BACKGROUND:Age-related hearing loss is common among older adults and may influence physical activity and sedentary behaviors, such as TV viewing. This study examined whether a hearing intervention could affect these behaviors over 3 years. METHODS:A total of 977 participants (mean age of 76.8, 53.5% female, 11.5% Black), recruited from the ARIC study (n = 238) and de novo (n = 739) with hearing loss (pure-tone average = 39.4 dB), were randomized to a hearing intervention or a health education control group. Physical activity, leisurely walking, and TV viewing were interrogated at baseline and 3-year follow-up. We used regression models adjusted for demographic and hearing loss severity to examine the impact of the intervention on the change in the frequency of engaging in these activities. RESULTS:At baseline, 57.6% of participants engaged in moderate-to-vigorous physical activity (MVPA), 29.1% in high-frequency leisurely walking, and 46.8% in high-frequency TV viewing. Over 3 years, MVPA decreased to 48.8%, whereas leisurely walking and TV viewing increased. After 3 years, the hearing intervention group had similar odds of engaging in MVPA (ratio of odds ratios [ROR] = 1.03, 95% confidence interval [CI], 0.93-1.14), leisurely walking (ROR = 1.04, 95% CI, 0.93-1.17), and TV viewing (ROR = 0.95, 95% CI, 0.87-1.02) compared with the control group. Results were consistent across recruitment sources (ARIC and de novo). CONCLUSION:A hearing intervention did not significantly influence physical activity, walking, or TV viewing behaviors in older adults over 3 years. Additional strategies may be needed to change physical and sedentary behaviors in this population.

Importance:Hearing loss may contribute to poor functional status via cognitive impairment and social isolation. Hearing aids may play a protective role by attenuating these downstream outcomes. However, population-based evidence is lacking. Objective:To examine the association of hearing loss and hearing aids with functional status. Design, Setting, and Participants:This cross-sectional (2016-2017) and longitudinal (2016-2022) analysis of data from the Atherosclerosis Risk in Communities cohort study included older, community-dwelling adults with complete data. Data were analyzed from June to December 2023. Exposures:The better-hearing ear's pure tone average (BPTA) at speech frequencies (0.5-4 kHz) was modeled categorically (no [BPTA ≤25 dB], mild [26-40 dB], and moderate or greater hearing loss [>40 dB]). Hearing aid use was self-reported. Main Outcomes and Measures:Difficulties in activities of daily living (ADLs; eg, dressing and eating), instrumental activities of daily living (IADLS; eg, household chores and meal preparation), and heavier tasks (eg, walking a quarter of a mile) were self-reported at visit 6. The ability to perform usual activities, walk a half mile, walk up and down stairs, and do heavy housework without help were collected in follow-up surveys. Linear and logistic regression models were used that were adjusted for sociodemographic and health covariates. Results:Among 3142 participants (mean [SD] age, 79.3 [4.6] years; 1828 women [58.2%]), 1013 (32.2%) had no hearing loss, 1220 (38.8%) had mild hearing loss, and 909 (29.0%) had moderate or greater hearing loss. Moderate or greater hearing loss was cross-sectionally associated with difficulty in 1 or more ADLs (odds ratio [OR], 1.27; 95% CI, 1.02-1.58), IADLs (OR, 1.34; 95% CI, 1.05-1.71), and heavier tasks (OR, 1.29; 95% CI, 1.04-1.62) compared with no hearing loss. Over time (mean [SD] follow-up, 1.9 [1.8] years), moderate or greater hearing loss was associated with a faster decline in the number of activities participants were able to do (β = -0.07 per year; 95% CI, -0.09 to -0.06) and greater odds of reporting inability to do 1 or more of the 4 activities (OR, 1.14; 95% CI, 1.05-1.24). Hearing aid users and nonusers did not differ. Conclusions and Relevance:The results of this study suggest that moderate or greater hearing loss was associated with functional difficulties and may contribute to a faster decline in function longitudinally independent of sociodemographic and health covariates. Hearing aids did not change the association among those with hearing loss.

Background: Existing estimates for the prevalence of dual sensory loss (vision and hearing) among older adults are either based on self-reported measures or aggregated for older age groups. Current and detailed estimates based on objective measures are needed for public health, clinical, and policy decision-making.Methods: We estimated the prevalence of dual sensory loss (DSL) using National Health Aging Trends Study (NHATS) Round 11 data (2021). We restricted to community-dwelling adults aged >= 71 years with complete sensory testing data (N = 2579). Hearing loss was defined by a 4-frequency (0.5, 1, 2 and 4 kHz) pure tone average for the better-hearing ear (>25 decibel hearing level). Vision loss was defined by the presence of distance, near (logarithm of the minimum angle of resolution >0.30), or contrast sensitivity loss (log contrast sensitivity <1.55). Participants were categorized into three groups: no sensory loss, single sensory loss (vision or hearing loss), and DSL (hearing and vision). Sensory loss prevalence was estimated by age group and sociodemographic characteristics.Results: In weighted analyses, among older Medicare beneficiaries (53% female, 7% Black, 6% Hispanic), 28% had no sensory loss and 22% had DSL. Prevalence of DSL increased with age. Most adults aged >= 90 years experienced DSL (59%), as opposed to single (39%) or no sensory loss (2%). DSL prevalence was greater among older adults with low education attainment (34%) and household income (43%). A higher proportion of older adults with a college education (17%), or from wealthier households (16%), had no sensory loss.Conclusions: One in 5 community-dwelling Medicare beneficiaries aged >= 71 years have DSL, increasing to 3 in 5 for those aged >= 90 years. Prevalence is higher among older adults with low education attainment and from low-income households, characteristics associated with low treatment. Policies increasing access and affordability of vision and hearing care could benefit millions of older Americans experiencing sensory loss.

Objective: The purpose of this study was to determine if dual sensory impairment (DSI) is associated with falls and fear of falling among older adults. Methods: Using data from the 2019 Medicare Current Beneficiary Survey (MCBS), we studied the cross-sectional association of self-reported hearing/vision impairment with self-reported history/number of falls over the past year, fear of falling (scale 1–6), and a fall requiring medical help using weighted multivariable regressions adjusted for demographic and clinical covariates. Results: Among 11,089 Medicare beneficiaries (mean age = 74, 55% female, 9% Black), DSI is associated with increased prevalence (prevalence ratio = 1.45 [1.28–1.65]) and incidence (incidence ratio = 2.21 [1.79–2.75]) rate of falls, and greater odds of a higher fear of falling score (odds ratio = 1.38 [1.08–1.77]). Discussion: DSI is associated with falls among older adults. Consideration of DSI as a marker to initiate fall prevention programs and inclusion of sensory interventions in these programs may be valuable.

Abstract Objective. Sensory impairments (SI) are associated with comorbidities, functional difficulties, and poor self-rated health. Few studies have examined associations between SI and pain, which is a strong correlate of poor health in later life. We examined the associations between SI and pain. Methods. We used cross-sectional data from the 2021 National Health and Aging Trends Study (n=2979 community-living older adults; ages ≥ 65 years, 57% ages 75-84). We included four measures of SI: objective hearing loss (HL), measured as pure-tone average >25 dB HL; subjective HL, measured as hearing aid use or being unable to hear in certain situations; objective vision loss (VL), measured as logMAR >0.30 for distance or near vision or logCS <1.55 for contrast sensitivity; and subjective VL, measured as inability to see in certain situations. We examined four participant-reported outcomes: being bothered by pain; activity-limiting pain; use of pain medication; and pain locations over the past month. Separate logistic and linear regressions controlled for sociodemographic and health characteristics (e.g., depressive symptoms, chronic conditions). Results. Objective HL was associated with higher odds of activity-limiting pain (aOR=1.33, 95%CI=1.02-1.74). Subjective VL was associated with higher odds of activity-limiting pain (aOR=1.44, 95%CI=1.07-1.93), lower odds of using pain medication (aOR=0.70, 95%CI=0.54-0.92), and more pain locations (B=0.59, 95%CI=0.14-0.97). Compared to having no SI, reporting one or more subjective SI was associated with more pain locations (single SI: B=0.23, 95%CI=0.006-0.46; dual SI: B=0.73, 95%CI=0.08-1.39). Conclusion. Findings suggest SI and pain are related, which may have important implications in clinical settings and research.

Importance:Patient education materials (PEMs) can promote patient engagement, satisfaction, and treatment adherence. The American Medical Association recommends that PEMs be developed for a sixth-grade or lower reading level. Health literacy (HL) refers to an individual's ability to seek, understand, and use health information to make appropriate decisions regarding their health. Patients with suboptimal HL may not be able to understand or act on health information and are at risk for adverse health outcomes. Objective:To assess the readability of PEMs on head and neck cancer (HNC) and to evaluate HL among patients with HNC. Evidence Review:A systematic review of the literature was performed by searching Cochrane, PubMed, and Scopus for peer-reviewed studies published from 1995 to 2024 using the keywords head and neck cancer, readability, health literacy, and related synonyms. Full-text studies in English that evaluated readability and/or HL measures were included. Readability assessments included the Flesch-Kincaid Grade Level (FKGL grade, 0-20, with higher grades indicating greater reading difficulty) and Flesch Reading Ease (FRE score, 1-100, with higher scores indicating easier readability), among others. Reviews, conference materials, opinion letters, and guidelines were excluded. Study quality was assessed using the Appraisal Tool for Cross-Sectional Studies. Findings:Of the 3235 studies identified, 17 studies assessing the readability of 1124 HNC PEMs produced by professional societies, hospitals, and others were included. The mean FKGL grade ranged from 8.8 to 14.8; none of the studies reported a mean FKGL of grade 6 or lower. Eight studies assessed HL and found inadequate HL prevalence ranging from 11.9% to 47.0%. Conclusions and Relevance:These findings indicate that more than one-third of patients with HNC demonstrate inadequate HL, yet none of the PEMs assessed were developed for a sixth grade or lower reading level, as recommended by the American Medical Association. This incongruence highlights the need to address the readability of HNC PEMs to improve patient understanding of the disease and to mitigate potential barriers to shared decision-making for patients with HNC. It is crucial to acknowledge the responsibility of health care professionals to produce and promote more effective PEMs to dismantle the potentially preventable literacy barriers.

BACKGROUND: Olfactory dysfunction (OD) is increasingly recognized as a hallmark of unhealthy aging and is intimately associated with mortality, but therapies remain elusive. Recognizing the increased prevalence of OD in individuals with diabetes, and the potential anti-aging effects of metformin, we studied the association of metformin use with OD. METHODS: Cross-temporal study of participants from Waves 2 (2010-11) and 3 (2015-16) of the National Social Life, Health, and Aging Project (NSHAP), a nationally representative cohort study of community-dwelling older adults. We included participants with diabetes who had complete data on olfaction and relevant covariates at Wave 2 and were not lost to follow-up at Wave 3. Olfactory identification (OI), the ability to identify the odorant, and olfactory sensitivity (OS), the ability to detect the presence of an odorant, were tested. Weighted multivariable logistic regression was used to study the association between metformin use at Wave 2 (baseline) and odds of having impaired OI/OS at Wave 3, adjusted for age, sex, race/ethnicity, education, smoking, BMI, HbA1c, years since diabetes diagnosis, and insulin use. RESULTS: Among 228 participants with diabetes (mean age=70 years, 53% female, 21% Black), 112 (49%) used metformin at baseline. Relative to nonusers, users had 58% lower odds of impaired OI and 67% lower odds of impaired OS at Wave 3. Among participants with normal baseline OS (N=62), users had 97% lower odds of impaired OS at Wave 3. CONCLUSIONS: Metformin use is associated with lower odds of OD among individuals with diabetes, suggesting a potential protective effect on olfaction. Future work including a larger sample and additional information on metformin use is needed to establish whether these findings are independent of diabetic control.

Abstract Hearing loss is common among older adults and is linked to poor physical function, but whether hearing aid use may slow physical function declines remains unknown. We investigated the association between hearing loss and functional status in older adults and modifying effects of hearing aid use. We used data from the Atherosclerosis Risk in Communities (ARIC) cohort study to examine cross-sectional (2016-2017) and longitudinal relationships (2016-2022) after adjustment for sociodemographic and health-related characteristics. Hearing loss (none, mild, moderate/severe) was based on the better-hearing ear’s pure tone average at speech frequencies. Hearing aid use was self-reported. Participants self-reported (any difficulty, regardless of level, vs. none) difficulties with activities of daily living (ADLs), instrumental activities of daily living (IADLs), and heavier tasks (lifting heavy objects, kneeling, going up stairs without stopping). Cross-sectionally, among 3,142 community-dwelling older adults (mean age=79, 58% female, 21% Black), moderate or greater hearing loss was associated with increased difficulties in ADLs (odds ratio [OR]=1.27, 95% CI 1.02, 1.58), IADLs (OR=1.34, 95% CI 1.05, 1.71), and heavier tasks (OR=1.29, 95% CI 1.04, 1.62) relative to no hearing loss. Longitudinally, over an average follow-up of 1.9 years, moderate or greater hearing loss was associated with higher odds of reporting any functional difficulty (OR=1.14, 95% CI 1.05, 1.24). Hearing aid use did not modify the associations. These findings emphasize the importance of hearing loss, its adverse effects on physical function in aging populations, and the need for comprehensive interventions beyond hearing aids for adults with hearing loss.

Background Hearing loss is associated with adverse health outcomes among older adults. Lower physical activity levels may partly explain these observations, yet the association between hearing loss, hearing aid use, and physical activity among older adults is understudied. Methods Cross-sectional analysis of National Health and Aging Trends Study (2021) participants. The better-hearing ear pure-tone average (BPTA) at speech frequencies (0.5-4 kHz) was modeled continuously (10-dB increments) and categorically (no: <= 25 dB, mild: 26-40 dB, moderate or greater: >40 dB hearing loss). Activity measures were wrist accelerometry-derived (Actigraph) total activity counts, daily active minutes, activity fragmentation (using active-to-sedentary transition probability), and self-reported participation in vigorous activities and walking for exercise in the last month. We used multivariable regression adjusted for sociodemographic and health covariates. Results Among 504 participants excluding hearing aid users (mean age = 79 years, 57% female, 9% Black), 338 (67%) had hearing loss. Worse hearing (continuously and categorically) was associated with fewer counts and active minutes, more fragmented activity, and greater odds of not reporting recent vigorous activities. Among 472 participants with hearing loss including hearing aid users, nonusers (n = 338) had more fragmented activity and greater odds of not reporting walking for exercise compared to users. Conclusions Older adults with hearing loss are less physically active. This may mediate the association between hearing loss and other adverse outcomes. Recognition of this potential association is essential for providers to better support older adults in maintaining an active lifestyle. Future research is warranted to understand the impact of hearing interventions.

OBJECTIVE Hearing loss may negatively impact satisfaction with health care via patient-provider communication barriers and may be amenable to hearing care treatment. STUDY DESIGN Cross-sectional. SETTING National Health Interview Survey, a nationally representative survey of noninstitutionalized US residents, 2013 to 2018 pooled cycles. METHODS Participants described satisfaction with health care in the past year, categorized as optimal (very satisfied) versus suboptimal (satisfied, dissatisfied, very dissatisfied) satisfaction. Self-report hearing without hearing aids (excellent, good, a little trouble, moderate trouble, a lot of trouble) and hearing aid use (yes, no) were collected. Weighted Poisson regression models adjusted for sociodemographic and health covariates were used to estimate prevalence rate ratios (PRRs) of satisfaction with care by hearing loss and hearing aid use. RESULTS Among 137,216 participants (mean age 50.9 years, 56% female, 12% black), representing 77.2 million Americans in the weighted model, 19% reported trouble hearing. Those with good (PRR = 1.20, 95% confidence interval [CI]: 1.18-1.23), a little trouble (PRR = 1.27, 95% CI, 1.23-1.31), moderate trouble (PRR = 1.29, 95% CI, 1.24-1.35), and a lot of trouble hearing (PRR = 1.26, 95% CI, 1.18-1.33) had a higher prevalence rate of suboptimal satisfaction with care relative to those with excellent hearing. Among all participants with trouble hearing, hearing aid users had a 17% decrease in the prevalence rate of suboptimal satisfaction with care (PRR = 0.83, 95% CI, 0.78-0.88) compared to nonusers. CONCLUSION Hearing loss decreases patient satisfaction with health care, which is tied to Medicare hospital reimbursement models. Hearing aid use may improve patient-provider communication and patient satisfaction, although prospective studies are warranted to truly establish their protective effect.

Objective Increased institutional surgical resection case volume for vestibular schwannomas (VSs) has been associated with improved patient outcomes, including reduced risk of prolonged hospital stay and readmission. Socioeconomic disparities in the pursuit of care at these high-volume institutions remain unknown. Study Design Retrospective cohort epidemiological study. Setting National Cancer Database, a hospital-based registry of over 1,500 facilities in the United States. Patients Adult VS patients (age, >18 years) treated surgically. Interventions High- versus low-volume facilities, defined using a facility case volume threshold of 25 cases per year. A risk-adjusted restricted cubic spline model was previously used to identify this risk threshold beyond which the incremental benefit of increasing case volume began to plateau. Main Outcome Measures Sociodemographic factors, including race, ethnicity, income, insurance status, and rurality. Multivariable analyses were adjusted for patient and tumor characteristics, including age, sex, Charlson–Deyo score, and tumor size. Results A totoal of 10,048 patients were identified (median [interquartile range] age = 51 [41–60] years, 54% female, 87% Caucasian). Patients with Spanish/Hispanic ethnicity (OR = 0.71, 95% confidence interval [CI] = 0.52–0.96), income below median (OR = 0.63, 95% CI = 0.55–0.73]), and Medicare, Medicaid, or other government insurance versus private insurance (OR = 0.63, 95% CI = 0.53–0.74) had reduced odds of treatment at a high-volume facility. Further sensitivity analyses in which facility volume was operationalized continuously reinforced direction and significance of these associations. Conclusions Socioeconomic disparities exist in the propensity for VS patients to be treated at a high-volume facility. Further work is needed to understand the nature of these associations and whether interventions can be designed to mitigate them.

Abstract Background The identification of modifiable risk factors is crucial for the prevention and/or reversal of frailty, which is associated with significant morbidity and mortality. Hearing loss affects two-thirds of older adults in the United States (U.S.) and is associated with physical and cognitive decline which may increase frailty risk. We investigated the association of hearing loss and hearing aid use with frailty and pre-frailty in a nationally representative sample of older adults in the U.S. Methods Cross-sectional analysis of the National Health and Aging Trends Study (2021 round). The better-hearing ear pure-tone average (BPTA) at speech-frequencies (0.5–4 kHz) was modeled continuously (per 10 dB) and categorically (no ≤ 25 dB, mild 26–40 dB, moderate or greater > 40 dB hearing loss). Hearing aid use was self-reported. The physical frailty phenotype (frail, pre-frail, robust) was determined based on Fried criteria: unintentional weight loss, exhaustion, low physical activity, weakness, slow walking speed. We used multinomial multivariable regression adjusted for sociodemographic and health characteristics (odds ratios [95% Confidence Intervals]). Results Among 2,361 participants (mean age = 81 years, 56% female, 19% Black), 860 (36%) had mild and 864 (37%) had moderate or greater hearing loss. Worse hearing was associated with greater odds of being frail versus robust (OR = 1.20 [1.05–1.38] per 10 dB difference). Categorically, moderate or greater hearing loss was associated with greater odds of being frail (OR = 1.84 [1.01–3.08]) and pre-frail (OR = 1.46 [1.01–2.10]) versus robust. Among 1,724 participants with hearing loss, compared to hearing aid users (N = 522), nonusers had greater odds of being frail (OR = 2.54 [1.54–4.18]) and pre-frail (OR = 1.51 [1.05–2.17]) versus robust, and frail versus pre-frail (OR = 1.68 [1.04–2.72]). Conclusions In a nationally representative sample of older adults in the U.S., using gold-standard hearing measures and a validated frailty phenotype, hearing loss and lack of hearing aid use was cross-sectionally associated with frailty and pre-frailty. Future longitudinal studies are needed to establish if hearing loss is a risk factor for frailty, which may have significant clinical importance.

Objectives: Hearing loss may contribute to frailty through cognitive and physical decline, but population-based evidence using validated measures remains scarce. We investigated the association of hearing loss with phenotypic frailty and its individual components and explored the potential protective role of hearing aid use.Design: Cross-sectional study of community-dwelling older adults at visit 6 (2016-2017) of the Athero-sclerosis Risk in Communities (ARIC) study, a cohort study of older adults from 4 U.S. communities (Washington County, MD; Forsyth County, NC; Jackson, MS; and Minneapolis, MN).Setting and Participants: Population-based study of 3179 participants (mean age = 79.2 years, 58.9% female).Methods: Pure-tone audiometry at 0.5-4 kHz was used to assess unaided hearing, and the better-hearing ear's pure-tone average was categorized as follows: no [<25 dB hearing level (HL)], mild (26-40 dB HL), and moderate or greater (>40 dB HL) hearing loss. Hearing aid use was self-reported. The Fried/physical frailty phenotype was used to categorize frailty status (robust, pre-frail, or frail). Multivariable multi-nomial and logistic regression models were used to study the association of hearing loss/hearing aid use with frailty status and individual frailty components, respectively.Results: In our sample, 40% had mild and 27% had moderate or greater hearing loss (12% and 55% reported hearing aid use, respectively). Moderate or greater hearing loss was associated with greater odds of being pre-frail [odds ratio (OR), 1.25; 95% CI, 1.01-1.57] and frail (OR, 1.62; 95% CI, 1.06-2.47) vs robust, and greater odds of having slow gait, low physical activity, and exhaustion, compared with no hearing loss. Among those with hearing loss (>25 dB HL), compared with hearing aid users, nonusers had greater odds of being frail vs robust, and having unintentional weight loss, slow gait, and low physical activity.Conclusions and Implications: Hearing loss is associated with pre-frailty and frailty. Longitudinal studies are warranted to establish if hearing aid use may prevent or delay frailty onset.(c) 2023 AMDA -The Society for Post-Acute and Long-Term Care Medicine.

In the context of a growing body of evidence associating olfactory dysfunction (OD) with cognitive decline, this cross-sectional study used data from the 2013–2014 National Health and Nutrition Examination Survey (NHANES) sample in order to explore the role of dietary intake in this association. Leveraging a nationally representative sample of U.S. adults aged 60 years and older, this study analyzed dietary patterns using exploratory factor analysis. OD was categorized based on the NHANES Pocket Smell Test, and cognitive function was measured with a battery of tests. Survey-weighted multivariable regressions and causal mediation analysis were used to examine the relationship between dietary patterns, OD, and cognitive function. Results indicated that a poor adherence to a diet rich in monounsaturated fats (MUFAs) and polyunsaturated fats (PUFAs) was independently associated with both cognitive and olfactory dysfunctions, after adjusting for sociodemographic and health factors. Moreover, the relationship between OD and cognitive decline was found to be partly mediated by adherence to such a diet. This study proposes a potential link between diet, olfactory function, and cognitive decline, highlighting the role of nutritional interventions in mitigating cognitive decline, particularly in individuals with olfactory impairment.

Abstract Frailty is common in older adults and increases the risk of functional limitations and death. Hearing loss affects ~2/3 of older adults in the U.S. and is associated with poorer physical and cognitive function and social isolation, which may increase the risk for frailty. We aimed to determine if hearing loss is associated with higher odds of being frail or pre-frail versus robust and if hearing aid use is protective. We analyzed data from 2,361 participants from the National Health and Aging Trends Study (NHTAS), a U.S. nationally representative sample of older adults, collected in 2021. Hearing was assessed by pure-tone audiometric testing, and we used a speech-frequency (0.5-4 kHz) better hearing ear’s pure-tone average (BPTA) to categorize participants into no hearing loss (BPTA≤25 dB HL), mild (26-40), and moderate or greater (>40) hearing loss. Physical frailty was categorized according to the presence of the frailty phenotype components (unintentional weight loss, exhaustion, low physical activity, weakness, slow walking speed) into robust (0), pre-frail (1-2), and frail (≥3). In our study population (mean age=81, 56% female, 19% Black), there were 1,724 (73%) participants with hearing loss. Using multinomial logistic regression, we found that participants with moderate or greater hearing loss (vs. those without) had higher odds of being frail versus robust (OR=1.82, 95% CI 1.11, 2.99, p-trend=0.016). Hearing loss may be a risk factor for frailty. Future studies on the impact of hearing interventions in preventing and managing frailty will have significant public health and clinical importance.