-drug interactions. The mean significance rating was greater than 3 for 39 practices. For each practice, alternative therapies were recommended. There was surprising congruence among the specialists on the significance rating and the suggested alternative therapies. CONCLUSION The authors have developed a valid, relevant list of inappropriate practices in prescribing for elderly people, to be used in a practice-based intervention study.
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Affiliation(s)
- P J McLeod
- Department of Medicine, McGill University, Montreal, Que
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Tamblyn RM, McLeod PJ, Abrahamowicz M, Monette J, Gayton DC, Berkson L, Dauphinee WD, Grad RM, Huang AR, Isaac LM. Questionable prescribing for elderly patients in Quebec. CMAJ 1994; 150:1801-9. [PMID: 8199957 PMCID: PMC1337055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
OBJECTIVE To estimate the prevalence of questionable and rational high-risk prescribing among elderly people of the three drug groups most commonly implicated in drug-related illness: cardiovascular drugs, psychotropic drugs and nonsteroidal anti-inflammatory drugs (NSAIDs). DESIGN Retrospective prevalence study; all prescription and billing records for the period Jan. 1 to Dec. 31, 1990, for the study sample were retrieved from the relevant provincial databases of the Régie de l'assurance-maladie du Québec. SETTING Quebec. PARTICIPANTS Regionally stratified random sample of 63,268 elderly medicare registrants who made at least one visit to physician in 1990 and were not living in a health care institution for the entire year. MAIN OUTCOME MEASURE Prescription information was examined for three types of high-risk prescribing: rational and questionable drug combinations, excessive treatment duration and drugs relatively contraindicated for use in elderly people. RESULTS Overall, 52.6% of the patients experienced one or more events of high-risk prescribing, and 45.6% experienced at least one that was questionable. High-risk prescribing was most prevalent for psychotropic drugs, and questionable prescribing was more frequent than rational prescribing in this drug group. An estimated 30.8% of the total elderly population in Quebec received benzodiazepines for more than 30 consecutive days, 12.9% received a long-acting benzodiazepine, and 13.0% received a questionable high-risk psychotropic drug combination. The prevalence of high-risk prescribing was higher among the women than among the men and increased with age until 75 to 84 years. There were significant unexplained differences between regions in the regional prevalence of high-risk prescribing, particularly of psychotropic drugs. CONCLUSION The prevalence of questionable high-risk prescribing, especially of psychotropic drugs, is substantial among elderly people. This may be a potentially important and avoidable risk factor for drug-related illness in elderly people.
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Affiliation(s)
- R M Tamblyn
- Department of Medicine, McGill University, Montreal, Que
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Huang AR. Nasogastric tube placement. CMAJ 1992; 147:1756. [PMID: 1458412 PMCID: PMC1336629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
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Affiliation(s)
- A R Huang
- Division of Geriatrics, Royal Victoria Hospital, Montreal, Quebec, Canada
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Huang AR, Ponka P. A study of the mechanism of action of pyridoxal isonicotinoyl hydrazone at the cellular level using reticulocytes loaded with non-heme 59Fe. Biochim Biophys Acta 1983; 757:306-15. [PMID: 6849979 DOI: 10.1016/0304-4165(83)90056-9] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Pyridoxal isonicotinoyl hydrazone (PIH) has recently been identified as a new iron chelating agent with a high degree of iron mobilizing activity in vitro and in vivo which makes this compound a candidate drug in the treatment of iron overload. This study was undertaken to elucidate the mechanism of action of the iron mobilizing activity of PIH at the cellular level. An in vitro system of rabbit reticulocytes with a high level of non-heme 59Fe was used as a model of iron overload. The effects of various biochemical and physiological maneuvers on the mobilization of 59Fe by PIH from the cells were studied. The fate of [14C]-PIH in the in vitro system was also studied. Studies were also carried out using a crude mitochondrial fraction. The results indicate three phases in the iron mobilizing activity of PIH: (1) the entry of PIH into erythroid cells seems to be by passive diffusion; (2) chelation occurs mainly from mitochondria and may depend on the availability of iron in a low molecular weight, non-heme pool. Chelation seems to be enhanced by reduction of Fe (III) to Fe (II); (3) the exit of the PIH2-Fe complex is an energy-dependent process. Iron mobilization by PIH is not dependent on (Na+ + K+)-ATPase activity, external ionic composition, or external hydrogen ion concentration. Membrane fluidity does not seem to play a role in PIH-Fe mobilization. The exit of the PIH2-Fe complex is inhibited by anti-microtubule agents (vinca alkaloids but not colchicine) suggesting that the PIH2-Fe complex is actively extruded from the cell by a microtubule-dependent event.
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