Frank Robert Lin

All Publications

• Obstructive sleep apnea and functional hearing loss over 8 years: results from the National Health and Aging Trends Study AMERICAN JOURNAL OF EPIDEMIOLOGY Jiang, K., Spira, A. P., Reed, N. S., Lin, F. R., Deal, J. A. 2026

  Abstract

  Obstructive sleep apnea (OSA) may cause functional hearing loss through ischemic damage to the cochlea or impaired auditory processing in the brain, but longitudinal evidence is lacking. Medicare beneficiaries completed the National Health and Aging Trends Study round 3 (2013) sleep module (n = 1433, 41% male, 21% Black) were followed until round 11 (2021). Elevated OSA risk was defined as a modified STOP-BANG (Snoring, Tiredness, Observed apneas, high blood Pressure, BMI, Age, Neck circumference, Gender) score ≥ 3. Functional hearing loss was defined as self-reported deafness, hearing aid use, or inability to hear well enough to use the telephone or have a conversation in a room with the television or radio on. Discrete-time complementary log-log models were used for incident functional hearing loss. Multinomial logistic regression was used for membership in hearing loss trajectory groups (stable normal hearing, transition to hearing loss, stable hearing loss) estimated using group-based trajectory modeling. Elevated OSA risk score was associated with 1.34 times the hazard of incident functional hearing loss (95% confidence interval [CI], 1.06-1.70) and with a higher likelihood of being in the stable hearing loss group (relative risk ratio = 1.79, 95% CI, 1.32-2.42). Screening and treating OSA may be important for hearing health.

  View details for DOI 10.1093/aje/kwag006

  View details for Web of Science ID 001683263500001

  View details for PubMedID 41526194

  View details for PubMedCentralID PMC12843603

• Associations Between Predisposing, Enabling, and Need Factors and Hours of Daily Hearing Aid Use in the Atherosclerosis Risk in Communities Study AMERICAN JOURNAL OF AUDIOLOGY Reed, N. S., Jiang, K., Bessen, S. Y., Gahlon, G., Tarabichi, O., Myers, C., Huang, A., Powell, D., Lin, F. R., Deal, J. A. 2025; 34 (4): 927-936

  Abstract

  Hearing aids are the primary treatment for age-related hearing loss but are vastly underutilized. We explored cross-sectional associations between predisposing, enabling, and need factors and hours of daily hearing aid use.In the Atherosclerosis Risk in Communities (ARIC) Study, 764 participants at Visit 6 (2016-2017) reported hearing aid use. Self-reported hours of daily hearing aid use were modeled continuously (hours) and categorically (< 6, 6-12, and > 12 hr). Covariates included predisposing (age, sex, race-center), enabling (education, marital status, years of prior hearing aid use, global cognitive factor score, depressive symptoms, access to health care, health literacy), and need factors (pure-tone average [PTA], Quick Speech-in-Noise Test [QuickSIN] score). Multivariable-adjusted linear and ordinal logistic models were used to examine associations between these factors and daily hearing aid use.Every 1-year increase in prior hearing aid use was associated with 0.08-hr increase in daily hearing aid use (95% confidence interval [CI] [0.04, 0.13]); every 10-dB increase in PTA was associated with 0.63-hr increase in daily hearing aid use (95% CI [0.18, 1.08]); every 5-point increase in QuickSIN score was associated with 0.53-hr decrease in daily hearing aid use (95% CI [-0.99, -0.06]). Longer duration of prior hearing aid use and poor PTA and QuickSIN performance were associated with higher odds of being in a higher hearing aid use category.Hours of daily hearing aid use is driven primarily by audiometric hearing, SIN performance, and years of prior hearing aid use. Further research into determinants of hours of use can improve precision of hearing care.https://doi.org/10.23641/asha.30192826.

  View details for DOI 10.1044/2025_AJA-24-00251

  View details for Web of Science ID 001654639400018

  View details for PubMedID 41043991

  View details for PubMedCentralID PMC12708018

• Plasma Neurodegeneration and AD Biomarkers Identify Populations With Rapid Cognitive Decline Coresh, J., Pike, J., Reed, N., Palta, P., Deal, J., Sullivan, K., Thyagarajan, B., Lin, F. OXFORD UNIV PRESS. 2025

  View details for DOI 10.1093/geroni/igaf122.211

  View details for Web of Science ID 001652716700001

• Effects of Hearing Intervention on Mobility Disability Over 3 Years: Findings From the ACHIEVE Study Martinez-Amezcua, P., Garcia-Morales, E., Bessen, S., Huang, A., Deal, J., Reed, N., Schrack, J., Lin, F. OXFORD UNIV PRESS. 2025

  View details for DOI 10.1093/geroni/igaf122.077

  View details for Web of Science ID 001652636700001

• Developing Topics. Alzheimer's & dementia : the journal of the Alzheimer's Association Nieman, C. L., Hope, P., Leoutsakos, J. S., Yasar, S., Lin, F. R., Rebok, G., Gitlin, L. N., Lyketsos, K. G., Oh, E. S. 2025; 21 Suppl 7: e108912

  Abstract

  BACKGROUND: Hearing loss is highly prevalent and can have significant consequences for older adults aging with cognitive impairment. Optimizing sensory function may be an important yet overlooked approach to reducing neuropsychiatric symptoms (NPS). Preliminary evidence supports the potential for hearing care interventions to reduce NPS. The Hearing health Equity through Research and Solutions (HEARS) intervention is a theory-driven hearing care intervention delivered by trained paraprofessionals using over-the-counter hearing technology, with demonstrated efficacy among older adults. Previously adapted for older adults with cognitive impairment, the HEARS-NPS intervention is a refined intervention aims to strengthen communication between care partners and participants with co-morbid hearing loss and cognitive impairment.METHOD: The refined HEARS-NPS intervention will be evaluated through an NIA-funded NIA Stage 1b randomized controlled trial with a 6-week delayed treatment group in a cohort of 150 community-dwelling participants with cognitive impairment and hearing loss and their care partners.RESULT: Dyads will be recruited in partnership with the Johns Hopkins Memory & Alzheimer's Treatment Center, the Johns Hopkins Alzheimer's Disease Research Center, and accompanying community outreach. The refined HEARS-NPS intervention will be delivered virtually by trained interventionists, older adults volunteers, and occur over two structured sessions that consist of 1) fitting and orientation to an OTC device and 2) targeted education and counseling on managing hearing loss in dementia. Outcomes will be assessed at baseline, 6-weeks, 3-months, and 6-months post-randomization.CONCLUSION: The HEARS-NPS trial seeks to explore the feasibility, acceptability, and preliminary efficacy of an affordable, accessible hearing care intervention as an accompanying non-pharmacological approach to NPS. The findings from this trial will not only inform best practices in managing NPS but may also be useful in the development of new, cost-effective non-pharmacological interventions for individuals with dementia and their care partners.

  View details for DOI 10.1002/alz70861_108912

  View details for PubMedID 41434347

• Public Health. Alzheimer's & dementia : the journal of the Alzheimer's Association Reed, N. S., Pike, J. R., Thyagarajan, B., Deal, J. A., Arnold, M. L., Chisolm, T., Couper, D., Gottesman, R. F., Hughes, T. M., Knopman, D. S., Mosley, T. H., Palta, P., Pankow, J. S., Sanchez, V. A., Selvin, E., Sullivan, K. J., Wagenknecht, L. E., Lin, F. R., Coresh, J. 2025; 21 Suppl 6: e107403

  Abstract

  BACKGROUND: The Aging and Cognitive Health Evaluation in Elders (ACHIEVE) randomized trial (n=977;ClinicalTrials.gov:NCT03243422) demonstrated that hearing intervention slowed 3-year cognitive decline by 48% among a subgroup of participants. To further investigate differences by treatment with respect to cognitive benefit, we tested the hypothesis that hearing intervention is associated with improved neurodegeneration blood biomarkers 3-years post-randomization and assessed whether combining biomarkers and cognitive results improved power in the trial design.METHOD: The ACHIEVE study is a multicenter, parallel-arm, randomized trial (hearing intervention vs health education control) on 3-year cognitive decline among adults 70-84years with untreated hearing loss and without substantial cognitive impairment. Participants were recruited from two populations: (1) a long-standing cardiovascular health observational study (Atherosclerosis Risk in Communities [ARIC]), and (2) de novo community volunteers. Plasma was collected in year 3 in a subsample (n=540) while ARIC participants (n=164) also had baseline plasma. Glial fibrillary acidic protein (GFAP) and neurofilament light (NfL) neurodegenerative biomarkers were derived using the Alamar CNS protein panel. Regression models estimated the association of treatment with 3-year biomarkers and global cognitive differences in the combined sample and by recruitment source and annualized change from baseline in the ARIC sample. We included a simple composite score of the standardized outcomes (Table 2).RESULT: Among the subsample, baseline characteristics were balanced by treatment. There were no significant differences on 3-year neurodegeneration biomarker levels by treatment in the combined (Table 1) or de novo groups (Table 2). Among ARIC participants, intervention resulted in lower 3-year GFAP (mean:-0.415;95%CI:-0.712,-0.118) and NfL (mean:-0.349;95%CI:-0.652,-0.046) (Table 2). Annualized change from baseline analyses among ARIC participants (Table 3) revealed intervention was associated with a slower rate of cognitive decline (difference-in-means:0.059;95%CI:0.018,0.100) and a slower rate of increase in GFAP (difference-in-means: -0.060;95%CI:-0.112,-0.009). Differences in estimates suggest combined score, relative to cognition alone, may increase power in clinical trials that show a positive effect (ARIC subgroup: p=0.02vs. 0.08[Table 2] and p=0.0009vs.0.048[Table 3]).CONCLUSION: Hearing intervention was associated with positive 3-year effects on neurodegeneration blood biomarkers in ARIC participants which parallels cognitive decline results. Results provides objective evidence of brain changes following hearing intervention and potential signal of a more powerful combined outcome approach for future brain health clinical trials.

  View details for DOI 10.1002/alz70860_107403

  View details for PubMedID 41434704

• Public Health. Alzheimer's & dementia : the journal of the Alzheimer's Association Deal, J. A., Pike, J. R., Kamath, V., Palta, P., Thyagarajan, B., Lin, F. R., Coresh, J., Reed, N. S. 2025; 21 Suppl 6: e106812

  Abstract

  BACKGROUND: Hearing loss is an established risk factor for Alzheimer's disease and related dementias (ADRD) but the mechanism is unknown. We investigated the cross-sectional association of hearing loss with plasma AD/ADRD biomarkers, hypothesizing that hearing loss is associated with biomarkers reflective of broader neurodegeneration (e.g., neurofilament light chain [NfL]) but not with AD-specific markers (e.g., amyloid-b, phosphorylated tau).METHODS: We used data from the observational cohort, the Atherosclerosis Risk in Communities Neurocognitive Study (ARIC-NCS). Pure tone air conduction hearing thresholds (frequencies 0.5-4 kHz) were obtained at Visit 6 (2016-17) and averaged, with better-ear hearing loss modeled continuously. The Quanterix SiMoA platform measured ADRD plasma biomarkers from stored specimens at the nearest visit - Visit 5 (2011-13), Visit 6 (2016-17) or Visit 7 (2018-19) - including amyloid-beta 42 /amyloid-beta 40 ratio (Ab42/40), phosphorylated tau at threonine 181 (p-tau 181), NfL, and glial fibrillary acidic protein (GFAP). Multivariable-adjusted linear regression was used to estimate differences in biomarker levels, adjusting for time between audiology assessment and plasma collection, age, sex, race, center, education, APOE e4 genotype, BMI, estimated glomerular filtration rate, cigarette use, total cholesterol, high-density lipoprotein cholesterol, hypertension, diabetes, coronary heart disease and hearing aid use. Global cognition (a composite cognitive score created from 10 cognitive tests) was modeled as a positive control.RESULTS: Participant ages ranged from 67-94 years, 60% were female and 36% identified as Black race (Table 1). As expected, audiometric hearing was not correlated with AD-specific biomarkers (Ab42/40 ratio, p-tau181). However, weak correlations were observed for markers more reflective of general neurodegeneration (NfL and GFAP) (Figure) and hearing loss was positively associated with NfL in adjusted linear regression models, with each 10 dB increase (worse hearing) associated with 0.079 (95% confidence interval [CI] 0.007, 0.150) higher log NfL (Table 2).CONCLUSIONS: Poorer audiometric hearing in older adults is associated with plasma biomarkers of neurodegeneration, specifically NfL, but is not associated with AD-specific markers (amyloid and tau), suggesting that pathways linking hearing and ADRD are independent of these pathognomonic Alzheimer's-related brain changes.

  View details for DOI 10.1002/alz70860_106812

  View details for PubMedID 41434110

• Modification of the Association Between Hearing Trouble and Satisfaction With Care by Accompaniment to Health Care Visits JOURNAL OF THE AMERICAN GERIATRICS SOCIETY Reed, N. S., Bessen, S. Y., Martinez-amezcua, P., Deal, J. A., Powell, D., Fong, J., Miller, E. R., Lin, F. R., Morris, M. A., Oh, E. S. 2026; 74 (1): 85-95

  Abstract

  Hearing loss affects nearly two-thirds of adults over the age of 70 years, and is associated with lower satisfaction with health care, which may be mediated by patient-provider communication barriers. Accompaniment, the presence and support of a companion during health care interactions, may modify the association between hearing and satisfaction with care by providing an intermediary to assist with communication.Cross-sectional study of 9698 Medicare beneficiaries from the 2016 Medicare Current Beneficiaries Survey. We used regression models to estimate the association between self-reported trouble hearing and satisfaction with care, which was measured through reported satisfaction with overall quality of care, satisfaction with information provided, and satisfaction with provider's concern. Interaction terms and stratification by being accompanied to healthcare visits were used to assess if accompaniment modified the association between hearing loss and satisfaction with care.Nearly 45% of Medicare beneficiaries reported at least a little trouble hearing. Adults with a little trouble hearing (Odds Ratio [OR] = 1.168; 95% Confidence Interval [CI] = 1.047-1.302) and a lot of trouble hearing (OR = 1.293; 95% CI = 1.043-1.603) had higher odds of being dissatisfied with the quality of their health care over the previous year compared to those with no trouble hearing. Among accompanied participants, no association was found between level of hearing trouble and dissatisfaction with care. Among unaccompanied adults, trouble with hearing was associated with higher odds of dissatisfaction. The associations were consistent across the three dissatisfaction outcomes.Medicare beneficiaries with hearing loss had higher odds of dissatisfaction with health care over the past year compared to those without functional hearing loss. Stratified models suggest that accompaniment may modify the association between hearing and dissatisfaction with care. Future research should consider interventions to support unaccompanied adults with hearing loss during health care interactions.

  View details for DOI 10.1111/jgs.70176

  View details for Web of Science ID 001601232000001

  View details for PubMedID 41147045

• Summary population attributable fraction of dementia prevalence associated with sensory risk factors JOURNAL OF ALZHEIMERS DISEASE Smith, J. R., Wang, X., Zhang, W., Garcia Morales, E. E., Varadaraj, V., Swenor, B. K., Almidani, L., Ramulu, P., Whitson, H. E., Martinez-Amezcua, P., Lin, F. R., Reed, N. S., Ehrlich, J. R., Deal, J. A. 2025: S152-S163

  Abstract

  BackgroundHearing and vision loss can be treatable sensory risk factors for dementia. Nationally-representative estimates of the proportion of dementia prevalence associated with sensory risk factors in late-life are needed for dementia prevention strategies.ObjectiveTo estimate the fraction of dementia prevalence associated with treatable sensory risk factors (hearing and vision loss) and to evaluate differences by age, race/ethnicity, income, and sex.MethodsThis was a cross-sectional analysis of Round 12 (2022) of the National Health and Aging Trends Study, a population-based study nationally representative of US Medicare beneficiaries. Among community-living adults aged ≥65 years eligible for cognitive, hearing, and vision assessments (n = 4623), the summary population attributable fraction (PAF) of dementia from at least one objectively-measured sensory risk factor was estimated.ResultsThe prevalence of at least one sensory risk factor was 66% and dementia was 9%. The PAF of dementia from at least one sensory risk factor was 57% (95% CI: 8%-61%). PAFs were larger for individuals who were aged <80 years compared to ≥80 years (59% [95% CI: 42%-74%] versus 33% [95% CI: -6%-68%), non-Hispanic White compared to Hispanic and non-Hispanic Black (63% [95% CI: 41%-80%] versus 50% [95% CI: 16%-80%] and 32% [95% CI: -1%-64%]), and had higher income versus lower income (57% [95% CI: 36%-74%] versus 47% [95% CI: 7%-81%]). PAFs were consistent by sex.ConclusionsUp to 57% of dementia prevalence in the US was associated with clinically-significant sensory risk factors. Addressing sensory impairments could play an important role in national dementia risk reduction strategies.

  View details for DOI 10.1177/13872877251386439

  View details for Web of Science ID 001597084200001

  View details for PubMedID 41105591

• Rationale for the Development of a Universal Hearing Metric for Public Consumption: Initiative 1 of the Hearing Health Collaborative OTOLOGY & NEUROTOLOGY Reed, N. S., Assi, S., Bush, M., Carlson, M. L., Cosetti, M., Creel, L., Gubbels, S., Gurgel, R., Holcomb, M., Jilla, A. M., Lin, F. R., Marinelli, J. P., Myers, C., Sladen, D. P., Spankovich, C., Sydlowski, S., Yueh, B., Nassiri, A. M. 2025; 46 (7): 743-747

  Abstract

  Present the rationale for the development of a new, patient-facing vital sign for adult hearing.Structured A3 process.Fourteen virtual meetings and two in-person meetings held between May 2021 and June 2022.Identification and refinement of a countermeasure to develop and imbed a hearing health vital sign for adult hearing.Through a rigorous, structured A3 process, the Hearing Health Collaborative identified and refined the rationale for and the qualities associated with a public-facing vital sign for adult hearing loss. Specifically, such a vital sign must embody five qualities: simple, accessible, stable, inclusive, and meaningful. These qualities together would ensure that a hearing health vital sign would be useful not only as a screening tool but also as an instrument to guide next steps in workup and potentially treatment.Successful identification and implementation of a hearing metric or "vital sign" for the presence of adult hearing loss, using precedent convention of other medical diseases, may help reframe public perceptions surrounding hearing loss, improve awareness and literacy regarding the presence of the disease, and prompt action to seek diagnostic assessment.

  View details for DOI 10.1097/MAO.0000000000004523

  View details for Web of Science ID 001589331300007

  View details for PubMedID 40360253

• Associations of Traumatic Brain Injury and Hearing: Results From the Atherosclerosis Risk in Communities Neurocognitive Study (ARIC-NCS) JOURNAL OF HEAD TRAUMA REHABILITATION Schneider, A. L. C., Kamath, V., Reed, N. S., Mosley, T., Gottesman, R. F., Sharrett, A., Lin, F. R., Deal, J. A. 2025; 40 (4): 287-295

  Abstract

  To examine associations of traumatic brain injury (TBI) with self-reported and clinical measures of hearing function.Four US communities.A total of 3176 Atherosclerosis Risk in Communities Study participants who attended the sixth study visit in 2016-2017, when hearing was assessed.Prospective cohort study. TBI occurring prior to the hearing assessment was defined using self-reported questions and "International Classification of Diseases-9th/10th Edition" (ICD-9/10) codes.Hearing function was assessed by self-reported questionnaires and clinically measured indices (audiometry [4-frequency pure tone average for each ear] and speech-in-noise testing). Linear, logistic, and multinomial logistic models adjusted for sociodemographics, vascular risk factors, and occupational noise exposure were used to examine associations.Participants were a mean age of 79 years, 59% were female, 21% were of self-reported Black race, and 33% had a history of TBI (median time from first TBI to hearing assessment: 39 years (25th-75th percentile = 19-63 years). Compared to participants without TBI, participants with prior TBI had higher age-adjusted prevalence of self-reported hearing loss (42.3% vs 35.3%), tinnitus (28.0% vs 23.8%), hearing aid use (23.4% vs 17.8%), pure tone average > 40 dB (30.6% vs 24.8%), and presence in the lowest quartile of speech-in-noise performance (27.6% vs 22.8%). With further adjustment, and particularly with adjustment for occupational noise exposure, associations with hearing measures were largely no longer statistically significant. In secondary analyses of associations of TBI frequency and severity with hearing function, results were similar to our main analyses, without evidence of dose-dependent associations.In this community-based cohort, prior TBI was associated with impaired hearing on both self-reported and clinically measured assessments, but these associations were attenuated after adjustment for occupational noise exposure. These results underscore the importance of the consideration of loud noise exposures, which may confound associations of TBI with hearing, in future studies.

  View details for DOI 10.1097/HTR.0000000000001032

  View details for Web of Science ID 001524173600016

  View details for PubMedID 39740144

• International Consortium on Ageing-Related Pathologies (ICCARP) Audiovestibular Group: fostering international consensus to refine International Classification of Diseases (ICD-11) codes for hearing loss across the life course GEROSCIENCE Tsimpida, D., Akeroyd, M. A., Bentley, B. L., Bhattacharjee, S., Bowl, M. R., Broome, E., Calimport, S. R. G., Calvert, S., Christopher, G., Dening, T., Di Bonaventura, S., Goswami, A., Gougousis, S., Govaerts, P. J., Gupta, M., Henshaw, H., Huckstepp, R. T. R., Iliadou, V., Koutsimani, T. K., Lewis, M. A., Lin, F. R., Miotto, C., Nolan, L. S., Nuttall, H. E., Onyekere, C., Phanguphangu, M., Plack, C. J., Raghavan, R. S., Reed, N. S., Rova, K., Steel, K. P., Stokroos, R. J., Swanepoel, D., Szczepek, A. J., Whitney, S. L. 2025

  View details for DOI 10.1007/s11357-025-01742-2

  View details for Web of Science ID 001518980100001

  View details for PubMedID 40580247

  View details for PubMedCentralID 7193988

• Impact of a Hearing Intervention on the Levels of Leisure-Time Physical Activity and TV Viewing in Older Adults: Results from a Secondary Analysis of the ACHIEVE Study JOURNALS OF GERONTOLOGY SERIES A-BIOLOGICAL SCIENCES AND MEDICAL SCIENCES Martinez-Amezcua, P., Zhang, W., Assi, S., Gupta, H., Twardzik, E., Huang, A. R., Reed, N. S., Deal, J. A., Arnold, M. L., Burgard, S., Chisolm, T., Couper, D., Glynn, N. W., Gmelin, T., Goman, A. M., Gravens-Mueller, L., Hayden, K. M., Mitchell, C. M., Pankow, J. S., Pike, J., Schrack, J. A., Sanchez, V. A., Sullivan, K. J., Lin, F. R., Coresh, J., ACHIEVE Collaborative Res Grp 2025; 80 (6)

  Abstract

  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.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.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).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.

  View details for DOI 10.1093/gerona/glaf033

  View details for Web of Science ID 001484667800001

  View details for PubMedID 39953975

• Effects of hearing intervention on falls in older adults: findings from a secondary analysis of the ACHIEVE randomised controlled trial LANCET PUBLIC HEALTH Goman, A. M., Tan, N., Pike, J., Bessen, S. Y., Chen, Z., Huang, A. R., Arnold, M. L., Burgard, S., Chisolm, T. H., Couper, D., Deal, J. A., Glynn, N. W., Gmelin, T., Gravens-Mueller, L., Hayden, K. M., Martinez-Amezcua, P., Mitchell, C. M., Pankow, J. S., Reed, N. S., Sanchez, V. A., Schrack, J. A., Sullivan, K. J., Coresh, J., Lin, F. R., ACHIEVE Collaborative Res Grp, A. 2025; 10 (6): e492-e502

  Abstract

  Hearing loss is highly prevalent among older adults and has been associated with an increased likelihood of falling. We aimed to examine the effect of a hearing intervention on falls over 3 years among older adults in a secondary analysis of the ACHIEVE study.The Aging and Cognitive Health Evaluation in Elders (ACHIEVE) study was a 3-year, unmasked, randomised controlled trial of adults aged 70-84 years at enrolment with untreated hearing loss and without substantial cognitive impairment. Participants were recruited at four US community-based field sites from two study populations: (1) an ongoing observational study of cardiovascular health (Atherosclerosis Risk in Communities [ARIC] study), and (2) de novo from the community. Participants were randomly assigned (1:1) to a hearing intervention (audiological counselling and provision of hearing aids) or a health education control (didactic education and enrichment activities covering chronic disease prevention topics). A prespecified exploratory outcome was falls. Self-reported falls in the past 12 months were assessed at baseline and annually for 3 years, and analysed by intention to treat with covariate adjustment. The study was registered with ClinicalTrials.gov, NCT03243422, and is completed.Between Nov 9, 2017, and Oct 25, 2019, 3004 individuals were screened for eligibility and 977 (238 [24%] from the ARIC study and 739 [76%] de novo) were randomly assigned, with 490 (50%) in the hearing intervention group and 487 (50%) in the health education control group. Overall mean age was 76·8 years (SD 4·0), 523 (54%) participants were female and 454 (46%) were male, and 112 (11%) were Black, 858 (88%) were White, and seven (1%) were other race. In adjusted analyses, the intervention group had a 27% reduction in the mean number of falls over 3 years compared with the control group (intervention group: 1·45 [95% CI 1·28 to 1·61]; control group: 1·98 [1·82 to 2·15]; mean difference: -0·54 [95% CI -0·77 to -0·31]). This 3-year effect of hearing intervention was consistent across both the ARIC and de novo study populations.Hearing intervention versus a health education control was associated with a reduction in the mean number of falls over 3 years in older adults. Ongoing follow-up of ACHIEVE participants in a separate follow-up study (NCT05532657) will enable examination of the longer term effects of hearing intervention on falls.US National Institutes of Health.

  View details for DOI 10.1016/S2468-2667(25)00088-X

  View details for Web of Science ID 001509152000002

  View details for PubMedID 40441816

  View details for PubMedCentralID PMC12203021

• Hearing Intervention, Social Isolation, and Loneliness A Secondary Analysis of the ACHIEVE Randomized Clinical Trial JAMA INTERNAL MEDICINE Reed, N. S., Chen, J., Huang, A. R., Pike, J. R., Arnold, M., Burgard, S., Chen, Z., Chisolm, T., Couper, D., Cudjoe, T. K. M., Deal, J. A., Goman, A. M., Glynn, N. W., Gmelin, T., Gravens-Mueller, L., Hayden, K. M., Mitchell, C. M., Mosley, T., Oh, E. S., Pankow, J. S., Sanchez, V. A., Schrack, J. A., Coresh, J., Lin, F. R. 2025; 185 (7): 797-806

  Abstract

  Promoting social connection among older adults is a public health priority. Addressing hearing loss may reduce social isolation and loneliness among older adults.To describe the effect of a best-practice hearing intervention vs health education control on social isolation and loneliness over a 3-year period in the Aging and Cognitive Health Evaluation in Elders (ACHIEVE) study.This secondary analysis of a multicenter randomized controlled trial with 3-year follow-up was completed in 2022 and conducted at 4 field sites in the US (Forsyth County, North Carolina; Jackson, Mississippi; Minneapolis, Minnesota; Washington County, Maryland). Data were analyzed in 2024. Participants included 977 adults (aged 70-84 years who had untreated hearing loss without substantial cognitive impairment) recruited from the Atherosclerosis Risk in Communities study (238 [24.4%]) and newly recruited (de novo; 739 [75.6%]). Participants were randomized (1:1) to hearing intervention or health education control and followed up every 6 months.Hearing intervention (4 sessions with certified study audiologist, hearing aids, counseling, and education) and health education control (4 sessions with a certified health educator on chronic disease, disability prevention).Social isolation (Cohen Social Network Index score) and loneliness (UCLA Loneliness Scale score) were exploratory outcomes measured at baseline and at 6 months and 1, 2, and 3 years postintervention. The intervention effect was estimated using a 2-level linear mixed-effects model under the intention-to-treat principle.Among the 977 participants, the mean (SD) age was 76.3 (4.0) years; 523 (53.5%) were female, 112 (11.5%) were Black, 858 (87.8%) were White, and 521 (53.4%) had a Bachelor's degree or higher. The mean (SD) better-ear pure-tone average was 39.4 dB (6.9). Over 3 years, mean (SD) social network size reduced from 22.6 (11.1) to 21.3 (11.0) and 22.3 (10.2) to 19.8 (10.2) people over 2 weeks in the hearing intervention and health education control arms, respectively. In fully adjusted models, hearing intervention (vs health education control) reduced social isolation (social network size [difference, 1.05; 95% CI, 0.01-2.09], diversity [difference, 0.19; 95% CI, 0.02-0.36], embeddedness [difference, 0.27; 95% CI, 0.09-0.44], and reduced loneliness [difference, -0.94; 95% CI, -1.78 to -0.11]) over 3 years. Results were substantively unchanged in sensitivity analyses that incorporated models that were stratified by recruitment source, analyzed per protocol and complier average causal effect, or that varied covariate adjustment.This secondary analysis of a randomized clinical trial indicated that older adults with hearing loss retained 1 additional person in their social network relative to a health education control over 3 years. While statistically significant, it is unknown whether observed changes in social network are clinically meaningful, and loneliness measure changes do not represent clinically meaningful changes. Hearing intervention is a low-risk strategy that may help promote social connection among older adults.ClinicalTrials.gov Identifier: NCT03243422.

  View details for DOI 10.1001/jamainternmed.2025.1140

  View details for Web of Science ID 001489622200001

  View details for PubMedID 40354063

  View details for PubMedCentralID PMC12070280

• Cognitive benefits of hearing intervention vary by risk of cognitive decline: A secondary analysis of the ACHIEVE trial ALZHEIMERS & DEMENTIA Pike, J., Huang, A. R., Reed, N. S., Arnold, M., Chisolm, T., Couper, D., Deal, J. A., Glynn, N. W., Goman, A. M., Hayden, K. M., Mitchell, C. M., Pankow, J. S., Sanchez, V., Sullivan, K. J., Tan, N. S., Coresh, J., Lin, F. R., ACHIEVE Collaborative Res Grp 2025; 21 (5): e70156

  Abstract

  Results from the Aging and Cognitive Health Evaluation in Elders (ACHIEVE) trial suggest hearing intervention may not reduce 3-year cognitive decline in all older adults with hearing loss but may be beneficial in certain groups. This secondary analysis investigated if participants with multiple risk factors for cognitive decline received greater benefits.We used a sample of dementia-free participants (N = 2692) from the Atherosclerosis Risk in Communities (ARIC) cohort to develop a predictive model for cognitive decline. The model was applied to baseline measures of ACHIEVE participants (N = 977) to estimate predicted risk. We tested an interaction between predicted risk and randomization to hearing intervention or health education control.Among ACHIEVE participants in the top quartile of predicted risk, 3-year cognitive decline in the hearing intervention was 61.6% (95% confidence interval [CI]: 33.7%-94.1%) slower than the control.The effect of hearing intervention on reducing 3-year cognitive decline was greatest among individuals with multiple baseline risk factors associated with faster cognitive decline.ClinicalTrials.gov Identifier: NCT03243422 HIGHLIGHTS: The Aging and Cognitive Health Evaluation in Elders (ACHIEVE) trial tested the effect of hearing intervention on cognitive decline. Participants were recruited from the Atherosclerosis Risk in Communities (ARIC) cohort or de novo from the local community. A 48% reduction in cognitive decline was observed in ARIC cohort participants. In this secondary analysis, there was an interaction between hearing intervention and predicted risk of cognitive decline. Among participants in the top quartile of predicted risk of cognitive decline, hearing intervention slowed cognitive decline by 62%.

  View details for DOI 10.1002/alz.70156

  View details for Web of Science ID 001506477300031

  View details for PubMedID 40369891

  View details for PubMedCentralID PMC12078761

• Association of Self-Recognition of Hearing Loss With Hospitalizations in Older Adults in the United States MEDICAL CARE Bessen, S., Zhang, W., Lin, F. R., Morales, E., Reed, N. S. 2025; 63 (5): 379-385

  Abstract

  Hearing loss is highly prevalent and associated with increased health care utilization. Recognition of hearing loss may play an important role in self-advocacy in difficult communication situations and prevent negative outcomes.To investigate the associations between self-recognition of hearing loss and hospitalization outcomes.This is a cross-sectional analysis of 1766 participants from the National Health and Aging Trends Study.The exposure, recognition of hearing loss, was constructed using participants' self-reported functional hearing difficulty, audiometric hearing loss, and self-reported hearing aid use. Primary outcomes included self-reported hospital stay occurrence and number of hospital stays within the last year. Regression models were adjusted for demographic, socioeconomic, and health characteristics and further stratified by severity of hearing loss.Among 1766 participants with hearing loss, those with unrecognized hearing loss [60.1% (n=1062)] had higher but statistically insignificant odds of any hospitalization [odds ratio (OR)=1.32; 95% CI: 0.96, 1.81] or higher count of hospitalizations [incident rate ratio (IRR)=1.13; 95% CI: 0.85, 1.51] compared with those with recognized hearing loss (39.9%, n=704). Among participants with mild hearing loss, those with unrecognized hearing loss demonstrated significantly higher odds of any hospitalization occurrence (OR=2.50; 95% CI: 1.26-4.97) and a higher count of hospitalizations (IRR=2.00, 95% CI: 1.00-4.01) than those with recognized hearing loss. There were no significant differences in hospitalization outcomes among participants with moderate or greater hearing loss.In a nationally representative sample of older adults, individuals with unrecognized hearing loss compared with those with self-recognized hearing loss may be at increased odds of adverse hospitalization outcomes.

  View details for DOI 10.1097/MLR.0000000000002133

  View details for Web of Science ID 001461560000003

  View details for PubMedID 39846991

• Sleep Medication Use Trajectories over 30 Years and Late-Life Hearing Loss Jiang, K., Deal, J., Liu, C., Kaizi-Lutu, M., Lee, A., Full, K., Lutsey, P., Morales, E., Punjabi, N., Reed, N., Wu, M., Lin, F., Gottesman, R., Spira, A. OXFORD UNIV PRESS INC. 2025: A238

  View details for DOI 10.1093/sleep/zsaf090.0546

  View details for Web of Science ID 001490498500040

• Cognitive Level Enhancement through Vision Exams and Refraction (CLEVER): study protocol for a randomised controlled trial TRIALS Marmamula, S., Alladi, S., Umapathy, K., Chan, V., MacKenzie, G., Lohfeld, L., Mettla, A., Rayasam, S., Gothwal, V. K., Narayanan, R., Pyda, G., Chadalavada, H. P., Thomas, P., Sigwadhi, L., Azuara-Blanco, A., McDowell, C., McMullan, S., Murphy, L., Clarke, M., Ehrlich, J. R., Sweenor, B., O'Neill, C., Komaravolu, S., Maulik, P. K., Murthy, G. S., Kumar, K., Nyshadham, A., Adhvaryu, A., McCabe, C., Bloom, D. E., Lee, J., Lin, F., Coghlan, S., Khanna, R. C., Congdon, N. 2025; 26 (1): 109

  Abstract

  Longitudinal observational studies have found an association between vision impairment and accelerated decline in cognition. However, no randomised trials have assessed the possible benefit of vision correction on cognitive change. We present the protocol for a three-year randomised controlled trial designed to assess the impact of spectacles for distance and/or near vision correction on cognitive change among community-dwelling elderly participants in India.Cognitive Level Enhancement through Vision Exams and Refraction (CLEVER) is a single-centre, open-label, parallel-group, individually-randomised trial. Participants (760 total, 380 in each arm) aged ≥ 60 years with correctable vision impairment at distance and/or near (presenting visual acuity < 6/18 in the better-seeing eye and improving to > = 6/18 with spectacles and/or presenting near vision worse than N6 at 40 cm and improving to N6 with spectacles), normal hearing (able to repeat at least three out of six words whispered from a 50 cm distance in the better ear) and normal cognition (Hindi Mini-mental Status Examination score > 18/31) will be enrolled. After a comprehensive eye examination, intervention group participants will receive distance, near, or bifocal spectacles, while controls will receive a prescription and spectacles at the end of the trial. The primary outcome will be the three-year change in Longitudinal Aging Study in India-Diagnostic Assessment of Dementia (LASI DAD) global cognitive factor score, with and without adjustment for baseline score, age, gender, education and other potential confounders.CLEVER is designed to assess the effectiveness of spectacles as a low-cost intervention to prevent or delay cognitive decline.This trial is registered with ClinicalTrials.gov, number NCT05458323, February 15, 2023.

  View details for DOI 10.1186/s13063-025-08813-x

  View details for Web of Science ID 001455928600001

  View details for PubMedID 40156032

  View details for PubMedCentralID PMC11954208

• Effects of Hearing Intervention on Physical Activity Measured by Accelerometry: A Secondary Analysis of the ACHIEVE Study JOURNAL OF THE AMERICAN GERIATRICS SOCIETY Schrack, J. A., Wanigatunga, A. A., Glynn, N. W., Arnold, M. L., Burgard, S., Chisolm, T. H., Couper, D., Deal, J. A., Gmelin, T., Goman, A. M., Huang, A. R., Gravens-Mueller, L., Hayden, K. M., Martinez-Amezcua, P., Mitchell, C. M., Pankow, J. S., Pike, J. R., Reed, N. S., Sanchez, V. A., Sullivan, K. J., Coresh, J., Lin, F. R., ACHIEVE Collaborative Res Grp 2025; 73 (6): 1762-1771

  Abstract

  Hearing loss is prevalent in older adults and is associated with reduced daily physical activity, but whether hearing intervention attenuates declines in physical activity is unknown. We investigated the 3-year effect of a hearing intervention versus a health education control on accelerometer-measured physical activity in older adults with hearing loss.This secondary analysis of the ACHIEVE randomized controlled trial included 977 adults aged 70-84 years with hearing loss. Participants were randomized to either a hearing intervention group or a health education control group. Physical activity was measured using wrist-worn accelerometers at baseline, 1, 2, and 3 years. Linear mixed models assessed the impact of the intervention on changes in total activity counts, active minutes per day, and activity fragmentation.Among 847 participants in the final analysis (mean age 76.2 years; 440 [52%] women; 87 [10%] Black; 5 [0.8%] Hispanic), total activity counts declined by 2.7% annually, and active minutes/day declined by 2.1% annually over 3 years in both intervention and control groups. Activity patterns also became more fragmented over time. No appreciable differences were observed between hearing intervention and health education control in the 3-year change in accelerometry-measured physical activity measures.Hearing intervention did not appreciably attenuate 3-year declines in physical activity compared to health education control in older adults with hearing loss. Alternative strategies beyond hearing treatment may be needed to enhance physical activity among older adults with hearing loss.

  View details for DOI 10.1111/jgs.19435

  View details for Web of Science ID 001450538300001

  View details for PubMedID 40126980

  View details for PubMedCentralID PMC12213142

• Safety, Dosimetry, and Feasibility of [<SUP>68</SUP>Ga]Ga-PSMA-R2 as an Imaging Agent in Patients with Biochemical Recurrence or Metastatic Prostate Cancer JOURNAL OF NUCLEAR MEDICINE Lindenberg, L., Hope, T. A., Lin, F. I., Rowe, S. P., Pucar, D., Gilbert, N., Chicco, D., He, B., Feuerecker, B., Castaldi, E., Solnes, L. B. 2025; 66 (3): 359-365

  Abstract

  Prostate-specific membrane antigen (PSMA) is highly expressed in most prostate cancers (PCs). PET and CT imaging studies using 68Ga-labeled PSMA ligands demonstrated the specific localization of 68Ga in PC lesions and distant metastatic lesions. [68Ga]Ga-PSMA-R2 (68Ga-PSMA-R2) is a PSMA-targeted PET/CT radiotracer with potential diagnostic applications. Methods: PROfind (NCT03490032) was a phase 1/2, open-label, multicenter study of administration of 3 MBq/kg of 68Ga-PSMA-R2 (from >150 to ≤250 MBq) in patients with biochemical recurrence (BCR) or metastatic PC (mPC). Participants underwent baseline conventional imaging (CT/MRI or bone scan) and PET/CT. Whole-body PET/CT imaging sequences were obtained between 20 min and 4 h after injection. Primary endpoints were safety and tolerability; secondary endpoints included biodistribution, potential lesion identification, pharmacokinetics, and dosimetry. Potential lesions were identified by 2 masked expert panels; a third panel evaluated the identified lesions. Results: Six patients with BCR were enrolled into phase 1, and 24 patients with BCR or mPC (n = 12 each) into phase 2. Thirteen treatment-emergent adverse events were reported, including 1 serious adverse event (ileus), unrelated to drug administration. All adverse events were mild or moderate and deemed not related to 68Ga-PSMA-R2. Peak blood concentration of 68Ga-PSMA-R2 was typically observed approximately 5 min after injection, steadily decreasing over 6 h. Mean absorbed radiation dose was highest in the urinary bladder wall (0.120 mGy/MBq) and kidney (0.061 mGy/MBq). No other organ mean absorbed radiation dose exceeded 0.020 mGy/MBq. Mean absorbed radiation doses in the salivary and lacrimal glands were 0.016 and 0.008 mGy/MBq, respectively. Mean total body absorbed radiation dose was 0.014 mGy/MBq. Mean effective total body dose was 0.015 mSv/MBq (range, 0.012-0.018 mSv/MBq). 68Ga-PSMA-R2 PET/CT detected 85 lesions in 22 participants at 1 h after injection and 103 lesions in 22 participants at 2 h after injection. Conventional imaging detected 49 lesions in 8 participants with mPC but none in participants with BCR. Conclusion: 68Ga-PSMA-R2 was well tolerated, with no drug-related treatment-emergent adverse events. Safety and preliminary imaging performance data support further development of 68Ga-PSMA-R2 as a diagnostic agent in patients with PC.

  View details for DOI 10.2967/jnumed.124.268318

  View details for Web of Science ID 001470417200008

  View details for PubMedID 39915126

  View details for PubMedCentralID PMC11876733

• Prevalence of Hearing Loss Among US Adolescents JAMA NETWORK OPEN Wu, H. C., Neeff, M., Lin, F. R. 2025; 8 (2): e2458854

  View details for DOI 10.1001/jamanetworkopen.2024.58854

  View details for Web of Science ID 001421859600006

  View details for PubMedID 39928339

  View details for PubMedCentralID PMC11811794

• Early detection and management of hearing loss to reduce dementia risk in older adults with mild cognitive impairment: findings from the treating auditory impairment and cognition trial (TACT) AGE AND AGEING Yu, R., Pavlou, M., Schilder, A. G. M., Bamiou, D., Lewis, G., Lin, F., Livingston, G., Proctor, D., Omar, R., Costafreda, S. G. 2025; 54 (1)

  Abstract

  Age-related hearing loss and mild cognitive impairment (MCI) independently increase dementia risk. The Ageing and Cognitive Health Evaluation in Elders randomised controlled trial (RCT) found hearing aids reduce cognitive decline in high-risk older adults with poor hearing.This pilot RCT in London memory clinics randomised people with MCI (aged ≥55, untreated hearing loss defined as Pure Tone Average 0.5-4 KHz between 25-70 dB) into two groups. The intervention group received 4 sessions of hearing aid fitting and support. The control group received healthy ageing education and a GP letter recommending audiological referral. Both were followed for 6 months. Primary outcomes were recruitment (feasibility target: 50%; 95% CI: 39%-61%) and retention (feasibility target: 80%; 95% CI: 71%-89%); intervention completion (≥2 visits) and hearing aid use (acceptability target: 80%; 95% CI: 71%-89%) for the intervention group and 50% difference between arms (95% CI: 31%-69%). Secondary outcomes included hearing aid fitting, cognition and other measures.From October 2018 to March 2020, 58 participants were recruited (29 per group, 95% [86%-99%]). Twenty-four participants were fitted with hearing aids in the intervention arm, and 6 in the control arm (difference: 62% [42%-82%]). At 6 months, retention was 81% [69%-90%]. Hearing intervention completion (≥2 visits) was achieved by 24 (83%). Daily hearing aid use was reported by 18 (75%) intervention versus 5 (22%) control participants, a difference of 53% [29%-77%].Randomisation of people with MCI to a personalised hearing intervention versus control is feasible. These findings support proceeding to a fully-powered multicentre RCT.

  View details for DOI 10.1093/ageing/afaf004

  View details for Web of Science ID 001400831100001

  View details for PubMedID 39835654

  View details for PubMedCentralID PMC11747994

• Residential Differences and Depression Among Older Adults With Dual Sensory Loss JAMA OTOLARYNGOLOGY-HEAD & NECK SURGERY Wang, E. B., Morales, E., Gross, A. L., Lin, F. R., Reed, N. S., Deal, J. A. 2025; 151 (3): 202-210

  Abstract

  Investigating rural-urban and regional differences in the association between dual sensory loss (concurrent hearing and vision loss) and depression may highlight gaps in sensory loss research and health care services, and by socioeconomic status. Whether urbanicity and region may modify associations between sensory loss and depression is unknown.To describe the rural-urban and regional differences in the association of dual sensory loss with depression among older adults.This cross-sectional study used data from wave 1 (April 2017-December 2019) of the population-based Longitudinal Aging Study in India (LASI). Participants were recruited from 35 states and union territories in India. LASI incorporated a multistage stratified area probability cluster sampling design to recruit participants 45 years and older and their spouses; 31 447 eligible participants 60 years of age or older were interviewed. Data analyses were conducted from May 17, 2022, to November 11, 2023.Sensory loss (no sensory loss, hearing loss only, vision loss only, and dual sensory loss) was determined by respondents' self-reported perceived difficulty regarding hearing and vision function.The Composite International Diagnostic Interview (CIDI-SF) scale was used to identify major episodic depression. Logistic regression was used to estimate the odds ratios (ORs) and 95% CIs of depression comparing participants with vs without sensory loss, adjusting for demographic and clinical covariates. Rural-urban and regional differences were assessed by including interaction terms between these variables and sensory loss.The study analysis included 27 927 participants (mean [SD] age, 68.0 [7.2] years; 14 477 [51%] females and 13 450 [49%] males). The fully adjusted models showed that the odds of depression with dual sensory loss (vs no loss) was higher in urban (OR, 3.16; 95% CI, 2.00-4.99) vs rural (OR, 1.73; 95% CI, 1.31-2.29) residents and among residents in the West (OR, 5.10; 95% CI, 1.74-14.97) vs North (OR, 1.38; 95% CI, 0.81-2.35) regions.These findings indicate that sensory loss is associated with depression in older adults, with differences by urbanicity and region. Adults with sensory loss across multiple systems may be an important group to target for intervention.

  View details for DOI 10.1001/jamaoto.2024.4488

  View details for Web of Science ID 001389481500001

  View details for PubMedID 39745745

  View details for PubMedCentralID PMC11907313

• ASSOCIATIONS BETWEEN HEARING LOSS AND FUNCTIONAL BRAIN CONNECTIVITY AMONG DEMENTIA-FREE OLDER ADULTS Jiang, K., Reed, N., Soldan, A., Lin, F., Albert, M., Deal, J., Pettigrew, C. OXFORD UNIV PRESS. 2024: 328-329

  View details for DOI 10.1093/geroni/igae098.1072

  View details for Web of Science ID 001387927600001

• AFFORDABLE, ACCESSIBLE HEARING CARE AMONG INDIVIDUALS WITH COGNITIVE IMPAIRMENT: LESSONS FROM THE HEARS RCT Nieman, C., Betz, J., Suen, J., Trumbo, J., Han, H., Marrone, N., Lin, F., Oh, E. OXFORD UNIV PRESS. 2024: 134

  View details for DOI 10.1093/geroni/igae098.0431

  View details for Web of Science ID 001387928700001

• Sleep characteristics and hearing loss in middle-aged and older adults: The National Health and Nutrition Examination Survey 2015-2018✰. Sleep epidemiology Jiang, K., Spira, A. P., Reed, N. S., Lin, F. R., Deal, J. A. 2024; 4

  Abstract

  Background: Population-based evidence linking sleep characteristics with hearing is limited and how the associations change with age remains unknown. We aim to investigate cross-sectional associations between sleep characteristics and hearing by age in a nationally representative sample of U.S. adults.Methods: We included 3,100 participants aged 40 years and older from the National Health and Nutrition Examination Survey 2015-18. Audiometric hearing thresholds at 0.5, 1, 2 and 4 kilohertz were averaged to calculate better-ear pure-tone average (PTA). Sleep questions were self-reported, including sleep duration on weekdays or workdays, snoring, snorting or stopping breathing, trouble sleeping, and daytime sleepiness. Multivariable-adjusted linear regression with an interaction term between sleep characteristic (categorical) and age (continuous in years) was used. Primary models adjusted for demographic and lifestyle factors with additional adjustment for cardiovascular factors in secondary models.Results: There was no association of reported sleep duration with PTA at age 50; however, compared to those reporting 7-8 h of sleep, there was a borderline-significant association at age 60 (<7 h: 1.72 dB, 95 % confidence interval [CI], -0.21, 3.66; >8 h: 1.25 dB, 95 % CI, -0.01, 2.51), and a significant association at age 70 (<7 h: 2.52 dB, 95 % CI, -0.27, 5.31; >8 h: 2.67 dB, 95 % CI, 0.56, 4.79). No consistent associations for other sleep characteristics were found.Conclusions: Long sleep duration is associated with worse hearing among middle-aged and older adults and the association differs by age. Longitudinal evidence is needed to establish temporality and examine changes in hearing associated with sleep characteristics.

  View details for DOI 10.1016/j.sleepe.2024.100082

  View details for PubMedID 39886101

• Clinical Manifestations. Alzheimer's & dementia : the journal of the Alzheimer's Association Pike, J. R., Huang, A. R., Deal, J. A., Reed, N. S., Burgard, S., Chisolm, T., Couper, D., Glynn, N. W., Gmelin, T., Goman, A. M., Gravens-Mueller, L., Hayden, K. M., Mitchell, C., Pankow, J., Sanchez, V. A., Schrack, J. A., Albert, M. S., Jack, C. R., Knopman, D. S., Coresh, J., Lin, F. R., ACHIEVE Collaborative Research Group 2024; 20 Suppl 3: e086740

  Abstract

  BACKGROUND: Prior longitudinal studies among older adults have documented associations between hearing loss and changes in brain morphology. Whether interventions involving hearing aids can reduce age-related atrophy is unknown. A substudy within the Aging and Cognitive Health Evaluation in Elders (ACHIEVE, Clinicaltrials.gov Identifier: NCT03243422) randomized controlled trial tested the effect of a best-practices hearing intervention versus health education control on three-year change in cortical thickness among older adults with hearing loss.METHOD: The ACHIEVE study enrolled 977 community-dwelling adults aged 70-84 years at baseline (2018-2019) with untreated hearing loss (better ear pure tone average [0.5-4 kHz] ≥30 and <70 dB HL) and without substantial cognitive impairment from four sites across the U.S. (Jackson, MS, Forsyth County, NC, Minneapolis, MN, Washington County, MD). Participants were randomized to a hearing intervention (provision of hearing aids and related technologies, counseling, and education) or a health education control (individual sessions with a health educator covering topics relevant to chronic disease and disability prevention). Three-dimensional magnetic resonance imaging was performed on 3 Tesla Siemens scanners in a subsample of 445 participants at the ACHIEVE baseline and three-year follow-up. Linear mixed effects models were used in intention-to-treat analyses to estimate three-year change in cortical thickness. All models adjusted for baseline measures of hearing loss, recruitment source, site, age, sex, and education. Missing outcome and covariate data was imputed to mitigate bias caused by informative attrition.RESULT: At baseline, 224 participants were women (50.3%), 52 participants were Black (11.7%), and the mean (SD) age was 76.4 (4.0) years old (Table 1). Compared to the health education control, the hearing intervention exhibited a nominally protective effect on three-year change in average cortical thickness (Figure 1). The greatest effect size for cortical thickness was observed in the occipital lobe, while the smallest effect size was detected in the temporal lobe. Statistically significant effects were detected in the pars orbitalis, rostral anterior cingulate, posterior cingulate, and isthmus cingulate (Figure 2).CONCLUSION: Hearing aid use may reduce decline in cortical thickness among older adults. The effects of hearing aids may be greatest in regions other than those associated with the auditory cortex.

  View details for DOI 10.1002/alz.086740

  View details for PubMedID 39750676

• A Hearing Intervention and Health-Related Quality of Life in Older Adults: A Secondary Analysis of the ACHIEVE Randomized Clinical Trial JAMA NETWORK OPEN Huang, A. R., Morales, E., Arnold, M. L., Burgard, S., Couper, D., Deal, J. A., Glynn, N. W., Gmelin, T., Goman, A. M., Gravens-Mueller, L., Hayden, K. M., Mitchell, C. M., Pankow, J. S., Pike, J. R., Reed, N. S., Sanchez, V. A., Schrack, J. A., Sullivan, K. J., Coresh, J., Lin, F. R., Chisolm, T. H. 2024; 7 (11): e2446591

  Abstract

  Health-related quality of life is a critical health outcome and a clinically important patient-reported outcome in clinical trials. Hearing loss is associated with poorer health-related quality-of-life in older adults.To investigate the 3-year outcomes of hearing intervention vs health education control on health-related quality of life.This secondary analysis of a randomized clinical trial included participants treated for hearing loss at multiple US centers between 2018 and 2019 with 3-year follow-up completed in 2022. Eligible participants were aged 70 to 84 years, had untreated hearing loss, and were without substantial cognitive impairment. Participants were randomized (1:1) to hearing intervention or health education control and followed every 6 months.Hearing intervention (provision of hearing aids and related technologies, counseling, education) or health education control (individual sessions covering topics relevant to chronic disease, disability prevention).Three-year change in the RAND-36 physical and mental health component scores over 3 years. The 8 individual domains of health-related quality-of-life were additionally assessed. Outcomes measured at baseline and at 6-month, 1-year, 2-year, and 3-year follow-ups. Intervention effect sizes estimated using a 2-level linear mixed effects model under the intention-to-treat principle.A total of 977 participants were analyzed (mean [SD] age, 76.8 [4.0] years; 523 female [53.5%]; 112 Black [11.5%], 858 White [87.8%]; 521 had a Bachelor's degree or higher [53.4%]), with 490 in the hearing intervention and 487 in the control group. Over 3 years, hearing intervention (vs health education control) had no significant association with physical (intervention, -0.49 [95% CI, -3.05 to 2.08]; control, -0.92 [95% CI, -3.39 to 1.55]; difference, 0.43 [95% CI, -0.64 to 1.51]) or mental (intervention, 0.38 [95% CI, -1.58 to 2.34]; control, -0.09 [95% CI, -1.99 to 1.81]; difference, 0.47 [95% CI, -0.41 to 1.35]) health-related quality of life.In this secondary analysis of a randomized clinical trial, hearing intervention had no association with physical and mental health-related quality-of-life over 3 years among older adults with hearing loss. Additional intervention strategies may be needed to modify health-related quality among older adults with hearing loss.ClinicalTrials.gov Identifier: NCT03243422.

  View details for DOI 10.1001/jamanetworkopen.2024.46591

  View details for Web of Science ID 001361868200007

  View details for PubMedID 39570588

  View details for PubMedCentralID PMC11582982

• Use of Hearing Services in Traditional Medicare and Medicare Advantage JAMA HEALTH FORUM Bessen, S. Y., Morales, E., Lin, F. R., Reed, N. S. 2024; 5 (10): e243619

  View details for DOI 10.1001/jamahealthforum.2024.3619

  View details for Web of Science ID 001342038100003

  View details for PubMedID 39453638

  View details for PubMedCentralID PMC11581654

• Effect of Hearing Intervention Versus Health Education Control on Fatigue: A Secondary Analysis of the ACHIEVE Study JOURNALS OF GERONTOLOGY SERIES A-BIOLOGICAL SCIENCES AND MEDICAL SCIENCES Bessen, S. Y., Zhang, W., Huang, A. R., Arnold, M., Burgard, S., Chisolm, T. H., Couper, D., Deal, J. A., Faucette, S. P., Goman, A. M., Glynn, N. W., Gmelin, T., Gravens-Mueller, L., Hayden, K. M., Mitchell, C. M., Pankow, J. S., Pike, J. R., Reed, N. S., Sanchez, V. A., Schrack, J. A., Sullivan, K. J., Coresh, J., Lin, F. R., Martinez-Amezcua, P. 2024; 79 (11)

  Abstract

  Fatigue is a common complaint among older adults with hearing loss. The impact of addressing hearing loss on fatigue symptoms has not been studied in a randomized controlled trial. In a secondary analysis of the Aging and Cognitive Health Evaluation in Elders (ACHIEVE) study, we investigated the effect of hearing intervention versus health education control on 3-year change in fatigue in community-dwelling older adults with hearing loss.Participants aged 70-84 years old with untreated hearing loss recruited across 4 study sites in the United States (Forsyth County, North Carolina; Jackson, Mississippi; Minneapolis, Minnesota; Washington County, Maryland) were randomized (1:1) to hearing intervention or health education control and followed for 3 years. Three-year change in fatigue symptoms was measured by 2 instruments (RAND-36 and PROMIS). We estimated the intervention effect as the difference in the 3-year change in fatigue between intervention and control groups using a linear mixed-effects model under the intention-to-treat principle.Participants (n = 977) had a mean age (SD) of 76.8 (4.0) years, were 53.5% female and 87.8% White. Over 3 years, a beneficial effect of the hearing intervention versus health education control on fatigue was observed using the RAND-fatigue score (β = -0.12 [95% CI: -0.22, -0.02]). Estimates also suggested beneficial effect of hearing intervention on fatigue when measured by the PROMIS-fatigue score (β = -0.32 [95% CI: -1.15, 0.51]).Our findings suggest that hearing intervention may reduce fatigue over 3 years among older adults with hearing loss.

  View details for DOI 10.1093/gerona/glae193

  View details for Web of Science ID 001312390500001

  View details for PubMedID 39093692

  View details for PubMedCentralID PMC11402025

• Effect of hearing intervention on communicative function: A secondary analysis of the ACHIEVE randomized controlled trial JOURNAL OF THE AMERICAN GERIATRICS SOCIETY Sanchez, V. A., Arnold, M. L., Morales, E., Reed, N. S., Faucette, S., Burgard, S., Calloway, H. N., Coresh, J., Deal, J. A., Goman, A. M., Gravens-Mueller, L., Hayden, K. M., Huang, A. R., Mitchell, C. M., Mosley, T. H., Pankow, J. S., Pike, J. R., Schrack, J. A., Sherry, L., Weycker, J. M., Lin, F. R., Chisolm, T. H., ACHIEVE Collaborative Study 2024; 72 (12): 3784-3799

  Abstract

  The Aging and Cognitive Health Evaluation in Elders (ACHIEVE) Study was designed to determine the effects of a best-practice hearing intervention on cognitive decline among community-dwelling older adults. Here, we conducted a secondary analysis of the ACHIEVE Study to investigate the effect of hearing intervention on self-reported communicative function.The ACHIEVE Study is a parallel-group, unmasked, randomized controlled trial of adults aged 70-84 years with untreated mild-to-moderate hearing loss and without substantial cognitive impairment. Participants were randomly assigned (1:1) to a hearing intervention (audiological counseling 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 semiannually for 3 years. Self-reported communicative function was measured with the Hearing Handicap Inventory-Elderly Screening version (HHIE-S, range 0-40, higher scores indicate greater impairment). Effect of hearing intervention versus control on HHIE-S was analyzed through an intention-to-treat model controlling for known covariates.HHIE-S improved after 6-months with hearing intervention compared to control, and continued to be better through 3-year follow-up. We estimated a difference of -8.9 (95% CI: -10.4, -7.5) points between intervention and control groups in change in HHIE-S score from baseline to 6 months, -9.3 (95% CI: -10.8, -7.9) to Year 1, -8.4 (95% CI: -9.8, -6.9) to Year 2, and - 9.5 (95% CI: -11.0, -8.0) to Year 3. Other prespecified sensitivity analyses that varied analytical parameters did not change the observed results.Hearing intervention improved self-reported communicative function compared to a control intervention within 6 months and with effects sustained through 3 years. These findings suggest that clinical recommendations for older adults with hearing loss should encourage hearing intervention that could benefit communicative function and potentially have positive downstream effects on other aspects of health.

  View details for DOI 10.1111/jgs.19185

  View details for Web of Science ID 001310691700001

  View details for PubMedID 39266468

  View details for PubMedCentralID PMC11637286

• Cross-Sectional Associations of Peripheral Hearing, Brain Imaging, and Cognitive Performance With Speech-in-Noise Performance: The Aging and Cognitive Health Evaluation in Elders Brain Magnetic Resonance Imaging Ancillary Study AMERICAN JOURNAL OF AUDIOLOGY Jiang, K., Albert, M. S., Coresh, J., Couper, D. J., Gottesman, R. F., Hayden, K. M., Jack Jr, C. R., Knopman, D. S., Mosley, T. H., Pankow, J. S., Pike, J. R., Reed, N. S., Sanchez, V. A., Sharrett, A., Lin, F. R., Deal, J. A., ACHIEVE Collaborative Study 2024; 33 (3): 683-694

  Abstract

  Population-based evidence in the interrelationships among hearing, brain structure, and cognition is limited. This study aims to investigate the cross-sectional associations of peripheral hearing, brain imaging measures, and cognitive function with speech-in-noise performance among older adults.We studied 602 participants in the Aging and Cognitive Health Evaluation in Elders (ACHIEVE) brain magnetic resonance imaging (MRI) ancillary study, including 427 ACHIEVE baseline (2018-2020) participants with hearing loss and 175 Atherosclerosis Risk in Communities Neurocognitive Study Visit 6/7 (2016-2017/2018-2019) participants with normal hearing. Speech-in-noise performance, as outcome of interest, was assessed by the Quick Speech-in-Noise (QuickSIN) test (range: 0-30; higher = better). Predictors of interest included (a) peripheral hearing assessed by pure-tone audiometry; (b) brain imaging measures: structural MRI measures, white matter hyperintensities, and diffusion tensor imaging measures; and (c) cognitive performance assessed by a battery of 10 cognitive tests. All predictors were standardized to z scores. We estimated the differences in QuickSIN associated with every standard deviation (SD) worse in each predictor (peripheral hearing, brain imaging, and cognition) using multivariable-adjusted linear regression, adjusting for demographic variables, lifestyle, and disease factors (Model 1), and, additionally, for other predictors to assess independent associations (Model 2).Participants were aged 70-84 years, 56% female, and 17% Black. Every SD worse in better-ear 4-frequency pure-tone average was associated with worse QuickSIN (-4.89, 95% confidence interval, CI [-5.57, -4.21]) when participants had peripheral hearing loss, independent of other predictors. Smaller temporal lobe volume was associated with worse QuickSIN, but the association was not independent of other predictors (-0.30, 95% CI [-0.86, 0.26]). Every SD worse in global cognitive performance was independently associated with worse QuickSIN (-0.90, 95% CI [-1.30, -0.50]).Peripheral hearing and cognitive performance are independently associated with speech-in-noise performance among dementia-free older adults. The ongoing ACHIEVE trial will elucidate the effect of a hearing intervention that includes amplification and auditory rehabilitation on speech-in-noise understanding in older adults.https://doi.org/10.23641/asha.25733679.

  View details for DOI 10.1044/2024_AJA-23-00108

  View details for Web of Science ID 001325407800005

  View details for PubMedID 38748919

  View details for PubMedCentralID PMC11427419

• Hearing intervention and cognitive decline: the ACHIEVE trial Reply LANCET Lin, F. R., Coresh, J. 2024; 404 (10447): 30

  View details for DOI 10.1016/S0140-6736(24)00713-X

  View details for Web of Science ID 001414630700001

  View details for PubMedID 38971593

• Age-Related Hearing Loss. Reply. The New England journal of medicine Lin, F. R. 2024; 391 (1): 96

  View details for DOI 10.1056/NEJMc2406363

  View details for PubMedID 38959492

• Age-Related Hearing Loss NEW ENGLAND JOURNAL OF MEDICINE Fink, D., Lin, F. R. 2024; 391 (1): 95-96

  View details for DOI 10.1056/NEJMc2406363

  View details for Web of Science ID 001272081300014

  View details for PubMedID 38959491

• Hearing Impairment and Physical Activity and Physical Functioning in Older Adults: Baseline Results From the ACHIEVE Trial JOURNALS OF GERONTOLOGY SERIES A-BIOLOGICAL SCIENCES AND MEDICAL SCIENCES Cai, Y., Martinez-Amezcua, P., Betz, J. F., Zhang, T., Huang, A. R., Wanigatunga, A. A., Glynn, N. W., Burgard, S., Chisolm, T. H., Coresh, J., Couper, D., Deal, J. A., Gmelin, T., Goman, A. M., Gravens-Mueller, L., Hayden, K. M., Mitchell, C. M., Mosley, T., Pankow, J. S., Pike, J. R., Reed, N. S., Sanchez, V. A., Lin, F. R., Schrack, J. A., ACHIEVE Collaborative Res Grp 2024; 79 (7)

  Abstract

  Hearing loss is associated with restricted physical activity (PA) and impaired physical functioning, yet the relationship between severity of hearing impairment (HI) and novel PA measures in older adults with untreated HI is not well understood.Analyses included 845 participants aged ≥70 years (mean = 76.6 years) with a better-hearing ear pure-tone average (PTA) ≥30 and <70 dB in the Aging and Cognitive Health Evaluation in Elders (ACHIEVE) study who wore an ActiGraph accelerometer for 7 days. Physical functioning measures included grip strength and the Short Physical Performance Battery (SPPB). Linear regression models estimated the association by HI level (moderate or greater [PTA ≥ 40 dB] vs mild [PTA < 40 dB]) and continuous hearing with total daily activity counts, active minutes/day, activity fragmentation, grip strength, and gait speed. Logistic regression models estimated odds ratios (ORs) and 95% confidence intervals (CIs) of poor performance on the SPPB (≤6) and its subtests (≤2). Mixed-effects models estimated differences by HI level in activity by time of day.Participants with moderate or greater HI had poorer physical functioning, particularly balance (OR = 2.17, 95% CI = 1.29-3.67), versus those with mild impairment. There was no association of HI level with activity quantities or fragmentation. For diurnal patterns of activity, participants with moderate or greater HI had fewer activity counts in the afternoon (12:00 pm -05:59 pm).Older adults with worse hearing had shifted diurnal patterns and poorer balance performance. Exercise programs should be tailored to older adults with different levels of HI to maintain PA and physical functioning, particularly balance control.

  View details for DOI 10.1093/gerona/glae117

  View details for Web of Science ID 001246118400002

  View details for PubMedID 38695059

  View details for PubMedCentralID PMC11170292

• Adult-onset hearing loss and incident cognitive impairment and dementia - A systematic review and meta-analysis of cohort studies AGEING RESEARCH REVIEWS Yu, R., Proctor, D., Soni, J., Pikett, L., Livingston, G., Lewis, G., Schilder, A., Bamiou, D., Mandavia, R., Omar, R., Pavlou, M., Lin, F., Goman, A. M., Gonzalez, S. 2024; 98: 102346

  Abstract

  We comprehensively summarized the cohort evidence to date on adult-onset hearing loss as risk factor for incident cognitive impairment and dementia, and examined the evidence for dose-response, risk for various dementia subtypes, and other moderators. Previous meta-analyses were less comprehensive.We included cohort studies with participants without dementia and with hearing assessments at baseline, minimum 2 years follow-up and incident cognitive outcomes. We used random-effect models and subgroup and meta-regression on moderator analyses.We identified fifty studies (N=1,548,754). Hearing loss (yes/no) was associated with incident dementia risk (HR=1.35 [95% CI = 1.26 - 1.45), mild cognitive impairment (MCI HR=1.29 [95% CI = 1.11 - 1.50]), cognitive decline not specified as MCI or dementia (HR=1.29 [95% CI = 1.17 - 1.42]), and Alzheimer's disease dementia (ADD, HR=1.56 [95% CI = 1.30 - 1.87]), but not with vascular dementia (HR, 1.30 [95% CI = 0.83 - 2.05]). Each 10-decibel worsening of hearing was associated with a 16% increase in dementia risk (95% CI = 1.07 - 1.27). The effect of hearing loss did not vary across potential moderators.Cohort studies consistently support that adult-onset hearing loss increases the risk of incident cognitive decline, dementia, MCI, and ADD.

  View details for DOI 10.1016/j.arr.2024.102346

  View details for Web of Science ID 001249602600001

  View details for PubMedID 38788800

• Perceived Challenges and Coping Strategies in Hearing-Impaired Individuals Across Normal Vision, Low Vision, and Blindness Reed, P., Nemargut, J., Goldstein, J. E., Lin, F., Xiong, Y. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2024

  View details for Web of Science ID 001313316207205

• Design and Methods of the Early Age-Related Hearing Loss Investigation Randomized Controlled Trial OTOLOGY & NEUROTOLOGY Denham, M. W., Arnold, M. L., Sanchez, V. A., Lin, F. R., Gomez, M. C., Neil, H., Boyle, S., Selevan, S., Sussman, T. J., Fine, I., Glynn, N. W., Teresi, J., Noble, J. M., Goldberg, T., Luchsinger, J. A., Golub, J. S. 2024; 45 (5): 594-601

  Abstract

  Hearing loss has been identified as a major modifiable risk factor for cognitive decline. The Early Age-Related Hearing Loss Investigation (EARHLI) study will assess the mechanisms linking early age-related hearing loss (ARHL) and cognitive impairment.Randomized, controlled, single-site, early phase II, superiority trial.Tertiary academic medical center.One hundred fifty participants aged 55 to 75 years with early ARHL (severity defined as borderline to moderate) and amnestic mild cognitive impairment will be included.Participants will be randomized 1:1 to a best practice hearing intervention or a health education control.The primary study outcome is cognition measured by the Alzheimer Disease Cooperative Study-Preclinical Alzheimer Cognitive Composite. Secondary outcomes include additional measures of cognition, social engagement, and brain organization/connectivity.Trial enrollment will begin in early 2024.After its completion in 2028, the EARHLI trial should offer evidence on the effect of hearing treatment versus a health education control on cognitive performance, social engagement, and brain organization/connectivity in 55- to 75-year-old community-dwelling adults with early ARHL and amnestic mild cognitive impairment.

  View details for DOI 10.1097/MAO.0000000000004093

  View details for Web of Science ID 001218119100003

  View details for PubMedID 38728564

  View details for PubMedCentralID PMC11093050

• Coronary artery calcium as a marker of healthy and unhealthy aging in adults aged 75 and older: The Atherosclerosis Risk in Communities (ARIC) study ATHEROSCLEROSIS Obisesan, O. H., Boakye, E., Wang, F. M., Dardari, Z., Dzaye, O., Cainzos-Achirica, M., Meyer, M. L., Gottesman, R., Palta, P., Coresh, J., Howard-Claudio, C. M., Lin, F. R., Punjabi, N., Nasir, K., Matsushita, K., Blaha, M. J. 2024; 392: 117475

  Abstract

  Coronary artery calcium (CAC) is validated for risk prediction among middle-aged adults, but there is limited research exploring implications of CAC among older adults. We used data from the Atherosclerosis Risk in Communities (ARIC) study to evaluate the association of CAC with domains of healthy and unhealthy aging in adults aged ≥75 years.We included 2,290 participants aged ≥75 years free of known coronary heart disease who underwent CAC scoring at study visit 7. We examined the cross-sectional association of CAC = 0, 1-999 (reference), and ≥1000 with seven domains of aging: cognitive function, hearing, ankle-brachial index (ABI), pulse-wave velocity (PWV), forced vital capacity (FVC), physical functioning, and grip strength.The mean age was 80.5 ± 4.3 years, 38.6% male, and 77.7% White. 10.3% had CAC = 0 and 19.2% had CAC≥1000. Individuals with CAC = 0 had the lowest while those with CAC≥1000 had the highest proportion with dementia (2% vs 8%), hearing impairment (46% vs 67%), low ABI (3% vs 18%), high PWV (27% vs 41%), reduced FVC (34% vs 42%), impaired grip strength (66% vs 74%), and mean composite abnormal aging score (2.6 vs 3.7). Participants with CAC = 0 were less likely to have abnormal ABI (aOR:0.15, 95%CI:0.07-0.34), high PWV (aOR:0.57, 95%CI:0.41-0.80), and reduced FVC (aOR:0.69, 95%CI:0.50-0.96). Conversely, participants with CAC≥1000 were more likely to have low ABI (aOR:1.74, 95%CI:1.27-2.39), high PWV (aOR:1.52, 95%CI:1.15-2.00), impaired physical functioning (aOR:1.35, 95%CI:1.05-1.73), and impaired grip strength (aOR:1.46, 95%CI:1.08-1.99).Our findings highlight CAC as a simple measure broadly associated with biological aging, with clinical and research implications for estimating the physical and physiological aging trajectory of older individuals.

  View details for DOI 10.1016/j.atherosclerosis.2024.117475

  View details for Web of Science ID 001242828800001

  View details for PubMedID 38408881

  View details for PubMedCentralID PMC11088977

• Age-Related Hearing Loss NEW ENGLAND JOURNAL OF MEDICINE Lin, F. R. 2024; 390 (16): 1505-1512

  View details for DOI 10.1056/NEJMcp2306778

  View details for Web of Science ID 001253004600007

  View details for PubMedID 38657246

• Description of the Baseline Audiologic Characteristics of the Participants Enrolled in the Aging and Cognitive Health Evaluation in Elders Study AMERICAN JOURNAL OF AUDIOLOGY Sanchez, V. A., Arnold, M. L., Betz, J. F., Reed, N. S., Faucette, S., Anderson, E., Burgard, S., Coresh, J., Deal, J. A., Eddins, A., Goman, A. M., Glynn, N. W., Gravens-Mueller, L., Hampton, J., Hayden, K. M., Huang, A. R., Liou, K., Mitchell, C. M., Mosley Jr, T. H., Neil, H. N., Pankow, J. S., Pike, J. R., Schrack, J. A., Sherry, L., Teece, K. H., Witherell, K., Lin, F. R., Chisolm, T. H., ACHIEVE Collaborative Study 2024; 33 (1): 122-138

  Abstract

  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.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.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.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.https://doi.org/10.23641/asha.24756948.

  View details for DOI 10.1044/2023_AJA-23-00066

  View details for Web of Science ID 001245952000011

  View details for PubMedID 38166200

  View details for PubMedCentralID PMC11001432

• Hearing loss and dementia in older adults: A narrative review JOURNAL OF THE CHINESE MEDICAL ASSOCIATION Huang, A. R., Lin, F. R. 2024; 87 (3): 252-258

  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.

  View details for DOI 10.1097/JCMA.0000000000001042

  View details for Web of Science ID 001179373600003

  View details for PubMedID 38112446

  View details for PubMedCentralID PMC12718930

• Sensory andmotor deficits as contributors to early cognitive impairment ALZHEIMERS & DEMENTIA Sayyid, Z. N., Wang, H., Cai, Y., Gross, A. L., Swenor, B. K., Deal, J. A., Lin, F. R., Wanigatunga, A. A., Dougherty, R. J., Tian, Q., Simonsick, E. M., Ferrucci, L., Schrack, J. A., Resnick, S., Agrawal, Y. 2024; 20 (4): 2653-2661

  Abstract

  Age-related sensory and motor impairment are associated with risk of dementia. No study has examined the joint associations of multiple sensory and motor measures on prevalence of early cognitive impairment (ECI).Six hundred fifty participants in the Baltimore Longitudinal Study of Aging completed sensory and motor function tests. The association between sensory and motor function and ECI was examined using structural equation modeling with three latent factors corresponding to multisensory, fine motor, and gross motor function.The multisensory, fine, and gross motor factors were all correlated (r = 0.74 to 0.81). The odds of ECI were lower for each additional unit improvement in the multisensory (32%), fine motor (30%), and gross motor factors (12%).The relationship between sensory and motor impairment and emerging cognitive impairment may guide future intervention studies aimed at preventing and/or treating ECI.Sensorimotor function and early cognitive impairment (ECI) prevalence were assessed via structural equation modeling. The degree of fine and gross motor function is associated with indicators of ECI. The degree of multisensory impairment is also associated with indicators of ECI.

  View details for DOI 10.1002/alz.13715

  View details for Web of Science ID 001169887200001

  View details for PubMedID 38375574

  View details for PubMedCentralID PMC11032563

• 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 & DEMENTIA-TRANSLATIONAL RESEARCH & CLINICAL INTERVENTIONS Reed, N. S., Gravens-Mueller, L., Huang, A. R., Goman, A. M., Mitchell, C. M., Arnold, M. L., Bolton, S., Burgard, S., Chisolm, T. H., Couper, D., Deal, J. A., Evans, J., Faucette, S., Glynn, N. W., Gmelin, T., Hayden, K. M., Miller, E., Minotti, M., Mosley, T., Naylor, S., Pankow, J. S., Pike, J., Sanchez, V. A., Schrack, J. A., Coresh, J., Lin, F. R., ACHIEVE Collaborative Res Grp 2024; 10 (1): e12453

  Abstract

  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.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.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.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.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.

  View details for DOI 10.1002/trc2.12453

  View details for Web of Science ID 001161241200001

  View details for PubMedID 38356470

  View details for PubMedCentralID PMC10865776

• Association between hearing aid use and mortality in adults with hearing loss in the USA: a mortality follow-up study of a cross-sectional cohort LANCET HEALTHY LONGEVITY Choi, J. S., Adams, M. E., Crimmins, E. M., Lin, F. R., Ailshire, J. A. 2024; 5 (1): e66-e75

  Abstract

  Hearing loss has been identified as an independent risk factor for negative health outcomes and mortality. However, whether rehabilitation with hearing aid use is associated with lower mortality is currently unknown. This study aimed to examine the associations of hearing loss, hearing aid use, and mortality in the USA.In this cross-sectional, follow-up study, we assessed 9885 adults (age 20 years and older) who participated in the National Health and Nutrition Examination Survey between 1999 and 2012 and completed audiometry and hearing aid use questionnaires (1863 adults with hearing loss). Main measures included hearing loss (speech-frequency pure-tone average) and hearing aid use (never users, non-regular users, and regular users). Mortality status of the cohort was linked to the National Death Index up to Dec 31, 2019. Cox proportional regression models were used to examine the association between hearing loss, hearing aid use, and mortality while adjusting for demographics and medical history.The cohort consisted of 9885 participants, of which 5037 (51·0%) were female and 4848 (49·0%) were male with a mean age of 48·6 years (SD 18·1) at baseline. The weighted prevalence of audiometry-measured hearing loss was 14·7% (95% CI 13·3-16·3%) and the all-cause mortality rate was 13·2% (12·1-14·4) at a median 10·4 years of follow-up (range 0·1-20·8). The rate of regular hearing aid use among adults with hearing loss was 12·7% (95% CI 10·6-15·1). Hearing loss was an independent risk factor associated with higher mortality (adjusted hazard ratio [HR] 1·40 [95% CI 1·21-1·62]). Among individuals with hearing loss, the adjusted mortality risk was lower among regular hearing aid users in comparison with never users (adjusted HR 0·76 [0·60-0·95]) accounting for demographics, hearing levels, and medical history. There was no difference in adjusted mortality between non-regular hearing aid users and never users (adjusted HR 0·93 [0·70-1·24]).Regular hearing aid use was associated with lower risks of mortality than in never users in US adults with hearing loss when accounting for age, hearing loss, and other potential confounders. Future research is needed to investigate the potential protective role of hearing aid use against mortality for adults with hearing loss.None.

  View details for DOI 10.1016/S2666-7568(23)00232-5

  View details for Web of Science ID 001155445100001

  View details for PubMedID 38183998

  View details for PubMedCentralID PMC11501007

• Hearing impairment and risk of dementia in The HUNT Study (HUNT4 70+): a Norwegian cohort study ECLINICALMEDICINE Myrstad, C., Engdahl, B., Costafreda, S., Krokstad, S., Lin, F., Livingston, G., Strand, B., Ohre, B., Selbaek, G. 2023; 66: 102319

  Abstract

  Hearing impairment is strongly associated with future dementia. No studies have reported objectively measured hearing impairment in a cohort with a long period of follow-up (>20 years), and few have reported follow-up over 10 years. Hence, there is a need for high quality studies with sufficient follow-up time and data to account for reverse causality and confounding. We aimed to address this knowledge gap.This cohort study used individual participant data from The Trøndelag Health Study (HUNT) in Norway. All current residents aged at least 20 years in the former Norwegian Nord-Trøndelag County were invited to participate in four decennial surveys: HUNT1 (1984-1986), HUNT2 (1995-1997), HUNT3 (2006-2008), and HUNT4 (2017-2019) with individuals aged at least 70 years included in a substudy, known as HUNT4 70+. Here, we report the findings of this substudy. HUNT4 70+ comprised 7135 participants who were assessed for dementia using the Diagnostic and Statistical Manual of Mental Disorders 5 criteria and who had audiometry between 1996 and 1998. The primary objective was to investigate, with gold standard audiometric testing and dementia diagnostic assessment, whether hearing impairment was an independent risk factor for all-cause dementia. The secondary objective was to investigate if a risk also applied to Alzheimer dementia and non-Alzheimer dementia. We analysed the association using Poisson regression and adjusted for confounders. This study is registered with ClinicalTrials.gov (NCT04284384).At baseline, 1058 (15%) individuals had acquired hearing impairment with a hearing threshold of at least 25 decibel (dB) and, at follow-up, 1089 (15%) had dementia. In the total group, people with hearing impairment had a relative risk (RR) 1.04 (95% confidence interval (CI) 1.00-1.09) per 10 dB increase in hearing thresholds. For individuals younger than 85 years at follow-up the RR was 1.12 (95% CI 1.05-1.21). Associations between hearing impairment and Alzheimer dementia and non-Alzheimer dementia were similar. There was no association for individuals aged at least 85 years.We found a moderate association between objectively measured hearing impairment and dementia in the younger age group (<85 years). The findings of no association in the older age group (≥85 years) might be due to the competing risk of death. The present study adds to the literature showing that acquired hearing impairment is a risk for dementias over a period which is too long for reverse causation, and with thorough consideration of confounders. Further research is needed to investigate associations between the different aetiologies of hearing loss and dementia subtypes, and risk differences for sexes.The Norwegian National Centre for Ageing and Health with a grant from Health South-East.

  View details for DOI 10.1016/j.eclinm.2023.102319

  View details for Web of Science ID 001140366000001

  View details for PubMedID 38192588

  View details for PubMedCentralID PMC10772264

• Hearing loss and cognition: A protocol for ensuring speech understanding before neurocognitive assessment ALZHEIMERS & DEMENTIA Kolberg, E. R., Morales, E., Thallmayer, T. W., Arnold, M. L., Burgard, S., Chisolm, T. H., Coresh, J., Couper, D., Hayden, K. M., Huang, A. R., Lin, F. R., Mitchell, C. M., Mosley, T. H., Gravens-Mueller, L., Owens, T. A., Pankow, J. S., Pike, J., Reed, N. S., Sanchez, V., Schrack, J. A., Deal, J. A., Goman, A. M., ACHIEVE Collaborative Res Grp 2024; 20 (3): 1671-1681

  Abstract

  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.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.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.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.

  View details for DOI 10.1002/alz.13552

  View details for Web of Science ID 001120090700001

  View details for PubMedID 38081140

  View details for PubMedCentralID PMC10947954

• OBSTRUCTIVE SLEEP APNEA RISK AND LONGITUDINAL TRAJECTORY OF FUNCTIONAL HEARING LOSS OVER EIGHT YEARS OF FOLLOW-UP Jiang, K., Spira, A., Reed, N., Lin, F., Deal, J. OXFORD UNIV PRESS. 2023: 492-493

  View details for Web of Science ID 001178258402303

• POPULATION ATTRIBUTABLE FRACTIONS FOR THE CONTRIBUTION OF HEARING LOSS ON DEMENTIA RISK ACROSS COHORT STUDIES Smith, J., Burg, E., Sharrett, A., Reed, N., Lin, F., Coresh, J., Deal, J., Ishak, E. OXFORD UNIV PRESS. 2023: 232-233

  View details for Web of Science ID 001178258401108

• MODIFICATION OF THE ASSOCIATION BETWEEN HEARING LOSS AND DEMENTIA PREVALENCE BY SELF-REPORTED SLEEP DISTURBANCES Jiang, K., Spira, A., Reed, N., Huang, A., Lin, F., Deal, J. OXFORD UNIV PRESS. 2023: 191-192

  View details for Web of Science ID 001178258400621

• HEARING LOSS AND FATIGUE IN MIDDLE-AGED AND OLDER ADULTS Jiang, K., Spira, A., Lin, F., Deal, J., Reed, N. OXFORD UNIV PRESS. 2023: 162

  View details for Web of Science ID 001178258400525

• Depression and Health-Related Quality of Life Among Older Adults With Hearing Loss in the ACHIEVE Study JOURNAL OF APPLIED GERONTOLOGY Huang, A. R., Reed, N. S., Deal, J. A., Arnold, M., Burgard, S., Chisolm, T., Couper, D., Glynn, N. W., Gmelin, T., Goman, A. M., Gravens-Mueller, L., Hayden, K. M., Mitchell, C., Pankow, J. S., Pike, J. R., Schrack, J. A., Sanchez, V., Coresh, J., Lin, F. R., ACHIEVE Collaborative Res Grp 2024; 43 (5): 550-561

  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.

  View details for DOI 10.1177/07334648231212291

  View details for Web of Science ID 001110357600001

  View details for PubMedID 38016096

  View details for PubMedCentralID PMC10981564

• Loneliness and Social Network Characteristics Among Older Adults With Hearing Loss in the ACHIEVE Study JOURNALS OF GERONTOLOGY SERIES A-BIOLOGICAL SCIENCES AND MEDICAL SCIENCES Huang, A. R., Reed, N. S., Deal, J. A., Arnold, M., Burgard, S., Chisolm, T., Couper, D., Glynn, N. W., Gmelin, T., Goman, A. M., Gravens-Mueller, L., Hayden, K. M., Mitchell, C., Pankow, J. S., Pike, J., Sanchez, V., Schrack, J. A., Coresh, J., Lin, F. R., ACHIEVE Collaborative Res Grp 2024; 79 (2)

  Abstract

  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.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.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]).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.

  View details for DOI 10.1093/gerona/glad196

  View details for Web of Science ID 001090714600001

  View details for PubMedID 37578190

  View details for PubMedCentralID PMC10809043

• Population prevalence of dual sensory loss in community-dwelling US adults 71 years and older: Evidence from the National Health and Aging Trends Study JOURNAL OF THE AMERICAN GERIATRICS SOCIETY Morales, E., Aud, N., Zhou, Y., Assi, S., Varadaraj, V., Lin, F. R., Ehrlich, J. R., Deal, J. A. 2024; 72 (2): 536-543

  Abstract

  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.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.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.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.

  View details for DOI 10.1111/jgs.18648

  View details for Web of Science ID 001094136100001

  View details for PubMedID 37888893

  View details for PubMedCentralID PMC10922129

• Hearing Loss and Frailty among Older Adults: The Atherosclerosis Risk in Communities Study JOURNAL OF THE AMERICAN MEDICAL DIRECTORS ASSOCIATION Assi, S., Morales, E., Windham, G., Lin, F. R., Bandeen-Roche, K., Shukla, A., Palta, P., Deal, J. A., Reed, N. S., Martinez-Amezcua, P. 2023; 24 (11): 1683-1689.e5

  Abstract

  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.Cross-sectional study of community-dwelling older adults at visit 6 (2016-2017) of the Atherosclerosis 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).Population-based study of 3179 participants (mean age = 79.2 years, 58.9% female).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 multinomial and logistic regression models were used to study the association of hearing loss/hearing aid use with frailty status and individual frailty components, respectively.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.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.

  View details for DOI 10.1016/j.jamda.2023.08.023

  View details for Web of Science ID 001104376600001

  View details for PubMedID 37748754

  View details for PubMedCentralID PMC10615781

• Associations of sleep characteristics in late midlife with late-life hearing loss in the Atherosclerosis Risk in Communities-Sleep Heart Health Study (ARIC-SHHS) SLEEP HEALTH Jiang, K., Spira, A. P., Gottesman, R. F., Full, K. M., Lin, F. R., Lutsey, P. L., Morales, E., Punjabi, N. M., Reed, N. S., Sharrett, A., Deal, J. A. 2023; 9 (5): 742-750

  Abstract

  This study investigated associations of late midlife sleep characteristics with late-life hearing, which adds to the existing cross-sectional evidence and is novel in examining polysomnographic sleep measures and central auditory processing.A subset of Atherosclerosis Risk in Communities Study participants underwent sleep assessment in the Sleep Heart Health Study in 1996-1998 and hearing assessment in 2016-2017. Peripheral hearing thresholds (0.5-4kHz) assessed by pure-tone audiometry were averaged to calculate speech-frequency pure-tone average in better-hearing ear (higher pure-tone average=worse hearing). Central auditory processing was measured by the Quick Speech-in-Noise Test (lower score=worse performance). Sleep was measured using polysomnography (time spent in stage 1, stage 2, stage 3/4, rapid eye movement sleep; sleep-disordered breathing [apnea-hypopnea index ≥5]) and self-report (habitual sleep duration; excessive daytime sleepiness [Epworth Sleepiness Scale 10]). Linear regression models adjusted for demographic and lifestyle factors with additional adjustment for cardiovascular factors.Among 719 Atherosclerosis Risk in Communities-Sleep Heart Health Study participants (61 ± 5years, 54% female, 100% White), worse speech-frequency pure-tone average was found with sleep-disordered breathing (2.51dB, 95% confidence interval: 0.27, 4.75) and excessive daytime sleepiness (3.35 dB, 95% confidence interval: 0.81, 5.90). Every additional hour of sleep when sleeping >8 hours was associated with worse Quick Speech-in-Noise score (1.61 points, 95% confidence interval: 0.03, 3.19). Every 10-minute increase in rapid eye movement sleep was associated with 0.14-point better Quick Speech-in-Noise score (95% confidence interval: 0.02, 0.25).Sleep abnormalities might be risk factors for late-life hearing loss. Future longitudinal studies are needed to confirm these novel findings and clarify the mechanisms.

  View details for DOI 10.1016/j.sleh.2023.06.011

  View details for Web of Science ID 001105200000001

  View details for PubMedID 37550152

  View details for PubMedCentralID PMC10592398

• 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 Lin, F. R., Pike, J. R., Albert, M. S., Arnold, M., Burgard, S., Chisolm, T., Couper, D., Deal, J. A., Goman, A. M., Glynn, N. W., Gmelin, T., Gravens-Mueller, L., Hayden, K. M., Huang, A. R., Knopman, D., Mitchell, C. M., Mosley, T., Pankow, J. S., Reed, N. S., Sanchez, V., Schrack, J. A., Windham, B., ACHIEVE Collaborative Res Grp, Coresh, J. 2023; 402 (10404): 786-797

  Abstract

  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.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.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.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.US National Institutes of Health.

  View details for DOI 10.1016/S0140-6736(23)01406-X

  View details for Web of Science ID 001071949300001

  View details for PubMedID 37478886

  View details for PubMedCentralID PMC10529382

• Hearing, β-Amyloid Deposition and Cognitive Test Performance in Black and White Older Adults: The ARIC-PET Study JOURNALS OF GERONTOLOGY SERIES A-BIOLOGICAL SCIENCES AND MEDICAL SCIENCES Deal, J. A., Jiang, K., Rawlings, A., Sharrett, A., Reed, N. S., Knopman, D., Mosley, T., Wong, D., Zhou, Y., Lin, F. R., Gottesman, R. F. 2023; 78 (11): 2105-2110

  Abstract

  Hearing loss is a risk factor for dementia; whether the association is causal or due to a shared pathology is unknown. We estimated the association of brain β-amyloid with hearing, hypothesizing no association. As a positive control, we quantified the association of hearing loss with neurocognitive test performance.Cross-sectional analysis of Atherosclerosis Risk in Communities-Positron Emission Tomography study data. Amyloid was measured using global cortical and temporal lobe standardized uptake value ratios (SUVRs) calculated from florbetapir-positron emission tomography scans. Composite global and domain-specific cognitive scores were created from 10 neurocognitive tests. Hearing was measured using an average of better-ear air conduction thresholds (0.5-4 kHz). Multivariable-adjusted linear regression estimated mean differences in hearing by amyloid and mean differences in cognitive scores by hearing, stratified by race.In 252 dementia-free adults (72-92 years, 37% Black race, and 61% female participants), cortical or temporal lobe SUVR was not associated with hearing (models adjusted for age, sex, education, and APOE ε4). Each 10 dB HL increase in hearing loss was associated with a 0.134 standard deviation lower mean global cognitive factor score (95% CI: -0.248, -0.019), after adjustment for demographic and cardiovascular factors. Observed hearing-cognition associations were stronger in Black versus White participants.Amyloid is not associated with hearing, suggesting that pathways linking hearing and cognition are independent of this pathognomonic Alzheimer's-related brain change. This is the first study to show that the impact of hearing loss on cognition may be stronger in Black versus White adults.

  View details for DOI 10.1093/gerona/glad159

  View details for Web of Science ID 001050623000001

  View details for PubMedID 37419460

  View details for PubMedCentralID PMC10613014

• Hearing Loss and Fatigue in Middle-Aged and Older Adults JAMA OTOLARYNGOLOGY-HEAD & NECK SURGERY Jiang, K., Spira, A. P., Lin, F. R., Deal, J. A., Reed, N. S. 2023; 149 (8): 758-760

  View details for DOI 10.1001/jamaoto.2023.1328

  View details for Web of Science ID 001025144600005

  View details for PubMedID 37410481

  View details for PubMedCentralID PMC10326728

• Prevalence of Hearing Loss and Hearing Aid Use Among US Medicare Beneficiaries Aged 71 Years and Older JAMA NETWORK OPEN Reed, N. S., Garcia-Morales, E. E., Myers, C., Huang, A. R., Ehrlich, J. R., Killeen, O. J., Hoover-Fong, J. E., Lin, F. R., Arnold, M. L., Oh, E. S., Schrack, J. A., Deal, J. A. 2023; 6 (7): e2326320

  Abstract

  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.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.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.Criterion-standard audiometric measures of hearing loss and self-reported hearing aid use.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.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.

  View details for DOI 10.1001/jamanetworkopen.2023.26320

  View details for Web of Science ID 001059379200007

  View details for PubMedID 37505496

  View details for PubMedCentralID PMC10383002

• Olfactory Dysfunction and Depression Trajectories in Community-Dwelling Older Adults JOURNALS OF GERONTOLOGY SERIES A-BIOLOGICAL SCIENCES AND MEDICAL SCIENCES Kamath, V., Jiang, K., Manning, K. J., Mackin, R., Walker, K. A., Powell, D., Lin, F. R., Chen, H., Brenowitz, W. D., Yaffe, K., Simonsick, E. M., Deal, J. A., Hlth ABC Study 2024; 79 (1)

  Abstract

  We examined the relationship between baseline olfactory performance and incident significant depressive symptoms and longitudinal depression trajectories in well-functioning older adults. Inflammation and cognitive status were examined as potential mediators.Older adults (n = 2 125, 71-82 years, 51% female, 37% Black) completed an odor identification task at Year 3 (our study baseline) of the Health, Aging, and Body Composition study. Cognitive assessments, depressive symptoms, and inflammatory markers were ascertained across multiple visits over 8 years. Discrete-time complementary log-log models, group-based trajectory models, and multivariable-adjusted multinomial logistic regression were employed to assess the relationship between baseline olfaction and incident depression and longitudinal depression trajectories. Mediation analysis assessed the influence of cognitive status on these relationships.Individuals with lower olfaction had an increased risk of developing significant depressive symptoms at follow-up (hazard ratio = 1.04, 95% confidence interval [CI]: 1.00, 1.08). Of the 3 patterns of longitudinal depression scores identified (stable low, stable moderate, and stable high), poorer olfaction was associated with a 6% higher risk of membership in the stable moderate (relative risk ratio [RRR] = 1.06, 95% CI: 1.02, 1.10)/stable high (RRR = 1.06, 95% CI: 1.00, 1.12) groups, compared to the stable low group. Poor cognitive status, but not inflammation, partially mediated the relationship between olfactory performance and incident depression symptom severity.Suboptimal olfaction could serve as a prognostic indicator of vulnerability for the development of late-life depression. These findings underscore the need for a greater understanding of olfaction in late-life depression and the demographic, cognitive, and biological factors that influence these relationships over time.

  View details for DOI 10.1093/gerona/glad139

  View details for Web of Science ID 001016083300001

  View details for PubMedID 37357824

  View details for PubMedCentralID PMC10733184

• Over-the-Counter Hearing Aids - Using Regulatory Policy to Improve Public Health NEW ENGLAND JOURNAL OF MEDICINE Lin, F. R., Chadha, S. 2023; 388 (23): 2117-2119

  View details for DOI 10.1056/NEJMp2302355

  View details for Web of Science ID 001000459700001

  View details for PubMedID 37272518

• The Population Attributable Fraction of Dementia From Audiometric Hearing Loss Among a Nationally Representative Sample of Community-Dwelling Older Adults JOURNALS OF GERONTOLOGY SERIES A-BIOLOGICAL SCIENCES AND MEDICAL SCIENCES Smith, J. R., Huang, A. R., Lin, F. R., Reed, N. S., Deal, J. A. 2023; 78 (7): 1300-1306

  Abstract

  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.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).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%).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.

  View details for DOI 10.1093/gerona/glad117

  View details for Web of Science ID 000997756000001

  View details for PubMedID 37139951

  View details for PubMedCentralID PMC10329222

• Sensory impairment and algorithmic classification of early cognitive impairment ALZHEIMER'S & DEMENTIA: DIAGNOSIS, ASSESSMENT & DISEASE MONITORING Cai, Y., Schrack, J. A. A., Gross, A. L. L., Armstrong, N. M. M., Swenor, B. K. K., Deal, J. A. A., Lin, F. R. R., Wang, H., Tian, Q., An, Y., Simonsick, E. M. M., Ferrucci, L., Resnick, S. M. M., Agrawal, Y. 2023; 15 (2): e12400

  Abstract

  Sensory impairment (SI) is linked to cognitive decline, but its association with early cognitive impairment (ECI) is unclear.Sensory functions (vision, hearing, vestibular function, proprioception, and olfaction) were measured between 2012 and 2018 in 414 Baltimore Longitudinal Study of Aging (BLSA) participants (age 74 ± 9 years; 55% women). ECI was defined as 1 standard deviation below age-, sex-, race-, and education-specific mean performance in Card Rotations or California Verbal Learning Test immediate recall. Log binomial models (cross-sectional analysis) and Cox regression models (time-to-event analysis) were used to examine the association between SI and ECI.Cross-sectionally, participants with ≥3 SI had twice the prevalence of ECI (prevalence ratio = 2.10, p = 0.02). Longitudinally, there was no significant association between SI and incident ECI over up to 6 years of follow-up.SI is associated with higher prevalence, but not incident ECI. Future studies with large sample sizes need to further elucidate the relationship between SI and ECI.Sensory impairment is associated with high prevalence of early cognitive impairmentMultisensory impairment may pose a strong risk of early changes in cognitive functionIdentifying multisensory impairment may help early detection of dementia.

  View details for DOI 10.1002/dad2.12400

  View details for Web of Science ID 000971128300001

  View details for PubMedID 37063388

  View details for PubMedCentralID PMC10103182

• Association of Carotid Atherosclerosis With Hearing Loss A Cross-sectional Analysis of the Atherosclerosis Risk in Communities Study JAMA OTOLARYNGOLOGY-HEAD & NECK SURGERY Morales, E. E., Croll, P. H. H., Palta, P., Goedegebure, A., Reed, N. S. S., Betz, J. F. F., Lin, F. R. R., Deal, J. A. A. 2023; 149 (3): 223-230

  Abstract

  To describe the association between midlife carotid atherosclerosis and late-life hearing loss among participants in the Atherosclerosis Risk in Communities (ARIC) study.For this cross-sectional study and temporal analysis of a cohort within the ongoing ARIC prospective cohort study, participants were recruited from 4 communities in the US. The analysis evaluated information on mean carotid intima-media thickness (cIMT), from visit 1 (1987-1989) to visit 4 (1994-1996), carotid plaque presence at visit 4, and audiometric data from visit 6 (2016-2017). The cIMT measures were calculated from ultrasonography recordings by trained readers at the ARIC Ultrasound Reading Center. At each visit, cIMT was computed as the average of 3 segments: the distal common carotid, the carotid artery bifurcation, and the proximal internal carotid arteries. Presence of carotid plaque was determined based on an abnormal wall thickness, shape, or wall texture. Audiometric 4-frequency pure tone average (PTA) was measured and calculated for the better-hearing ear and modeled as a continuous variable. Linear regression estimated the association between cIMT and carotid plaque with hearing, adjusting for age, sex, race and study center, education level, body mass index (calculated as weight in kilograms divided by height in meters squared), smoking status, hypertension, cholesterol levels, diabetes, and exposure to occupational noise. Missing data (exposure and covariates) were imputed with multiple imputation by chained equations. Data analyses were performed from April 6 to July 13, 2022.Hearing loss assessed using 4-frequency (0.5, 1.0, 2.0, and 4.0 kilohertz) PTA for both ears and carotid plaque at visit 4 and mean cIMT from visit 1 to visit 4.Among a total of 3594 participants (mean [SD] age at visit 4, 59.4 [4.6] years; 2146 [59.7%] female; 819 [22.8%] Black and 2775 [77.2%] White individuals), fully adjusted models indicated that an additional 0.1 mm higher mean cIMT was associated with 0.59 dB (95% CI, 0.17 to 1.02 dB) higher PTA. Compared with participants without carotid plaque, plaque presence was associated with 0.63 dB (95% CI, -0.57 to 1.84 dB) higher PTA.The findings of this cross-sectional study with temporal analyses of a cohort with the ongoing ARIC study found that subclinical atherosclerosis in midlife was associated with worse hearing in older adulthood. Prevention and control of carotid atherosclerosis during middle age may positively affect the hearing health of older adults.

  View details for DOI 10.1001/jamaoto.2022.4651

  View details for Web of Science ID 000919553400002

  View details for PubMedID 36656574

  View details for PubMedCentralID PMC9857750

• Hearing Loss and Dementia Prevalence in Older Adults in the US JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION Huang, A. R., Jiang, K., Lin, F. R., Deal, J. A., Reed, N. S. 2023; 329 (2): 171-173

  View details for DOI 10.1001/jama.2022.20954

  View details for Web of Science ID 001053888400018

  View details for PubMedID 36625819

  View details for PubMedCentralID PMC9856835

• Performance of Smartphone Automated Audiogram Image Recognition for Personalized Sound Amplification JAMA OTOLARYNGOLOGY-HEAD & NECK SURGERY Choi, J. S., Gathman, T. J., Lin, F. R., Adams, M. E. 2023; 149 (3): 282-284

  View details for DOI 10.1001/jamaoto.2022.4383

  View details for Web of Science ID 000909513000004

  View details for PubMedID 36602783

  View details for PubMedCentralID PMC9857832

• Hearing Loss and Dementia - From Epidemiological Insights to the ACHIEVE Randomized Trial Lin, F. R. OXFORD UNIV PRESS. 2023

  View details for Web of Science ID 001110801400309

• Effect of a Community Health Worker-Delivered Personal Sound Amplification Device on Self-Perceived Communication Function in Older Adults With Hearing Loss: A Randomized Clinical Trial JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION Nieman, C. L., Betz, J., Morales, E., Suen, J. J., Trumbo, J., Marrone, N., Han, H., Szanton, S. L., Lin, F. R. 2022; 328 (23): 2324-2333

  Abstract

  Age-related hearing loss that impairs daily communication is associated with adverse health outcomes, but use of hearing aids by older adults is low and disparities exist.To test whether an affordable, accessible hearing care intervention, delivered by community health workers using over-the-counter hearing technology, could improve self-perceived communication function among older adults with hearing loss compared with a wait-list control.Open-label randomized clinical trial conducted between April 2018 and October 2019 with 3-month data collection completed in June 2020. The trial took place at 13 community sites, including affordable independent housing complexes (n = 10), senior centers (n = 2), and an older adult social club (n = 1) in Baltimore, Maryland. A total of 151 participants aged 60 years or older with hearing loss were randomized.Participants were randomized to receive a community health worker-delivered hearing care intervention (n = 78) or to a wait-list control group (n = 73). The 2-hour intervention consisted of fitting a low-cost amplification device and instruction.The primary outcome was change in self-perceived communication function (Hearing Handicap Inventory for the Elderly-Screening Version [HHIE-S]; score range, 0-40; higher scores indicate poorer function) from baseline to 3 months postrandomization. The average treatment effect was estimated using the doubly robust weighted least squares estimator, which uses an outcome regression model weighted by the inverse probability of attrition to account for baseline covariate imbalance and missing data.Among 151 participants randomized (mean age, 76.7 [SD, 8.0] years; 101 [67.8%] women; 65 [43%] self-identified as African American; 96 [63.6%] with low income [<$25 000 annual household income]), 136 (90.1%) completed 3-month follow-up for the primary outcome. In the intervention group, 90.5% completed the intervention session and reported at least 1 hour of daily amplification use at 3 months postrandomization. Mean scores for the HHIE-S were 21.7 (SD, 9.4) at baseline and 7.9 (SD, 9.2) at 3 months (change of -13.2 [SD, 10.3]) in the intervention group, and 20.1 (SD, 10.1) at baseline and 21 (SD, 9.1) at 3 months (change of 0.6 [SD, 7.1]) in the control group. Self-perceived communication function significantly improved in the intervention group compared with the control group, with an estimated average treatment effect of the intervention of a -12.98-point HHIE-S change (95% CI, -15.51 to -10.42). No study-related adverse events were reported.Among older adults with hearing loss, a community health worker-delivered personal sound amplification device intervention, compared with a wait-list control, significantly improved self-perceived communication function at 3 months. Findings are limited by the absence of a sham control, and further research is needed to understand effectiveness compared with other types of care delivery models and amplification devices.ClinicalTrials.gov Identifier: NCT03442296.

  View details for DOI 10.1001/jama.2022.21820

  View details for Web of Science ID 000916605400017

  View details for PubMedID 36538311

  View details for PubMedCentralID PMC9856971

• Associations of audiometric hearing and speech-in-noise performance with cognitive decline among older adults: The Baltimore Longitudinal Study of Aging (BLSA) FRONTIERS IN NEUROLOGY Jiang, K., Armstrong, N. M., Agrawal, Y., Gross, A. L., Schrack, J. A., Lin, F. R. R., Ferrucci, L., Resnick, S. M., Deal, J. A., Powell, D. S. 2022; 13: 1029851

  Abstract

  Established associations between hearing loss and cognitive decline were primarily defined by pure-tone audiometry, which reflects peripheral hearing ability. Speech-in-noise performance, which reflects central hearing ability, is more limited in prior literature. We examined the longitudinal associations of audiometric hearing and speech-in-noise performance with cognitive decline.We studied 702 participants aged ≥60 years in the Baltimore Longitudinal Study of Aging 2012-2019. Global and domain-specific (language, memory, attention, executive function, visuospatial ability) cognitive performance were assessed by the cognitive assessment battery. Hearing thresholds at 0.5, 1, 2, and 4 kilohertz obtained from pure-tone audiometry were averaged to calculate better-ear pure-tone average (PTA) and participants were categorized as having hearing loss (>25 decibels hearing level [dB HL]) or normal hearing (≤25 dB HL). Speech-in-noise performance was assessed by the Quick Speech-in-Noise (QuickSIN) test, and participants were categorized as having below-median (worse) or above-median performance. Linear mixed effects models with random intercepts and slopes were used to assess baseline cognitive performance and cognitive decline by hearing status. Models adjusted for demographic, lifestyle and disease factors.Participants with audiometric hearing loss showed similar baseline cognitive performance but faster decline in global cognitive function, language, executive function, and attention. Participants with below-median QuickSIN score showed worse baseline cognitive performance in all domains and faster decline in global cognitive function, language, memory, executive function and attention.Audiometric hearing might be targeted to delay cognitive decline. Speech-in-noise performance might be a novel marker and might be more sensitive to memory decline.

  View details for DOI 10.3389/fneur.2022.1029851

  View details for Web of Science ID 000903055600001

  View details for PubMedID 36570462

  View details for PubMedCentralID PMC9784219

• Peripheral Neuropathy and Vision and Hearing Impairment in US Adults With and Without Diabetes AMERICAN JOURNAL OF EPIDEMIOLOGY Hicks, C. W., Wang, D., Lin, F. R., Reed, N., Windham, B., Selvin, E. 2023; 192 (2): 237-245

  Abstract

  We aimed to assess the associations of peripheral neuropathy (PN) with vision and hearing impairment among adults aged ≥40 years who attended the lower-extremity disease exam for the National Health and Nutrition Examination Survey (United States, 1999-2004). Overall, 11.8% (standard error (SE), 0.5) of adults had diabetes, 13.2% (SE, 0.5) had PN (26.6% (SE, 1.4) with diabetes, 11.4% (SE, 0.5) without diabetes), 1.6% (SE, 0.1) had vision impairment, and 15.4% (SE, 1.1) had hearing impairment. The prevalence of vision impairment was 3.89% (95% CI: 2.99, 5.05) among adults with PN and 1.29% (95% CI: 1.04, 1.60) among adults without PN (P < 0.001). After adjustment, PN was associated with vision impairment overall (odds ratio (OR) = 1.48, 95% confidence interval (CI): 1.03, 2.13) and among adults without diabetes (OR = 1.80, 95% CI: 1.17, 2.77) but not among adults with diabetes (P for interaction = 0.018). The prevalence of hearing impairment was 26.5% (95% CI: 20.4, 33.7) among adults with PN and 14.2% (95% CI: 12.4, 16.3) among adults without PN (P < 0.001). The association of PN with moderate/severe hearing impairment was significant overall (OR = 2.55, 95% CI: 1.40, 4.64) and among adults without diabetes (OR = 3.26, 95% CI: 1.80, 5.91). Overall, these findings suggest an association between peripheral and audiovisual sensory impairment that is unrelated to diabetes.

  View details for DOI 10.1093/aje/kwac195

  View details for Web of Science ID 000902399400001

  View details for PubMedID 36345076

  View details for PubMedCentralID PMC10308505

• The Association Between Midlife Leisure-Time Physical Activity and Hearing Loss in Late Life in the Atherosclerosis Risk in Communities Study JOURNALS OF GERONTOLOGY SERIES A-BIOLOGICAL SCIENCES AND MEDICAL SCIENCES Martinez-Amezcua, P., Morales, E., Gabriel, K. P., Dooley, E. E., Hornikel, B., Coresh, J., Lin, F. R., Pankow, J. S., Sharrett, A., Schrack, J. A., Sullivan, K. J., Reed, N., Deal, J. A., Palta, P. 2023; 78 (7): 1292-1299

  Abstract

  Hearing loss is highly prevalent in older ages and has several health consequences. Some cardiovascular risk factors are associated with worse hearing at older ages. Still, the role of midlife leisure-time physical activity (PA) as a risk factor for hearing loss is yet to be investigated.Among 3 198 participants of the Atherosclerosis Risk in Communities study, we investigated the associations of midlife and change from mid- to late-life PA (assessed via modified Baecke questionnaire) with hearing loss (audiometric battery [worse-ear pure-tone average, and speech-in-noise test]) at older ages. We used regression analyses, adjusted for demographics, medical conditions, and noise exposure, to estimate differences in hearing between those who met and did not meet PA recommendations at midlife and at late life.A total of 1 386 (43.3%) participants met PA recommendations at midlife. These participants, compared to those who did not meet recommendations, had lower (better) pure-tone average by 1.51 (0.46, 2.55) decibels, identified 0.37 (0.01, 0.74) more words (better score) in the speech-in-noise test, and had a lower relative risk of having hearing loss at older ages (eg, relative risk ratio for severe hearing loss vs normal hearing = 0.70 [0.52, 0.95]). Similarly, those who persistently met PA recommendations from mid- to late life had, compared with those who did not, a better hearing at older ages.Meeting PA public health recommendations in midlife and mid- to late life was associated with better hearing at older ages and reduced risk of hearing loss. Promoting adequate levels of PA may be an essential component of hearing care.

  View details for DOI 10.1093/gerona/glac194

  View details for Web of Science ID 000877669600001

  View details for PubMedID 36124822

  View details for PubMedCentralID PMC10329230

• ADVANCING HEARING HEALTH EQUITY FOR OLDER ADULTS: FINDINGS FROM THE HEARS RCT Nieman, C., Betz, J., Morales, E., Suen, J., Marrone, N., Han, H., Szanton, S., Lin, F. OXFORD UNIV PRESS. 2022: 239

  View details for Web of Science ID 000913044001162

• HEARING LOSS AND INCIDENT DEMENTIA OVER 7 YEARS IN BLACK AND WHITE OLDER ADULTS IN ARIC-NCS Shin, J., Jiang, K., Reed, N., Knopman, D., Mosley, T., Sharrett, R., Lin, F., Deal, J. OXFORD UNIV PRESS. 2022: 238

  View details for Web of Science ID 000913044001159

• ASSOCIATIONS OF AUDIOMETRIC HEARING, BRAIN MRI, AND COGNITIVE PERFORMANCE WITH SPEECH-IN-NOISE PERFORMANCE Jiang, K., Coresh, J., Hayden, K., Jack, C., Mosley, T., Pankow, J., Lin, F., Deal, J. OXFORD UNIV PRESS. 2022: 152

  View details for Web of Science ID 000913044000597

• DUAL SENSORY LOSS AND DEPRESSIVE SYMPTOMS: FINDINGS FROM THE LONGITUDINAL AGING STUDY IN INDIA (LASI) Wang, E., Morales, E., Lin, F., Reed, N., Deal, J. OXFORD UNIV PRESS. 2022: 238

  View details for Web of Science ID 000913044001160

• CAPTURING OLDER ADULT PEER MENTORS' EXPERIENCE WITH COMMUNITY-DELIVERED HEARING CARE THROUGH PHOTOVOICE Nieman, C., Mossman, A., Yi, J., Suen, J., Lin, F., Szanton, S., Han, H. OXFORD UNIV PRESS. 2022: 378-379

  View details for Web of Science ID 000913044001705

• MIDLIFE PHYSICAL ACTIVITY AND HEARING IMPAIRMENT IN LATE LIFE: ATHEROSCLEROSIS RISK IN COMMUNITIES (ARIC) STUDY Martinez-Amezcua, P., Dooley, E., Morales, E., Reed, N., Lin, F., Schrack, J., Deal, J., Palta, P. OXFORD UNIV PRESS. 2022: 293

  View details for Web of Science ID 000913044001376

• Hearing loss and risk of depressive symptoms in older adults in the Health ABC study FRONTIERS IN EPIDEMIOLOGY Powell, D. S., Betz, J. F., Yaffe, K., Kritchevsky, S., Strotmeyer, E., Simonsick, E. M., Rubin, S., Houston, D. K., Pratt, S. R., Purchase Helzner, E., Brewster, K. K., Lin, F. R., Gross, A. L., Deal, J. A. 2022; 2: 980476

  Abstract

  Hearing loss (HL) is highly prevalent among older adults and may lead to increased risk of depressive symptoms. In both cross-sectional and longitudinal analysis, we quantified the association between HL and depressive symptoms, incorporating the variable nature of depressive symptoms and characterizing by race and gender.Data were from the Health, Aging, and Body Composition study. Depressive symptoms were measured using the Center for Epidemiologic Study Depression Scale short form (CES-D 10), defined as CES-D 10 score ≥10 or treatment for depression. Hearing was defined via four-frequency pure-tone average (PTA) decibel hearing level (dB HL), categorized as normal hearing (PTA ≤25 dB HL), mild HL (PTA26-40 dB HL), and ≥moderate HL (PTA > 40 dB HL). Associations at baseline were quantified using logistic regression, incident depressive symptoms using Cox proportional hazard models, and change in depressive symptoms over time using growth mixture models and multinomial logistic regression.Among 2,089 older adults (1,082 women, 793 Black; mean age 74.0 SD: 2.8), moderate or greater HL was associated with greater odds of concurrent [Odds Ratio (OR):2.45, 95% CI:1.33, 4.51] and incident depressive symptoms [Hazard Ratio (HR):1.26, 95% CI:1.00, 1.58]. Three depressive symptom trajectory patterns were identified from growth mixture models: low, moderate increasing, and borderline high depressive symptom levels. Those with moderate or greater HL were more likely to be in the borderline high depressive-symptom trajectory class than the low trajectory class [Relative Risk Ratio (RRR):1.16, 95% CI:1.01, 1.32].HL was associated with greater depressive symptoms. Although findings were not statistically significantly different by gender and race, estimates were generally stronger for women and Black participants. Investigation of psychosocial factors and amelioration by hearing aid use could have significant benefit for older adults' quality of life.

  View details for DOI 10.3389/fepid.2022.980476

  View details for Web of Science ID 001539236200001

  View details for PubMedID 38455326

  View details for PubMedCentralID PMC10910912

• Web Exclusive. Annals Graphic Medicine - Medicare Hearing Policy: A Path Forward. Annals of internal medicine Lin, F., Sheehan, M., Reed, N., Sampson, I. 2022; 175 (10): W120-W135

  View details for DOI 10.7326/G21-0092

  View details for PubMedID 36215710

• Considering hearing loss as a modifiable risk factor for dementia EXPERT REVIEW OF NEUROTHERAPEUTICS Brewster, K. K., Deal, J. A., Lin, F. R., Rutherford, B. R. 2022; 22 (9): 805-813

  Abstract

  Accumulating evidence links hearing loss to impaired cognitive performance and increased risk for dementia. Hearing loss can lead to deafferentation-induced atrophy of frontotemporal brain regions and dysregulation of cognitive control networks from increased listening effort. Hearing loss is also associated with reduced social engagement, loneliness, and depression, which are independently associated with poor cognitive function.We summarize the evidence and postulated mechanisms linking hearing loss to dementia in older adults and synthesize the available literature demonstrating beneficial effects of hearing remediation on brain structure and function.: Further research is needed to evaluate whether treatment of hearing loss may reduce risk of cognitive decline and improve neural consequences of hearing loss. Studies may investigate the pathologic mechanisms linking these late-life disorders and identify individuals vulnerable to dementia, and future clinical trials may evaluate whether hearing treatment may reduce the risk for dementia.

  View details for DOI 10.1080/14737175.2022.2128769

  View details for Web of Science ID 000860602000001

  View details for PubMedID 36150235

  View details for PubMedCentralID PMC9647784

• Labor Force Participation and Hearing Loss Among Adults in the United States: Evidence From the National Health and Nutrition Examination Survey AMERICAN JOURNAL OF AUDIOLOGY Morales, E., Lin, H., Suen, J. J., Varadaraj, V., Lin, F. R., Reed, N. S. 2022; 31 (3): 604-612

  Abstract

  The purpose of this article was to study the association between hearing loss (HL) and labor force participation in the National Health and Nutrition Examination Survey (NHANES).This cross-sectional study used data from the 1999-2000, 2001-2002, 2003-2004, 2011-2012, and 2015-2016 cycles of the NHANES. The sample was restricted to adults aged 25-65 years with complete audiometric data. HL was defined based on the pure-tone average (PTA) of 0.5-, 1-, 2-, and 4-kHz thresholds in the better hearing ear as follows: no loss (PTA < 25 dB), mild HL (25 dB < PTA < 40 dB), and moderate-to-severe HL (PTA > 40 dB). The association between HL and labor force participation was estimated using weighted logistic regression adjusted for age, sex, race/ethnicity, education, living arrangements, and health status.In a sample of 9,963 participants (50.6% women, 22.6% Black, 27% Hispanic), we found that compared with adults without HL, individuals with moderate-to-severe HL had greater odds of being outside of the labor force (odds ratio = 2.35; 95% confidence interval: 1.42-3.88). However, there were no differences by HL status in being employed or having a full- versus part-time job.Moderate-to-severe HL, but not mild HL, was associated with higher odds of not participating in the labor force. However, there were no differences by HL status in being employed or having a full- versus part-time job. Further research is needed to better characterize how HL may affect labor force participation.https://doi.org/10.23641/asha.19858930.

  View details for DOI 10.1044/2022_AJA-21-00266

  View details for Web of Science ID 000965694600008

  View details for PubMedID 35623104

  View details for PubMedCentralID PMC9886159

• Hearing impairment, family financial support, and depressive symptoms among Chinese middle-aged and older adults INTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY Gao, J., Zhu, D., Deal, J. A., Lin, F. R., He, P. 2022; 37 (9)

  Abstract

  Hearing impairment (HI) is prevalent among middle-aged and older adults, but few studies have examined its mental health consequences in China. This study investigated the association of HI with depressive symptoms and whether family financial support moderated the association among adults aged 45 in China.Data were obtained from three waves of the China Health and Retirement Longitudinal Study (2011, 2013 and 2015). Hearing impairment was defined as a self-reported hearing problem in one or both ears. Depressive symptoms were measured with CESD-10. Associations between HI and depressive symptoms were modeled using fixed-effect models.People with self-reported hearing loss were more likely than those without hearing loss to have depressive symptoms, with an odds ratio of 1.25 [1.07-1.47]. The association remained significant after adjusting for socio-demographic characteristics, lifestyle behaviors, and health conditions. Family financial support moderated this association. Among those with HI, adults with a higher level of family financial support tend to have better performance on symptoms of depression.HI was positively associated with depressive symptoms among adults aged ≥45 in China, and family financial support played a buffering role in the relationship between HI and depressive symptoms.

  View details for DOI 10.1002/gps.5788

  View details for Web of Science ID 000928422700001

  View details for PubMedID 36004947

• Associations of dual sensory impairment with long-term depressive and anxiety symptoms in the United States JOURNAL OF AFFECTIVE DISORDERS Armstrong, N. M., Teixeira, C., Gendron, C., Brenowitz, W. D., Lin, F. R., Swenor, B., Powell, D. S., Deal, J. A., Simonsick, E. M., Jones, R. N. 2022; 317: 114-122

  Abstract

  We explored the associations of dual sensory impairment (DSI) with long-term depressive and anxiety symptoms as well as low perceived social support (LPSS) as a modifier of these associations.Multinomial logistic regression models were used to examine the associations of DSI and single sensory impairment (hearing [pure-tone average > 25 dB] and vision [impaired visual acuity and/or contrast sensitivity]) with long-term depressive symptom (≥8 on the 10-item Center for Epidemiologic Studies-Depression Scale) and anxiety symptom (present on the Hopkins Symptom Checklist) latent classes from group-based trajectory models (rare/never; mild/moderate increasing; chronically high) among 2102 Health, Aging and Body Composition Study participants (mean age:74.0 ± 2.8 years; 51.9 % female) over 10 years. Models were adjusted by demographic characteristics and cardiovascular risk factors, and LPSS. An additional model evaluated the two-way interaction between DSI and LPSS.DSI was associated with increased risk of being chronically depressed (Risk Ratio, RR = 1.99, 95 % Confidence Interval, CI: 1.25, 3.17), not mild/moderate increasingly depressed (RR = 1.25, 95 % CI: 0.91, 1.71). DSI had increased risk of being mild/moderate increasingly anxious (RR = 1.60, 95 % CI: 1.16, 2.19) and chronically anxious (RR = 1.86, 95 % CI: 1.05, 3.27) groups, as compared to no impairments. Hearing impairment was associated with being mild/moderate increasingly anxious (RR = 1.34, 95 % CI: 1.01, 1.79). No other associations were found for single sensory impairments. LPSS did not modify associations.Sensory measures were time-fixed, and LPSS, depression and anxiety measures were self-reported.Future research is warranted to determine if DSI therapies may lessen long-term chronically high depressive and anxiety symptoms.

  View details for DOI 10.1016/j.jad.2022.07.067

  View details for Web of Science ID 000889995700015

  View details for PubMedID 35932940

  View details for PubMedCentralID PMC10696594

• Over-the-counter hearing aids: How we got here and necessary next steps JOURNAL OF THE AMERICAN GERIATRICS SOCIETY Lin, F. R., Reed, N. S. 2022; 70 (7): 1954-1956

  View details for DOI 10.1111/jgs.17842

  View details for Web of Science ID 000802058600001

  View details for PubMedID 35512226

• Hearing and Mobility in Aging-The Moderating Role of Neuropsychological Function JOURNALS OF GERONTOLOGY SERIES A-BIOLOGICAL SCIENCES AND MEDICAL SCIENCES Pupo, D. A., Small, B. J., Deal, J. A., Armstrong, N. M., Simonsick, E. M., Resnick, S. M., Lin, F., Ferrucci, L., Tian, Q. 2022; 77 (10): 2141-2146

  Abstract

  In older persons, neuropsychological function, especially sensorimotor function, is strongly associated with mobility. Hearing impairment is related to poor mobility, and we hypothesize that such relationships would be stronger in persons with compromised sensorimotor function than those with preserved sensorimotor function.We analyzed 601 cognitively normal (Mini-Mental State Examination ≥24 or free of cognitive impairment/dementia) Baltimore Longitudinal Study of Aging participants aged 50 or older with concurrent data on hearing (better ear pure-tone average [PTA]), mobility (6 m usual gait, 400 m endurance walk), and neuropsychological function including attention via Trail Making Test (TMT)-A, executive function via the difference between TMT-A and B, and Digit Symbol Substitution Test, and manual dexterity via Pegboard performance. We examined the association of PTA, each cognitive measure, and their interaction with mobility using multivariable linear regression, adjusted for covariates.After covariate adjustment, there were significant interactions between PTA and all cognitive measures in the association with 400 m endurance walking speed as the outcome. There was also a significant interaction between PTA and pegboard nondominant hand performance in the association with 6 m gait as the outcome. In all these cases, the PTA-mobility relationship was stronger among participants with lower cognition.Impaired hearing more strongly relates to poor mobility among those with compromised neuropsychological performance, especially manual dexterity reflecting the motor-cognitive interface and sensorimotor function, than those with preserved neuropsychological performance. Future longitudinal studies are needed to test whether hearing impairment more strongly predicts mobility decline over time in older persons with compromised neuropsychological function.

  View details for DOI 10.1093/gerona/glac047

  View details for Web of Science ID 000784114000001

  View details for PubMedID 35226729

  View details for PubMedCentralID PMC9536448

• Associations of dual sensory impairment with incident mobility and ADL difficulty JOURNAL OF THE AMERICAN GERIATRICS SOCIETY Armstrong, N. M., Teixeira, C., Gendron, C., Brenowitz, W. D., Lin, F. R., Swenor, B., Deal, J. A., Simonsick, E. M., Jones, R. N. 2022; 70 (7): 1997-2007

  Abstract

  There is a dearth of studies examining the associations of objectively measured dual sensory impairment (DSI) with incident mobility and activities of daily life (ADL) difficulty longitudinally.Cox proportional hazards models were used to examine the associations of DSI and single sensory impairment (hearing, vision) with incident mobility difficulty (many problems or inability to walk ¼ mile and/or climb 10 steps) and ADL difficulty up to six years of follow-up among 2020 participants of the Health, Aging, and Body Composition Study, a cohort of older adults aged 70-79 years from Pittsburgh, PA and Memphis, TN. Vision impairment (VI) was defined as impaired visual acuity (20/50 or worse on Bailey-Lovie distance test) and contrast sensitivity (<1.3 log units on Pelli-Robson test), and hearing impairment (HI) was defined as pure-tone average in better-hearing ear >25 decibels. Models were adjusted by age, race, sex, education, diabetes, depressive symptoms, hypertension, gait speed from 20-meter walk, global cognition score, prevalent cardiovascular disease, and body mass index.There were 23% with DSI (n = 459). DSI was associated with increased risk of both incident report of mobility (hazard ratio [HR] = 2.25, 95% confidence interval [CI]: 1.47, 3.43), and ADL difficulty (HR = 2.26, 95% CI: 1.50, 3.40). Neither VI nor HI alone was associated with risk of either outcome.DSI is associated with increased risk of incident mobility and ADL difficulty. Rehabilitation and adaptive environmental changes for individuals living with DSI may be important to maximize mobility and daily function.

  View details for DOI 10.1111/jgs.17764

  View details for Web of Science ID 000773547400001

  View details for PubMedID 35343588

  View details for PubMedCentralID PMC9283239

• Hearing Loss and Cognition: What We Know and Where We Need to Go FRONTIERS IN AGING NEUROSCIENCE Powell, D. S., Oh, E. S., Reed, N. S., Lin, F. R., Deal, J. A. 2022; 13: 769405

  Abstract

  Although a causal association remains to be determined, epidemiologic evidence suggests an association between hearing loss and increased risk of dementia. If we determine the association is causal, opportunity for targeted intervention for hearing loss may play a fundamental role in dementia prevention. In this discussion, we summarize current research on the association between hearing loss and dementia and review potential casual mechanisms behind the association (e.g., sensory-deprivation hypothesis, information-degradation hypothesis, common cause). We emphasize key areas of research which might best inform our investigation of this potential casual association. These selected research priorities include examination of the causal mechanism, measurement of co-existing hearing loss and cognitive impairment and determination of any bias in testing, potential for managing hearing loss for prevention of dementia and cognitive decline, or the potential to reduce dementia-related symptoms through the management of hearing loss. Addressing these research gaps and how results are then translated for clinical use may prove paramount for dementia prevention, management, and overall health of older adults.

  View details for DOI 10.3389/fnagi.2021.769405

  View details for Web of Science ID 001027369200001

  View details for PubMedID 35295208

  View details for PubMedCentralID PMC8920093

• A Broad Examination of Health Policy Barriers to Access and Affordability of Hearing Treatment for Medicare Beneficiaries. Seminars in hearing Myers, C., Reed, N. S., Lin, F. R., Willink, A. 2022; 43 (1): 13-19

  Abstract

  In 2016, the National Academies on Science, Engineering, and Medicine (NASEM) released a report titled, "Hearing Health Care for Adults," which detailed the challenges and provided recommendations for improving the access to affordable hearing care for adults in the United States. Arguably the most significant outcome from this report was the subsequent passage of the Over-the-Counter Hearing Aid Act in 2017, which requires the Food and Drug Administration to develop regulations for a class of hearing aids that address mild to moderate hearing loss to be available for sale over the counter (OTC). While this presents an important step toward improving access and affordability of hearing treatment, it does not represent a complete solution. In fact, optimizing the new landscape of hearing care for individuals with hearing loss also may require new policy solutions. This article reflects on the progress achieved since the NASEM report and the policy issues that remain to improve accessibility and affordability of hearing care among older adults.

  View details for DOI 10.1055/s-0042-1743122

  View details for PubMedID 35719747

• Association of Cigarette Smoking Patterns Over 30 Years With Audiometric Hearing Impairment and Speech-in-Noise Perception The Atherosclerosis Risk in Communities Study JAMA OTOLARYNGOLOGY-HEAD & NECK SURGERY Morales, E., Ting, J., Gross, A. L., Betz, J. F., Jiang, K., Du, S., Power, M. C., Reed, N. S., Sharrett, A., Lin, F. R., Deal, J. A. 2022; 148 (3): 243-251

  Abstract

  The implications of cigarette smoking and smoking cessation for hearing impairment remain unknown. Many studies on this topic have failed to account for attrition among smokers in their findings.To assess the association of cigarette smoking patterns with audiometric and speech-in-noise hearing measures among participants of the Atherosclerosis Risk in Communities Study.This cross-sectional study included participants of the Atherosclerosis Risk in Communities Study from 4 US communities. The analysis includes data from visit 1 (1987-1989) through visit 6 (2016-2017); data were analyzed from March 16 through June 25, 2021. Audiometric hearing and speech-in-noise testing was offered to all participants at visit 6. Participants with incomplete audiometric data or missing data for educational level, body mass index, drinking status, a diabetes or hypertension diagnosis, or occupational noise were excluded. In addition, individuals were excluded if they self-reported as having other than Black or White race and ethnicity, or if they self-reported as having Black race or ethnicity and lived in 2 predominantly White communities.Smoking behavior was classified from visit 1 (1987-1989) to visit 6 (2016-2017) using group-based trajectory modeling based on self-reported smoking status at each clinic visit. Hearing was assessed at visit 6. An audiometric 4-frequency (0.5, 1, 2, 4 kHz) pure-tone average (PTA) was calculated for the better-hearing ear and modeled as a continuous variable. Speech-in-noise perception was assessed via the Quick Speech-in-Noise Test (QuickSIN) and modeled continuously. Attrition during the 30 years of follow-up was addressed by inverse probability of attrition weighting.A total of 3414 participants aged 72 to 94 years (median [IQR] age, 78.8 [76.0-82.9] years; 2032 [59.5%] women) when hearing was measured at visit 6 (2016-2017) were included in the cohort; 766 (22.4%) self-identified as Black and 2648 (77.6%) as White individuals. Study participants were classified into 3 smoking groups based on smoking behavior: never or former smoking at baseline (n = 2911 [85.3%]), quit smoking during the study period (n = 368 [10.8%]), and persistent smoking (n = 135 [4.0%]). In fully adjusted models, persistent smoking vs never or former smoking was associated with an average 2.69 (95% CI, 0.56-4.81) dB higher PTA (worse hearing) and 1.42 (95% CI, -2.29 to -0.56) lower QuickSIN score (worse performance). Associations were stronger when accounting for informative attrition during the study period (3.53 [95% CI, 1.14-5.93] dB higher PTA; 1.46 [95% CI, -2.52 to -0.41] lower QuickSIN scores). Smoking cessation during the study (vs never or former smoking) was not associated with changes in hearing.In this cross-sectional study, persistent smoking was associated with worse audiometric hearing and speech-in-noise perception. Hearing measures among participants who quit smoking during the study period did not differ from those for never or former smokers, indicating that smoking cessation (as opposed to persistent smoking) may have benefits for hearing health.

  View details for DOI 10.1001/jamaoto.2021.3982

  View details for Web of Science ID 000747990900002

  View details for PubMedID 35084441

  View details for PubMedCentralID PMC8796063

• Examining the Combined Estimated Effects of Hearing Loss and Depressive Symptoms on Risk of Cognitive Decline and Incident Dementia JOURNALS OF GERONTOLOGY SERIES B-PSYCHOLOGICAL SCIENCES AND SOCIAL SCIENCES Powell, D. S., Brenowitz, W. D., Yaffe, K., Armstrong, N. M., Reed, N. S., Lin, F. R., Gross, A. L., Deal, J. A. 2022; 77 (5): 839-849

  Abstract

  Late-life depression is a comorbidity that may co-occur in older adults with hearing loss-each has prevalent and independent modifiable risk factors for dementia.Using data from 1,820 Health, Aging and Body Composition study participants (74 ± 2.8 years, 38% Black race), we compared the hearing loss-dementia/cognitive decline relationship between those with normal hearing/mild hearing loss and those with moderate or greater hearing loss. Using linear mixed-effects and Cox proportional hazard models, we investigated if the associations between hearing loss and cognitive decline or dementia (Modified Mini-Mental State [3MS] Examination and Digit Symbol Substitution Test [DSST]) differed by the presence or absence of depressive symptoms. Depressive symptoms were defined as Center for Epidemiologic Study-Depression scale 10 ≥10 at one or more visits from Years 1-5. Algorithmic incident dementia was defined using medication use, hospitalizations, and cognitive test scores. Audiometric hearing loss was measured at Year 5 and categorized as normal/mild versus moderate or greater hearing loss.Having both hearing loss and depressive symptoms (vs. having neither) was associated with faster rates of decline in 3MS Examination (β = -0.30; 95% confidence interval [CI]: -0.78, -0.19) and DSST (β = -0.35; 95% CI: -0.67, -0.03) over 10 years of follow-up. Having both hearing loss and depressive symptoms (vs. neither) was associated with increased risk (hazard ratio [HR]: 2.91; 95% CI: 1.59, 5.33 vs. HR: 1.54; 95% CI: 1.10, 2.15 hearing loss only and HR: 2.35; 95% CI: 1.56, 3.53 depressive symptoms only) of incident dementia in multivariable-adjusted Cox proportional hazards models.Comorbid conditions among hearing-impaired older adults should be considered and may aid in dementia prevention and management strategies.

  View details for DOI 10.1093/geronb/gbab194

  View details for Web of Science ID 000790048200001

  View details for PubMedID 34655295

  View details for PubMedCentralID PMC9071460

• Epigenetic Age Acceleration and Hearing: Observations From the Baltimore Longitudinal Study of Aging FRONTIERS IN AGING NEUROSCIENCE Kuo, P., Moore, A., Lin, F. R., Ferrucci, L. 2021; 13: 790926

  Abstract

  Objectives: Age-related hearing loss (ARHL) is highly prevalent among older adults, but the potential mechanisms and predictive markers for ARHL are lacking. Epigenetic age acceleration has been shown to be predictive of many age-associated diseases and mortality. However, the association between epigenetic age acceleration and hearing remains unknown. Our study aims to investigate the relationship between epigenetic age acceleration and audiometric hearing in the Baltimore Longitudinal Study of Aging (BLSA). Methods: Participants with both DNA methylation and audiometric hearing measurements were included. The main independent variables are epigenetic age acceleration measures, including intrinsic epigenetic age acceleration-"IEAA," Hannum age acceleration-"AgeAccelerationResidualHannum," PhenoAge acceleration-"AgeAccelPheno," GrimAge acceleration-"AgeAccelGrim," and methylation-based pace of aging estimation-"DunedinPoAm." The main dependent variable is speech-frequency pure tone average. Linear regression was used to assess the association between epigenetic age acceleration and hearing. Results: Among the 236 participants (52.5% female), after adjusting for age, sex, race, time difference between measurements, cardiovascular factors, and smoking history, the effect sizes were 0.11 995% CI: (-0.00, 0.23), p = 0.054] for Hannum's clock, 0.08 [95% CI: (-0.03, 0.19), p = 0.143] for Horvath's clock, 0.10 [95% CI: (-0.01, 0.21), p = 0.089] for PhenoAge, 0.20 [95% CI: (0.06, 0.33), p = 0.004] for GrimAge, and 0.21 [95% CI: (0.09, 0.33), p = 0.001] for DunedinPoAm. Discussion: The present study suggests that some epigenetic age acceleration measurements are associated with hearing. Future research is needed to study the potential subclinical cardiovascular causes of hearing and to investigate the longitudinal relationship between DNA methylation and hearing.

  View details for DOI 10.3389/fnagi.2021.790926

  View details for Web of Science ID 000738577700001

  View details for PubMedID 34975461

  View details for PubMedCentralID PMC8714776

• Changes in US hearing aid regulations: possible benefits and risks to Australia PUBLIC HEALTH RESEARCH & PRACTICE Willink, A., Reed, N. S., Boisvert, I., McMahon, C. M., Lin, F. R. 2021; 31 (5)

  Abstract

  Hearing aids are costly for many Australians with hearing loss who are not eligible for public funding, and are not widely used. The purpose of this article is to describe a recent policy shift from the United States (US) that might improve access to hearing devices and services in Australia. Type of program or service: In 2017, the US legislated the Over-the-Counter Hearing Aid Act of 2017, directing the Food and Drug Administration (FDA) to develop regulations for over-the-counter sale of hearing aids for mild to moderate hearing loss.Changes in the development of hearing devices and changes to service delivery were well underway in the US prior to anticipated release of new FDA regulations, with new technology entrants in the 'hearables' market. For Australians with hearing loss not eligible for public funding, the current hearing health system is expensive and device-centred. If Australia follows suit with regulatory changes for a class of over-the-counter hearing aids, consumers are likely to benefit from access to safe and affordable devices. Additional policies to support access to hearing services are also likely to be needed.The hearing health system in Australia will undergo tremendous change in the coming years because of the introduction of over-the-counter hearing aids in the US. For Australians to benefit, changes to regulations of devices, as well as hearing services and device provision, will be required.

  View details for DOI 10.17061/phrp3152132

  View details for Web of Science ID 000727774100010

  View details for PubMedID 34873617

• Self-reported dual sensory impairment, dementia, and functional limitations in Medicare beneficiaries. Journal of the American Geriatrics Society Assi, L., Ehrlich, J. R., Zhou, Y., Huang, A., Kasper, J., Lin, F. R., McKee, M. M., Reed, N. S., Swenor, B. K., Deal, J. A. 2021; 69 (12): 3557-3567

  Abstract

  Vision and hearing impairments often co-exist with dementia, and all are independently associated with limitations in daily activities. Our aim was to examine the association of dual sensory impairment with functional limitations, and further examine the combined estimated association of sensory impairment and dementia with these functional limitations.Cross-sectional analysis of the National Health and Aging Trends Study (NHATS), a population-based cohort of Medicare beneficiaries, was performed. Participants were selected from the 2015 round. Survey weighted Poisson regression models adjusted for dementia, demographics, and health status variables examined the association of self-reported dual sensory impairment (no sensory impairment, single sensory impairment, dual sensory impairment) with scores of limitations in mobility, self-care, and household activities. Models were repeated to take into account the combined effects of dual sensory impairment and dementia.Overall, 7124 participants representative of Medicare beneficiaries 65 years or older were included. Of them, 43.9% were 75 years or older and 55.3% were female. Older adults with dual sensory impairment had greater limitations with mobility (prevalence rate ratio [PRR] = 1.45, 95% CI = 1.28-1.63), self-care (PRR = 1.41, 95% CI = 1.25-1.59), and household activities (PRR = 1.54, 95% CI = 1.37-1.72) compared with those without sensory impairment. They also had greater limitations than those with a single sensory impairment across the different activity categories. In models taking into account the combined estimated effect of both sensory impairment and dementia, those with dual sensory impairment and dementia had greater limitations than those without sensory impairment or dementia in each category (mobility: PRR = 1.85, 95% CI = 1.59-2.14, self-care: PRR = 1.86, 95% CI = 1.59-2.18, household: PRR = 2.41, 95% CI = 2.09-2.77).Older adults with dual sensory impairment had greater functional limitations compared with those without sensory impairment and those with a single sensory impairment. Strategies to improve visual and/or hearing function (e.g., sensory aids, rehabilitation) could potentially help prevent or minimize disability, even among those with dementia.

  View details for DOI 10.1111/jgs.17448

  View details for PubMedID 34478566

  View details for PubMedCentralID PMC8648982

• Alternative Pathways for Hearing Care May Address Disparities in Access FRONTIERS IN DIGITAL HEALTH Willink, A., Assi, L., Nieman, C., McMahon, C., Lin, F. R., Reed, N. S. 2021; 3: 740323

  Abstract

  Background/Objectives: Low-uptake of hearing aids among older adults has long dogged the hearing care system in the U.S. and other countries. The introduction of over-the-counter hearing aids is set to disrupt the predominantly high-cost, specialty clinic-based delivery model of hearing care with the hope of increasing accessibility and affordability of hearing care. However, the current model of hearing care delivery may not be reaching everyone with hearing loss who have yet to use hearing aids. In this study, we examine the group of people who do not use hearing aids and describe their characteristics and health care utilization patterns. We also consider what other healthcare pathways may be utilized to increase access to hearing treatment. Design: Cross-sectional, the 2017 Medicare Current Beneficiary Survey. Setting: Non-institutionalized adults enrolled in Medicare, the U.S. public health insurance program for older adults (65 years and older) and those with qualifying medical conditions and disabilities. Participants: A nationally representative sample of 7,361 Medicare beneficiaries with self-reported trouble hearing and/or hearing aid use. Measurements: Survey-weighted proportions described the population characteristics and health care utilization of those with hearing loss by hearing aid use, and the characteristics of those with untreated hearing loss by health care service type utilized. Results: Women, racial/ethnic minorities, and low-income Medicare beneficiaries with self-reported hearing trouble were less likely to report using hearing aids than their peers. Among those who do not use hearing aids, the most commonly used health care services were obtaining prescription drugs (64%) and seeing a medical provider (50%). Only 20% did not access either service in the past year. These individuals were more likely to be young and to have higher educational attainment and income. Conclusion: Alternative models of care delivered through pharmacies and general medical practices may facilitate access to currently underserved populations as they are particularly high touch-points for Medicare beneficiaries with untreated hearing trouble. As care needs will vary across a spectrum of hearing loss, alternative models of hearing care should look to complement not substitute for existing access pathways to hearing care.

  View details for DOI 10.3389/fdgth.2021.740323

  View details for Web of Science ID 001033172600001

  View details for PubMedID 34901925

  View details for PubMedCentralID PMC8655113

• Individual Life-Course Socioeconomic Position and Hearing Aid Use in the Atherosclerosis Risk in Communities Study JOURNALS OF GERONTOLOGY SERIES A-BIOLOGICAL SCIENCES AND MEDICAL SCIENCES Yi, J. S., Morales, E., Betz, J. F., Deal, J. A., Dean, L. T., Du, S., Goman, A. M., Griswold, M. E., Palta, P., Rebok, G. W., Reed, N. S., Thorpe, R. J., Lin, F. R., Nieman, C. L. 2022; 77 (3): 647-655

  Abstract

  To measure the association between individual life-course socioeconomic position (SEP) and hearing aid use, we examined childhood and adulthood socioeconomic variables collected at the Atherosclerosis Risk in Communities (ARIC) study baseline visit (1987-1989)/Life Course Socioeconomic Status study (2001-2002) and hearing aid use data collected at visit 6 (2016-2017).ARIC is a prospective cohort study of older adults (45-64 years) recruited from 4 U.S. communities. This analysis included a subset of 2 470 participants with hearing loss at visit 6 (≥25 decibels hearing level [dB HL] better-ear) with complete hearing aid use data. Childhood SEP variables included parental education, parental occupation, and parental home ownership. Young and older adulthood SEP variables included income, education, occupation, and home ownership. Each life epoch was assigned a score ranging from 0 to 5 and then summed to calculate the individual cumulative SEP score. Multivariable-adjusted logistic regression was used to estimate the association between individual cumulative SEP and hearing aid use. Missing SEP scores were imputed for participants with incomplete socioeconomic data.Of the 2 470 participants in the analytic cohort (median [interquartile interval] age 79.9 [76.7-84.0], 1 330 [53.8%] women, 450 [18.2%] Black), 685 (27.7%) participants reported hearing aid use. Higher cumulative SEP was positively associated with hearing aid use (odds ratio [OR] = 1.09, 95% confidence interval [CI]: 1.04-1.14), and slightly stronger for childhood (OR = 1.09, 95% CI: 1.00-1.20) than older adulthood SEP score (OR = 1.06, 95% CI: 0.95-1.18).In this community-based cohort of older adults with hearing loss, higher individual life-course SEP was positively associated with hearing aid use.

  View details for DOI 10.1093/gerona/glab273

  View details for Web of Science ID 000763655800032

  View details for PubMedID 35239947

  View details for PubMedCentralID PMC8893260

• Accuracy of self- and proxy-rated hearing among older adults with and without cognitive impairment JOURNAL OF THE AMERICAN GERIATRICS SOCIETY Kim, A. S., Betz, J. F., Albert, M., Deal, J. A., Faucette, S. P., Oh, E. S., Reed, N. S., Lin, F. R., Nieman, C. L. 2022; 70 (2): 490-500

  Abstract

  Hearing loss is highly prevalent among older adults with cognitive impairment and may exacerbate neuropsychiatric symptoms and affect interactions with others. Although audiometry is the gold standard for measuring hearing, it is not always used in research or clinical settings focused on the care of individuals with cognitive impairment. Subjective assessments of hearing, both self- and proxy-rated, are widespread but may not adequately capture the presence of hearing loss as compared to audiometry. This study investigates the concordance between subjective and objective hearing assessments among older adults with and without cognitive impairment and evaluates factors associated with concordance.Participants were a subset of the Atherosclerosis Risk in Communities Neurocognitive Study (ARIC-NCS), a prospective cohort study representing four US communities with adjudicated cognitive diagnoses and audiometric data, totaling 3326 self-rated and 520 proxy-rated hearing assessments. Sensitivity and specificity were calculated, and multivariable logistic regression estimated the magnitude of the association between the concordance of hearing assessments and variables of interest.Sensitivity and specificity for self-rated hearing status were 71.2% and 85.9% among cognitively normal older adults, 61.1% and 84.9% among persons with MCI, and 52.6% and 81.2% among persons with dementia, respectively. For proxy-rated hearing, sensitivity and specificity were 65.7% and 83.3% for persons with MCI and 73.3% and 60.3% for persons with dementia, respectively. Female sex was positively associated with concordance for self-rated hearing assessments.The low sensitivity of self- and proxy-rated hearing assessments compared to audiometry suggests that hearing loss among older adults with cognitive impairment may go underreported and unaddressed in subjective assessments. Clinicians and researchers should recognize the limitations of using self- and proxy-rated hearing assessments as measures of hearing status and incorporate objective audiometric evaluation whenever possible.

  View details for DOI 10.1111/jgs.17558

  View details for Web of Science ID 000722256700001

  View details for PubMedID 34813080

  View details for PubMedCentralID PMC8821325

• Patterns of Prevalence of Multiple Sensory Impairments Among Community-dwelling Older Adults JOURNALS OF GERONTOLOGY SERIES A-BIOLOGICAL SCIENCES AND MEDICAL SCIENCES Armstrong, N. M., Wang, H., Jian-Yu, E., Lin, F. R., Abraham, A. G., Ramulu, P., Resnick, S. M., Tian, Q., Simonsick, E., Gross, A. L., Schrack, J. A., Ferrucci, L., Agrawal, Y. 2022; 77 (10): 2123-2132

  Abstract

  Much is known about individual sensory deficits among older adults, but there is a dearth of information about the prevalence of multiple concurrent sensory deficits in this population.We evaluated the prevalence of individual and multiple sensory impairments at the most recent clinic visit among participants aged 24 years and older in the Baltimore Longitudinal Study of Aging (BLSA) (hearing, vision, olfaction, proprioception, and vestibular function) and Atherosclerosis Risk in Communities Study (ARIC) (hearing, vision, olfaction). We compared observed prevalence of multiple sensory impairments with expected prevalence based on compounded probabilities of multiple impairments using Fisher Exact Tests. Also, we evaluated the comparability of different measures used between these two studies.In both studies, the prevalence of each individual sensory impairment was common (>10%), and higher with older age, and the most common pattern of co-occurring sensory impairments was hearing and visual impairments (17.4% [BLSA]; 50.2% [ARIC]). In BLSA, the pattern that differed the most between observed and expected prevalence was combined hearing, vision, and olfactory impairments (observed 5.2% vs 1.4% expected, p = .01). In ARIC, this difference was much smaller (observed 8.1% vs 7.2% expected, p = .49).Although concurrent hearing and vision impairments were the most common co-occurring deficits, combined hearing, vision, and olfactory impairments are most likely to co-occur above chance, especially at older ages.

  View details for DOI 10.1093/gerona/glab294

  View details for Web of Science ID 000790037900001

  View details for PubMedID 34608938

  View details for PubMedCentralID PMC9536434

• Changes to Medicare Policy Needed to Address Hearing Loss JAMA HEALTH FORUM Reed, N. S., Lin, F. R., Willink, A. 2021; 2 (11): e213582

  View details for DOI 10.1001/jamahealthforum.2021.3582

  View details for Web of Science ID 000837180200006

  View details for PubMedID 36218840

• Hearing impairment and objectively measured physical activity: A systematic review JOURNAL OF THE AMERICAN GERIATRICS SOCIETY Martinez-Amezcua, P., Suen, J. J., Lin, F., Schrack, J. A., Deal, J. A. 2022; 70 (1): 301-304

  View details for DOI 10.1111/jgs.17529

  View details for Web of Science ID 000712285900001

  View details for PubMedID 34713440

  View details for PubMedCentralID PMC8742764

• Longitudinal Associations of Subclinical Hearing Loss With Cognitive Decline JOURNALS OF GERONTOLOGY SERIES A-BIOLOGICAL SCIENCES AND MEDICAL SCIENCES Irace, A. L., Armstrong, N. M., Deal, J. A., Chern, A., Ferrucci, L., Lin, F. R., Resnick, S. M., Golub, J. S. 2022; 77 (3): 623-631

  Abstract

  Several studies have demonstrated that age-related hearing loss is associated with cognitive decline. We investigated whether subclinical hearing loss (SCHL) or imperfect hearing traditionally categorized as normal (pure-tone average ≤25 dB) may be similarly linked to cognitive decline and risk of incident mild cognitive impairment (MCI)/dementia.Participants from the Baltimore Longitudinal Study of Aging were cognitively normal adults at least 50 years old with cognitive assessments from 1991 to 2019 and pure-tone average ≤25 dB measured between 1991 and 1994 (n = 263). The exposure was hearing based on the better ear pure-tone average. Outcomes were test scores in various cognitive domains. Multivariable linear-mixed effects models were developed to analyze the association between hearing and change in cognition over time, adjusting for age, sex, education, vascular burden, and race. Kaplan-Meier survival curves and Cox proportional hazards models portrayed associations between hearing and incident MCI/dementia diagnosis based on predefined criteria.Of 263 participants, 145 (55.1%) were female; mean age was 68.3 years (SD = 8.9). Follow-up ranged up to 27.7 years (mean = 11.7 years). Adjusting for multiple comparisons, a 10-dB increase in hearing loss was associated with an annual decline of -0.02 SD (95% confidence interval: -0.03, -0.01) in Letter Fluency. No significant relationships were observed between hearing and incident MCI/dementia.A relationship between SCHL and cognitive decline was observed for the Letter Fluency test. Further studies are necessary to determine where in the spectrum of hearing loss there begins to be an observable relationship between hearing and cognitive decline.

  View details for DOI 10.1093/gerona/glab263

  View details for Web of Science ID 000763655800029

  View details for PubMedID 34516645

  View details for PubMedCentralID PMC8893253

• Sleep Characteristics and Hearing Loss in Older Adults: The National Health and Nutrition Examination Survey 2005-2006 JOURNALS OF GERONTOLOGY SERIES A-BIOLOGICAL SCIENCES AND MEDICAL SCIENCES Jiang, K., Spira, A. P., Reed, N. S., Lin, F. R., Deal, J. A. 2022; 77 (3): 632-639

  Abstract

  Sleep characteristics might be associated with hearing loss through disturbed energy metabolism and disrupted cochlear blood flow, but prior evidence is limited. This study aims to investigate cross-sectional associations of sleep duration and signs/symptoms of sleep-disordered breathing with hearing in a nationally representative cohort of US older adults aged 70 and older.We studied 632 older adults aged 70 and older from the 2005-2006 cycle of the National Health and Nutrition Examination Survey. Hearing thresholds were measured using pure-tone audiometry and were averaged to create speech-frequency (0.5-4 kHz), low-frequency (0.5-2 kHz), and high-frequency (4-8 kHz) pure-tone averages (PTAs) in better-hearing ear, with higher values indicate worse hearing. Sleep duration and signs/symptoms of sleep-disordered breathing (snoring, snorting/stopping breathing, excessive sleepiness) were collected through questionnaires. Multivariable-adjusted spline models with knots at 6 and 8 hours were fitted for associations between sleep duration and PTAs. Multivariable-adjusted linear regression was used for associations between sleep-disordered breathing and PTAs. Primary models adjusted for demographic and lifestyle factors, secondary models additionally adjusted for cardiovascular factors.When sleep duration exceeded 8 hours, every additional hour of sleep duration was marginally associated with higher(poorer) high-frequency PTA (primary: 2.45 dB in hearing level, 95% CI: -0.34 to 5.24; secondary: 2.89 dB in hearing level, 95% CI: 0.02-5.76). No associations were observed between sleep-disordered breathing and hearing.Longer sleep duration is marginally associated with poorer high-frequency hearing among older adults sleeping more than 8 hours. However, we cannot infer temporality given the cross-sectional design. Future longitudinal studies are needed to establish temporality and clarify mechanisms.

  View details for DOI 10.1093/gerona/glab214

  View details for Web of Science ID 000756510100001

  View details for PubMedID 34302481

  View details for PubMedCentralID PMC9122752

• Development, assessment, and monitoring of audiologic treatment fidelity in the aging and cognitive health evaluation in elders (ACHIEVE) randomised controlled trial INTERNATIONAL JOURNAL OF AUDIOLOGY Arnold, M. L., Haley, W., Lin, F. R., Faucette, S., Sherry, L., Higuchi, K., Witherell, K., Anderson, E., Reed, N. S., Chisolm, T. H., Sanchez, V. A. 2022; 61 (9): 720-730

  Abstract

  Studies investigating hearing interventions under-utilise and under-report treatment fidelity planning, implementation, and assessment. This represents a critical gap in the field that has the potential to impede advancements in the successful dissemination and implementation of interventions. Thus, our objective was to describe treatment fidelity planning and implementation for hearing intervention in the multi-site Ageing and Cognitive Health Evaluation in Elders (ACHIEVE) randomised controlled trial.Our treatment fidelity plan was based on a framework defined by the National Institutes of Health Behaviour Change Consortium (NIH BCC), and included strategies to enhance study design, provider training, and treatment delivery, receipt, and enactment.To assess the fidelity of the ACHIEVE hearing intervention, we distributed a checklist containing criteria from each NIH BCC core treatment fidelity category to nine raters.The ACHIEVE hearing intervention fidelity plan satisfied 96% of NIH BCC criteria. Our assessment suggested a need for including clear, objective definitions of provider characteristics and non-treatment aspects of intervention delivery in future fidelity plans.The ACHIEVE hearing intervention fidelity plan can serve as a framework for the application of NIH BCC fidelity strategies for future studies and enhance the ability of researchers to reliably implement evidence-based interventions.

  View details for DOI 10.1080/14992027.2021.1973126

  View details for Web of Science ID 000696890000001

  View details for PubMedID 34533430

  View details for PubMedCentralID PMC11992692

• Longitudinal Blood Pressure Patterns From Mid- to Late Life and Late-Life Hearing Loss in the Atherosclerosis Risk in Communities Study JOURNALS OF GERONTOLOGY SERIES A-BIOLOGICAL SCIENCES AND MEDICAL SCIENCES Ting, J., Jiang, K., Du, S., Betz, J., Reed, N., Power, M. C., Gottesman, R., Sharrett, A., Griswold, M., Walker, K. A., Miller, E. R., Lin, F. R., Deal, J. A. 2022; 77 (3): 640-646

  Abstract

  Hearing loss is prevalent and associated with adverse functional outcomes in older adults. Prevention thus has far-reaching implications, yet few modifiable risk factors have been identified. Hypertension may contribute to age-related hearing loss, but epidemiologic evidence is mixed. We studied a prospective cohort of 3343 individuals from the Atherosclerosis Risk in Communities study, aged 44-65 years at baseline with up to 30 years of follow-up.Hearing was assessed in late life (2016-2017) using a better-ear audiometric pure tone average (0.5, 1, 2, 4 kHz) and the Quick Speech-in-Noise (QuickSIN) test. Hypertension was defined as systolic blood pressure ≥140 mmHg, diastolic blood pressure ≥90 mmHg, or antihypertensive medication use. Midlife hypertension was defined by hypertension at 2 consecutive visits between 1987-1989 and 1996-1998. Late-life hypertension was defined in 2016-2017. Late-life low blood pressure was defined as a systolic blood pressure less than 90 mmHg or diastolic blood pressure less than 60 mmHg, irrespective of antihypertensive medication use. Associations between blood pressure patterns from mid- to late life and hearing outcomes were assessed using multivariable-adjusted linear regression.Compared to persistent normotension, persistent hypertension from mid- to late life was associated with worse central auditory processing (difference in QuickSIN score = -0.66 points, 95% CI: -1.14, -0.17) but not with audiometric hearing.Participants with persistent hypertension had poorer late-life central auditory processing. These findings suggest that hypertension may be more strongly related to hearing-related changes in the brain than in the cochlea.

  View details for DOI 10.1093/gerona/glab153

  View details for Web of Science ID 000755893800001

  View details for PubMedID 34043799

  View details for PubMedCentralID PMC8893194

• Prevalence Trends in Hearing Aid Use Among US Adults Aged 50 to 69 Years With Hearing Loss-2011 to 2016 vs 1999 to 2004 JAMA OTOLARYNGOLOGY-HEAD & NECK SURGERY Wu, H. C., Thallmayer, T., Deal, J. A., Betz, J. F., Reed, N. S., Lin, F. R. 2021; 147 (9): 831-832

  Abstract

  This cross-sectional study examines the prevalence of hearing aid use among mid- to late-life older adults aged 50 to 69 years in 2011 to 2016 vs 1999 to 2004 in the US.

  View details for DOI 10.1001/jamaoto.2021.1572

  View details for Web of Science ID 000679478300001

  View details for PubMedID 34323926

  View details for PubMedCentralID PMC8323044

• Association of Age-Related Hearing Impairment With Physical Functioning Among Community-Dwelling Older Adults in the US JAMA NETWORK OPEN Martinez-Amezcua, P., Powell, D., Kuo, P., Reed, N. S., Sullivan, K. J., Palta, P., Szklo, M., Sharrett, R., Schrack, J. A., Lin, F. R., Deal, J. A. 2021; 4 (6): e2113742

  Abstract

  Hearing impairment, a common treatable condition, may contribute to poorer physical function with aging.To assess whether hearing impairment is associated with poorer physical function, reduced walking endurance, and faster decline in physical function.In this cohort study, cross-sectional and longitudinal analyses were performed using data from the 2011 to 2019 period of the Atherosclerosis Risk in Communities study, a population-based study of community-dwelling adults at 4 sites in the US.Hearing thresholds (per 10 dB) assessed with pure tone audiometry and categorized as normal hearing or mild, moderate, or severe hearing impairment.Physical function was assessed using the short physical performance battery (SPPB), with composite scores ranging from 0 to 12. A composite score of 6 or less and a score for each component (balance, gait speed, and chair stands) of 2 or less indicated poor performance. Walking endurance was assessed using a 2-minute fast-paced walk test. Tobit regression models adjusted for sociodemographic factors and medical history were used to calculate the mean differences in SPPB composite scores; logistic regression models, to estimate the odds ratios (ORs) of low SPPB composite and component scores; and linear mixed-effects models, to estimate the mean rate of change in SPPB composite scores over time.Of the 2956 participants (mean [SD] age, 79 [4.6] years) who attended study visit 6 between 2016 and 2017, 1722 (58.3%) were women, and 2356 (79.7%) were White. As determined by pure tone audiometry, 973 (33%) participants had normal hearing, 1170 (40%) had mild hearing impairment, 692 (23%) had moderate hearing impairment, and 121 (4%) had severe hearing impairment. In the Tobit regression model, severe hearing impairment was associated with a lower mean SPPB score (β, -0.82; 95% CI, -0.34 to -1.30) compared with normal hearing. In fully adjusted logistic regression models, hearing impairment was associated with higher odds of low physical performance scores (severe impairment vs normal hearing: OR for composite physical performance, 2.51 [95% CI, 1.47-4.27]; OR for balance, 2.58 [95% CI, 1.62-4.12]; OR for gait speed, 2.11 [95% CI, 1.03-4.33]). Over time (2 to 3 visits; maximum, 8.9 years), participants with hearing impairment had faster declines in SPPB compared with those with normal hearing (moderate hearing impairment × time interaction, -0.34 [-0.52 to -0.16]). In adjusted models for walking endurance, participants with moderate or severe hearing impairment walked a mean distance of -2.81 m (95% CI, -5.45 to -0.17 m) and -5.31 m (95% CI, -10.20 to -0.36 m) than those with normal hearing, respectively, during the 2-minute walk test.In this cohort study, hearing impairment was associated with poorer performance, faster decline in physical function, and reduced walking endurance. The results of the longitudinal analysis suggest that hearing impairment may be associated with poorer physical function with aging. Whether management of hearing impairment could delay decline in physical function requires further investigation.

  View details for DOI 10.1001/jamanetworkopen.2021.13742

  View details for Web of Science ID 000666388800001

  View details for PubMedID 34170305

  View details for PubMedCentralID PMC8233700

• Association of Hearing Impairment With Higher-Level Physical Functioning and Walking Endurance: Results From the Baltimore Longitudinal Study of Aging JOURNALS OF GERONTOLOGY SERIES A-BIOLOGICAL SCIENCES AND MEDICAL SCIENCES Martinez-Amezcua, P., Kuo, P., Reed, N. S., Simonsick, E. M., Agrawal, Y., Lin, F. R., Deal, J. A., Ferrucci, L., Schrack, J. A. 2021; 76 (10): E290-E298

  Abstract

  Although hearing impairment (HI) is linked to poorer physical functioning, the longitudinal associations between HI and higher-level functional measures are unclear.Data are from the Baltimore Longitudinal Study of Aging (2012-2019). Using pure-tone audiometry, we categorized hearing into normal, mild, and moderate or greater HI. Physical function was assessed with the expanded Short Physical Performance Battery (eSPPB) and walking endurance with time to walk 400 m. Multivariable and mixed-effects linear models tested the hypotheses that participants with HI, at baseline, have poorer physical performance and walking endurance, and faster decline over time (up to 6 measurements). In a subset (n = 526), we further adjusted for vestibular function. Among participants with HI, we evaluated the differences in eSPPB scores and walking endurance between hearing aid users and nonusers.Of 831 participants, 26% had mild, and 17% moderate or greater HI. After adjustment for demographics and medical history, moderate or greater impairment versus normal hearing was associated with poorer function (0.17 [95% CI: 0.09, 0.26] lower eSPPB score, and 13.3 [95% CI: 3.31, 23.4] seconds slower 400-m walk time) and faster decline in these parameters over 6 years. Adjustment for vestibular function did not attenuate these associations. Hearing aid users walked 400 m 24 seconds faster than nonusers (p = .001).Moderate or greater HI is associated with poorer initial and greater decline in higher-level physical performance. The observation that hearing aid users had better walking endurance suggests that screening for and treatment of HI may delay or slow progression of hearing-related functional decline.

  View details for DOI 10.1093/gerona/glab144

  View details for Web of Science ID 000745673000008

  View details for PubMedID 34003883

  View details for PubMedCentralID PMC8436975

• Hearing Impairment and Cognition in an Aging World JARO-JOURNAL OF THE ASSOCIATION FOR RESEARCH IN OTOLARYNGOLOGY Powell, D. S., Oh, E. S., Lin, F. R., Deal, J. A. 2021; 22 (4): 387-403

  Abstract

  With the increasing number of older adults around the world, the overall number of dementia cases is expected to rise dramatically in the next 40 years. In 2020, nearly 6 million individuals in the USA were living with Alzheimer's disease, the most common type of dementia, with anticipated growth to nearly 14 million by year 2050. This increasing prevalence, coupled with high societal burden, makes prevention and intervention of dementia a medical and public health priority. As clinicians and researchers, we will continue to see more individuals with hearing loss with other comorbidities including dementia. Epidemiologic evidence suggests an association between hearing loss and increased risk of dementia, presenting opportunity for targeted intervention for hearing loss to play a fundamental role in dementia prevention. In this discussion, we summarize current research on the association between hearing loss and dementia and review potential casual mechanisms behind the association (e.g., sensory-deprivation hypothesis, information-degradation hypothesis, common cause). We emphasize key areas of research which might best inform our investigation of this potential casual association. These selected research priorities include examination of the causal mechanism, measurement of co-existing hearing loss and cognitive impairment, and potential of aural rehabilitation. Addressing these research gaps and how results are then translated for clinical use is paramount for dementia prevention and overall health of older adults.

  View details for DOI 10.1007/s10162-021-00799-y

  View details for Web of Science ID 000651714200002

  View details for PubMedID 34008037

  View details for PubMedCentralID PMC8329135

• Association of Hearing Loss With Neuropsychiatric Symptoms in Older Adults With Cognitive Impairment AMERICAN JOURNAL OF GERIATRIC PSYCHIATRY Kim, A. S., Morales, E., Amjad, H., Cotter, V. T., Lin, F. R., Lyketsos, C. G., Nowrangi, M. A., Mamo, S. K., Reed, N. S., Yasar, S., Oh, E. S., Nieman, C. L. 2021; 29 (6): 544-553

  Abstract

  Neuropsychiatric symptoms (NPS) in persons with dementia (PWD) are common and can lead to poor outcomes, such as institutionalization and mortality, and may be exacerbated by sensory loss. Hearing loss is also highly prevalent among older adults, including PWD.This study investigated the association between hearing loss and NPS among community- dwelling patients from a tertiary memory care center.Participants of this cross-sectional study were patients followed at the Johns Hopkins Memory and Alzheimer's Treatment Center who underwent audiometric testing during routine clinical practice between October 2014 and January 2017.Included measures were scores on the Neuropsychiatric Inventory-Questionnaire and the Cornell Scale for Depression in Dementia.Participants (n = 101) were on average 76 years old, mostly female and white, and had a mean Mini-Mental State Examination score of 23. We observed a positive association between audiometric hearing loss and the number of NPS (b = 0.7 per 10 dB; 95% confidence interval [CI]: 0.2, 1.1; t = 2.86; p = 0.01; df = 85), NPS severity (b = 1.3 per 10 dB; 95% CI: 0.4, 2.5; t = 2.13; p = 0.04; df = 80), and depressive symptom severity (b = 1.5 per 10 dB; 95% CI: 0.4, 2.5; t = 2.83; p = 0.01; df = 89) after adjustment for demographic and clinical characteristics. Additionally, the use of hearing aids was inversely associated with the number of NPS (b = -2.09; 95% CI -3.44, -0.75; t = -3.10; p = 0.003; df = 85), NPS severity (b = -3.82; 95% CI -7.19, -0.45; t = -2.26; p = 0.03; df = 80), and depressive symptom severity (b = -2.94; 95% CI: -5.93, 0.06; t = 1.70; p = 0.05; df = 89).Among patients at a memory clinic, increasing severity of hearing loss was associated with a greater number of NPS, more severe NPS, and more severe depressive symptoms, while hearing aid use was associated with fewer NPS, lower severity, and less severe depressive symptoms. Identifying and addressing hearing loss may be a promising, low-risk, non-pharmacological intervention in preventing and treating NPS.

  View details for DOI 10.1016/j.jagp.2020.10.002

  View details for Web of Science ID 000651382700005

  View details for PubMedID 33168388

  View details for PubMedCentralID PMC8044263

• Safety and tolerability of <SUP>68</SUP>Ga-PSMA-R2 as an imaging agent in patients with biochemical recurrence or metastatic prostate cancer Lindenberg, M., Hope, T., Lin, F., Rowe, S., Pucar, D., Gilbert, N., Chicco, D., He, B., Dalal, D., Solnes, L. SOC NUCLEAR MEDICINE INC. 2021

  View details for Web of Science ID 000713713600452

• Medicare Beneficiaries With Self-Reported Functional Hearing Difficulty Have Unmet Health Care Needs HEALTH AFFAIRS Reed, N. S., Assi, L., Horiuchi, W., Hoover-Fong, J. E., Lin, F. R., Ferrante, L. E., Inouye, S. K., Miller, E. R., Boss, E. F., Oh, E. S., Willink, A. 2021; 40 (5): 786-794

  Abstract

  Hearing loss is associated with higher health care spending and use, but little is known about the unmet health care needs of people with hearing loss or difficulty. Analysis of 2016 Medicare Current Beneficiary Survey data for beneficiaries ages sixty-five and older reveals that those who reported a lot of trouble hearing in the past year were 49 percent more likely than those who reported no trouble hearing to indicate not having a usual source of care. Compared with those who reported no trouble hearing, those who reported some trouble hearing were more likely to indicate not having obtained medical care in the past year when they thought it was needed, as well as not filling a prescription, with the risk for both behaviors being greater among those reporting a lot of trouble hearing versus a little. Interventions that improve access to hearing services and aid communication may help older Medicare beneficiaries meet their health care needs.

  View details for DOI 10.1377/hlthaff.2020.02371

  View details for Web of Science ID 000649750000014

  View details for PubMedID 33939509

  View details for PubMedCentralID PMC8323057

• Relationship of Hearing Impairment With MRI Brain Volumes, White Matter Integrity and Amyloid Deposition in a Population-Based Observational Cohort Deal, J., Sharrett, A., Reed, N., Gottesman, R., Lin, F. ELSEVIER SCIENCE INC. 2021: S74

  View details for Web of Science ID 000645683800179

• Racial/Ethnic and Sex Representation in US-Based Clinical Trials of Hearing Loss Management in Adults A Systematic Review JAMA OTOLARYNGOLOGY-HEAD & NECK SURGERY Pittman, C. A., Roura, R., Price, C., Lin, F. R., Marrone, N., Nieman, C. L. 2021; 147 (7): 663-664

  Abstract

  Although the National Institutes of Health (NIH) mandated the inclusion and reporting of women and racial or ethnic minority groups in NIH-funded research in 1993, little is known regarding the representation of women and racial or ethnic minority groups in trials that investigate hearing loss management.To assess sex and racial/ethnic representation in US-based clinical trials of hearing loss management in an adult population.Pertinent studies were identified using search strategies in PubMed, Embase, and ClinicalTrials.gov.Our search strategy yielded 6196 studies. We included prospective studies that were written in English, performed in the US, and evaluated hearing loss management in adults, including amplification devices, such as hearing aids or assistive listening devices, cochlear implants, aural rehabilitation, and therapeutics. Given its prevalence, only studies that addressed bilateral sensorineural hearing loss were included.Data from 125 studies were extracted. The Preferred Reporting Items for Systematic Reviews and Meta-analyses diagram for systematic reviews was used for abstracting data. The guidelines were applied using independent extraction by multiple observers.Among 125 clinical studies performed from January 1990 to July 2020 regarding hearing loss management, only 16 (12.8%) reported race/ethnicity, and 88 (70.4%) reported sex. Of the 16 studies that reported race/ethnicity, only 5 included more than 30% non-White representation. Among the 88 articles that reported sex, 44 (35.2%) reported more than 45% female representation. While the mean number of participants included in the observed trials was 80 (range, 7-644), the median number of participants from racial or ethnic minority groups in studies that reported race/ethnicity was 9 (range, 1-77), and a median of 12 female participants were included in studies with a numerical breakdown by sex. A mean of 41% (range, 1.55%-77.5%) of participants were female among studies that reported sex, and a mean of 30% (range, 1.96%-100%) of participants were from racial or ethnic minority groups among the 16 studies that reported race/ethnicity. Reporting of race/ethnicity varied substantially by funding source and journal type, while reporting by sex differed only by journal type.Studies investigating hearing loss management do not adequately reflect the US population. A closer examination of the inclusion of diverse adults in clinical research associated with hearing health may work to ameliorate disparities and contribute to the development of tailored interventions that address the needs of an increasingly diverse US population.

  View details for DOI 10.1001/jamaoto.2021.0550

  View details for Web of Science ID 000642588600008

  View details for PubMedID 33885733

• Analysis of Hearing Loss and Physical Activity Among US Adults Aged 60-69 Years JAMA NETWORK OPEN Kuo, P., Di, J., Ferrucci, L., Lin, F. R. 2021; 4 (4): e215484

  Abstract

  Hearing loss may be a modifiable factor associated with decreased physical activity in older adults.To examine the association of hearing loss with objectively measured physical activity, including moderate-to-vigorous physical activity, light-intensity physical activity, sedentary behavior, and pattern of physical activity (physical activity fragmentation).This population-based cross-sectional study used National Health and Nutrition Examination Survey (NHANES) data collected in the 2003 to 2004 cycle and analyzed in 2017 to 2020. Participants aged 60 to 69 years with complete audiometry, physical activity, and comorbidity data were included in the analysis. Data analysis was performed from January 2017 to December 2020.Hearing defined by the pure tone average (PTA; range, 0.5-4 kHz) in the better ear, with normal PTA defined as less than 25 dB hearing loss, mild hearing loss defined as PTA 25 to less than 40 dB hearing loss, and moderate or greater hearing loss defined as a PTA greater than or equal to 40 dB hearing loss.The primary outcomes were comprehensive metrics of objectively measured physical activity, including time spent in moderate-to-vigorous physical activity, light-intensity physical activity, and sedentary behavior, and physical activity fragmentation. Linear regression was used to model the association between hearing loss and physical activity.Of the 291 participants (mean [SD] age, 64.53 [2.96] years), 139 (47.8%) were male, 48 (16.5%) had mild hearing loss, and 22 (7.6%) had moderate or greater hearing loss. After adjusting for age, sex, education, race/ethnicity, and comorbidities, hearing loss (vs normal hearing) was significantly associated with less time spent in moderate-to-vigorous physical activity by 5.53 minutes per day (95% CI, -10.15 to -0.90 minutes per day), less time spent in light-intensity physical activity by 28.55 minutes per day (95% CI, -53.07 to -4.02 minutes per day), more time spent in sedentary behaviors by 34.07 minutes per day (95% CI, 8.32 to 59.82 minutes per day), and more fragmented physical activity pattern by 0.38 SD higher in active-to-sedentary transition probability (95% CI, to 0.10 to 0.65). The magnitude of the association of hearing loss (vs normal hearing) with physical activity metrics was equivalent to 7.28 years (95% CI, 3.19 to 11.37 years) of accelerated age for moderate-to-vigorous physical activity, 5.84 years (95% CI, 1.45 to 10.23 years) of accelerated age for light-intensity physical activity, and 10.53 years (95% CI, 2.89 to 18.16 years) of accelerated age for degree of physical activity fragmentation.These findings suggest that hearing loss is associated with a worse physical activity profile. Whether interventions to address hearing loss in adults could improve physical activity profiles will require further study.

  View details for DOI 10.1001/jamanetworkopen.2021.5484

  View details for Web of Science ID 000642635500003

  View details for PubMedID 33871617

  View details for PubMedCentralID PMC8056278

• Hearing impairment and missing cognitive test scores in a population-based study of older adults: The Atherosclerosis Risk in Communities neurocognitive study ALZHEIMERS & DEMENTIA Deal, J. A., Gross, A. L., Sharrett, A., Abraham, A. G., Coresh, J., Carlson, M., Griswold, M., Mosley, T., Power, M. C., Ramulu, P., Reed, N. S., Lin, F. R., Swenor, B. K. 2021; 17 (10): 1725-1734

  Abstract

  Hearing impairment is associated with poor cognitive test performance in older adults. However, hearing's impact on cognitive test completion is poorly described, and missing cognitive data due to hearing impairment could misestimate the association.We investigated if hearing impairment is associated with missing neurocognitive scores in 3678 adults (72-94 years). Hearing impairment was defined by the better-ear pure tone average of speech-frequency thresholds (0.5-4 kHz) >25 decibels.Hearing impairment was associated with greater missingness on all auditory-only tests, including Logical Memory (prevalence ratio [PR] comparing ≥ moderate impairment vs normal hearing:1.68, 95% confidence interval [CI] 1.26, 2.25) and Digits Backwards (PR 1.62; 95% CI 1.21, 2.17); and two non-auditory tests, Boston Naming (PR 1.61; 95% CI 1.21, 2.17) and Trail Making B (PR 1.55; 95% CI 1.29, 1.86). Models that imputed missing cognitive scores showed the strongest hearing-cognition associations.Older adults with hearing impairment are less likely to complete cognitive testing, thereby underestimating the hearing impairment-cognition relationship.

  View details for DOI 10.1002/alz.12339

  View details for Web of Science ID 000639953900001

  View details for PubMedID 33844443

  View details for PubMedCentralID PMC12416502

• USPSTF Recommendations for Hearing Loss Screening in Asymptomatic Older Adults-A Case of Missing Evidence and Missing Treatment Options JAMA NETWORK OPEN Deal, J. A., Lin, F. R. 2021; 4 (3): e210274

  View details for DOI 10.1001/jamanetworkopen.2021.0274

  View details for Web of Science ID 000633041400001

  View details for PubMedID 33755162

• Prevalence of Concurrent Functional Vision and Hearing Impairment and Association With Dementia in Community-Dwelling Medicare Beneficiaries JAMA NETWORK OPEN Kuo, P., Huang, A. R., Ehrlich, J. R., Kasper, J., Lin, F. R., McKee, M. M., Reed, N. S., Swenor, B. K., Deal, J. A. 2021; 4 (3): e211558

  Abstract

  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.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.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.Self-reported functional sensory impairments (ie, no sensory impairment, functional vision impairment only, functional hearing impairment only, and functional dual sensory impairment).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.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:

  View details for DOI 10.1001/jamanetworkopen.2021.1558

  View details for Web of Science ID 000630470300001

  View details for PubMedID 33739429

  View details for PubMedCentralID PMC8601132

• A Geriatrician's Guide to Hearing Loss JOURNAL OF THE AMERICAN GERIATRICS SOCIETY Jilla, A. M., Reed, N. S., Oh, E. S., Lin, F. R. 2021; 69 (5): 1190-1198

  Abstract

  The high prevalence of hearing loss among older adults creates a perception that it is simply a benign consequence of aging, which leads to unaddressed communication needs. Strategies to address hearing loss as part of routine clinical care are pertinent to the geriatric care setting where hearing loss is prevalent in two out of every three patients 70 years and older. Our objectives are to briefly discuss the pathophysiology of hearing loss, describe the epidemiologic prevalence and impact, identify statutory barriers facing older adults in accessing hearing care, discuss current progress on legislation to address accessibility issues, and provide actionable strategies for addressing hearing loss as a barrier to effective communication. Simple steps can be taken to improve hearing care accessibility for older adults with hearing loss and can optimize understanding in daily communication, re-engage patients in being actively involved in their care, and promote patient autonomy in informed decision- making.

  View details for DOI 10.1111/jgs.17073

  View details for Web of Science ID 000626613700001

  View details for PubMedID 33687733

• Hearing Loss, Hearing Aid Use, and Depressive Symptoms in Older Adults-Findings from the Atherosclerosis Risk in Communities Neurocognitive Study (ARIC-NCS) JOURNALS OF GERONTOLOGY SERIES B-PSYCHOLOGICAL SCIENCES AND SOCIAL SCIENCES Shukla, A., Reed, N. S., Armstrong, N. M., Lin, F. R., Deal, J. A., Goman, A. M. 2021; 76 (3): 518-523

  Abstract

  Investigate the cross-sectional association between hearing loss (HL), hearing aid use, and depressive symptoms in community-dwelling older adults.The analytic sample consisted of 3,188 participants (age range 71-94 years) in the Atherosclerosis Risk in Communities Neurocognitive Study (ARIC-NCS). Multivariable logistic regression was used to evaluate the association of audiometric hearing status and self-reported hearing aid use with depressive symptoms (11-item Center for Epidemiologic Studies Depression scale).4.6% of participants had depressive symptoms. Forty percent had mild HL and 27% had moderate or greater HL. In multivariable-adjusted models, mild HL was associated with 1.90 times higher odds (95% confidence interval [CI] 1.20-3.01) and moderate or greater HL with 2.42 times higher odds (95% CI 1.44-4.07) of depressive symptoms compared to normal hearing. Each 10dB increase in HL was associated with 1.30 higher odds of depressive symptoms (95% CI 1.14-1.49). Hearing aid use was not associated with depressive symptoms among those with mild (odds ratio [OR] 0.94, 95% CI 0.35-2.54) or moderate or greater (OR 1.12, 95% CI 0.60-2.11) HL.Older adults with HL have higher odds of depressive symptoms compared to adults with normal hearing. Future studies are needed to assess whether hearing care is protective against depressive symptoms in older adults.

  View details for DOI 10.1093/geronb/gbz128

  View details for Web of Science ID 000649391400019

  View details for PubMedID 31628485

  View details for PubMedCentralID PMC7887727

• Interpreting Results from Epidemiologic Studies. Seminars in hearing Deal, J. A., Betz, J., Lin, F. R., Reed, N. S. 2021; 42 (1): 3-9

  Abstract

  Epidemiology is the science of public health. The focus of this discussion is to present a brief overview of how epidemiology approaches questions of disease causation, including why it sometimes gets things wrong, and so to provide a framework for how we consume and use this type of research, particularly when it comes to patient care.

  View details for DOI 10.1055/s-0041-1725996

  View details for PubMedID 33883787

• Prevalence of Asymmetric Hearing Among Adults in the United States OTOLOGY & NEUROTOLOGY Suen, J. J., Betz, J., Reed, N. S., Deal, J. A., Lin, F. R., Goman, A. M. 2021; 42 (2): E111-E113

  Abstract

  To estimate the national prevalence of asymmetric hearing among adults through applying two distinct audiometric criteria.National cross-sectional survey.Ambulatory examination centers within the National Health and Nutrition Examination Survey (NHANES).Non-institutionalized adults in the United States from the 2001 to 2012 cycles of NHANES aged 20 years and older with pure tone audiometric and tympanometric data (n = 6,190).Standardized protocol for pure tone audiometry and tympanometry.Proportion of asymmetric hearing according to two distinct audiometric criteria. One criterion (American Academy of Otolaryngology-Head and Neck Surgery [AAO-HNS]) specifies asymmetry as a difference between pure tone averages (PTA) greater than 15 dB, and the other (Veterans Affairs [VA]) specifies asymmetry as a difference greater than/equal to 20 dB across two contiguous frequencies or 10 dB across three contiguous frequencies. Analyses included sampling weights to account for the epidemiologic survey's complex sampling design.Using a definition from the AAO-HNS, overall prevalence was 2.77 and 9.46% when calculating the PTA with 0.5 to 4 kHz and 4 to 8 kHz, respectively. In contrast, through a working definition used within the VA, overall prevalence was 25.05% across 0.5 to 8 kHz. Estimates differed across sex and age, with men and older age cohorts exhibiting higher prevalence.A nationally-representative sample of US adults indicates higher prevalence of asymmetric hearing among men and older adult cohorts. There is currently no standard audiometric criterion for defining asymmetry, and prevalence estimates vary markedly depending on which audiometric criteria is used. Given the potentially high prevalence of asymmetry depending on criterion, clinicians should also consider other supplementary clinical data when recommending medical referral.

  View details for DOI 10.1097/MAO.0000000000002931

  View details for Web of Science ID 000612743600001

  View details for PubMedID 33332857

  View details for PubMedCentralID PMC9186817

• A Community Health Worker Training Program to Deliver Accessible and Affordable Hearing Care to Older Adults JOURNAL OF HEALTH CARE FOR THE POOR AND UNDERSERVED Suen, J. J., Han, H., Peoples, C. Y., Weikert, M., Marrone, N., Lin, F. R., Nieman, C. L. 2021; 32 (1): 37-49

  Abstract

  Community leaders collaborated with human-centered design practitioners and academic researchers to co-develop a community health worker (CHW) training program for delivering community-based hearing care to fellow older adults. When implemented by CHWs, clients' communication function improved comparably with outcomes following professional interventions. Community-based models offer opportunities to advance hearing health.

  View details for Web of Science ID 000625296600007

  View details for PubMedID 33678679

  View details for PubMedCentralID PMC9195336

• Association of Hearing Loss with Physical, Social, and Mental Activity Engagement. Seminars in hearing Goman, A. M., Gao, T., Betz, J., Reed, N. S., Deal, J. A., Lin, F. R., ACHIEVE-P Study Group 2021; 42 (1): 59-65

  Abstract

  This article aims to evaluate a hearing loss intervention versus an aging education intervention on activity engagement in the Aging and Cognitive Health Evaluation in Elders pilot (ACHIEVE-P). Forty adults (70-84 years) with hearing loss recruited from the Atherosclerosis Risk in Communities Study and de novo participated. Participants were randomized 1:1 to a best practices hearing intervention or a successful aging intervention. Hearing was measured with pure-tone audiometry. The Community Healthy Activities Model Program for Seniors questionnaire measured self-reported time engaging in activities at baseline and 6-month follow-up. At baseline, greater hearing loss was associated with reduced time per week on mental activities (-3.0hours per 10dB of hearing loss, 95% confidence interval: -5.8, -0.2). Mental activity engagement increased (mean: +1.3hours, SD=6.6) for the hearing intervention group but decreased (mean: -1.1hours, SD=4.8) for the aging education group (Cohen's d : 0.41). Hearing loss may be associated with reduced engagement in mental activities. Whether hearing loss treatment impacts activity will be studied in the full-scale ACHIEVE trial.

  View details for DOI 10.1055/s-0041-1726001

  View details for PubMedID 33883792

• COMMUNITY ENGAGEMENT AND HUMANCENTERED DESIGN: LESSONS FROM HEARS IN INCLUSIVE RECRUITMENT OF OLDER ADULTS Nieman, C., Han, H., Marrone, N., Suen, J., Szanton, S., Trumbo, J., Lin, F. OXFORD UNIV PRESS. 2021: 471

  View details for Web of Science ID 000842009902274

• Satisfaction With Quality of Health Care Among Medicare Beneficiaries With Functional Hearing Loss MEDICAL CARE Reed, N. S., Boss, E. F., Lin, F. R., Oh, E. S., Willink, A. 2021; 59 (1): 22-28

  Abstract

  Nearly 38 million Americans have hearing loss. Understanding how sensory deficits such as hearing loss, which limit communication, impact satisfaction has implications for Medicare value-based reimbursement mechanisms. The aim of this study was to characterize the association of functional hearing loss and dissatisfaction with quality of health care over the past year among Medicare beneficiaries.Cross-sectional study of satisfaction with quality of health care among Medicare beneficiaries with self-reported trouble hearing from the 2015 Medicare Current Beneficiaries Survey. There were 11,441 Medicare beneficiaries representing a 48.6 million total weighted nationally representative sample.Forty-eight percent of Medicare beneficiaries reported a little or a lot of trouble hearing. Medicare beneficiaries with a little trouble hearing (odds ratio=1.496; 95% confidence interval, 1.079-2.073; P=0.016) and a lot of trouble hearing (odds ratio=1.769; 95% confidence interval, 1.175-2.664; P=0.007) had 49.6% and 76.9% higher odds of being dissatisfied with the quality of their health care over the previous year, respectively.Medicare beneficiaries with functional hearing loss had higher odds of dissatisfaction with health care over the past year compared to those without functional hearing loss. Given Medicare's reliance on patient satisfaction as a value-based measure for hospital reimbursement, interventions to address hearing loss in the health care system are needed.

  View details for DOI 10.1097/MLR.0000000000001419

  View details for Web of Science ID 000599708600005

  View details for PubMedID 32925460

  View details for PubMedCentralID PMC7736070

• Peripheral Hearing Loss and Its Association with Cognition among Ethnic Chinese Older Adults DEMENTIA AND GERIATRIC COGNITIVE DISORDERS Nicholas, S., Koh, E., Wee, S., Eikelboom, R. H., Jayakody, D. M. P., Lin, F., Ng, T., Heywood, R. L. 2021; 50 (4): 394-400

  Abstract

  Many studies on hearing loss (HL) and cognition are limited by subjective hearing assessments and verbally administered cognition tests, the majority of the document findings in Western populations. This study aimed to assess the association of HL with cognitive impairment among ethnic Chinese Singaporean older adults using visually presented cognitive tests.The hearing of community-dwelling older adults was assessed using pure tone audiometry. Cognitive function was assessed using the Computerized Cambridge Cognitive Test Battery (CANTAB). Multiple regression analyses examined the association between hearing and cognitive function, adjusted for age, education, and gender.HL (pure-tone average [PTA] of thresholds at 0.5, 1, 2, and 4 kHz in the better ear, BE4PTA) was associated with reduced performance in delayed matching and multitasking tasks (β = -0.25, p = 0.019, and β = 0.02, p = 0.023, respectively). Moderate to severe HL was associated with reduced performance in delayed matching and verbal recall memory tasks (β = -10.6, p = 0.019, and β = -0.28, p = 0.042). High-frequency HL was associated with reduced performance in the spatial working memory task (β = 0.004, p = 0.022). All-frequency HL was associated with reduced performance in spatial working memory and multitasking (β = 0.01, p = 0.040, and β = 0.02, p = 0.048).Similar to Western populations, HL among tonal language-speaking ethnic Chinese was associated with worse performance in tasks requiring working memory and executive function.

  View details for DOI 10.1159/000519291

  View details for Web of Science ID 000921530400011

  View details for PubMedID 34592737

• Functional Hearing Loss and Social Engagement Among Medicare Beneficiaries JOURNALS OF GERONTOLOGY SERIES B-PSYCHOLOGICAL SCIENCES AND SOCIAL SCIENCES Shukla, A., Cudjoe, T. K. M., Lin, F. R., Reed, N. S. 2021; 76 (1): 195-200

  Abstract

  Hearing loss is common in older adults and limits communication. We investigated the independent association between functional hearing loss and social engagement in a nationally representative sample of older adults.Using data from the 2015 Medicare Current Beneficiaries Survey, we modeled the cross-sectional association between self-reported hearing ability and limitation in social activity over the past month using multivariable logistic regression.The majority of the study population was female (54.8%) and non-Hispanic white (74.3%). Participants (40.4%) reported "a little trouble" hearing and 7.4% reported "a lot of trouble" hearing. Those who reported any trouble hearing had higher odds of limited social engagement in the past month. After adjustment for demographic, clinical, and functional covariates, those who reported "a lot of trouble" hearing had 37% higher odds of limited social activity in the past month compared to those with normal hearing.These results suggest that hearing loss may be an important risk factor for limited social engagement and downstream negative health consequences, independent of other disability and health conditions.

  View details for DOI 10.1093/geronb/gbz094

  View details for Web of Science ID 000649390900020

  View details for PubMedID 31359056

  View details for PubMedCentralID PMC7756723

• PREVALENCE OF CONCURRENT FUNCTIONAL VISION AND HEARING IMPAIRMENT AND ITS ASSOCIATION WITH DEMENTIA Deal, J., Kuo, P., Huang, A., Ehrlich, J., Kasper, J., Reed, N., Lin, F., Swenor, B. OXFORD UNIV PRESS. 2021: 434

  View details for Web of Science ID 000842009902141

• COGNITION MODERATES THE RELATIONSHIP BETWEEN HEARING AND MOBILITY IN COGNITIVELY NORMAL OLDER ADULTS Pupo, D., Small, B., Deal, J., Armstrong, N., Resnick, S., Lin, F., Ferrucci, L., Tian, Q. OXFORD UNIV PRESS. 2021: 161

  View details for Web of Science ID 000842009900620

• ASSOCIATIONS OF HABITUAL SLEEP DURATION AND SLEEP STAGES WITH SPEECH-IN-NOISE PERFORMANCE Jiang, K., Spira, A., Full, K., Garcia, E., Lin, F., Reed, N., Lutsey, P., Deal, J. OXFORD UNIV PRESS. 2021: 35

  View details for Web of Science ID 000842009900133

• ASSOCIATION OF HEARING IMPAIRMENT WITH HIGHER LEVEL PHYSICAL FUNCTIONING AND WALKING ENDURANCE Amezcua, P., Kuo, P., Reed, N., Simonsick, E., Agrawal, Y., Lin, F., Deal, J., Schrack, J. OXFORD UNIV PRESS. 2021: 437

  View details for Web of Science ID 000842009902153

• WORSE SELF-REPORTED HEARING ABILITY IS ASSOCIATED WITH GREATER PERCEIVED PHYSICAL AND MENTAL FATIGABILITY Gmelin, T., Moored, K., Lin, F., Golub, J., Wojczynski, M., Boudreau, R., Galvin, A., Glynn, N. W. OXFORD UNIV PRESS. 2021: 155

  View details for Web of Science ID 000842009900597

• DERIVATION AND VALIDATION OF AN ALGORITHMIC CLASSIFICATION OF EARLY COGNITIVE IMPAIRMENT Gross, A., An, Y., Lin, F., Ferrucci, L., Schrack, J., Agrawal, Y., Resnick, S. OXFORD UNIV PRESS. 2021: 436

  View details for Web of Science ID 000842009902149

• ASSOCIATIONS OF CENTRAL AUDITORY PROCESSING WITH BRAIN VOLUMES Jiang, K., Coresh, J., Hayden, K., Jack, C., Mosley, T., Pankow, J., Lin, F., Deal, J. OXFORD UNIV PRESS. 2021: 155

  View details for Web of Science ID 000842009900599

• EXAMINING THE COMBINED ESTIMATED EFFECTS OF HEARING IMPAIRMENT AND DEPRESSION ON COGNITIVE DECLINE AND DEMENTIA Powell, D., Brenowitz, W., Yaffe, K., Lin, F., Gross, A., Deal, J. OXFORD UNIV PRESS. 2021: 477-478

  View details for Web of Science ID 000842009902300

• The Pure-Tone Average as a Universal Metric-Knowing Your Hearing JAMA OTOLARYNGOLOGY-HEAD & NECK SURGERY Lin, F. R., Reed, N. S. 2021; 147 (3): 230-231

  View details for DOI 10.1001/jamaoto.2020.4862

  View details for Web of Science ID 000604111500003

  View details for PubMedID 33355634

• Long-term Impact of Hearing Aid Provision or Cochlear Implantation on Hearing Handicap LARYNGOSCOPE Kim, A. S., Betz, J. F., Nieman, C. L., Hoyer, M. R., Applebaum, J., Lin, F. R., Goman, A. M. 2021; 131 (5): 1122-1126

  Abstract

  Previous research has shown hearing handicap to be reduced following hearing aid use or cochlear implantation in short-to-medium follow-up periods, yet the impact of interventions for hearing loss on hearing handicap in the long term remains understudied. This article reports hearing handicap at 6 months, 12 months, and 5 years after either hearing aid provision or cochlear implantation.Observational study.A study of 115 participants from the Studying Multiple Outcomes after Aural Rehabilitative Treatment (SMART) study cohort assessed self-reported hearing handicap using the Hearing Handicap Inventory for the Elderly Screening version (HHIE-S) at baseline, 6 months, 12 months, and 5 years. Generalized estimating equations (GEE) were used to estimate the population mean HHIE-S score over time, accounting for the correlated nature of repeated measures data, and multiple imputation with chained equations was performed to impute missing data.Compared to baseline, mean HHIE-S scores after hearing aid provision were significantly reduced at 6 months (mean = -7.96, 95% confidence interval [CI]: -10.40, -5.53), 12 months (mean = -6.58, 95% CI: -9.26, -3.90), and 5 years (mean = -4.58, 95% CI: -7.87, -1.30). After cochlear implantation, mean hearing handicap scores were also significantly lower compared to baseline at 6 months (mean = -8.18, 95% CI: -11.07, -5.30), 12 months (mean = -10.04, 95% CI: -12.92, -7.16), and 5 years (mean = -8.97, 95% CI: -12.92, -7.16).This study found short-term benefits from hearing aids and cochlear implantation on hearing handicap were maintained over 5 years. Laryngoscope, 131:1122-1126, 2021.

  View details for DOI 10.1002/lary.29175

  View details for Web of Science ID 000583350200001

  View details for PubMedID 33135838

• Hearing loss and microstructural integrity of the brain in a dementia-free older population ALZHEIMERS & DEMENTIA Croll, P. H., Vernooij, M. W., Reid, R., Goedegebure, A., Power, M. C., Rigters, S. C., Sharrett, A., de Jong, R., Mosley, T. H., de Groot, M., Lin, F. R., Deal, J. A. 2020; 16 (11): 1515-1523

  Abstract

  As hearing loss has been identified as an important risk factor for dementia, we aimed to assess the association between hearing loss and microstructural integrity of the brain.A total of 1086 dementia-free participants (mean age = 75.2 [standard deviation: 4.9], 61.4% female) of the population-based Atherosclerosis Risk in Communities (ARIC) study underwent hearing assessment (2016-2017) and magnetic resonance imaging of the brain (2011-2013). Microstructural integrity was determined with diffusion tensor imaging. Multivariable linear regression was used to investigate associations between hearing loss and microstructural integrity of different brain regions and white matter (WM) tracts.Hearing loss was associated with lower WM microstructural integrity in the temporal lobe, lower gray matter integrity of the hippocampus, and with lower WM microstructural integrity of the limbic tracts and the uncinate fasciculus.Our results demonstrate that hearing loss is indepedently associated with lower microstructural integrity in brain regions that are important for different cognitive processes.

  View details for DOI 10.1002/alz.12151

  View details for Web of Science ID 000617056600005

  View details for PubMedID 32743902

• Association of Poorer Hearing With Longitudinal Change in Cerebral White Matter Microstructure JAMA OTOLARYNGOLOGY-HEAD & NECK SURGERY Armstrong, N. M., Williams, O. A., Landman, B. A., Deal, J. A., Lin, F. R., Resnick, S. M. 2020; 146 (11): 1035-1042

  Abstract

  There is a dearth of studies that examine the association between poorer hearing and change in cerebral white matter (WM) microstructure.To examine the association of poorer hearing with baseline and change in WM microstructure among older adults.This was a prospective cohort study that evaluated speech-in-noise, pure-tone audiometry, and WM microstructure, as measured by mean diffusivity (MD) and fractional anisotropy (FA), both of which were evaluated by diffusion tensor imaging (DTI) in 17 WM regions. Data were collected between October 2012 and December 2018 and analyzed between March 2019 and August 2019 with a mean follow-up time of 1.7 years. The study evaluated responses to the Baltimore Longitudinal Study of Aging among 356 cognitively normal adults who had at least 1 hearing assessment and DTI session. Excluded were those with baseline cognitive impairment, stroke, head injuries, Parkinson disease, and/or bipolar disorder.Peripheral auditory function was measured by pure-tone average in the better-hearing ear. Central auditory function was measured by signal-to-noise ratio score from a speech-in-noise task and adjusted by pure-tone average.Linear mixed-effects models with random intercepts and slopes were used to examine the association of poorer peripheral and central auditory function with baseline and longitudinal DTI metrics in 17 WM regions, adjusting for baseline characteristics (age, sex, race, hypertension, elevated total cholesterol, and obesity).Of 356 cognitively normal adults included in the study, the mean (SD) age was 73.5 (8.8) years, and 204 (57.3%) were women. There were no baseline associations between hearing and DTI measures. Longitudinally, poorer peripheral hearing was associated with increases in MD in the inferior fronto-occipital fasciculus (β = 0.025; 95% CI, 0.008-0.042) and the body (β = 0.050; 95% CI, 0.015-0.085) of the corpus callosum, but there were no associations of peripheral hearing with FA changes in these tracts. Poorer central auditory function was associated with longitudinal MD increases (β = 0.031; 95% CI, 0.010-0.052) and FA declines (β = -1.624; 95% CI, -2.511 to -0.738) in the uncinate fasciculus.Findings of this cohort study suggest that poorer hearing is related to change in integrity of specific WM regions involved with auditory processing.

  View details for DOI 10.1001/jamaoto.2020.2497

  View details for Web of Science ID 000606823000001

  View details for PubMedID 32880621

  View details for PubMedCentralID PMC7489397

• Association of Speech Recognition Thresholds With Brain Volumes and White Matter Microstructure: The Rotterdam Study OTOLOGY & NEUROTOLOGY Armstrong, N. M., Croll, P. H., Oosterloo, B. C., Lin, F. R., Ikram, M., Goedegebure, A., Vernooij, M. W. 2020; 41 (9): 1202-1209

  Abstract

  Brain volumetric declines may underlie the association between hearing loss and dementia. While much is known about the peripheral auditory function and brain volumetric declines, poorer central auditory speech processing may also be associated with decreases in brain volumes.Central auditory speech processing, measured by the speech recognition threshold (SRT) from the Digits-in-Noise task, and neuroimaging assessments (structural magnetic resonance imaging [MRI] and fractional anisotropy and mean diffusivity from diffusion tensor imaging), were assessed cross-sectionally in 2,368 Rotterdam Study participants aged 51.8 to 97.8 years. SRTs were defined continuously and categorically by degrees of auditory performance (normal, insufficient, and poor). Brain volumes from structural MRI were assessed on a global and lobar level, as well as for specific dementia-related structures (hippocampus, entorhinal cortex, parahippocampal gyrus). Multivariable linear regression models adjusted by age, age-squared, sex, educational level, alcohol consumption, intracranial volume (MRI only), cardiovascular risk factors (hypertension, diabetes, obesity, current smoking), and pure-tone average were used to determine associations between SRT and brain structure.Poorer central auditory speech processing was associated with larger parietal lobe volume (difference in mL per dB increase= 0.24, 95% CI: 0.05, 0.42), but not with diffusion tensor imaging measures. Degrees of auditory performance were not associated with brain volumes and white matter microstructure.Central auditory speech processing in the presence of both vascular burden and pure-tone average may not be related to brain volumes and white matter microstructure. Longitudinal follow-up is needed to explore these relationships thoroughly.

  View details for DOI 10.1097/MAO.0000000000002739

  View details for Web of Science ID 000588492200027

  View details for PubMedID 32925839

• The Hearing Intervention for the Aging and Cognitive Health Evaluation in Elders Randomized Control Trial: Manualization and Feasibility Study EAR AND HEARING Sanchez, V. A., Arnold, M. L., Reed, N. S., Oree, P. H., Matthews, C. R., Clock Eddins, A., Lin, F. R., Chisolm, T. H. 2020; 41 (5): 1333-1348

  Abstract

  This work describes the development of a manualized best-practice hearing intervention for older adults participating in the Aging and Cognitive Health Evaluation in Elders (ACHIEVE) randomized controlled clinical trial. Manualization of interventions for clinical trials is critical for assuring intervention fidelity and quality, especially in large multisite studies. The multisite ACHIEVE randomized controlled trial is designed to assess the efficacy of a hearing intervention on rates of cognitive decline in older adults. We describe the development of the manualized hearing intervention through an iterative process that included addressing implementation questions through the completion of a feasibility study (ACHIEVE-Feasibility).Following published recommendations for manualized intervention development, an iterative process was used to define the ACHIEVE-hearing intervention elements and create an initial manual. The intervention was then delivered within the ACHIEVE-Feasibility study using one-group pre-post design appropriate for assessing questions related to implementation. Participants were recruited from the Tampa, Florida area between May 2015 and April 2016. Inclusion criteria were cognitively healthy adults aged 70 to 89 with symmetrical mild-to-moderately severe sensorineural hearing loss. The ACHIEVE-Feasibility study sought to assess the implementation of the manualized hearing intervention by: (1) confirming improvement in expected outcomes were achieved including aided speech-in-noise performance and perception of disease-specific self-report measures; (2) determining whether the participants would comply with the intervention including session attendance and use of hearing aids; and (3) determining whether the intervention sessions could be delivered within a reasonable timeframe.The initial manualized intervention that incorporated the identified best-practice elements was evaluated for feasibility among 21 eligible participants and 9 communication partners. Post-intervention expected outcomes were obtained with speech-in-noise performance results demonstrating a significant improvement under the aided condition and self-reported measures showing a significant reduction in self-perceived hearing handicap. Compliance was excellent, with 20 of the 21 participants (95.2%) completing all intervention sessions and 19 (90.4%) returning for the 6-month post-intervention visit. Furthermore, self-reported hearing aid compliance was >8 hr/day, and the average daily hearing aid use from datalogging was 7.8 hr. Study completion was delivered in a reasonable timeframe with visits ranging from 27 to 85 min per visit. Through an iterative process, the intervention elements were refined, and the accompanying manual was revised based on the ACHIEVE-Feasibility study activities, results, and clinician and participant informal feedback.The processes for the development of a manualized intervention described here provide guidance for future researchers who aim to examine the efficacy of approaches for the treatment of hearing loss in a clinical trial. The manualized ACHIEVE-Hearing Intervention provides a patient-centered, yet standardized, step-by-step process for comprehensive audiological assessment, goal setting, and treatment through the use of hearing aids, other hearing assistive technologies, counseling, and education aimed at supporting self-management of hearing loss. The ACHIEVE-Hearing Intervention is feasible in terms of implementation with respect to verified expected outcomes, compliance, and reasonable timeframe delivery. Our processes assure intervention fidelity and quality for use in the ACHIEVE randomized controlled trial (ClinicalTrials.gov Identifier: NCT03243422).

  View details for DOI 10.1097/AUD.0000000000000858

  View details for Web of Science ID 000565624900026

  View details for PubMedID 32251012

  View details for PubMedCentralID PMC10436703

• Hearing Impairment and Loneliness in Older Adults in the United States JOURNAL OF APPLIED GERONTOLOGY Huang, A. R., Deal, J. A., Rebok, G. W., Pinto, J. M., Waite, L., Lin, F. R. 2021; 40 (10): 1366-1371

  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.

  View details for DOI 10.1177/0733464820944082

  View details for Web of Science ID 000556315000001

  View details for PubMedID 32749194

• Association of Hearing Loss With Psychological Distress and Utilization of Mental Health Services Among Adults in the United States JAMA NETWORK OPEN Bigelow, R. T., Reed, N. S., Brewster, K. K., Huang, A., Rebok, G., Rutherford, B. R., Lin, F. R. 2020; 3 (7): e2010986

  Abstract

  Psychological distress affects health and health care utilization. Hearing loss (HL) is highly prevalent and undertreated, and it may be a potentially modifiable risk factor for psychological distress.To investigate the association between HL, psychological distress, and mental health care utilization among adults in the United States.This cross-sectional study included 25 665 individuals aged 18 years and older who participated in the 2017 National Health Interview Survey, a home-based nationally representative cross-sectional survey of noninstitutionalized US adults conducted by trained interviewers.Self-reported hearing and hearing aid use.Kessler psychological distress scale (scores ≥5 indicating moderate distress), self-reported use of medication to treat depression or anxiety symptoms, and use of mental health services in the past year.A total of 25 665 adults (mean [SD] age 47.0 [18.1] years, 51.7% [95% CI, 51.0%-52.5%] women, weighted to be representative of the US adult population) were included in the analysis. Compared with 11 558 participants (49.3%; 95% CI, 48.2%-50.5%) with no HL, the 9390 (35.3%; 95% CI, 34.4%-36.2%) with mild HL and 4717 (15.4%; 95% CI, 14.8%-16.0%) with moderate or worse HL had increased odds of moderate psychological distress (mild HL: odds ratio [OR], 1.49; 95% CI, 1.35-1.62; moderate HL: OR, 2.12; 95% CI, 1.87-2.41) and were more likely to report antidepressant medication use (mild HL: OR, 1.39; 95% CI, 1.17-1.67; moderate HL: OR, 2.07; 95% CI, 1.70-2.57), and antianxiety medication use (mild HL: OR, 1.39; 95% CI, 1.16-1.67; moderate HL: OR, 1.94; 95% CI, 1.57-2.39). Moderate HL was associated with increased odds of use of mental health services (moderate HL: OR, 1.53; 95% CI, 1.30-1.79). Among individuals with moderate HL, those with hearing aids (1066 [22.6%]) were less likely to experience psychological distress than those without hearing aids (3651 [77.4%]; OR, 0.66; 95% CI, 0.53-0.83).In a large nationally representative sample of US adults, self-reported HL was associated with both greater psychological distress and increased rates of antidepressant and antianxiety medication use and utilization of mental health services. Further research is needed to investigate whether HL may be a modifiable risk factor for these outcomes.

  View details for DOI 10.1001/jamanetworkopen.2020.10986

  View details for Web of Science ID 000555947400004

  View details for PubMedID 32687587

  View details for PubMedCentralID PMC7372323

• Hearing loss and cognitive function among Chinese older adults: the role of participation in leisure activities BMC GERIATRICS Gao, J., Armstrong, N. M., Deal, J. A., Lin, F. R., He, P. 2020; 20 (1): 215

  Abstract

  Hearing loss, a highly prevalent sensory impairment affecting older adults, is a risk factor for cognition decline. However, there were very limited studies on this association in low-resource countries. This study aimed to assess the association between self-reported hearing loss and cognitive decline, and whether engagement in leisure activities moderated this association among older adults in China.Data were obtained from two waves of the nationally representative survey of China Longitudinal Healthy Longevity Survey (CLHLS) between 2011/12-2014. Eight thousand eight hundred forty-four individuals aged 65 years old or above with a dichotomized measure of self-reported hearing status were included. Modified Mini-Mental Examination (MMSE) was used to measure global cognition. Fixed-effects models were used to estimate whether leisure activity engagement moderated the association of self-perceived hearing loss with global cognitive change in the overall sample and sex subsamples.Self-reported hearing loss was associated with cognitive impairment, with an odds ratio of 2.48 [1.22, 5.06]. Sex difference in the association of hearing loss and cognitive impairment was not found. Self-reported hearing loss was associated with cognitive decline, with 8% increase in risk compared with those with normal hearing. Frequent engagement in leisure activities moderated the association between hearing loss and cognitive decline for the whole and male samples.Hearing loss was associated with cognitive decline, and leisure activities engagement moderated the association among males rather than females.

  View details for DOI 10.1186/s12877-020-01615-7

  View details for Web of Science ID 000547502500001

  View details for PubMedID 32560691

  View details for PubMedCentralID PMC7305626

• Hearing Loss, Loneliness, and Social Isolation: A Systematic Review OTOLARYNGOLOGY-HEAD AND NECK SURGERY Shukla, A., Harper, M., Pedersen, E., Goman, A., Suen, J. J., Price, C., Applebaum, J., Hoyer, M., Lin, F. R., Reed, N. S. 2020; 162 (5): 622-633

  Abstract

  Social isolation and loneliness are associated with increased mortality and higher health care spending in older adults. Hearing loss is a common condition in older adults and impairs communication and social interactions. The objective of this review is to summarize the current state of the literature exploring the association between hearing loss and social isolation and/or loneliness.PubMed, Embase, CINAHL Plus, PsycINFO, and the Cochrane Library.Articles were screened for inclusion by 2 independent reviewers, with a third reviewer for adjudication. English-language studies of older adults with hearing loss that used a validated measure of social isolation or loneliness were included. A modified Newcastle-Ottawa Scale was used to assess the quality of the studies included in the review.Of the 2495 identified studies, 14 were included in the review. Most of the studies (12/14) were cross-sectional. Despite the heterogeneity of assessment methods for hearing status (self-report or objective audiometry), loneliness, and social isolation, most multivariable-adjusted studies found that hearing loss was associated with higher risk of loneliness and social isolation. Several studies found an effect modification of gender such that among women, hearing loss was more strongly associated with loneliness and social isolation than among men.Our findings that hearing loss is associated with loneliness and social isolation have important implications for the cognitive and psychosocial health of older adults. Future studies should investigate whether treating hearing loss can decrease loneliness and social isolation in older adults.

  View details for DOI 10.1177/0194599820910377

  View details for Web of Science ID 000523813200001

  View details for PubMedID 32151193

  View details for PubMedCentralID PMC8292986

• Making Sense of the Senses in Aging Research JOURNALS OF GERONTOLOGY SERIES A-BIOLOGICAL SCIENCES AND MEDICAL SCIENCES Lin, F. R. 2020; 75 (3): 529-530

  View details for DOI 10.1093/gerona/glaa028

  View details for Web of Science ID 000518534800016

  View details for PubMedID 32060540

• Age-related Hearing Loss: Recent Developments in Approaching a Public Health Challenge CURRENT OTORHINOLARYNGOLOGY REPORTS Shan, A., Lin, F. R., Nieman, C. L. 2020; 8 (1): 24-33

  View details for DOI 10.1007/s40136-020-00271-0

  View details for Web of Science ID 000702480900005

• Temporal Sequence of Hearing Impairment and Cognition in the Baltimore Longitudinal Study of Aging JOURNALS OF GERONTOLOGY SERIES A-BIOLOGICAL SCIENCES AND MEDICAL SCIENCES Armstrong, N. M., An, Y., Ferrucci, L., Deal, J. A., Lin, F. R., Resnick, S. M. 2020; 75 (3): 574-580

  Abstract

  Hearing impairment (HI) could be a risk factor for cognitive decline, but cognition could plausibly also affect psychoacoustic assessment of hearing with audiometry. We examined the temporal sequence of hearing and cognitive function among nondemented, community-dwelling older adults.Hearing and cognition were assessed between 2012 and 2015 and 2 years thereafter in 313 nondemented participants aged ≥60 years in the Baltimore Longitudinal Study of Aging. Poorer hearing was defined by pure-tone average of 0.5-4 kHz tones in the better-hearing ear. Cognitive measures with either visual or auditory inputs were Trail-making Test Part B; Digit Symbol Substitution Test; California Verbal Learning Test immediate recall, short delay, and long delay; Digit Span Forward/Backward; Benton Visual Retention Test; and Mini-Mental State Examination. We used linear regression models for cross-sectional associations at each timepoint and autoregressive, cross-lagged models to evaluate whether baseline hearing impairment (Time 1) predicted cognitive performance 2 years after baseline (Time 2) and vice versa.Cross-sectionally, there were no associations between poorer hearing and cognitive performance. Longitudinally, poorer hearing was associated with declines in California Verbal Learning Test immediate (β = -0.073, SE = 0.032, p = .024), short-delayed (β = -0.134, SE = 0.043, p = .002), long-delayed (β = -0.080, SE = 0.032, p = .012) recall, and Digit Span Forward (β = -0.074, SE = 0.029, p = .011).) from Time 1 to Time 2. Cognitive performance at Time 1 did not predict change in hearing status at Time 2.Audiometric hearing impairment predicted short-term cognitive declines in both California Verbal Learning Test and auditory stimuli for attention.

  View details for DOI 10.1093/gerona/gly268

  View details for Web of Science ID 000518534800023

  View details for PubMedID 30500877

  View details for PubMedCentralID PMC7328201

• Associations of Hearing Loss and Depressive Symptoms With Incident Disability in Older Adults: Health, Aging, and Body Composition Study JOURNALS OF GERONTOLOGY SERIES A-BIOLOGICAL SCIENCES AND MEDICAL SCIENCES Armstrong, N. M., Deal, J. A., Betz, J., Kritchevsky, S., Pratt, S., Harris, T., Barry, L. C., Simonsick, E. M., Lin, F. R. 2020; 75 (3): 531-536

  Abstract

  Depressive symptoms and hearing loss (HL) are independently associated with increased risk of incident disability; whether the increased risk is additive is unclear.Cox Proportional Hazards models were used to assess joint associations of HL (normal, mild, moderate/severe) and late-life depressive symptoms (defined by a score of ≥8 on the 10-item Center for Epidemiologic Studies-Depression scale) with onset of mobility disability (a lot of difficulty or inability to walk ¼ mile and/or climb 10 steps) and any disability in activities of daily living (ADL), among 2,196 participants of the Health, Aging and Body Composition Study, a cohort of well-functioning older adults aged 70-79 years. Models were adjusted for age, race, sex, education, diabetes, hypertension, and body mass index.Relative to participants with normal hearing and without depressive symptoms, participants without depressive symptoms who had mild or moderate/severe HL had increased risk of incident mobility and ADL disability (hazard ratio [HR] for mobility disability, mild HL:1.34, 95% confidence interval [CI]: 1.09, 1.64 and HR for mobility disability, moderate/severe HL: 1.37, 95% CI: 1.08, 1.75 and HR for ADL disability, mild HL: 1.32, 95% CI: 1.08, 1.63, and HR for ADL disability, moderate/severe HL: 1.42, 95% CI: 1.11, 1.82). Among participants with depressive symptoms, mild HL (HR: 1.71, 95% CI: 1.09, 2.70) was associated with increased risk of incident mobility disability.Independent of depressive symptoms, risk of incident disability was greater in older adults with HL, regardless of severity. Further research into HL interventions may delay disability onset.

  View details for DOI 10.1093/gerona/gly251

  View details for Web of Science ID 000518534800017

  View details for PubMedID 30561511

  View details for PubMedCentralID PMC7328205

• Variations in Prevalence and Number of Older Adults With Self-reported Hearing Trouble by Audiometric Hearing Loss and Sociodemographic Characteristics JAMA OTOLARYNGOLOGY-HEAD & NECK SURGERY Goman, A. M., Reed, N. S., Lin, F. R., Willink, A. 2020; 146 (2): 201-203

  Abstract

  This cross-sectional study evaluates 2613 participants 60 years or older in the NHANES study (2001-2012) for variations in self-reported hearing trouble by audiometric hearing loss and sociodemographic characteristics.

  View details for DOI 10.1001/jamaoto.2019.3584

  View details for Web of Science ID 000518016400022

  View details for PubMedID 31750866

  View details for PubMedCentralID PMC6902177

• Association Between Microvascular Retinal Signs and Age-Related Hearing Loss in the Atherosclerosis Risk in Communities Neurocognitive Study (ARIC-NCS) JAMA OTOLARYNGOLOGY-HEAD & NECK SURGERY Kim, S., Reed, N., Betz, J. F., Abraham, A., Lee, M., Sharrett, A., Lin, F. R., Deal, J. A. 2020; 146 (2): 152-159

  Abstract

  Given that age-related hearing loss is highly prevalent and treatable, understanding its causes may have implications for disease prevention.To investigate whether microvascular retinal signs are associated with age-related hearing loss attributable to a hypothesized underlying shared pathologic entity involving microvascular disease.The Atherosclerosis Risk in Communities Neurocognitive Study (ARIC-NCS) is a community-based prospective cohort study of 15 792 men and women aged 45 to 64 years at baseline. The ARIC-NCS participants returned for a fifth clinic visit in 2011-2013 and a sixth clinic visit in 2016-2017. Participants were recruited from 4 US communities (Washington County, Maryland; Forsyth County, North Carolina; Jackson, Mississippi; and Minneapolis suburbs, Minnesota). Participants included a subset of the ARIC-NCS cohort with complete covariate data who underwent retinal fundus photography at visit 5 (2011-2013) and completed hearing assessment at visit 6 (2016-2017) (N = 1458). Overall, 453 participants had diabetes; of those, 68 had retinopathy. Of 1005 participants without diabetes, 42 had retinopathy.Microvascular retinal signs included retinopathy, arteriovenous (AV) nicking, and generalized arteriolar narrowing measured using the central retinal arteriolar equivalent (CRAE).Hearing was measured using the better-hearing ear pure-tone average (PTA) of air conduction speech thresholds (0.5, 1, 2, and 4 kHz). Multivariable-adjusted linear and ordered logistic regression was used to estimate the association between microvascular retinal signs and age-related hearing loss to describe the precision of the estimates and provide a plausible range for the true association.After full adjustment among 1458 individuals in the analytic cohort (mean [SD] age, 76.1 [5.0] years [age range, 67-90 years]; 825 women [56.6%]; 285 black [19.5%]), the difference in PTA per dB hearing level in persons with and without retinopathy was 2.21 (95% CI, -0.22 to 4.63), suggesting that retinopathy is associated with poorer hearing, although the width of the 95% CI prevents definitive conclusions about the strength of the observed association. Restricting the analysis to participants without diabetes, the difference in PTA associated with retinopathy was even greater (4.14; 95% CI, 0.10-8.17 dB hearing level), but the large width of the 95% CI prevents definitive conclusions about the association. In analyses quantifying the mean differences in hearing thresholds at individual frequencies by retinopathy status, the estimates trended toward retinopathy being associated, contrary to expectation, with better high-frequency hearing. At 8 kHz, the estimated difference in hearing thresholds in persons with retinopathy vs those without was -4.24 (95% CI, -7.39 to -1.09).In this population-based study, an association between the presence of microvascular retinal signs and hearing loss was observed, suggesting that retinopathy may have the potential to identify risk for hearing loss in persons without diabetes. The precision of these estimates is low; therefore, additional epidemiologic studies are needed to better define the degree of microvascular contributions to age-related hearing loss.

  View details for DOI 10.1001/jamaoto.2019.3987

  View details for Web of Science ID 000518016400013

  View details for PubMedID 31876936

  View details for PubMedCentralID PMC6990841

• Trends in Employment by Dual Sensory Impairment Status JAMA OPHTHALMOLOGY Varadaraj, V., Wang, Y., Reed, N. S., Deal, J. A., Lin, F. R., Swenor, B. K. 2020; 138 (2): 213-215

  Abstract

  This study compares employment rates by vision impairment, hearing impairment, and dual sensory impairment using data from the National Health Interview Survey from the 2008 to 2017 cycles.

  View details for DOI 10.1001/jamaophthalmol.2019.4955

  View details for Web of Science ID 000515514700022

  View details for PubMedID 31804660

  View details for PubMedCentralID PMC6902122

• Hearing Loss and Physical Functioning Among Adults with Heart Failure: Data from NHANES CLINICAL INTERVENTIONS IN AGING Cosiano, M. F., Jannat-Khah, D., Lin, F. R., Goyal, P., McKee, M., Sterling, M. R. 2020; 15: 635-643

  Abstract

  Hearing loss (HL) is associated with poor physical functioning among older adults, yet this association has not been examined in heart failure (HF), a disease in which both hearing loss and poor physical functioning are highly prevalent. We investigated whether this association exists in HF since HL represents a potentially modifiable risk factor for poor physical functioning.We studied adults aged ≥70 years with self-reported HF in the National Health and Nutrition Examination Survey (NHANES). HL was assessed and categorized using pure-tone averages. Activities of daily living (ADLs), instrumental ADLs (IADLs), leisure and social activities (LSA), lower extremity mobility (LEM), and general physical activity (GPA) were assessed. Negative binomial regression was used to examine the association between HL and physical functioningOne hundred eighty-one participants comprised our population. Those with ≥ moderate HL had more difficulty with ADLs (37.0% vs 24.0%, p=0.02), IADLs (36.0% vs 23.0%, p=0.05), and LEM (37.3% vs 20.0%, p=0.009), compared to participants with none or mild HL. In multivariable models, ≥ moderate HL was significantly associated with difficulty in physical functioning across four of the five domains: ADLs: PR: 1.71 (95% CI: 1.07-2.72); IADLs: PR: 1.71 (1.24-2.34); LEM: PR: 1.51 (1.01-2.26); and GPA: PR: 1.19 (1.00-1.41).Among older adults with HF, moderate or greater HL was associated with a higher prevalence of difficulty with ADLs, IADLs, and LEM, compared to mild or no HL.

  View details for DOI 10.2147/CIA.S246662

  View details for Web of Science ID 000530326300001

  View details for PubMedID 32440106

  View details for PubMedCentralID PMC7211960

• Relationship Between Domain-Specific Cognitive Function and Speech-in-Noise Performance in Older Adults: The Atherosclerosis Risk in Communities Hearing Pilot Study AMERICAN JOURNAL OF AUDIOLOGY Mamo, S. K., Reed, N. S., Sharrett, A., Albert, M. S., Coresh, J., Mosley, T. H., Knopman, D., Lin, F. R., Deal, J. A. 2019; 28 (4): 1006-1014

  Abstract

  Purpose The purpose of this study was to investigate associations between performance on a clinical speech-in-noise measure with a comprehensive neurocognitive battery of tests. Method A group of older adults (N = 250, M age = 77 years, age range: 67.3-89.1 years) enrolled in the Atherosclerosis Risk in Communities Neurocognitive Study took part in the hearing pilot study (2013) that included testing for audiometric thresholds and speech-in-noise performance (Quick Speech-in-Noise Test; Killion, Niquette, Gudmundsen, Revit, & Banerjee, 2004). This research study analyzed the associations between domain-specific cognitive function and speech-in-noise performance after adjusting for hearing thresholds and other demographic and cardiovascular factors. Results Multivariable-adjusted associations were found between all cognitive domains and speech-in-noise performance in the full sample, but the observed associations varied when participants with varying levels of moderate to moderately severe hearing loss were excluded from the analysis. Conclusions The findings are discussed in terms considering the cognitive status of older adults in relation to their speech-in-noise performance during audiological evaluation and implications for aural rehabilitation.

  View details for DOI 10.1044/2019_AJA-19-00043

  View details for Web of Science ID 000566667500016

  View details for PubMedID 31825642

  View details for PubMedCentralID PMC7210433

• Carotid Atherosclerosis Is Associated With Poorer Hearing in Older Adults JOURNAL OF THE AMERICAN MEDICAL DIRECTORS ASSOCIATION Croll, P. H., Bos, D., Vernooij, M. W., Arshi, B., Lin, F. R., de Jong, R., Ikram, M., Goedegebure, A., Kavousi, M. 2019; 20 (12): 1617-+

  Abstract

  Cardiovascular disease may be linked to hearing loss through narrowing of the nutrient arteries of the cochlea, but large-scale population-based evidence for this association remains scarce. We investigated the association of carotid atherosclerosis as a marker of generalized cardiovascular disease with hearing loss in a population-based cohort.Cross-sectional.A population-based cohort study.3724 participants [mean age: 65.5 years, standard deviation (SD): 7.5, 55.4% female].Ultrasound and pure-tone audiograms to assess carotid atherosclerosis and hearing loss.We investigated associations of carotid plaque burden and carotid intima-media thickness (IMT) (overall and side-specific carotid atherosclerosis) with hearing loss (in the best hearing ear and side-specific hearing loss) using multivariable linear and ordinal regression models. We found that higher maximum IMT was related to poorer hearing in the best hearing ear [difference in decibel hearing level per 1-mm increase in IMT: 2.09 dB, 95% confidence interval (CI): 0.08, 4.10]. Additionally, third and fourth quartile plaque burden as compared to first quartile was related to poorer hearing in the best hearing ear (difference: 1.06 dB, 95% CI: 0.04, 2.08; and difference: 1.55 dB, 95% CI: 0.49, 2.60, respectively). Larger IMT (difference: 2.97 dB, 95% CI: 0.79, 5.14), third quartile plaque burden compared to first quartile (difference: 1.24 dB, 95% CI: 0.14, 2.35), and fourth plaque quartile compared to first quartile (difference: 2.12 dB, 95% CI: 0.98, 3.26) in the right carotid were associated with poorer hearing in the right ear.Carotid atherosclerosis is associated with poorer hearing in older adults, almost exclusively with poorer hearing in the right ear. Based on our results, it seems that current therapies for the prevention of cardiovascular disease may also prove beneficial for hearing loss in older adults by promoting and maintaining inner ear health.

  View details for DOI 10.1016/j.jamda.2019.06.022

  View details for Web of Science ID 000499073900023

  View details for PubMedID 31399361

• Age-Related Hearing Loss and the Listening Environment: Communication Challenges in a Group Care Setting for Older Adults. The annals of long-term care : the official journal of the American Medical Directors Association Mamo, S. K., Reed, N. S., McNabney, M. K., Rund, J., Oh, E. S., Lin, F. R. 2019; 27 (11): e8-e13

  Abstract

  Ensuring that older adults in long-term care settings can effectively communicate is important. The goal of this study was to characterize key modifiable factors that could affect verbal communication in an adult day care setting, namely prevalence of audiometric hearing loss and the acoustic characteristics in the activity hall. The prevalence of age-related hearing loss among participants (n=51) was 71%, although only 15% of enrollees at the group care setting (n=21 of 140) used amplification. The noise and reverberation characteristics of the activity hall revealed signal-to-noise ratios of -3.1 decibels (dB) and -2.4 dB during morning activity and lunch, respectively, which are poorer than the recommended levels for understanding speech in background noise. Older adults attending adult day services are likely to spend the day in a room with acoustics that are too challenging to understand speech clearly. Opportunities to improve listening environments in group care settings for older adults are discussed.

  View details for PubMedID 32542069

• Corrigendum to: Associations of Hearing Loss and Menopausal Hormone Therapy With Change in Global Cognition and Incident Cognitive Impairment Among Postmenopausal Women. The journals of gerontology. Series A, Biological sciences and medical sciences Armstrong, N. M., Espeland, M. A., Chen, J., Masaki, K., Wactawski-Wende, J., Li, W., Gass, M. L., Stefanick, M. L., Manson, J. E., Deal, J. A., Rapp, S. R., Lin, F. R., Resnick, S. M. 2019

  View details for DOI 10.1093/gerona/glz208

  View details for PubMedID 31624848

• Access to adults' hearing aids: policies and technologies used in eight countries BULLETIN OF THE WORLD HEALTH ORGANIZATION Yong, M., Willink, A., McMahon, C., McPherson, B., Nieman, C. L., Reed, N. S., Lin, F. R. 2019; 97 (10): 699-710

  Abstract

  As the proportion of older adults in the world's total population continues to grow, the adverse health outcomes of age-related hearing loss are becoming increasingly recognized. While research has shown that age-related hearing loss is the single greatest modifiable risk factor for dementia, use of hearing aids remains low worldwide, even in many middle- and high-income countries. Reasons for poor uptake of hearing aids are likely to involve a combination of factors, ranging from increasing costs of hearing aid technology to a widespread lack of insurance coverage. This article aims to identify the current state of access to hearing aids, focusing on eight middle- and high-income countries. We discuss how to facilitate greater access to hearing aids for patients by addressing changes in how devices are regulated, technological advancements in hearing devices, the need to adjust reimbursement schemes and the importance of adaptation among the community workforce for hearing-care.

  View details for DOI 10.2471/BLT.18.228676

  View details for Web of Science ID 000493963000021

  View details for PubMedID 31656335

  View details for PubMedCentralID PMC6796668

• Audiologic profile of the jackson heart study cohort and comparison to other cohorts LARYNGOSCOPE Bishop, C. E., Spankovich, C., Lin, F. R., Seals, S. R., Su, D., Valle, K., Schweinfurth, J. M. 2019; 129 (10): 2391-2397

  Abstract

  The objective of this study was to determine the audiological profile of an African American cohort, identify related factors, and compare them to other datasets.Cross-sectional, longitudinal cohort study.The Jackson Heart Study (JHS) is a longitudinal cohort study of 5,306 African Americans living in the metropolitan Jackson, Mississippi area, with a focus on cardiometabolic health. The JHS Hearing Study (n = 1,314) was implemented to measure the prevalence of hearing, tinnitus, and balance outcomes and relationship to predictor variables. Here we present prevalence and covariate relationships in comparison to the Epidemiology of Hearing Loss Study and the National Health and Nutrition Examination Survey.The prevalence of self-reported hearing difficulty was 38.1% (n = 500). The prevalence of hearing loss based on audiometric pure tone threshold average (0.5, 1.0, 2.0, 4.0 kHz) of the better ear was 19.8% (n = 260) and for the worse ear 29.8% (n = 392). The prevalence of tinnitus was 29.5% (n = 388) and balance dysfunction 24.1% (n = 317). Relationships of hearing loss to demographic, cardiometabolic, and audiologic variables are presented.These results demonstrate that hearing loss, tinnitus, and balance dysfunction are common issues affecting adult African Americans, and that hearing loss is related to numerous modifiable and nonmodifiable risk factors. Furthermore, our findings are consistent with lower prevalence of hearing loss in African Americans compared to the non-African American populations. However, despite the lower audiometric evidence of hearing loss, nearly 40% of participants reported hearing difficulty.2b Laryngoscope, 129:2391-2397, 2019.

  View details for DOI 10.1002/lary.27920

  View details for Web of Science ID 000488184200046

  View details for PubMedID 30889290

• Cultural Adaptation of a Community-Based Hearing Health Intervention for Korean American Older Adults with Hearing Loss JOURNAL OF CROSS-CULTURAL GERONTOLOGY Choi, J. S., Shim, K. S., Shin, N. E., Nieman, C. L., Mamo, S. K., Han, H., Lin, F. R. 2019; 34 (3): 223-243

  Abstract

  Although hearing loss is known to be associated with many adverse health outcomes in older adults, current hearing healthcare remains expensive and inaccessible to most ethnic minorities in the US. We aim to adapt an affordable, community-based hearing intervention to older Korean Americans (KAs), describe the cultural adaption process, and report pilot trial outcomes. We undertook the first four stages of Barrera & Castro's cultural adaptation framework: information gathering, preliminary adaptation design, adaptation test, and adaptation refinement in 15 older KAs with hearing loss and 15 of their communication partners. We developed a culturally adapted intervention consisting of provision of an affordable listening device and aural rehabilitative training. Six weeks post-intervention, participants' mean hearing handicap score (range: 0-40) reduced from 15.7 to 6.4. Communication partners demonstrated improved social-emotional function. Post-intervention focus group revealed increased hearing benefit, confidence in hearing health navigation, and awareness in hearing health among study participants. The adapted intervention was well-accepted and feasible among older KAs. This study is the first to report the cultural adaptation process of a hearing care model into older KAs and its methodology may be applied to other minority groups.

  View details for DOI 10.1007/s10823-019-09376-6

  View details for Web of Science ID 000492409800001

  View details for PubMedID 31264090

  View details for PubMedCentralID PMC6814539

• Association of Midlife Hearing Impairment With Late-Life Temporal Lobe Volume Loss JAMA OTOLARYNGOLOGY-HEAD & NECK SURGERY Armstrong, N. M., An, Y., Doshi, J., Erus, G., Ferrucci, L., Davatzikos, C., Deal, J. A., Lin, F. R., Resnick, S. M. 2019; 145 (9): 794-802

  Abstract

  Hearing impairment (HI) in midlife (45-65 years of age) may be associated with longitudinal neurodegeneration of temporal lobe structures, a biomarker of early Alzheimer disease.To evaluate the association of midlife HI with brain volume trajectories in later life (≥65 years of age).This prospective cohort study used data from the Baltimore Longitudinal Study of Aging to evaluate hearing from November 5, 1990, to October 3, 1994, and late-life volume change from July 10, 2008, to January 29, 2015, using magnetic resonance imaging (MRI) (mean follow-up time, 19.3 years). Data analysis was performed from September 22, 2017, to August 27, 2018. A total of 194 community-dwelling older adults who had midlife measures of peripheral hearing at a mean age of 54.5 years and late-life volume change of up to 6 years between the first and most recent MRI assessment were studied. Excluded were those with baseline cognitive impairment, stroke, head injuries, Parkinson disease, and bipolar disorder.Hearing as measured with pure tone audiometry in each ear from November 5, 1990, to October 3, 1994, and late-life temporal lobe volume change measured by MRI.Linear mixed-effects models with random intercepts were used to examine the association of midlife hearing (pure tone average of 0.5-4 kHz tones in the better ear and each ear separately) with longitudinal late-life MRI-based measures of temporal lobe structures (hippocampus, entorhinal cortex, parahippocampal gyrus, and superior, middle, and inferior temporal gyri) in the left and right hemispheres, in addition to global and lobar regions, adjusting for baseline demographic characteristics (age, sex, subsequent cognitive impairment status, and educational level) and intracranial volume.A total of 194 patients (mean [SD] age at hearing assessment, 54.5 [10.0] years; 106 [54.6%] female; 169 [87.1%] white) participated in the study. After Bonferroni correction, poorer midlife hearing in the better ear was associated with steeper late-life volumetric declines in the right temporal gray matter (β = -0.113; 95% CI, -0.182 to -0.044), right hippocampus (β = -0.008; 95% CI, -0.012 to -0.004), and left entorhinal cortex (β = -0.009; 95% CI, -0.015 to -0.003). Poorer midlife hearing in the right ear was associated with steeper late-life volumetric declines in the right temporal gray matter (β = -0.136; 95% CI, -0.197 to -0.075), right hippocampus (β = -0.008; 95% CI, -0.012 to -0.004), and left entorhinal cortex (β = -0.009; 95% CI, -0.015 to -0.003), whereas there were no associations between poorer midlife hearing in the left ear with late-life volume loss.The findings suggest that midlife HI is a risk factor for temporal lobe volume loss. Poorer midlife hearing, particularly in the right ear, was associated with declines in hippocampus and entorhinal cortex.

  View details for DOI 10.1001/jamaoto.2019.1610

  View details for Web of Science ID 000489529900004

  View details for PubMedID 31268512

  View details for PubMedCentralID PMC6613307

• Impact of Cognitive Impairment Across Specialties: Summary of a Report From the U13 Conference Series JOURNAL OF THE AMERICAN GERIATRICS SOCIETY Carpenter, C. R., McFarland, F., Avidan, M., Berger, M., Inouye, S. K., Karlawish, J., Lin, F. R., Marcantonio, E., Morris, J. C., Reuben, D. B., Shah, R. C., Whitson, H. E., Asthana, S., Verghese, J. 2019; 67 (10): 2011-2017

  Abstract

  Although declines in cognitive capacity are assumed to be a characteristic of aging, increasing evidence shows that it is age-related disease, rather than age itself, that causes cognitive impairment. Even so, older age is a primary risk factor for cognitive decline, and with individuals living longer as a result of medical advances, cognitive impairment and dementia are increasing in prevalence. On March 26 to 27, 2018, the American Geriatrics Society convened a conference in Bethesda, MD, to explore cognitive impairment across the subspecialties. Bringing together representatives from several subspecialties, this was the third of three conferences, supported by a U13 grant from the National Institute on Aging, to aid recipients of Grants for Early Medical/Surgical Specialists' Transition to Aging Research (GEMSSTAR) in integrating geriatrics into their subspecialties. Scientific sessions focused on the impact of cognitive impairment, sensory contributors, comorbidities, links between delirium and dementia, and issues of informed consent in cognitively impaired populations. Discussions highlighted the complexity not only of cognitive health itself, but also of the bidirectional relationship between cognitive health and the health of other organ systems. Thus, conference participants noted the importance of multidisciplinary team science in future aging research. This article summarizes the full conference report, "The Impact of Cognitive Impairment Across Specialties," and notes areas where GEMSSTAR scholars can contribute to progress as they embark on their careers in aging research. J Am Geriatr Soc 67:2011-2017, 2019.

  View details for DOI 10.1111/jgs.16093

  View details for Web of Science ID 000482735300001

  View details for PubMedID 31436318

  View details for PubMedCentralID PMC6800784

• Association of Midlife Hypertension with Late-Life Hearing Loss OTOLARYNGOLOGY-HEAD AND NECK SURGERY Reed, N. S., Huddle, M. G., Betz, J., Power, M. C., Pankow, J. S., Gottesman, R., Sharrett, A., Mosley, T. H., Lin, F. R., Deal, J. A. 2019; 161 (6): 996-1003

  Abstract

  To investigate the association of midlife hypertension with late-life hearing impairment.Data from the Atherosclerosis Risk in Communities study, an ongoing prospective longitudinal population-based study (baseline, 1987-1989).Washington County, Maryland, research field site.Subjects included 248 community-dwelling men and women aged 67 to 89 years in 2013. Systolic blood pressure (SBP) and diastolic blood pressure were measured at each of 5 study visits from 1987-1989 to 2013. Hypertension was defined by elevated systolic or diastolic blood pressure or antihypertensive medication use. A 4-frequency (0.5-4 kHz) better-hearing ear pure tone average in decibels hearing loss (dB HL) was calculated from pure tone audiometry measured in 2013. A cutoff of 40 dB HL was used to indicate clinically significant moderate to severe hearing impairment. Hearing thresholds at 5 frequencies (0.5-8 kHz) were also considered separately.Forty-seven participants (19%) had hypertension at baseline (1987-1989), as opposed to 183 (74%) in 2013. The SBP association with late-life pure tone average differed by the time of measurement, with SBP measured at earlier visits associated with poorer hearing; the difference in pure tone average per 10-mm Hg SBP measured was 1.43 dB HL (95% CI, 0.32-2.53) at baseline versus -0.43 dB HL (95% CI, -1.41 to 0.55) in 2013. Baseline hypertension was associated with higher thresholds (poorer hearing) at 4 frequencies (1, 2, 4, 8 kHz).Midlife SBP was associated with poorer hearing measured 25 years later. Further analysis into the longitudinal relationship between hypertension and hearing impairment is warranted.

  View details for DOI 10.1177/0194599819868145

  View details for Web of Science ID 000481063400001

  View details for PubMedID 31382849

  View details for PubMedCentralID PMC7262678

• Long-term subjective loneliness in adults after hearing loss treatment INTERNATIONAL JOURNAL OF AUDIOLOGY Applebaum, J., Hoyer, M., Betz, J., Lin, F. R., Goman, A. M. 2019; 58 (8): 464-467

  Abstract

  Objective: While hearing loss is associated with loneliness, the long term impact of hearing loss interventions remains unknown. We investigated levels of loneliness in adults at baseline, 6-months, 1-year and 5-years after receiving a hearing aid (HA) or cochlear implant (CI). Design: In this 5-year follow-up to the Studying Multiple Outcomes after Aural Rehabilitative Treatment study, participants completed the University of California, Los Angeles (UCLA) Loneliness Scale at baseline, 6-months, 1-year, and 5-year time points. Generalized estimating equations modeled the population average UCLA score over time. Study Sample: Analytic cohort of 115 participants (74% of original 156) 50 years or older who received a HA or CI at baseline and completed at least one follow up visit. Results: Loneliness scores were not different at 5 years versus baseline for HA users. CI users showed significantly reduced loneliness at 6-months and 1-year from baseline and with no significant difference at 5 years. Conclusion: Over 5 years, we observed no increase in loneliness from baseline in a cohort of adults receiving HAs and CIs. Short-term reduction in loneliness in CI users was demonstrated. Future randomized trials are needed to definitively assess the impact of treated versus untreated hearing loss on loneliness.

  View details for DOI 10.1080/14992027.2019.1593523

  View details for Web of Science ID 000480303700002

  View details for PubMedID 30929531

  View details for PubMedCentralID PMC10436704

• Associations of Hearing Loss and Menopausal Hormone Therapy with Change in Global Cognition and Incident Cognitive Impairment among Postmenopausal Women. The journals of gerontology. Series A, Biological sciences and medical sciences Armstrong, N. M., Espeland, M. A., Chen, J., Masaki, K., Wactawski-Wende, J., Li, W., Gass, M. L., Stefanick, M. L., Manson, J. E., Deal, J. A., Rapp, S. R., Lin, F. R., Resnick, S. M. 2019

  Abstract

  BACKGROUND: Hearing loss (HL) and menopausal hormone (conjugated equine estrogens [CEE] and/or medroxyprogesterone acetate [MPA]) are separately associated with cognitive decline and increased risk of incident cognitive impairment. Joint effects of HL and HT could be associated with additive or synergistic decline in global cognition and risk of incident cognitive impairment among postmenopausal women.METHODS: Using the Women's Health Initiative (WHI) Memory Study, 7,220 postmenopausal women with measures of HL, global cognition (Modified Mini- Mental State Examination score), and cognitive impairment (centrally-adjudicated diagnoses of mild cognitive impairment and dementia) from 1996-2009. Multivariable linear mixed effects models were used to analyze rate of change in global cognition. Accelerated failure time models were used to evaluate time to incident cognitive impairment, stratified by HT.RESULTS: Within the CEE-Alone trial, observed adverse effects of CEE-Alone on change in global cognition did not differ by HL, and estimated joint effects of HL and CEE-Alone were not associated with incident cognitive impairment. Within the CEE+MPA trial, HL did not independently accelerate time to cognitive impairment, the adverse effect of CEE+MPA was heightened in older women with HL. Older women on CEE+MPA either with HL (Time Ratio, [TR]=0.82, 95% Confidence Interval, [CI]: 0.71, 0.94) or with normal hearing (TR=0.86, 95% CI: 0.76, 0.97) had faster time to cognitive impairment than those with normal hearing and placebo.CONCLUSIONS: HL may accentuate the adverse effect of CEE+MPA, not CEE-Alone, on global cognitive decline, not incident cognitive impairment, among postmenopausal women on HT.

  View details for DOI 10.1093/gerona/glz173

  View details for PubMedID 31326978

• Multiple Sensory Impairment Is Associated With Increased Risk of Dementia Among Black and White Older Adults JOURNALS OF GERONTOLOGY SERIES A-BIOLOGICAL SCIENCES AND MEDICAL SCIENCES Brenowitz, W. D., Kaup, A. R., Lin, F. R., Yaffe, K. 2019; 74 (6): 890-896

  Abstract

  Few studies have examined impairment in multiple senses (multisensory impairment) and risk of dementia in comparison to having a single or no sensory impairment.We studied 1,810 black and white nondemented participants from Health, Aging, and Body Composition (Health ABC) Study aged 70-79 years at enrollment. Sensory impairment was determined at our study baseline (Year 3-5 of Health ABC) using established cut points for vision (Bailey-Lovie visual acuity and Pelli-Robson contrast sensitivity test), hearing (audiometric testing), smell (12-item Cross-Cultural Smell Identification Test), and touch (peripheral nerve function tests). Incident dementia over 10 years of follow-up was based on hospitalization records, dementia medications, or at least 1.5 SD decline in Modified Mini-Mental State Examination score (race-specific). Cox proportional hazard models with adjustment for demographics, health behaviors, and health conditions evaluated the relationship between risk of dementia and increasing number of sensory impairments.Sensory impairments were common: 28% had visual impairment, 35% had hearing loss, 22% had poor smell, 12% had touch insensitivity; 26% had more than two impairments, and 5.6% had more than three sensory impairments. Number of impairments was associated with risk of dementia in a graded fashion (p < .001). Compared to no sensory impairments, the adjusted hazard ratio was 1.49 (95% CI: 1.12, 1.98) for one sensory impairment, 1.91 (95% CI: 1.39, 2.63) for two sensory impairments, and 2.85 (95% CI: 1.88, 4.30) for more than three sensory impairments.Multisensory impairment was strongly associated with increased risk of dementia. Although, the nature of this relationship needs further investigation, sensory function assessment in multiple domains may help identify patients at high risk of dementia.

  View details for DOI 10.1093/gerona/gly264

  View details for Web of Science ID 000475713200019

  View details for PubMedID 30452551

  View details for PubMedCentralID PMC6521912

• Impact of Hearing Loss on Patient-Provider Communication Among Hospitalized Patients: A Systematic Review AMERICAN JOURNAL OF MEDICAL QUALITY Shukla, A., Nieman, C. L., Price, C., Harper, M., Lin, F. R., Reed, N. S. 2019; 34 (3): 284-292

  Abstract

  Age-related hearing loss is a highly prevalent chronic condition in older adults, but hearing loss is rarely accounted for in patient-provider communication studies. This systematic review synthesizes current evidence on the impact of age-related hearing loss on patient-provider communication in hospitalized older adults. Five databases were queried to identify original research that examined patient-provider communication in older adults with hearing loss in an inpatient setting. Of 1053 studies, 13 were included in the final review. All studies reported an adverse effect of hearing loss on patient-provider communication. Among studies that evaluated an intervention to improve communication in older adults with hearing loss, simple interventions such as low-cost voice amplifiers were found to improve communication. An understanding of the effect of hearing loss on patient-provider communication and strategies to mitigate the impact are needed in order to provide safe, quality, patient-centered care to older adults with hearing loss.

  View details for DOI 10.1177/1062860618798926

  View details for Web of Science ID 000469392200009

  View details for PubMedID 30196712

• Cost-Benefit Analysis of Hearing Care Services: What Is It Worth to Medicare? JOURNAL OF THE AMERICAN GERIATRICS SOCIETY Willink, A., Reed, N. S., Lin, F. R. 2019; 67 (4): 784-789

  Abstract

  Hearing care services for older adults with hearing aids are underutilized and are not covered by the Medicare program. Little information exists to the value of hearing care services for older adults with hearing aids. The objective of this analysis is to estimate the potential costs and benefits to the Medicare program of covering hearing care services.Cross-sectional analysis using propensity score matching methods to create balanced and comparable groups. We conducted a 1:1 match of older Medicare beneficiaries with hearing aids who self-reported use of hearing care services in the previous 12 months to those with hearing aids who did not use hearing care services. Groups were balanced on demographic and socioeconomic characteristics as well as health status, functional impairment, and trouble hearing. We compared average total Medicare spending per person between matched groups, as well as by service type.Nationally representative survey of Medicare beneficiaries in the United States (Medicare Current Beneficiary Survey) 2013.Study participants were limited to those in the survey who reported using hearing aids in 2013 (n = 1120).Average annual Medicare spending was $8196 (95% confidence interval [CI] = $6670-$9723) among Medicare beneficiaries who used hearing care services and $10,709 (95% CI = $8878-$12,541) among matched controls who did not use hearing care services. Total spending per person was $2513 (95% CI = $150-$4876) higher among those who did not use hearing care services, with spending differences driven mostly by higher-skilled nursing facility (difference = $825; 95% CI = $193-$1455) and home health (difference = $287; 95% CI = $7-$568) spending among matched controls.Utilization of hearing care services among older adults with hearing aids is associated with reduced Medicare spending. Increasing access to hearing care services among Medicare beneficiaries with hearing aids may provide value to the healthcare system and net savings to the Medicare program. J Am Geriatr Soc 67:784-789, 2019.

  View details for DOI 10.1111/jgs.15757

  View details for Web of Science ID 000464350900021

  View details for PubMedID 30641615

• Quantification of Hearing Loss Research on Children Compared With Older Adults JAMA OTOLARYNGOLOGY-HEAD & NECK SURGERY Villavisanis, D. F., Lin, F. R., Deal, J. A. 2019; 145 (3): 283-285

  Abstract

  This database study assesses areas of research on hearing loss in children and older adults.

  View details for DOI 10.1001/jamaoto.2018.3889

  View details for Web of Science ID 000462001800020

  View details for PubMedID 30653206

  View details for PubMedCentralID PMC6439747

• Hearing loss and satisfaction with healthcare: An unexplored relationship JOURNAL OF THE AMERICAN GERIATRICS SOCIETY Reed, N. S., Betz, J. F., Kucharska-Newton, A. M., Lin, F. R., Deal, J. A. 2019; 67 (3): 624-626

  View details for DOI 10.1111/jgs.15689

  View details for Web of Science ID 000461567700036

  View details for PubMedID 30512196

  View details for PubMedCentralID PMC6403017

• AGE-RELATED HEARING LOSS AS A RISK FACTOR FOR LATE LIFE DEPRESSION AND COGNITIVE DECLINE Sharma, A., Rutherford, B. R., Lin, F., Golub, J., Brewster, K. ELSEVIER SCIENCE INC. 2019: S43-S44

  View details for DOI 10.1016/j.jagp.2019.01.195

  View details for Web of Science ID 000461378800059

• Translating Public Health Practices: Community-Based Approaches for Addressing Hearing Health Care Disparities. Seminars in hearing Suen, J. J., Marrone, N., Han, H., Lin, F. R., Nieman, C. L. 2019; 40 (1): 37-48

  Abstract

  Epidemiologic studies reveal disparities in hearing health care with lower prevalence of hearing aid use among older adults from racial/ethnic minority groups and lower socioeconomic positions. Recent national reports recommend exploring innovative delivery models to increase the accessibility and affordability of hearing health care, particularly for underserved and vulnerable populations. With an expected rise in the prevalence of age-related hearing loss over the next four decades due to a rapidly aging population, the condition is a growing public health imperative. This review describes key public health practices for developing and delivering community-based care that characterizes an emerging area of research in novel approaches of hearing loss management programs to reach underserved populations. With evolving technologies that enable care to extend beyond the clinic, adapting a long-utilized community health worker approach presents a strategy for the field of hearing health care to be actively involved in designing and leading initiatives for achieving hearing health equity. Principles from community-based participatory research offer a paradigm for the field to integrate into its research endeavors for addressing disparities. An interdisciplinary approach for engaging these challenges offers hearing health care researchers and providers an opportunity to advance the field and delivery of care.

  View details for DOI 10.1055/s-0038-1676782

  View details for PubMedID 30728648

• Pilot Comparison of Adjustment Protocols of Personal Sound Amplification Products. Seminars in hearing Reed, N. S., Oliver, A., Srinivasan, N. K., Lin, F. R., Korczak, P. A. 2019; 40 (1): 26-36

  Abstract

  The Over-the-Counter Hearing Aid Act of 2017 was signed into law in August 2017 and facilitates the introduction of direct-to-consumer sales of hearing aids for adults with mild-to-moderate hearing loss. Among many questions surrounding over-the-counter sales is the ability of users to self-fit amplification. Many studies have conducted self-fitting procedures using guidance materials provided by audiologists. In this pilot, we explore the ability of users to self-adjust personal sound amplification devices using only materials provided by the manufacturer and contrast this with models that involve a hearing professional. Outcomes to assess adjustments included clinic-based speech-in-noise measures and ability to approximate NAL-NL2 prescriptive targets. We found that an audiologist-driven model provided the best outcomes. However, it is unknown if the difference is clinically meaningful.

  View details for DOI 10.1055/s-0038-1676781

  View details for PubMedID 30728647

• The association between obesity, diet quality and hearing loss in older adults AGING-US Croll, P. H., Voortman, T., Vernooij, M. W., de Jong, R., Lin, F. R., Rivadeneira, F., Ikram, M., Goedegebure, A. 2019; 11 (1): 48-62

  Abstract

  With the aging population, the prevalence of age-related hearing loss will increase substantially. Prevention requires more knowledge on modifiable risk factors. Obesity and diet quality have been suggested to play a role in the etiology of age-related hearing loss. We aimed to investigate independent associations of body composition and diet quality with age-related hearing loss.We performed cross-sectional and longitudinal analyses (follow-up: 4.4 years) in the population-based Rotterdam Study. At baseline (2006-2014), 2,906 participants underwent assessment of body composition, diet, and hearing. Of these 2,906 participants, 636 had hearing assessment at follow-up (2014-2016). Association of body composition and of diet quality with hearing loss were examined using multivariable linear regression models.Cross-sectionally, higher body mass index and fat mass index were associated with increased hearing thresholds. These associations did not remain statistically significant at follow-up. We found no associations between overall diet quality and hearing thresholds.This study shows that a higher body mass index, and in particular a higher fat mass index, is related to age-related hearing loss. However, whether maintaining a healthy body composition may actually reduce the effects of age-related hearing loss in the aging population requires further longitudinal population-based research.

  View details for DOI 10.18632/aging.101717

  View details for Web of Science ID 000457388700011

  View details for PubMedID 30609412

  View details for PubMedCentralID PMC6339793

• Access To Hearing Care Services Among Older Medicare Beneficiaries Using Hearing Aids HEALTH AFFAIRS Willink, A., Reed, N. S., Lin, F. R. 2019; 38 (1): 124-131

  Abstract

  The Over-the-Counter Hearing Aid Act of 2017 will soon allow people to purchase hearing aids without an audiologist or hearing aid dispenser acting as a go-between. Under this new arrangement there will be no guarantee that purchasers with hearing loss will have access to the hearing care services that are often needed to optimize hearing and communication with the devices. Using data for 2013 from the Medicare Current Beneficiary Survey, we examined existing barriers to accessing those services among older Medicare beneficiaries who owned and used hearing aids. Within this population, beneficiaries who were dually eligible for Medicaid had 41 percent lower odds of using hearing care services and were twice as likely to report having a lot of trouble hearing with their aids, compared to high-income Medicare beneficiaries. Existing barriers to device owners' receiving hearing care services are likely to be exacerbated when over-the-counter sales further separate the purchase of hearing aids from payment for supportive services. Coverage of hearing care services under the Medicare program should be considered to address income-related constraints to service access.

  View details for DOI 10.1377/hlthaff.2018.05217

  View details for Web of Science ID 000463969800017

  View details for PubMedID 30615534

• Trends in Health Care Costs and Utilization Associated With Untreated Hearing Loss Over 10 Years JAMA OTOLARYNGOLOGY-HEAD & NECK SURGERY Reed, N. S., Altan, A., Deal, J. A., Yeh, C., Kravetz, A. D., Wallhagen, M., Lin, F. R. 2019; 145 (1): 27-34

  Abstract

  Nearly 38 million individuals in the United States have untreated hearing loss, which is associated with cognitive and functional decline. National initiatives to address hearing loss are currently under way.To determine whether untreated hearing loss is associated with increased health care cost and utilization on the basis of data from a claims database.Retrospective, propensity-matched cohort study of persons with and without untreated hearing loss based on claims for health services rendered between January 1, 1999, and December 31, 2016, from a large health insurance database. There were 154 414, 44 852, and 4728 participants at the 2-, 5-, and 10-year follow-up periods, respectively. The study was conceptualized and data were analyzed between September 2016 and November 2017.Untreated hearing loss (ie, hearing loss that has not been treated with hearing devices) was identified via claims measures.Medical costs, inpatient hospitalizations, total days hospitalized, 30-day hospital readmission, emergency department visits, and days with at least 1 outpatient visit.Among 4728 matched adults (mean age at baseline, 61 years; 2280 women and 2448 men), untreated hearing loss was associated with $22 434 (95% CI, $18 219-$26 648) or 46% higher total health care costs over a 10-year period compared with costs for those without hearing loss. Persons with untreated hearing loss experienced more inpatient stays (incidence rate ratio, 1.47; 95% CI, 1.29-1.68) and were at greater risk for 30-day hospital readmission (relative risk, 1.44; 95% CI, 1.14-1.81) at 10 years postindex. Similar trends were observed at 2- and 5-year time points across measures.Older adults with untreated hearing loss experience higher health care costs and utilization patterns compared with adults without hearing loss. To further define this association, additional research on mediators, such as treatment adherence, and mitigation strategies is needed.

  View details for DOI 10.1001/jamaoto.2018.2875

  View details for Web of Science ID 000456153100006

  View details for PubMedID 30419131

  View details for PubMedCentralID PMC6439810

• Incident Hearing Loss and Comorbidity A Longitudinal Administrative Claims Study JAMA OTOLARYNGOLOGY-HEAD & NECK SURGERY Deal, J. A., Reed, N. S., Kravetz, A. D., Weinreich, H., Yeh, C., Lin, F. R., Altan, A. 2019; 145 (1): 36-43

  Abstract

  Because hearing loss is highly prevalent and treatable, determining its association with morbidity has major public health implications for disease prevention and the maintenance of health in adults with hearing loss.To investigate the association between the diagnosis of incident hearing loss and medical comorbidities in adults 50 years or older.Retrospective, propensity-matched cohort study using administrative claims data from commercially insured and Medicare Advantage members in a geographically diverse US health plan. Adults 50 years or older with claims for services rendered from January 1, 2000, to December 31, 2016, were observed for 2 (n = 154 414), 5 (n = 44 852), and 10 (n = 4728) years. This research was conceptualized and data were analyzed between September 2016 and November 2017.A claim for incident hearing loss is defined as 2 claims for hearing loss within 2 consecutive years without evidence of hearing device use, excluding claims for sudden hearing loss or hearing loss secondary to medical conditions.Incident claims for dementia, depression, accidental falls, nonvertebral fractures, acute myocardial infarction, and stroke.After cohort matching, 48% of participants were women (n = 74 464), 61% were white (n = 93 442), and 31% (n = 48 056) were Medicare Advantage insured, with a mean (SD) age of 64 (10) years. In a multivariate-adjusted modified Poisson regression with robust standard errors, relative associations were strongest for dementia (relative risk at 5 years, 1.50; 95% CI, 1.38-1.64) and depression (relative risk at 5 years, 1.41; 95% CI, 1.26-1.58). The absolute risk of all outcomes was greater in persons with hearing loss than in those without hearing loss at all times, with the greatest risk difference observed at 10 years for all outcomes. The 10-year risk attributable to hearing loss was 3.20 per 100 persons (95% CI, 1.76-4.63) for dementia, 3.57 per 100 persons (95% CI, 1.67-5.47) for falls, and 6.88 per 100 persons (95% CI, 4.62-9.14) for depression.In this large observational study using administrative claims data, incident untreated hearing loss was associated with greater incident morbidity than no hearing loss across a range of health conditions. Future studies are needed to elucidate the mechanisms underlying these associations and to determine if treatment for hearing loss could reduce the risk of comorbidity.

  View details for DOI 10.1001/jamaoto.2018.2876

  View details for Web of Science ID 000456153100008

  View details for PubMedID 30419134

  View details for PubMedCentralID PMC6439817

• Hearing loss in older adults - From epidemiological insights to national initiatives Goman, A. M., Lin, F. R. ELSEVIER SCIENCE BV. 2018: 29-32

  Abstract

  The broader implications of hearing loss for the health and functioning of older adults have begun to be demonstrated in epidemiologic studies. These research findings on the association between hearing loss and poorer health outcomes have formed the foundation for national initiatives on hearing loss and public health. These national initiatives range from the Aging and Cognitive Health Evaluation in Elders (ACHIEVE) clinical trial to the recent passage of the bipartisan Over-The-Counter Hearing Aid Act. Utilizing population health research methodologies to study hearing loss can provide the foundation for initiating top-down approaches to increase the adoption and accessibility of hearing care for older Americans with hearing loss.

  View details for DOI 10.1016/j.heares.2018.03.031

  View details for Web of Science ID 000449449400005

  View details for PubMedID 29653842

• Otolaryngology for the Internist: Hearing Loss. The Medical clinics of North America Nieman, C. L., Reed, N. S., Lin, F. R. 2018; 102 (6): 977-992

  Abstract

  Hearing loss is the third most common chronic condition but can be secondary to a range of conditions encountered in primary care. This article reviews the presentation, evaluation, differential diagnosis, and associated treatments for both acute and chronic causes of hearing loss. As the most common cause of hearing loss, this article provides an overview of age-related hearing loss, its consequences, and pragmatic treatment approaches, including over-the-counter hearing technology.

  View details for DOI 10.1016/j.mcna.2018.06.013

  View details for PubMedID 30342615

• Understanding Hearing Loss and Barriers to Hearing Health Care Among Korean American Older Adults: A Focus Group Study JOURNAL OF APPLIED GERONTOLOGY Choi, J. S., Shim, K. S., Kim, K., Nieman, C. L., Mamo, S. K., Lin, F. R., Han, H. 2018; 37 (11): 1344-1367

  Abstract

  Hearing loss is associated with an accelerated decline in social, cognitive, and physical functioning among older adults. However, little is known about its impact and barriers to hearing health care in any ethnic minorities. The aim of this study was to explore experiences related to hearing loss and barriers to hearing health care among older Korean Americans (KAs). We conducted four focus groups with 19 older KAs with hearing loss and four communication partners. Qualitative content analysis revealed four themes: (a) impact of hearing loss, (b) self-perception of hearing loss, (c) coping strategies for hearing loss, and (d) barriers to hearing health care (price, language, lack of collaborative communications, perceptions about hearing aids, and lack of knowledge). Older KAs were significantly impacted by hearing loss but tended not to seek care due to multiple factors. Culturally tailored hearing interventions are urgently needed to promote hearing health in the KA community.

  View details for DOI 10.1177/0733464816663554

  View details for Web of Science ID 000447216000002

  View details for PubMedID 27550062

  View details for PubMedCentralID PMC12861332

• American Geriatrics Society and National Institute on Aging Bench-to-Bedside Conference: Sensory Impairment and Cognitive Decline in Older Adults JOURNAL OF THE AMERICAN GERIATRICS SOCIETY Whitson, H. E., Cronin-Golomb, A., Cruickshanks, K. J., Gilmore, G. C., Owsley, C., Peelle, J. E., Recanzone, G., Sharma, A., Swenor, B., Yaffe, K., Lin, F. R. 2018; 66 (11): 2052-2058

  Abstract

  This article summarizes the presentations and recommendations of the tenth annual American Geriatrics Society and National Institute on Aging Bench-to-Bedside research conference, "Sensory Impairment and Cognitive Decline," on October 2-3, 2017, in Bethesda, Maryland. The risk of impairment in hearing, vision, and other senses increases with age, and almost 15% of individuals aged 70 and older have dementia. As the number of older adults increases, sensory and cognitive impairments will affect a growing proportion of the population. To limit its scope, this conference focused on sensory impairments affecting vision and hearing. Comorbid vision, hearing, and cognitive impairments in older adults are more common than would be expected by chance alone, suggesting that some common mechanisms might affect these neurological systems. This workshop explored the mechanisms and consequences of comorbid vision, hearing, and cognitive impairment in older adults; effects of sensory loss on the aging brain; and bench-to-bedside innovations and research opportunities. Presenters and participants identified many research gaps and questions; the top priorities fell into 3 themes: mechanisms, measurement, and interventions. The workshop delineated specific research questions that provide opportunities to improve outcomes in this growing population. J Am Geriatr Soc 66:2052-2058, 2018.

  View details for DOI 10.1111/jgs.15506

  View details for Web of Science ID 000450029300004

  View details for PubMedID 30248173

  View details for PubMedCentralID PMC6410371

• Hearing Care Access? Focus on Clinical Services, Not Devices JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION Reed, N. S., Lin, F. R., Willink, A. 2018; 320 (16): 1641-1642

  View details for DOI 10.1001/jama.2018.11649

  View details for Web of Science ID 000448069100010

  View details for PubMedID 30242394

• Hearing Loss Treatment in Older Adults With Cognitive Impairment: A Systematic Review JOURNAL OF SPEECH LANGUAGE AND HEARING RESEARCH Mamo, S. K., Reed, N. S., Price, C., Occhipinti, D., Pletnikova, A., Lin, F. R., Oh, E. S. 2018; 61 (10): 2589-2603

  Abstract

  The purpose of this systematic review was to assess studies of treating hearing loss in older adults with cognitive impairment. Of interest to this review is identifying clinical adaptations that may be used to tailor hearing loss treatment to older adults with cognitive impairment in order to better serve this vulnerable population.A systematic search with controlled vocabulary and key word terms was applied to PubMed, the Cochrane Library, Embase, CINAHL, and PsycINFO. Search concepts included terms related to hearing loss and cognitive impairment. The overall search resulted in 4,945 unique references, 50 of which were eligible for full-text review and 13 of which were included in the final review. Included manuscripts were categorized according to the American Speech-Language-Hearing Association's levels of evidence and the National Institutes of Health Quality Assessment Tools.Only 1 study implemented a randomized controlled trial design to assess cognitive function and behavioral symptoms after treatment with hearing aids. Other quasiexperimental studies evaluated dementia-related symptoms and/or auditory function after treating hearing loss in pre/post research designs. Finally, evidence from case studies suggested that hearing loss treatment is feasible, reduces stressful communication for caregivers, and improves dementia-related behavior problems.Based on the systematic review, evidence suggests that treating hearing loss in persons with cognitive impairment can have benefits to communication and quality of life. Because of the quasi- and nonexperimental nature of most of the evidence found in this review, further studies are necessary to understand the effect of treatment in the context of a variable and progressive disease.

  View details for DOI 10.1044/2018_JSLHR-H-18-0077

  View details for Web of Science ID 000448400000011

  View details for PubMedID 30304320

  View details for PubMedCentralID PMC6428235

• State of research and program development for adults with hearing loss DISABILITY AND HEALTH JOURNAL McKee, M. M., Lin, F. R., Zazove, P. 2018; 11 (4): 519-524

  Abstract

  Hearing loss is common with a growing body of evidence of its global impact on our patient population. There remains much to learn about the mechanisms and epidemiologic, genetic, and other biobehavioral risk factors associated with hearing loss and its chronic disease sequelae, as well as how hearing healthcare, surveillance, and clinician-based training programs can best reduce the overall health burden among older individuals with hearing loss. This paper provides an update on the state of research for adults with hearing loss. The goal of the paper is to educate the reader on what is known and highlight areas where further work is still needed.

  View details for DOI 10.1016/j.dhjo.2018.07.010

  View details for Web of Science ID 000446518000006

  View details for PubMedID 30087082

• Pilot Study of Audiometric Patterns in Fuchs Corneal Dystrophy JOURNAL OF SPEECH LANGUAGE AND HEARING RESEARCH Reed, N. S., Deal, J. A., Huddle, M. G., Betz, J. F., Bailey, B. E., McGlumphy, E. J., Eghrari, A. O., Riazuddin, S., Lin, F. R., Gottsch, J. D. 2018; 61 (10): 2604-2608

  Abstract

  Although Fuchs corneal dystrophy (FCD) is considered an eye disease, a small number of studies have identified genes related to both FCD and hearing loss. Whether FCD is related to hearing loss is unknown.This is a case-control study comparing pure-tone audiometry hearing thresholds in 180 patients with FCD from a hospital-based ophthalmology clinic with 2,575 population-based controls from a nationally representative survey, the National Health and Nutrition Examination Survey (from cycles 2005-06 and 2009-10). Generalized estimating equations were used to compare mean better-hearing ear thresholds in the 2 groups adjusted for age, sex, race, and noise exposure.Patients with FCD had higher hearing thresholds (worse hearing) in lower frequencies (mean difference at 0.5 kHz = 3.49 dB HL) and lower hearing thresholds (better hearing) in higher frequencies (difference at 4 kHz = -4.25 dB HL) compared with population-based controls.In the first study to use objectively measured hearing, FCD was associated with poorer low-frequency and better high-frequency audiometric thresholds than population controls. Further studies are needed to characterize this relationship.

  View details for DOI 10.1044/2018_JSLHR-H-18-0088

  View details for Web of Science ID 000448400000012

  View details for PubMedID 30286242

  View details for PubMedCentralID PMC6428237

• Dual sensory impairment: The association between glaucomatous vision loss and hearing impairment and function PLOS ONE Mudie, L. I., Varadaraj, V., Gajwani, P., Munoz, B., Ramulu, P., Lin, F. R., Swenor, B. K., Friedman, D. S., Zebardast, N. 2018; 13 (7): e0199889

  Abstract

  Hearing impairment, vision impairment, and dual impairment (both hearing and vision impairment), have been independently associated with functional and cognitive decline. In prior studies of dual impairment, vision impairment is generally not defined or defined by visual acuity alone. Glaucoma is a leading cause of blindness and does not affect visual acuity until late in the disease; instead, visual field loss is used to measure vision impairment from glaucoma.To examine the effect of glaucomatous visual field loss and hearing impairment on function.Cross-sectional.Hospital-based clinic in Baltimore, Maryland.220 adults, ≥55 years presenting to the glaucoma clinic.Vision impairment was defined as mean deviation on visual field testing worse than -5 decibels in the better eye, and hearing impairment was defined as pure tone average worse than 25 decibels on threshold audiometry testing in the better ear. Standardized questionnaires were used to assess functional status.Five participants were excluded for incomplete testing, leaving 32 with vision impairment only, 63 with hearing impairment only, 42 with dual impairment, and 78 controls with no hearing impairment or vision impairment. Participants with dual impairment were more likely to be older and non-White. Dual impairment was associated with significantly more severe driving limitation and more difficulty with communication compared to those without sensory impairment when adjusted for age, race, gender and number of comorbidities.Older individuals with glaucoma and hearing loss seem to have generally poorer functioning than those with single sensory loss. Health professionals should consider visual field loss as a type of vision impairment when managing patients with dual impairment.

  View details for DOI 10.1371/journal.pone.0199889

  View details for Web of Science ID 000437809500039

  View details for PubMedID 29979753

  View details for PubMedCentralID PMC6034827

• Hearing Difficulty Is Associated With Injuries Requiring Medical Care EAR AND HEARING Mick, P., Foley, D., Lin, F., Pichora-Fuller, M. 2018; 39 (4): 631-644

  Abstract

  Injuries are responsible for 11% of global disability-adjusted life years. Hearing difficulty may be a modifiable risk factor for injury. The primary aim was to determine whether subjective hearing difficulty is associated with increased incidence of injuries (all-type, workplace, and nonworkplace) serious enough to require health care among Americans aged 18 years and older. The secondary aim was to determine whether hearing difficulty is associated with increased use of health care for injuries.The analysis was performed using data from the 1999 to 2012 Medical Expenditure Panel Surveys-Household Component (MEPS-HC). Multivariable estimates are generalizable to the American noninstitutionalized adult population in 2006. Hearing difficulty was determined by computer-assisted personal interview. The primary outcome was number of separate injuries requiring health care (emergency department visits, hospital inpatient admissions, or medical office visits) during the follow-up period. Crude injury incidence rates were calculated with 95% confidence intervals (CIs). Multivariable negative binomial regression was performed to determine the relative incidence rate of injuries among the group reporting hearing difficulties relative to the group reporting no difficulty in hearing, adjusting for relevant confounders. Variance estimates were adjusted to take into account the complex sample design. Results were stratified by sex.Of the 121,453 participants in MEPS-HC panels 6-16, 107,352 (88.4%) had complete data and were included in the analysis. The average follow-up was 1.27 years. Seven thousand six hundred and twenty-four participants (7.1%) reported hearing difficulty at baseline. During the follow-up period, 10,727 participants (10.0%) had one or more injuries. In multivariable analyses, hearing difficulty was significantly associated with increased incidence of all-type (males: incidence rate ratio [IRR] 1.31, 95% CI 1.18-1.45, p value < 0.001; females: IRR 1.21, 95% CI 1.07-1.36, p value < 0.001), workplace (males: IRR 1.42, 95% CI 1.16-1.75, p value 0.001; females: IRR 1.61, 95% CI 1.12-2.31, p value 0.010), and nonworkplace injuries (males: IRR 1.24, 95% CI 1.09-1.42, p value 0.001; females: IRR 1.17, 95% CI, 1.02-1.34, p value 0.023). In multivariable analyses, hearing difficulty was associated with increased incidence of emergency department use in males (IRR 1.36, 95% CI 1.13-1.62, p value 0.001) and medical office visits in females (IRR 1.52, 95% CI 1.12-2.05, p value 0.007).The study results suggest the need to investigate the mechanisms underlying the measured associations so that efforts may be directed toward reducing the risk of injury for individuals with hearing difficulties.

  View details for DOI 10.1097/AUD.0000000000000535

  View details for Web of Science ID 000442151500005

  View details for PubMedID 29309398

• Prevalence of Adult Unilateral Hearing Loss and Hearing Aid Use in the United States Golub, J. S., Lin, F. R., Lustig, L. R., Lalwani, A. K. WILEY. 2018: 1681-1686

  Abstract

  The prevalence of unilateral hearing loss (UHL) in adults has not been well characterized. The objectives of this study are to determine the prevalence of UHL in U.S. adults and its treatment with hearing aids using a nationally representative study.Cross-sectional national epidemiologic study (n = 6,242).Subjects ≥ 18 years old with audiometric testing in the 2005 to 2006, 2009 to 2010, and 2011 to 2012 cycles of the National Health and Nutrition Examination Study were included. UHL was defined as normal hearing (≤25 decibels hearing level [dB HL] pure tone average [PTA]) in one ear and at least mild hearing loss (>25 dB HL PTA) in the other ear. Hearing aid usage was defined by at least 5 hours per week (2005-2006) or at least seldom (2009-2012) use. Sampling weights were utilized to ensure generalizability to the U.S.The overall prevalence of UHL in adult Americans was 7.2% (95% confidence interval 6.1%-8.6%), with 5.7% (4.8%-6.7%) having mild and 1.5% (0.1%-2.1%) with moderate-or-worse UHL; nearly one-third of the latter reported trouble hearing. The prevalence of hearing aid usage in those with UHL was 2.0% (0.6%-6.7%). Of those with mild UHL, 1.4% (0.2%-8.0%) used hearing aids. Of those with moderate UHL, 4.2% (0.1%-22%) used hearing aids. Among those with UHL and also at least moderate subjective difficulty hearing, only 11% wore hearing aids.UHL is common among U.S. adults. Hearing aid usage is very low, even when there is perceived handicap. Public health education is needed to increase awareness of and auditory rehabilitation for UHL.2. Laryngoscope, 128:1681-1686, 2018.

  View details for DOI 10.1002/lary.27017

  View details for Web of Science ID 000440007000046

  View details for PubMedID 29193112

• Response to Letter From Fuller-Thomson "Might Lifetime Exposure to Lead Confound the Association between Hearing Impairment and Incident Dementia?" JOURNALS OF GERONTOLOGY SERIES A-BIOLOGICAL SCIENCES AND MEDICAL SCIENCES Deal, J. A., Lin, F. R. 2018; 73 (7): 993-994

  View details for DOI 10.1093/gerona/gly007

  View details for Web of Science ID 000435469200023

  View details for PubMedID 29529125

  View details for PubMedCentralID PMC6001892

• Age-related hearing loss and communication at a PACE Day Health Center JOURNAL OF THE AMERICAN MEDICAL DIRECTORS ASSOCIATION Mamo, S. K., Mayhew, S. J., McNabney, M. K., Rund, J., Lin, F. R. 2018; 19 (5): 458-459

  View details for DOI 10.1016/j.jamda.2018.01.005

  View details for Web of Science ID 000431000200016

  View details for PubMedID 29526596

  View details for PubMedCentralID PMC7384376

• PREVALENCE OF POTENTIAL HYBRID AND CONVENTIONAL COCHLEAR IMPLANT CANDIDATES BASED ON AUDIOMETRIC PROFILE OTOLOGY & NEUROTOLOGY Goman, A. M., Dunn, C. C., Gantz, B. J., Lin, F. R. 2018; 39 (4): 515-517

  View details for DOI 10.1097/MAO.0000000000001728

  View details for Web of Science ID 000457773500031

  View details for PubMedID 29498962

  View details for PubMedCentralID PMC6157728

• Hearing Loss Among Older Adults With Heart Failure in the United States: Data From the National Health and Nutrition Examination Survey JAMA OTOLARYNGOLOGY-HEAD & NECK SURGERY Sterling, M. R., Lin, F. R., Jannat-Khah, D. P., Goman, A. M., Echeverria, S. E., Safford, M. M. 2018; 144 (3): 273-275

  Abstract

  This secondary analysis of the National Health and Nutrition Examination Survey examines the prevalence and correlates of hearing loss among older adults with and without heart failure in the United States.

  View details for DOI 10.1001/jamaoto.2017.2979

  View details for Web of Science ID 000427593700018

  View details for PubMedID 29372239

  View details for PubMedCentralID PMC5854543

• Time for a Top-Down Approach to Hearing Aid Affordability and Accessibility AMERICAN JOURNAL OF PUBLIC HEALTH Lin, F. R. 2018; 108 (2): 166-168

  View details for DOI 10.2105/AJPH.2017.304236

  View details for Web of Science ID 000439715700016

  View details for PubMedID 29320290

  View details for PubMedCentralID PMC5846613

• Hearing treatment for reducing cognitive decline: Design and methods of the Aging and Cognitive Health Evaluation in Elders randomized controlled trial. Alzheimer's & dementia (New York, N. Y.) Deal, J. A., Goman, A. M., Albert, M. S., Arnold, M. L., Burgard, S., Chisolm, T., Couper, D., Glynn, N. W., Gmelin, T., Hayden, K. M., Mosley, T., Pankow, J. S., Reed, N., Sanchez, V. A., Richey Sharrett, A., Thomas, S. D., Coresh, J., Lin, F. R. 2018; 4: 499-507

  Abstract

  INTRODUCTION: Hearing impairment is highly prevalent and independently associated with cognitive decline. The Aging and Cognitive Health Evaluation in Elders study is a multicenter randomized controlled trial to determine efficacy of hearing treatment in reducing cognitive decline in older adults. Clinicaltrials.gov Identifier: NCT03243422.METHODS: Eight hundred fifty participants without dementia aged 70 to 84years with mild-to-moderate hearing impairment recruited from four United States field sites and randomized 1:1 to a best-practices hearing intervention or health education control. Primary study outcome is 3-year change in global cognitive function. Secondary outcomes include domain-specific cognitive decline, incident dementia, brain structural changes on magnetic resonance imaging, health-related quality of life, physical and social function, and physical activity.RESULTS: Trial enrollment began January 4, 2018 and is ongoing.DISCUSSION: When completed in 2022, Aging and Cognitive Health Evaluation in Elders study should provide definitive evidence of the effect of hearing treatment versus education control on cognitive decline in community-dwelling older adults with mild-to-moderate hearing impairment.

  View details for DOI 10.1016/j.trci.2018.08.007

  View details for PubMedID 30364572

• Relating Sensory, Cognitive, and Neural Factors to Older Persons' Perceptions about Happiness: An Exploratory Study JOURNAL OF AGING RESEARCH Horne, A. J., Chiew, K. S., Zhuang, J., George, L. K., Adcock, R., Potter, G. G., Lad, E. M., Cousins, S. W., Lin, F. R., Mamo, S. K., Chen, N., Maciejewski, A. J., Fernandez, X., Whitson, H. E. 2018; 2018: 4930385

  Abstract

  Despite increased rates of disease, disability, and social losses with aging, seniors consistently report higher levels of subjective well-being (SWB), a construct closely related to happiness, than younger adults. In this exploratory study, we utilized an available dataset to investigate how aspects of health commonly deteriorating with age, including sensory (i.e., vision and hearing) and cognitive status, relate to variability in self-described contributors to happiness. Community-dwelling seniors (n = 114) responded to a single-item prompt: "name things that make people happy." 1731 responses were categorized into 13 domains of SWB via structured content analysis. Sensory health and cognition were assessed by Snellen visual acuity, pure-tone audiometry, and in-person administration of the Brief Test of Adult Cognition by Telephone (BTACT) battery. A subset of eligible participants (n = 57) underwent functional magnetic resonance imaging (fMRI) to assess resting state functional connectivity (FC) within a previously described dopaminergic network associated with reward processing. SWB response patterns were relatively stable across gender, sensory status, and cognitive performance with few exceptions. For example, hearing-impaired participants listed fewer determinants of SWB (13.59 vs. 17.16; p < 0.001) and were less likely to name things in the "special events" category. Participants with a higher proportion of responses in the "accomplishments" domain (e.g., winning, getting good grades) demonstrated increased FC between the ventral tegmental area and nucleus accumbens, regions implicated in reward and motivated behavior. While the framework for determinants of happiness among seniors was largely stable across the factors assessed here, our findings suggest that subtle changes in this construct may be linked to sensory loss. The possibility that perceptions about determinants of happiness might relate to differences in intrinsic connectivity within reward-related brain networks also warrants further investigation.

  View details for DOI 10.1155/2018/4930385

  View details for Web of Science ID 000619288300010

  View details for PubMedID 30652033

  View details for PubMedCentralID PMC6311777

• The Baltimore HEARS Pilot Study: An Affordable, Accessible, Community-Delivered Hearing Care Intervention GERONTOLOGIST Nieman, C. L., Marrone, N., Mamo, S. K., Betz, J., Choi, J. S., Contrera, K. J., Thorpe, R. J., Gitlin, L. N., Tanner, E. K., Han, H., Szanton, S. L., Lin, F. R. 2017; 57 (6): 1173-1186

  Abstract

  Age-related hearing loss negatively affects health outcomes, yet disparities in hearing care, such as hearing aid use, exist based on race/ethnicity and socioeconomic position. Recent national efforts highlight reduction of hearing care disparities as a public health imperative. This study a) describes a community engagement approach to addressing disparities, b) reports preliminary outcomes of a novel intervention, and c) discusses implementation processes and potential for wide-scale testing and use.This was a prospective, randomized control pilot, with a 3-month delayed treatment group as a waitlist control, that assessed feasibility, acceptability, and preliminary efficacy of a community-delivered, affordable, and accessible intervention for older adults with hearing loss. Outcomes were assessed at 3 months, comparing immediate and delayed groups, and pooled to compare the cohort's pre- and 3-month post-intervention results.All participants completed the study (n = 15). The program was highly acceptable: 93% benefited, 100% would recommend the program, and 67% wanted to serve as future program trainers. At 3 months, the treated group (n = 8) experienced fewer social and emotional effects of hearing loss and fewer depressive symptoms as compared to the delayed treatment group (n = 7). Pooling 3-month post-intervention scores (n = 15), participants reported fewer negative hearing-related effects (effect size = -0.96) and reduced depressive symptoms (effect size = -0.43).The HEARS (Hearing Equality through Accessible Research & Solutions) intervention is feasible, acceptable, low risk, and demonstrates preliminary efficacy. HEARS offers a novel, low-cost, and readily scalable solution to reduce hearing care disparities and highlights how a community-engaged approach to intervention development can address disparities.

  View details for DOI 10.1093/geront/gnw153

  View details for Web of Science ID 000415085600020

  View details for PubMedID 27927734

  View details for PubMedCentralID PMC5881797

• Personal Sound Amplification Products for Hearing Loss Reply JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION Reed, N. S., Lin, F. R. 2017; 318 (18): 1831

  View details for DOI 10.1001/jama.2017.14787

  View details for Web of Science ID 000415660700029

  View details for PubMedID 29136439

• The Economic Impact of Adult Hearing Loss A Systematic Review JAMA OTOLARYNGOLOGY-HEAD & NECK SURGERY Huddle, M. G., Goman, A. M., Kernizan, F. C., Foley, D. M., Price, C., Frick, K. D., Lin, F. R. 2017; 143 (10): 1040-1048

  Abstract

  Hearing impairment (HI) is highly prevalent in older adults and has been associated with adverse health outcomes. However, the overall economic impact of HI is not well described.The goal of this review was to summarize available data on all relevant costs associated with HI among adults.A literature search of PubMed, Embase, the Cochrane Library, CINAHL, and Scopus was conducted in August 2015. For this systematic review, data extraction and quality assessment were performed by 2 independent reviewers. Eligibility criteria for included studies were presence of quantitative estimation of economic impact or loss of productivity of patients with HI, full-text English-language access, and publication in an academic, peer-reviewed journal or government report prior to August 2015. This review follows the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement. A meta-analysis was not performed owing to the studies' heterogeneity in outcomes measures, methodology, and study country.The initial literature search yielded 4595 total references. After 2043 duplicates were removed, 2552 publications underwent title and abstract review, yielding 59 articles for full-text review. After full-text review, 25 articles were included. Of the included articles, 8 incorporated measures of disability; 5 included direct estimates of medical expenditures; 8 included other cost estimates; and 7 were related to noise-induced or work-related HI. Estimates of the economic cost of lost productivity varied widely, from $1.8 to $194 billion in the United States. Excess medical costs resulting from HI ranged from $3.3 to $12.8 billion in the United States.Hearing loss is associated with billions of dollars of excess costs in the United States, but significant variance is seen between studies. A rigorous, comprehensive estimate of the economic impact of hearing loss is needed to help guide policy decisions around the management of hearing loss in adults.

  View details for DOI 10.1001/jamaoto.2017.1243

  View details for Web of Science ID 000413245300014

  View details for PubMedID 28796850

• Increasing access to hearing rehabilitation for older adults CURRENT OPINION IN OTOLARYNGOLOGY & HEAD AND NECK SURGERY Nieman, C. L., Lin, F. R. 2017; 25 (5): 342-346

  Abstract

  To provide an update on the recent research and policy developments affecting the current and future care of the 23 million older Americans with untreated hearing loss.Increasing evidence supports the association of age-related hearing loss with significant negative outcomes that affect the ability of older adults to age well. Despite an evolving understanding of the role hearing loss plays in the well being and vitality of older adults, the vast majority of older adults go untreated and hearing health care disparities exist. Recent work to understand the multitude of factors involved in hearing health care decisions, coupled with innovative approaches and technology to deliver hearing care, aim to provide more older adults with equal access to the tools needed to age well. Most importantly, significant national efforts and policy proposals substantiate these efforts and will be reviewed.Age-related hearing loss is a critical public health issue that affects almost all older adults. Through the application of novel approaches and perspectives, the delivery of hearing health care for older adults is evolving to provide more affordable and accessible care. Accompanying policy efforts provide the necessary support needed to increase access to care significantly.

  View details for DOI 10.1097/MOO.0000000000000386

  View details for Web of Science ID 000408845800003

  View details for PubMedID 28682821

  View details for PubMedCentralID PMC5869064

• A randomized feasibility pilot trial of hearing treatment for reducing cognitive decline: Results from the Aging and Cognitive Health Evaluation in Elders Pilot Study. Alzheimer's & dementia (New York, N. Y.) Deal, J. A., Albert, M. S., Arnold, M., Bangdiwala, S. I., Chisolm, T., Davis, S., Eddins, A., Glynn, N. W., Goman, A. M., Minotti, M., Mosley, T., Rebok, G. W., Reed, N., Rodgers, E., Sanchez, V., Sharrett, A. R., Coresh, J., Lin, F. R. 2017; 3 (3): 410-415

  Abstract

  INTRODUCTION: Hearing loss (HL) is prevalent and independently related to cognitive decline and dementia. There has never been a randomized trial to test if HL treatment could reduce cognitive decline in older adults.METHODS: A 40-person (aged 70-84years) pilot study in Washington County, MD, was conducted. Participants were randomized 1:1 to a best practices hearing or successful aging intervention and followed for 6months. clinicaltrials.gov Identifier: NCT02412254.RESULTS: The Aging and Cognitive Health Evaluation in Elders Pilot (ACHIEVE-P) Study demonstrated feasibility in recruitment, retention, and implementation of interventions with no treatment-related adverse events. A clear efficacy signal of the hearing intervention was observed in perceived hearing handicap (mean of 0.11 to -1.29 standard deviation [SD] units; lower scores better) and memory (mean of -0.10 SD to 0.38 SD).DISCUSSION: ACHIEVE-P sets the stage for the full-scale ACHIEVE trial (N=850, recruitment beginning November 2017), the first randomized trial to determine efficacy of a best practices hearing (vs. successful aging) intervention on reducing cognitive decline in older adults with HL.

  View details for DOI 10.1016/j.trci.2017.06.003

  View details for PubMedID 29067347

• Change in Loneliness After Intervention With Cochlear Implants or Hearing Aids Contrera, K. J., Sung, Y. K., Betz, J., Li, L., Lin, F. R. WILEY. 2017: 1885-1889

  Abstract

  To investigate the impact of hearing aid (HA) and cochlear implant (CI) use on loneliness in adults.Prospective observational cohort study.One hundred and thirteen adults, aged ≥ 50 years, with postlingual hearing loss and receiving routine clinical care at a tertiary academic medical center, were evaluated with the University of California at Los Angeles Loneliness Scale before and 6 and 12 months after intervention with HAs or CIs. Change in score was assessed using linear mixed effect models adjusted for age; gender; education; and history of hypertension, diabetes, and smoking.Significant improvements in loneliness scores were observed in CI users from baseline to 6 months (-3.79 [95% confidence interval): -5.73, -1.85], P <.001) and baseline to 12 months (-3.26 [95% confidence interval: -5.66, -0.87], P =.007). We did not observe a significant improvement in loneliness scores in HA users from baseline to 6 months (-0.83 [95% confidence interval: -2.68, 1.02], P =.381) or baseline to 12 months (-0.34 [95% confidence interval: -2.77, -2.10], P = .007). The most substantial increases were observed in individuals with the lowest baseline scores.Treatment of hearing loss with CIs results in a significant reduction in loneliness symptoms. This improvement was not observed with HAs. We observed differential effects of treatment depending on the baseline loneliness score, with the greatest improvements observed in individuals with the most loneliness symptoms at baseline.2b. Laryngoscope, 127:1885-1889, 2017.

  View details for DOI 10.1002/lary.26424

  View details for Web of Science ID 000406867800037

  View details for PubMedID 28059448

  View details for PubMedCentralID PMC5500450

• Association of Hearing Impairment and Subsequent Driving Mobility in Older Adults. The Gerontologist Edwards, J. D., Lister, J. J., Lin, F. R., Andel, R., Brown, L., Wood, J. M. 2017; 57 (4): 767-775

  Abstract

  Hearing impairment (HI) is associated with driving safety (e.g., increased crashes and poor on-road driving performance). However, little is known about HI and driving mobility. This study examined the longitudinal association of audiometric hearing with older adults' driving mobility over 3 years.Secondary data analyses were conducted of 500 individuals (63-90 years of age) from the Staying Keen in Later Life (SKILL) study. Hearing (pure tone average of 0.5, 1, and 2kHz) was assessed in the better hearing ear and categorized into normal hearing ≤25 dB hearing level (HL); mild HI 26-40 dB HL; or moderate and greater HI ≥41 dB HL. The Useful Field of View Test (UFOV) was used to estimate the risk for adverse driving events. Multivariate analysis of covariance compared driving mobility between HI levels across time, adjusting for age, sex, race, hypertension, and stroke. Adjusting for these same covariates, Cox regression analyses examined incidence of driving cessation by HI across 3 years.Individuals with moderate or greater HI performed poorly on the UFOV, indicating increased risk for adverse driving events (p < .001). No significant differences were found among older adults with varying levels of HI for driving mobility (p values > .05), including driving cessation rates (p = .38), across time.Although prior research indicates older adults with HI may be at higher risk for crashes, they may not modify driving over time. Further exploration of this issue is required to optimize efforts to improve driving safety and mobility among older adults.

  View details for DOI 10.1093/geront/gnw009

  View details for PubMedID 26916667

  View details for PubMedCentralID PMC5881668

• The Common Sense of Considering the Senses in Patient Communication JOURNAL OF THE AMERICAN GERIATRICS SOCIETY Lin, F. R., Whitson, H. E. 2017; 65 (8): 1659-1660

  View details for DOI 10.1111/jgs.14926

  View details for Web of Science ID 000407648200005

  View details for PubMedID 28436020

  View details for PubMedCentralID PMC6590671

• Personal Sound Amplification Products vs a Conventional Hearing Aid for Speech Understanding in Noise JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION Reed, N. S., Betz, J., Kendig, N., Korczak, M., Lin, F. R. 2017; 318 (1): 89-90

  Abstract

  This cross-sectional study compared functional hearing with use of personal sound amplification products vs conventional hearing aid among older adults with mild to moderate hearing loss.

  View details for DOI 10.1001/jama.2017.6905

  View details for Web of Science ID 000404717700020

  View details for PubMedID 28672306

  View details for PubMedCentralID PMC5817472

• Addressing Estimated Hearing Loss in Adults in 2060 JAMA OTOLARYNGOLOGY-HEAD & NECK SURGERY Goman, A. M., Reed, N. S., Lin, F. R. 2017; 143 (7): 733-734

  Abstract

  This population epidemiology study uses data from the NHANES to estimate the number of adults expected to have hearing loss in the next 43 years.

  View details for DOI 10.1001/jamaoto.2016.4642

  View details for Web of Science ID 000406025100019

  View details for PubMedID 28253386

  View details for PubMedCentralID PMC5824202

• Pilot Electroacoustic Analyses of a Sample of Direct-to-Consumer Amplification Products OTOLOGY & NEUROTOLOGY Reed, N. S., Betz, J., Lin, F. R., Mamo, S. K. 2017; 38 (6): 804-808

  Abstract

  Recent national initiatives from the White House and Institute of Medicine have focused on strategies to increase the accessibility and affordability of hearing loss treatment given the average cost of $4700 for bilateral hearing aids. More affordable direct-to-consumer hearing technologies are increasingly gaining recognition, but the performance of these devices has been poorly studied. We investigated the technical and electroacoustic capabilities of several direct-to-consumer hearing devices to inform otolaryngologists who may be asked by patients to comment on these devices.Nine direct-to-consumer hearing devices ranging in retail cost from $144.99 to $395.00 and one direct-to-consumer hearing device with a retail cost of $30.00.Electroacoustic results and simulated real-ear measurements. Main electroacoustic measures are frequency response, equivalent input noise, total harmonic distortion, and maximum output sound pressure level at 90 dB.Five devices met all four electroacoustic tolerances presented in this study, two devices met three tolerances, one device met two tolerances, one device met one tolerance, and one device did not meet any tolerances. Nine devices were able to approximate five of nine National Acoustics Laboratories (NAL) targets within 10 dB while only three devices were able to approximate five of nine NAL targets within a more stringent 5 dB.While there is substantial heterogeneity among the selection of devices, certain direct-to-consumer hearing devices may be able to provide appropriate amplification to persons with mild-to-moderate hearing loss and serve as alternatives for hearing aids in specific cases.

  View details for DOI 10.1097/MAO.0000000000001414

  View details for Web of Science ID 000403225200023

  View details for PubMedID 28595255

  View details for PubMedCentralID PMC5467454

• Hearing Impairment and Incident Dementia and Cognitive Decline in Older Adults: The Health ABC Study JOURNALS OF GERONTOLOGY SERIES A-BIOLOGICAL SCIENCES AND MEDICAL SCIENCES Deal, J. A., Betz, J., Yaffe, K., Harris, T., Purchase-Helzner, E., Satterfield, S., Pratt, S., Govil, N., Simonsick, E. M., Lin, F. R., Health ABC Study Grp 2017; 72 (5): 703-709

  Abstract

  Age-related peripheral hearing impairment (HI) is prevalent, treatable, and may be a risk factor for dementia in older adults. In prospective analysis, we quantified the association of HI with incident dementia and with domain-specific cognitive decline in memory, perceptual speed, and processing speed.Data were from the Health, Aging and Body Composition (Health ABC) study, a biracial cohort of well-functioning adults aged 70-79 years. Dementia was defined using a prespecified algorithm incorporating medication use, hospital records, and neurocognitive test scores. A pure-tone average in decibels hearing level (dBHL) was calculated in the better hearing ear using thresholds from 0.5 to 4kHz, and HI was defined as normal hearing (≤25 dBHL), mild (26-40 dBHL), and moderate/severe (>40 dBHL). Associations between HI and incident dementia and between HI and cognitive change were modeled using Cox proportional hazards models and linear mixed models, respectively.Three-hundred eighty seven (20%) participants had moderate/severe HI, and 716 (38%) had mild HI. After adjustment for demographic and cardiovascular factors, moderate/severe audiometric HI (vs. normal hearing) was associated with increased risk of incident dementia over 9 years (hazard ratio: 1.55, 95% confidence interval [CI]: 1.10, 2.19). Other than poorer baseline memory performance (difference of -0.24 SDs, 95% CI: -0.44, -0.04), no associations were observed between HI and rates of domain-specific cognitive change during 7 years of follow-up.HI is associated with increased risk of developing dementia in older adults. Randomized trials are needed to determine whether treatment of hearing loss could postpone dementia onset in older adults.

  View details for DOI 10.1093/gerona/glw069

  View details for Web of Science ID 000404518000016

  View details for PubMedID 27071780

  View details for PubMedCentralID PMC5964742

• Enhancing Communication in Adults with Dementia and Age-Related Hearing Loss. Seminars in hearing Mamo, S. K., Oh, E., Lin, F. R. 2017; 38 (2): 177-183

  Abstract

  For many adults with dementia, age-related hearing loss is undiagnosed and/or untreated. Untreated hearing loss can exacerbate common dementia-related behavioral symptoms, such as depression, apathy, agitation. Despite the potential benefits to the individual and the family, pursuing and adopting hearing aids for persons with dementia presents with many challenges. As such, this group of vulnerable older adults is well suited for alternative approaches that adopt an interventional audiology framework. This article reviews alternative hearing care models that we have tested when working with older adults with cognitive impairments. We have found that some individuals show improvements in dementia-related problem behaviors and/or in measures of social engagement after brief aural rehabilitation interventions that provide non-custom amplification. We have developed simple training materials to help family and professional caregivers use communication strategies and non-custom amplification. Providing services that can be integrated into the person's broader dementia care has the potential to improve communication and quality of life for individuals and families. There are opportunities in this population to provide basic, simple strategies and make substantial improvements as long as we adopt approaches that bring the services to the people, instead of bringing the people to us in the audiology clinic.

  View details for DOI 10.1055/s-0037-1601573

  View details for PubMedID 28522892

• Diabetes mellitus and the incidence of hearing loss: a cohort study INTERNATIONAL JOURNAL OF EPIDEMIOLOGY Kim, M., Zhang, Y., Chang, Y., Ryu, S., Choi, Y., Kwon, M., Moon, I., Deal, J. A., Lin, F. R., Guallar, E., Chung, E., Hong, S., Ban, J., Shin, H., Cho, J. 2017; 46 (2): 717-726

  Abstract

  To evaluate the association between diabetes mellitus (DM) and the development of incident hearing loss.Prospective cohort study was performed in 253 301 adults with normal hearing tests who participated in a regular health-screening exam between 2002 and 2014. The main exposure was the presence of DM at baseline, defined as a fasting serum glucose ≥ 126 mg/dL, a self-reported history of DM or current use of anti-diabetic medications. Pre-diabetes was defined as a fasting glucose 100-125 mg/dL and no history of DM or anti-diabetic medication use. Incident hearing loss was defined as a pure-tone average of thresholds at 0.5, 1.0 and 2.0 kHz > 25 dB in both right and left ears.During 1 285 704 person-years of follow-up (median follow-up of four years), 2817 participants developed incident hearing loss. The rate of hearing loss in participants with normal glucose levels, pre-diabetes and DM were 1.8, 3.1 and 9.2 per 1000 person-years, respectively ( P < 0.001). The multivariable-adjusted hazard ratios for incident hearing loss for participants with pre-diabetes and DM compared with those with normal glucose levels were 1.04 (95% confidence interval 0.95-1.14) and 1.36 (1.19-1.56), respectively. In spline regression analyses, the risk of incident hearing loss increased progressively with HbA1c levels above 5%.In this large cohort study of young and middle-aged men and women, DM was associated with the development of bilateral hearing loss. DM patients have a moderately increased risk of future hearing loss.

  View details for DOI 10.1093/ije/dyw243

  View details for Web of Science ID 000402996000061

  View details for PubMedID 27818377

  View details for PubMedCentralID PMC6251644

• Association of Hearing Impairment and Anxiety in Older Adults JOURNAL OF AGING AND HEALTH Contrera, K. J., Betz, J., Deal, J., Choi, J. S., Ayonayon, H. N., Harris, T., Helzner, E., Martin, K. R., Mehta, K., Pratt, S., Rubin, S. M., Satterfield, S., Yaffe, K., Simonsick, E. M., Lin, F. R., Hlth ABC Study 2017; 29 (1): 172-184

  Abstract

  The objective of the study is was investigate the association between hearing impairment and anxiety.We conducted a cross-sectional analysis of 1,732 community-based adults aged 76 to 85 years who participated in the Health Aging and Body Composition (ABC) study. Logistic regression models were adjusted for demographic and cardiovascular risk factors. Hearing impairment was defined by the speech-frequency pure tone average. Anxiety was defined as reporting two symptoms of at least "a little" or one symptom "quite a bit" on the three-item Hopkins Symptom Checklist.Compared with individuals with no hearing impairment, the odds of prevalent anxiety were higher among individuals with mild hearing impairment (odds ratio [OR] = 1.32, 95% confidence interval [CI] = [1.01, 1.73]) and moderate or greater hearing impairment (OR = 1.59, 95% CI = [1.14, 2.22]). Hearing aid use was not significantly associated with lower odds of anxiety.Hearing impairment is independently associated with greater odds of anxiety symptoms in older adults.

  View details for DOI 10.1177/0898264316634571

  View details for Web of Science ID 000392868600008

  View details for PubMedID 26916793

  View details for PubMedCentralID PMC5704938

• Age-related hearing loss in older adults with cognitive impairment INTERNATIONAL PSYCHOGERIATRICS Nirmalasari, O., Mamo, S. K., Nieman, C. L., Simpson, A., Zimmerman, J., Nowrangi, M. A., Lin, F. R., Oh, E. S. 2017; 29 (1): 115-121

  Abstract

  Hearing loss can impair effective communication between caregivers and individuals with cognitive impairment. However, hearing loss is not often measured or addressed in care plans for these individuals. The aim of this study is to measure the prevalence of hearing loss and the utilization of hearing aids in a sample of individuals with cognitive impairment in a tertiary care memory clinic.A retrospective review of 133 charts of individuals >50 years who underwent hearing assessment at a tertiary care memory clinic over a 12-month period (June 2014-June 2015) was undertaken. Using descriptive statistics, the prevalence of hearing loss was determined and associations with demographic variables, relevant medical history, cognitive status, and hearing aid utilization were investigated.Results indicate that hearing loss is highly prevalent among this sample of cognitively impaired older adults. Sixty percent of the sample had at least a mild hearing loss in the better hearing ear. Among variables examined, age, MMSE, and medical history of diabetes were strongly associated with hearing impairment. Hearing aid utilization increased in concordance with severity of hearing loss, from 9% to 54% of individuals with a mild or moderate/severe hearing loss, respectively.Hearing loss is highly prevalent among older adults with cognitive impairment. Despite high prevalence of hearing loss, hearing aid utilization remains low. Our study highlights the importance of hearing evaluation and rehabilitation as part of the cognitive assessment and care management plan in this vulnerable population.

  View details for DOI 10.1017/S1041610216001459

  View details for Web of Science ID 000401140100012

  View details for PubMedID 27655111

  View details for PubMedCentralID PMC6296752

• The Studying Multiple Outcomes After Aural Rehabilitative Treatment Study: Study Design and Baseline Results GERONTOLOGY AND GERIATRIC MEDICINE Li, L., Blake, C., Sung, Y., Shpritz, B., Chen, D., Genther, D. J., Betz, J., Lin, F. R. 2017; 3: 2333721417704947

  Abstract

  Hearing loss may affect critical domains of health and functioning in older adults. This article describes the rationale and design of the Studying Multiple Outcomes After Aural Rehabilitative Treatment (SMART) study, which was developed to determine to what extent current hearing rehabilitative therapies could mitigate the effects of hearing loss on health outcomes. One hundred and forty-five patients ≥50 years receiving hearing aids (HA) or cochlear implants (CI) were recruited from the Johns Hopkins Department of Otolaryngology-HNS. A standardized outcome battery was administered to assess cognitive, social, mental, and physical functioning. Of the 145 participants aged 50 to 94.9 years who completed baseline evaluations, CI participants had significantly greater loneliness, social isolation, and poorer hearing and communicative function compared with HA participants. This study showed that standardized measures of health-related outcomes commonly used in gerontology appear sensitive to hearing impairment and are feasible to implement in clinical studies of hearing loss.

  View details for DOI 10.1177/2333721417704947

  View details for Web of Science ID 000475368900019

  View details for PubMedID 28491918

  View details for PubMedCentralID PMC5406145

• Hearing Care Intervention for Persons with Dementia: A Pilot Study AMERICAN JOURNAL OF GERIATRIC PSYCHIATRY Mamo, S. K., Nirmalasari, O., Nieman, C. L., McNabney, M. K., Simpson, A., Oh, E. S., Lin, F. R. 2017; 25 (1): 91-101

  Abstract

  Hearing loss is a commonly unmet need among adults with dementia that may exacerbate common dementia-related behavioral symptoms. Accessing traditional audiology services for hearing loss is a challenge because of high cost and time commitment. To improve accessibility and affordability of hearing treatment for persons with dementia, there is a need for unique service delivery models. The purpose of this study is to test a novel hearing intervention for persons with dementia and family caregivers delivered in outpatient settings.The Memory-HEARS pilot study delivered a 2-hour in-person intervention in an outpatient setting. A trained interventionist provided hearing screening, communication strategies, and provision of and instruction using a simple over-the-counter amplification device. Caregivers (N = 20) responded to questionnaires related to depression, neuropsychiatric symptoms, and caregiver burden at baseline and 1-month postintervention.Overall, caregivers believed the intervention was beneficial, and most participants with dementia wore the amplification device daily. For the depression and neuropsychiatric outcome measures, participants with high symptom burden at baseline showed improvement at 1-month postintervention. The intervention had no effect on caregiver burden. Qualitative responses from caregivers described improved engagement for their loved ones, such as laughing more, telling more stories, asking more questions, and having more patience.The Memory-HEARS intervention is a low-cost, low-risk, nonpharmacologic approach to addressing hearing loss and behavioral symptoms in patients with dementia. Improved communication has the potential to reduce symptom burden and improve quality of life.

  View details for DOI 10.1016/j.jagp.2016.08.019

  View details for Web of Science ID 000396484300014

  View details for PubMedID 27890543

  View details for PubMedCentralID PMC5164856

• Prevalence of Untreated Hearing Loss by Income among Older Adults in the United States JOURNAL OF HEALTH CARE FOR THE POOR AND UNDERSERVED Mamo, S. K., Nieman, C. L., Lin, F. R. 2016; 27 (4): 1812-1818

  Abstract

  Age-related hearing loss is highly prevalent and only 20% of adults with hearing loss report using hearing aids. A major barrier to increased hearing aid use is the high out-of-pocket costs associated with hearing aids. The objective of this brief report is to estimate the numbers of millions of Americans 60 years or older with untreated hearing loss stratified by income level. Using multiple cycles from the National Health and Nutrition Examination Survey (NHANES; 1999-2006 and 2009-2010), the prevalence of untreated hearing loss is reported based on audiometric hearing tests and self-reported hearing aid use from a cross-sectional, nationally representative sample. Overall, approximately 20 million Americans 60 years or older have an untreated clinically significant hearing loss. Importantly for the nearly six million low-income older adults with untreated hearing loss, the high cost of hearing aids makes hearing treatment particularly inaccessible for this vulnerable population.

  View details for DOI 10.1353/hpu.2016.0164

  View details for Web of Science ID 000387092800015

  View details for PubMedID 27818440

  View details for PubMedCentralID PMC7307013

• Prevalence of Hearing Loss by Severity in the United States AMERICAN JOURNAL OF PUBLIC HEALTH Goman, A. M., Lin, F. R. 2016; 106 (10): 1820-1822

  Abstract

  To estimate the age- and severity-specific prevalence of hearing impairment in the United States.We conducted cross-sectional analyses of 2001 through 2010 data from the National Health and Nutrition Examination Survey on 9648 individuals aged 12 years or older. Hearing loss was defined as mild (> 25 dB through 40 dB), moderate (> 40 dB through 60 dB), severe (> 60 dB through 80 dB), or profound (> 80 dB).An estimated 25.4 million, 10.7 million, 1.8 million, and 0.4 million US residents aged 12 years or older, respectively, have mild, moderate, severe, and profound better-ear hearing loss. Older individuals displayed a higher prevalence of hearing loss and more severe levels of loss. Across most ages, the prevalence was higher among Hispanic and non-Hispanic Whites than among non-Hispanic Blacks and was higher among men than women.Hearing loss directly affects 23% of Americans aged 12 years or older. The majority of these individuals have mild hearing loss; however, moderate loss is more prevalent than mild loss among individuals aged 80 years or older.Our estimates can inform national public health initiatives on hearing loss and help guide policy recommendations currently being discussed at the Institute of Medicine and the White House.

  View details for DOI 10.2105/AJPH.2016.303299

  View details for Web of Science ID 000388076500047

  View details for PubMedID 27552261

  View details for PubMedCentralID PMC5024365

• Racial Differences of Pigmentation in the Human Vestibular Organs OTOLARYNGOLOGY-HEAD AND NECK SURGERY Erbele, I. D., Lin, F. R., Agrawal, Y., Francis, H. W., Carey, J. P., Chien, W. W. 2016; 155 (3): 479-484

  Abstract

  Melanin pigmentation is present in the human inner ear. In this study, we quantify the melanin pigmentation in the vestibular system and examine racial differences of vestibular melanin pigmentation using human cadaveric temporal bone specimens.Basic research.Laboratory.Light microscopy was used to examine specimens from 40 left temporal bones from the Johns Hopkins Human Temporal Bone Collection. Color images of (1) ampulla of the horizontal canal, (2) utricular wall, (3) endolymphatic duct, and (4) posterior ampullary nerve as it enters the posterior canal were acquired with a digital camera attached to the microscope and image acquisition software. Acquired images of each anatomic area of interest were processed offline through ImageJ. Melanin content was then compared according to ethnicity, age, sex, and location.Fifteen African American and 25 Caucasian specimens were analyzed. Mean age was 68.8 years. African American specimens had a significantly greater amount of pigment at all 4 sampled locations as compared with Caucasian specimens (P < .01). Between sexes, there was a statistically significant difference (P < .05) at the posterior ampullary nerve, with males having more than females. Melanin content was not associated with age.There is greater melanin pigmentation within the vestibular system of African Americans than in Caucasians, similar to what has been described in the cochlea. Racial differences in vestibular physiologic function have been observed in the literature and may be explained by differences in melanin pigmentation.

  View details for DOI 10.1177/0194599816645764

  View details for Web of Science ID 000383032800017

  View details for PubMedID 27165682

• Association of Hearing Loss and Loneliness in Older Adults JOURNAL OF AGING AND HEALTH Sung, Y., Li, L., Blake, C., Betz, J., Lin, F. R. 2016; 28 (6): 979-994

  Abstract

  The objective of this study is to determine factors associated with loneliness in older adults presenting for hearing loss treatment.A cross-sectional analysis was conducted of 145 participants (aged 50-94) who presented for hearing aids or cochlear implants and were enrolled in the Studying Multiple Outcomes After Aural Rehabilitative Treatment (SMART) study from 2011 to 2013. Social, communicative, physical, and mental health functioning were assessed using self-administered questionnaires, and loneliness using the University of California, Los Angeles (UCLA) Loneliness Scale.Younger age and greater hearing loss were significantly associated with greater loneliness. Metrics of depressive symptoms and hearing-related quality of life, communication difficulties, and emotional well-being, mental health, and 36-Item Medical Outcomes Study Short-Form (SF-36) scores were moderately or highly correlated with loneliness.Younger age and greater hearing loss are independently associated with higher levels of loneliness in older adults presenting to clinic for hearing loss treatment. Further studies needed to determine whether hearing treatment can reduce loneliness in older adults.

  View details for DOI 10.1177/0898264315614570

  View details for Web of Science ID 000382570600003

  View details for PubMedID 26597841

• Quality of life after intervention with a cochlear implant or hearing aid LARYNGOSCOPE Contrera, K. J., Betz, J., Li, L., Blake, C. R., Sung, Y. K., Choi, J. S., Lin, F. R. 2016; 126 (9): 2110-2115

  Abstract

  To investigate the impact of hearing aid and cochlear implant use on quality of life in adults.Prospective observational cohort study.One hundred thirteen adults aged ≥50 years with postlingual hearing loss receiving routine clinical care at a tertiary academic medical center were evaluated with the Medical Outcome Study Short Form-36 before and 6 and 12 months after intervention with hearing aids or cochlear implants. Change in score was assessed using linear mixed effect models adjusted for age, gender, education, and history of hypertension, diabetes, and smoking.A significant increase in Mental Component Summary score was observed in both hearing aid and cochlear implant users from baseline to 12 months, with cochlear implant users increasing nearly twice that of hearing aid users (hearing aid: 2.49 [95% confidence interval: 0.11, 4.88], P = .041; cochlear implant: 4.20 [95% confidence interval: 1.85, 6.55], P < .001). The most substantial increases were observed in individuals with the lowest baseline scores. There was no significant difference in physical component summary score from baseline to 12 months.Treatment of hearing loss with hearing aids and cochlear implants results in significant increases in mental health quality of life. The majority of the increase is observed by 6 months post-treatment, and we observed differential effects of treatment depending on the level of baseline quality of life score with the greatest gains observed in those with the lowest scores.2b. Laryngoscope, 126:2110-2115, 2016.

  View details for DOI 10.1002/lary.25848

  View details for Web of Science ID 000383289400039

  View details for PubMedID 26775283

  View details for PubMedCentralID PMC4947575

• Priorities for Improving Hearing Health Care for Adults A Report From the National Academies of Sciences, Engineering, and Medicine JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION Lin, F. R., Hazzard, W. R., Blazer, D. G. 2016; 316 (8): 819-820

  View details for DOI 10.1001/jama.2016.7916

  View details for Web of Science ID 000381736200009

  View details for PubMedID 27254725

• Association Between Dual Sensory Impairment, Hospitalization, and Burden of Disease JOURNAL OF THE AMERICAN GERIATRICS SOCIETY Huddle, M. G., Deal, J. A., Swenor, B., Genther, D. J., Lin, F. R. 2016; 64 (8): 1735-1737

  View details for DOI 10.1111/jgs.14210

  View details for Web of Science ID 000383541500034

  View details for PubMedID 27448758

  View details for PubMedCentralID PMC4988881

• A Comparison of Self-Report and Audiometric Measures of Hearing and Their Associations With Functional Outcomes in Older Adults JOURNAL OF AGING AND HEALTH Choi, J. S., Betz, J., Deal, J., Contrera, K. J., Genther, D. J., Chen, D. S., Gispen, F. E., Lin, F. R. 2016; 28 (5): 890-910

  Abstract

  The aim was to investigate whether associations of hearing impairment (HI) with functional outcomes in older adults differ when using self-report versus pure-tone audiometry.We examined 1,669 participants ≥70 years in National Health and Examination Survey from 2005-2006 and 2009-2010 whose hearing was assessed by self-report and pure-tone audiometry. We explored functional outcomes associated with audiometric HI (low physical activity, poor physical functioning, and hospitalization).In adjusted models, we found significant associations of audiometric HI with both subjective and objective outcomes (e.g., dichotomous HI with self-reported difficulty in activities of daily living [ADLs], odds ratio [OR] = 1.47, 95% confidence interval [CI] [1.05, 2.06], and low accelerometer-measured physical activity, OR = 2.19, 95% CI [1.11, 4.34]). In contrast, self-reported HI was only associated with subjective outcomes and not with objective outcomes (e.g., dichotomous HI with difficulty in ADLs, OR = 1.63, 95% CI [1.12, 2.38], and low accelerometer-measured physical activity, OR = 0.95, 95% CI [0.66, 1.35]).Results using self-reported hearing should not be considered representative of results using audiometry and may provide distinct aspects of HI in older adults.

  View details for DOI 10.1177/0898264315614006

  View details for Web of Science ID 000379512600009

  View details for PubMedID 26553723

  View details for PubMedCentralID PMC5937530

• Association of Using Hearing Aids or Cochlear Implants With Changes in Depressive Symptoms in Older Adults JAMA OTOLARYNGOLOGY-HEAD & NECK SURGERY Choi, J. S., Betz, J., Li, L., Blake, C. R., Sung, Y. K., Contrera, K. J., Lin, F. R. 2016; 142 (7): 652-657

  Abstract

  Hearing loss is a common health problem in older adults that is strongly associated with the development of depression. Previous cross-sectional studies have reported lower odds of depression among individuals who use hearing aids. However, there have been limited prospective studies investigating the effect of hearing loss treatments on depressive symptoms.To investigate the association between treatment with a hearing aid or cochlear implant with depressive symptoms in older adults.A prospective observational study was conducted of 113 participants 50 years or older who received hearing aids (n = 63) or cochlear implants (n = 50). Participants were recruited from August 1, 2011, to January 31, 2014, at a tertiary care academic center.Hearing aid or cochlear implantation.Depressive symptoms were evaluated by the 15-item Geriatric Depression Scale (GDS) at baseline and at 6 and 12 months after intervention. The score ranges from 0 to 15, and various scores between 3 and 10 have been used as being suggestive of depression.The median age of the 113 study participants was 69.6 years (interquartile range, 63.5-77.4 years). At baseline, the mean GDS score for the participants was 41% lower (95% CI, 7%-63%) among those receiving hearing aids (mean score, 1.5; 95% CI, 0.7-3.3) compared with those receiving cochlear implants (mean score, 2.6; 95% CI, 1.3-5.1). Cochlear implant recipients' GDS scores improved from baseline to 6 months after treatment by 31% (95% CI, 10%-47%) and from baseline to 12 months after treatment by 38% (95% CI, 18%-54%). Hearing aid recipients' GDS scores improved by 28% (95% CI, 0%-48%) at 6 months after treatment but were not significantly different from baseline at 12 months after treatment (16%; 95% CI, -24% to 43%).There was a significant improvement in depressive symptoms at 6 months after treatment for patients receiving cochlear implants and hearing aids; this improvement persisted to 12 months for those who received cochlear implants. Further research is warranted to assess the long-term effect of hearing rehabilitation on mental health in older adults.

  View details for DOI 10.1001/jamaoto.2016.0700

  View details for Web of Science ID 000380264600007

  View details for PubMedID 27258813

  View details for PubMedCentralID PMC12861333

• Association of Hearing Impairment With Incident Frailty and Falls in Older Adults JOURNAL OF AGING AND HEALTH Kamil, R. J., Betz, J., Powers, B., Pratt, S., Kritchevsky, S., Ayonayon, H. N., Harris, T. B., Helzner, E., Deal, J. A., Martin, K., Peterson, M., Satterfield, S., Simonsick, E. M., Lin, F. R., Hlth ABC study 2016; 28 (4): 644-660

  Abstract

  We aimed to determine whether hearing impairment (HI) in older adults is associated with the development of frailty and falls.Longitudinal analysis of observational data from the Health, Aging and Body Composition study of 2,000 participants aged 70 to 79 was conducted. Hearing was defined by the pure-tone-average of hearing thresholds at 0.5, 1, 2, and 4 kHz in the better hearing ear. Frailty was defined as a gait speed of <0.60 m/s and/or inability to rise from a chair without using arms. Falls were assessed annually by self-report.Older adults with moderate-or-greater HI had a 63% increased risk of developing frailty (adjusted hazard ratio [HR] = 1.63, 95% confidence interval [CI] = [1.26, 2.12]) compared with normal-hearing individuals. Moderate-or-greater HI was significantly associated with a greater annual percent increase in odds of falling over time (9.7%, 95% CI = [7.0, 12.4] compared with normal hearing, 4.4%, 95% CI = [2.6, 6.2]).HI is independently associated with the risk of frailty in older adults and with greater odds of falling over time.

  View details for DOI 10.1177/0898264315608730

  View details for Web of Science ID 000375714700005

  View details for PubMedID 26438083

  View details for PubMedCentralID PMC5644033

• Association of Hearing Impairment and Emotional Vitality in Older Adults JOURNALS OF GERONTOLOGY SERIES B-PSYCHOLOGICAL SCIENCES AND SOCIAL SCIENCES Contrera, K. J., Betz, J., Deal, J. A., Choi, J. S., Ayonayon, H. N., Harris, T., Helzner, E., Martin, K. R., Mehta, K., Pratt, S., Rubin, S. M., Satterfield, S., Yaffe, K., Garcia, M., Simonsick, E. M., Lin, F. R., Hlth ABC Study 2016; 71 (3): 400-404

  Abstract

  To better understand the potential impact of hearing impairment (HI) and hearing aid use on emotional vitality and mental health in older adults.We investigated the cross-sectional association of HI with emotional vitality in 1,903 adults aged 76-85 years in the Health ABC study adjusted for demographic and cardiovascular risk factors. Hearing was defined by the speech frequency pure tone average (no impairment < 25 dB, mild impairment 25-40 dB, and moderate or greater impairment > 40 dB). Emotional vitality was defined as having a high sense of personal mastery, happiness, low depressive symptomatology, and low anxiety.Compared with individuals with no HI, participants with moderate or greater HI had a 23% lower odds of emotional vitality (odds ratio [OR] = 0.77; 95% confidence interval [CI]: 0.59-0.99). Hearing aid use was not associated with better emotional vitality (OR = 0.98; 95% CI: 0.81-1.20).HI is associated with lower odds of emotional vitality in older adults. Further studies are needed to examine the longitudinal impact of HI on mental health and well-being.

  View details for DOI 10.1093/geronb/gbw005

  View details for Web of Science ID 000379814400002

  View details for PubMedID 26883806

  View details for PubMedCentralID PMC5013924

• Hearing Loss Health Care for Older Adults JOURNAL OF THE AMERICAN BOARD OF FAMILY MEDICINE Contrera, K. J., Wallhagen, M. I., Mamo, S. K., Oh, E. S., Lin, F. R. 2016; 29 (3): 394-403

  Abstract

  Hearing deficits are highly prevalent among older adults and are associated with declines in cognitive, physical, and mental health. However, hearing loss in the geriatric population often goes untreated and generally receives little clinical emphasis in primary care practice. This article reviews hearing health care for older adults, focusing on what is most relevant for family physicians. The objective of hearing loss treatment is to ensure that a patient can communicate effectively in all settings. We present the 5 major obstacles to obtaining effective hearing and rehabilitative care: awareness, access, treatment options, cost, and device effectiveness. Hearing technologies are discussed, along with recommendations on when it is appropriate to screen, refer, or counsel a patient. The purpose of this article is to provide pragmatic recommendations for the clinical management of the older adult with hearing loss that can be conducted in family medicine practices.

  View details for DOI 10.3122/jabfm.2016.03.150235

  View details for Web of Science ID 000375756600014

  View details for PubMedID 27170797

• Hearing Impairment and Physical Function and Falls in the Atherosclerosis Risk in Communities Hearing Pilot Study JOURNAL OF THE AMERICAN GERIATRICS SOCIETY Deal, J. A., Sharrett, A., Bandeen-Roche, K., Kritchevsky, S. B., Pompeii, L. A., Windham, B., Lin, F. R. 2016; 64 (4): 906-908

  View details for DOI 10.1111/jgs.14075

  View details for Web of Science ID 000374705900038

  View details for PubMedID 27100600

  View details for PubMedCentralID PMC4843829

• Effects of Community-Based Health Worker Interventions to Improve Chronic Disease Management and Care Among Vulnerable Populations: A Systematic Review AMERICAN JOURNAL OF PUBLIC HEALTH Kim, K., Choi, J. S., Choi, E., Nieman, C. L., Joo, J., Lin, F. R., Gitlin, L. N., Han, H. 2016; 106 (4): E3-E28

  Abstract

  Community-based health workers (CBHWs) are frontline public health workers who are trusted members of the community they serve. Recently, considerable attention has been drawn to CBHWs in promoting healthy behaviors and health outcomes among vulnerable populations who often face health inequities.We performed a systematic review to synthesize evidence concerning the types of CBHW interventions, the qualification and characteristics of CBHWs, and patient outcomes and cost-effectiveness of such interventions in vulnerable populations with chronic, noncommunicable conditions.We undertook 4 electronic database searches-PubMed, EMBASE, Cumulative Index to Nursing and Allied Health Literature, and Cochrane-and hand searched reference collections to identify randomized controlled trials published in English before August 2014.We screened a total of 934 unique citations initially for titles and abstracts. Two reviewers then independently evaluated 166 full-text articles that were passed onto review processes. Sixty-one studies and 6 companion articles (e.g., cost-effectiveness analysis) met eligibility criteria for inclusion.Four trained research assistants extracted data by using a standardized data extraction form developed by the authors. Subsequently, an independent research assistant reviewed extracted data to check accuracy. Discrepancies were resolved through discussions among the study team members. Each study was evaluated for its quality by 2 research assistants who extracted relevant study information. Interrater agreement rates ranged from 61% to 91% (average 86%). Any discrepancies in terms of quality rating were resolved through team discussions.All but 4 studies were conducted in the United States. The 2 most common areas for CBHW interventions were cancer prevention (n = 30) and cardiovascular disease risk reduction (n = 26). The roles assumed by CBHWs included health education (n = 48), counseling (n = 36), navigation assistance (n = 21), case management (n = 4), social services (n = 7), and social support (n = 18). Fifty-three studies provided information regarding CBHW training, yet CBHW competency evaluation (n = 9) and supervision procedures (n = 24) were largely underreported. The length and duration of CBHW training ranged from 4 hours to 240 hours with an average of 41.3 hours (median: 16.5 hours) in 24 studies that reported length of training. Eight studies reported the frequency of supervision, which ranged from weekly to monthly. There was a trend toward improvements in cancer prevention (n = 21) and cardiovascular risk reduction (n = 16). Eight articles documented cost analyses and found that integrating CBHWs into the health care delivery system was associated with cost-effective and sustainable care.Interventions by CBHWs appear to be effective when compared with alternatives and also cost-effective for certain health conditions, particularly when partnering with low-income, underserved, and racial and ethnic minority communities. Future research is warranted to fully incorporate CBHWs into the health care system to promote noncommunicable health outcomes among vulnerable populations.

  View details for DOI 10.2105/AJPH.2015.302987

  View details for Web of Science ID 000375913000002

  View details for PubMedID 26890177

  View details for PubMedCentralID PMC4785041

• Aging and Hearing Health: The Life-course Approach GERONTOLOGIST Davis, A., McMahon, C. M., Pichora-Fuller, K. M., Russ, S., Lin, F., Olusanya, B. O., Chadha, S., Tremblay, K. L. 2016; 56: S256-S267

  Abstract

  Sensory abilities decline with age. More than 5% of the world's population, approximately 360 million people, have disabling hearing loss. In adults, disabling hearing loss is defined by thresholds greater than 40 dBHL in the better hearing ear.Hearing disability is an important issue in geriatric medicine because it is associated with numerous health issues, including accelerated cognitive decline, depression, increased risk of dementia, poorer balance, falls, hospitalizations, and early mortality. There are also social implications, such as reduced communication function, social isolation, loss of autonomy, impaired driving ability, and financial decline. Furthermore, the onset of hearing loss is gradual and subtle, first affecting the detection of high-pitched sounds and with difficulty understanding speech in noisy but not in quiet environments. Consequently, delays in recognizing and seeking help for hearing difficulties are common. Age-related hearing loss has no known cure, and technologies (hearing aids, cochlear implants, and assistive devices) improve thresholds but do not restore hearing to normal. Therefore, health care for persons with hearing loss and people within their communication circles requires education and counseling (e.g., increasing knowledge, changing attitudes, and reducing stigma), behavior change (e.g., adapting communication strategies), and environmental modifications (e.g., reducing noise). In this article, we consider the causes, consequences, and magnitude of hearing loss from a life-course perspective. We examine the concept of "hearing health," how to achieve it, and implications for policy and practice.

  View details for DOI 10.1093/geront/gnw033

  View details for Web of Science ID 000374222200009

  View details for PubMedID 26994265

  View details for PubMedCentralID PMC6283365

• Personal Sound Amplifiers for Adults with Hearing Loss AMERICAN JOURNAL OF MEDICINE Mamo, S. K., Reed, N. S., Nieman, C. L., Oh, E. S., Lin, F. R. 2016; 129 (3): 245-250

  Abstract

  Age-related hearing loss is highly prevalent and often untreated. Use of hearing aids has been associated with improvements in communication and quality of life, but such treatment is unaffordable or inaccessible for many adults. The purpose of this review is to provide a practical guide for physicians who work with older adults who are experiencing hearing and communication difficulties. Specifically, we review direct-to-consumer amplification products that can be used to address hearing loss in adults. Helping adults with hearing loss navigate hearing loss treatment options ranging from being professionally fitted with hearing aids to using direct-to-consumer amplification options is important for primary care clinicians to understand given our increasing understanding of the impact of hearing loss on cognitive, social, and physical functioning.

  View details for DOI 10.1016/j.amjmed.2015.09.014

  View details for Web of Science ID 000369947300016

  View details for PubMedID 26498713

  View details for PubMedCentralID PMC4755807

• Racial/Ethnic and Socioeconomic Disparities in Hearing Health Care Among Older Americans JOURNAL OF AGING AND HEALTH Nieman, C. L., Marrone, N., Szanton, S. L., Thorpe, R. J., Lin, F. R. 2016; 28 (1): 68-94

  Abstract

  Hearing impairment is highly prevalent, but little is known about hearing health care among older minority adults.We analyzed nationally representative, cross-sectional data from 1,544 older adults ≥ 70 years with audiometry and hearing care data from the 2005-2006 and 2009-2010 National Health and Nutritional Examination Surveys.After adjusting for age and speech frequency pure tone average, Blacks (odds ratio [OR] = 1.68, vs. Whites) and those with greater education (OR = 1.63, ≥ college vs. < high school) were more likely to report recent hearing testing, while White older adults and those with greater socioeconomic status were more likely to report regular hearing aid use (all ps < .05). Based on a multivariate analysis, Blacks were not more likely than Whites to use hearing aids despite being more likely to have had recent hearing testing.Racial/ethnic and socioeconomic disparities exist in hearing health care and represent critical areas for research and intervention.

  View details for DOI 10.1177/0898264315585505

  View details for Web of Science ID 000368574600004

  View details for PubMedID 25953816

  View details for PubMedCentralID PMC4826391

• Apolipoprotein E Allele and Hearing Thresholds in Older Adults AMERICAN JOURNAL OF ALZHEIMERS DISEASE AND OTHER DEMENTIAS Mener, D. J., Betz, J., Yaffe, K., Harris, T. B., Helzner, E. P., Satterfield, S., Houston, D. K., Strotmeyer, E. S., Pratt, S. R., Simonsick, E. M., Lin, F. R., Hlth ABC Study 2016; 31 (1): 34-39

  Abstract

  Whether apolipoprotein E (APOE) E4 allele status which is associated with an increased risk of cognitive decline is also associated with hearing impairment is unknown.We studied 1833 men and women enrolled in the Health, Aging and Body Composition study. Regression models adjusted for demographic and cardiovascular risk factors were used to assess the cross-sectional association of APOE-E4 status with individual pure tone hearing thresholds and the 4-frequency pure tone average (0.5-4 kHz) in the better hearing ear.Compared to participants with no APOE-E4 alleles, participants with 1 allele had better thresholds at 4.0 kHz (β = -2.72 dB, P = .013) and 8.0 kHz (β = -3.05 kHz, P = .006), and participants with 2 alleles had better hearing thresholds at 1.0 kHz (β = -8.56 dB, P = .021).Our results suggest that APOE-E4 allele status may be marginally associated with better hearing thresholds in older adults.

  View details for DOI 10.1177/1533317514537549

  View details for Web of Science ID 000368175600004

  View details for PubMedID 24906966

  View details for PubMedCentralID PMC4258173

• Does Sensory Function Decline Independently or Concomitantly with Age? Data from the Baltimore Longitudinal Study of Aging. Journal of aging research Gadkaree, S. K., Sun, D. Q., Li, C., Lin, F. R., Ferrucci, L., Simonsick, E. M., Agrawal, Y. 2016; 2016: 1865038

  Abstract

  Objectives. To investigate whether sensory function declines independently or in parallel with age within a single individual. Methods. Cross-sectional analysis of Baltimore Longitudinal Study of Aging (BLSA) participants who underwent vision (visual acuity threshold), proprioception (ankle joint proprioceptive threshold), vestibular function (cervical vestibular-evoked myogenic potential), hearing (pure-tone average audiometric threshold), and Health ABC physical performance battery testing. Results. A total of 276 participants (mean age 70 years, range 26-93) underwent all four sensory tests. The function of all four systems declined with age. After age adjustment, there were no significant associations between sensory systems. Among 70-79-year-olds, dual or triple sensory impairment was associated with poorer physical performance. Discussion. Our findings suggest that beyond the common mechanism of aging, other distinct (nonshared) etiologic mechanisms may contribute to decline in each sensory system. Multiple sensory impairments influence physical performance among individuals in middle old-age (age 70-79).

  View details for PubMedID 27774319

• Association of Hearing Impairment and Mortality in the National Health and Nutrition Examination Survey JAMA OTOLARYNGOLOGY-HEAD & NECK SURGERY Contrera, K. J., Betz, J., Genther, D. J., Lin, F. R. 2015; 141 (10): 944-946

  View details for DOI 10.1001/jamaoto.2015.1762

  View details for Web of Science ID 000362978400016

  View details for PubMedID 26401904

  View details for PubMedCentralID PMC4803066

• Assessing Systemic Stress in Otolaryngology: Methodology and Feasibility of Hair and Salivary Cortisol Testing. Journal of nature and science Genther, D. J., Laudenslager, M. L., Sung, Y., Blake, C. R., Chen, D. S., Lin, F. R. 2015; 1 (8)

  Abstract

  OBJECTIVE: Elevated systemic stress is a predictor of adverse health outcomes, and stress can be objectively quantified by cortisol concentration. Despite its utility, such testing is rarely performed in otolaryngology. This manuscript provides details on the principles, methodology, and feasibility of performing laboratory assessments of hair and salivary cortisol to inform researchers wishing to incorporate these novel tests in future otolaryngologic studies.METHODS: Participants were older adults with hearing impairment. One hair sample and eight saliva samples were collected. Feasibility of study design was assessed through rates of participation in hair and saliva sampling and protocol adherence for saliva collection. Area under the curve (AUC) was used to evaluate overall secretion, and cortisol awakening response (CAR) was used to evaluate the dynamic secretion response.RESULTS: From 9/1/2013 to 12/31/2013, 26/30 (86.7%) eligible participants agreed to hair sampling. All 30 subjects agreed to collect saliva, with 29 (96.7%) adhering to the collection protocol. Mean AUC was 401.2 nmol/L per hour, and CAR was 4.5 nmol/L.CONCLUSIONS: Evaluating systemic stress in an otolaryngologic population using hair and saliva is feasible with acceptable participation and adherence. Repeat measurements over time will allow for evaluation of changes in systemic stress in relation to treatment.

  View details for PubMedID 26436139

• The Safety and Efficacy of PF-04958242 in Age-Related Sensorineural Hearing Loss A Randomized Clinical Trial JAMA OTOLARYNGOLOGY-HEAD & NECK SURGERY Bednar, M. M., DeMartinis, N., Banerjee, A., Bowditch, S., Gaudreault, F., Zumpano, L., Lin, F. R. 2015; 141 (7): 607-613

  Abstract

  To our knowledge, this is the first study to assess the potential to pharmacologically improve auditory function in adults with age-related sensorineural hearing loss.To explore the potential for the α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid potentiator mechanism to affect auditory function in individuals with mild to moderate age-related sensorineural hearing loss.A randomized, double-blind, placebo-controlled, single-dose, 3-way crossover study was conducted in 3 academic ear, nose, and throat clinics and 2 private clinical research centers between December 22, 2011, and February 26, 2013. Participants were 50- to 75-year-old men and women of nonchildbearing potential with mild to moderate sensorineural hearing loss.Three single doses of PF-04958242, an α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid glutamate-positive allosteric modulator, and placebo.Pure-tone average, speech discrimination score, and speech in noise testing change from baseline at 1 and 5 hours after a single dose of PF-04958242.The treatment was safe and well tolerated. The estimates for the primary end point change from baseline in pure-tone average compared with placebo at 1 hour were -0.77 (95% CI, -2.14 to 0.59) and 0.37 (95% CI, -0.97 to 1.72) for 0.27 and 0.35 mg, respectively. At 5 hours the estimates were -0.57 (95% CI, -2.43 to 1.29) and -0.56 (95% CI, -2.45 to 1.33) for 0.27 and 0.35 mg, respectively. No significant change from baseline was demonstrated compared with placebo in the primary or secondary study end points at 1 or 5 hours after receiving treatment.To our knowledge, this clinical trial is the first study of a pharmacologic treatment for age-related sensorineural hearing loss and provides information with regard to study design, end points, variability, data characteristics, and operational feasibility to guide the design of future hearing loss trials.clinicaltrials.gov Identifier: NCT01518920.

  View details for DOI 10.1001/jamaoto.2015.0791

  View details for Web of Science ID 000358081900004

  View details for PubMedID 25997115

• Peripheral Hearing and Cognition: Evidence From the Staying Keen in Later Life (SKILL) Study EAR AND HEARING Bush, A., Lister, J. J., Lin, F. R., Betz, J., Edwards, J. D. 2015; 36 (4): 395-407

  Abstract

  Research has increasingly suggested a consistent relationship between peripheral hearing and selected measures of cognition in older adults. However, other studies yield conflicting findings. The primary purpose of the present study was to further elucidate the relationship between peripheral hearing and three domains of cognition and one measure of global cognitive status. It was hypothesized that peripheral hearing loss would be significantly associated with poorer performance across measures of cognition, even after adjusting for documented risk factors. No study to date has examined the relationship between peripheral hearing and such an extensive array of cognitive measures.Eight hundred ninety-four older adult participants from the Staying Keen in Later Life study cohort were eligible, agreed to participate, and completed the baseline evaluation. Inclusion criteria were minimal to include a sample of older adults with a wide range of sensory and cognitive abilities. Multiple linear regression analyses were conducted to evaluate the extent to which peripheral hearing predicted performance on a global measure of cognitive status, as well as multiple cognitive measures in the domains of speed of processing (Digit Symbol Substitution and Copy, Trail Making Test Part A, Letter and Pattern Comparison, and Useful Field of View), executive function (Trail Making Test Part B and Stroop Color-Word Interference Task), and memory (Digit Span, Spatial Span, and Hopkins Verbal Learning Test).Peripheral hearing, measured as the three-frequency pure-tone average (PTA) in the better ear, accounted for a significant, but minimal, amount of the variance in measures of speed of processing, executive function, and memory, as well as global cognitive status. Alternative measures of hearing (i.e., three-frequency PTAs in the right and left ears and a bilateral, six-frequency PTA [three frequencies per ear]) yielded similar findings across measures of cognition and did not alter the study outcomes in any meaningful way.Consistent with literature suggesting a significant relationship between peripheral hearing and cognition, and in agreement with our hypothesis, peripheral hearing was significantly related to 10 of 11 measures of cognition that assessed processing speed, executive function, or memory, as well as global cognitive status. Although evidence, including the present results, suggests a relationship between peripheral hearing and cognition, little is known about the underlying mechanisms. Examination of these mechanisms is a critical need to direct appropriate treatment.

  View details for DOI 10.1097/AUD.0000000000000142

  View details for Web of Science ID 000357264900002

  View details for PubMedID 25587666

  View details for PubMedCentralID PMC4478097

• Association Between Hearing Impairment and Risk of Hospitalization in Older Adults JOURNAL OF THE AMERICAN GERIATRICS SOCIETY Genther, D. J., Betz, J., Pratt, S., Martin, K. R., Harris, T. B., Satterfield, S., Bauer, D. C., Newman, A. B., Simonsick, E. M., Lin, F. R., Hlth Aging Body Composition Study 2015; 63 (6): 1146-1152

  Abstract

  To determine the association between hearing impairment (HI) and risk and duration of hospitalization in community-dwelling older adults in the United States.Prospective observational study.Health, Aging and Body Composition Study.Well-functioning community-dwelling white and black Medicare beneficiaries aged 70 to 79 at study enrollment in 1997-98 were followed for a median of 12 years.Incidence, annual rate, and duration of hospitalization were the primary outcomes. Hearing was defined as the pure-tone average (PTA) of hearing thresholds in decibels re: hearing level (dB HL) at octave frequencies from 0.5 to 4.0 kHz. Mild HI was defined as a PTA from 25 to 40 dB HL, and moderate or greater HI was defined as a PTA greater than 40 dB HL.Of the 2,148 participants included in the analysis, 1,801 (83.5%) experienced one or more hospitalizations, with 7,007 adjudicated hospitalization events occurring during the study period. Eight hundred eighty-two (41.1%) participants had normal hearing, 818 (38.1%) had mild HI, and 448 (20.9%) had moderate or greater HI. After adjusting for demographic characteristics and cardiovascular comorbidities, persons with mild HI experienced a 16% (hazard ratio (HR) = 1.16, 95% confidence interval (CI) = 1.04-1.29) greater risk of incident hospitalization and a 17% (incidence rate ratio (IRR) = 1.17, 95% CI = 1.04-1.32) greater annual rate of hospitalization, and those with moderate or greater HI experienced a 21% (HR = 1.21, 95% CI = 1.06-1.38) greater risk of incident hospitalization and a 19% (IRR = 1.19, 95% CI = 1.04-1.38) greater annual rate of hospitalization than persons with normal hearing. There was no significant association between HI and mean duration of hospitalization.Hearing-impaired older adults experience a greater incidence and annual rate of hospitalization than those with normal hearing. Investigating whether rehabilitative therapies could affect the risk of hospitalization in older adults requires further study.

  View details for DOI 10.1111/jgs.13456

  View details for Web of Science ID 000356679500012

  View details for PubMedID 26096388

  View details for PubMedCentralID PMC4477278

• Hearing Impairment and Cognitive Decline: A Pilot Study Conducted Within the Atherosclerosis Risk in Communities Neurocognitive Study AMERICAN JOURNAL OF EPIDEMIOLOGY Deal, J. A., Sharrett, A., Albert, M. S., Coresh, J., Mosley, T. H., Knopman, D., Wruck, L. M., Lin, F. R. 2015; 181 (9): 680-690

  Abstract

  Hearing impairment (HI) is prevalent, is modifiable, and has been associated with cognitive decline. We tested the hypothesis that audiometric HI measured in 2013 is associated with poorer cognitive function in 253 men and women from Washington County, Maryland (mean age = 76.9 years) in a pilot study carried out within the Atherosclerosis Risk in Communities Neurocognitive Study. Three cognitive tests were administered in 1990-1992, 1996-1998, and 2013, and a full neuropsychological battery was administered in 2013. Multivariable-adjusted differences in standardized cognitive scores (cross-sectional analysis) and trajectories of 20-year change (longitudinal analysis) were modeled using linear regression and generalized estimating equations, respectively. Hearing thresholds for pure tone frequencies of 0.5-4 kHz were averaged to obtain a pure tone average in the better-hearing ear. Hearing was categorized as follows: ≤25 dB, no HI; 26-40 dB, mild HI; and >40 dB, moderate/severe HI. Comparing participants with moderate/severe HI to participants with no HI, 20-year rates of decline in memory and global function differed by -0.47 standard deviations (P = 0.02) and -0.29 standard deviations (P = 0.02), respectively. Estimated declines were greatest in participants who did not wear a hearing aid. These findings add to the limited literature on cognitive impairments associated with HI, and they support future research on whether HI treatment may reduce risk of cognitive decline.

  View details for DOI 10.1093/aje/kwu333

  View details for Web of Science ID 000353817100007

  View details for PubMedID 25841870

  View details for PubMedCentralID PMC4408947

• Association of Hearing Impairment with Declines in Physical Functioning and the Risk of Disability in Older Adults JOURNALS OF GERONTOLOGY SERIES A-BIOLOGICAL SCIENCES AND MEDICAL SCIENCES Chen, D. S., Betz, J., Yaffe, K., Ayonayon, H. N., Kritchevsky, S., Martin, K. R., Harris, T. B., Purchase-Helzner, E., Satterfield, S., Xue, Q., Pratt, S., Simonsick, E. M., Lin, F. R., Hlth ABC Study 2015; 70 (5): 654-661

  Abstract

  Identifying factors associated with functional declines in older adults is important given the aging of the population. We investigated if hearing impairment is independently associated with objectively measured declines in physical functioning in a community-based sample of older adults.Prospective observational study of 2,190 individuals from the Health, Aging, and Body Composition study. Participants were followed annually for up to 11 visits. Hearing was measured with pure-tone audiometry. Physical functioning and gait speed were measured with the Short Physical Performance Battery (SPPB). Incident disability and requirement for nursing care were assessed semiannually through self-report.In a mixed-effects model, greater hearing impairment was associated with poorer physical functioning. At both Visit 1 and Visit 11, SPPB scores were lower in individuals with mild (10.14 [95% CI 10.04-10.25], p < .01; 7.35 [95% CI 7.12-7.58], p < .05) and moderate or greater hearing impairment (10.04 [95% CI 9.90-10.19], p < .01; 7.00 [95% CI 6.69-7.32], p < .01) than scores in normal hearing individuals (10.36 [95% CI 10.26-10.46]; 7.71 [95% CI 7.49-7.92]). We observed that women with moderate or greater hearing impairment had a 31% increased risk of incident disability (Hazard ratio [HR] =1.31 [95% CI 1.08-1.60], p < .01) and a 31% increased risk of incident nursing care requirement (HR = 1.31 [95% CI 1.05-1.62], p = .02) compared to women with normal hearing.Hearing impairment is independently associated with poorer objective physical functioning in older adults, and a 31% increased risk for incident disability and need for nursing care in women.

  View details for DOI 10.1093/gerona/glu207

  View details for Web of Science ID 000353899100016

  View details for PubMedID 25477427

  View details for PubMedCentralID PMC4400396

• The Effects of Hearing Impairment in Older Adults on Communication Partners: A Systematic Review JOURNAL OF THE AMERICAN ACADEMY OF AUDIOLOGY Kamil, R. J., Lin, F. R. 2015; 26 (2): 155-182

  Abstract

  Hearing impairment is highly prevalent in older adults and can affect the daily activities of a person who is hard of hearing (HOH). The impact of hearing impairment may also have collateral effects on the primary communication partner (CP; e.g., spouse, close family member, or caregiver) of the person who is HOH.We aimed to characterize the impact of hearing loss in a person who is HOH on his or her CP.We conducted a systematic review of manuscripts examining the consequences of hearing loss in a person who is HOH on the CP. We searched PubMed, Embase, Scopus, PyscINFO, CINAHL Plus with full text, and Web of Science for peer-reviewed articles using a predefined search string and hand-searched reference lists of relevant articles.We initially screened abstracts blinded for author and journal to eliminate irrelevant and duplicate articles. Descriptive information on study populations, hearing assessments, outcome metrics, and study findings were extracted from full-length manuscripts.Of the 1,047 abstracts retrieved from database searching and 5 hand-searched articles, 24 articles met inclusion criteria. These articles included observational clinical studies, randomized clinical trials, and epidemiologic studies. Overall, CPs experienced a restricted social life, increased burden of communication, and poorer quality of life (QOL) and relationship satisfaction. Effects of hearing impairment on a CP's mental health were unclear. Treatment of hearing loss in the person who is HOH tended to improve QOL, communication, feelings toward the person who is HOH, and activity participation of the CP.This review highlights the broad effects of hearing impairment and the importance of involving CPs in hearing loss treatment decisions.

  View details for DOI 10.3766/jaaa.26.2.6

  View details for Web of Science ID 000349269100006

  View details for PubMedID 25690776

• At the interface of sensory and motor dysfunctions and Alzheimer's disease ALZHEIMERS & DEMENTIA Albers, M. W., Gilmore, G. C., Kaye, J., Murphy, C., Wingfield, A., Bennett, D. A., Boxer, A. L., Buchman, A. S., Cruickshanks, K. J., Devanand, D. P., Duffy, C. J., Gall, C. M., Gates, G. A., Granholm, A., Hensch, T., Holtzer, R., Hyman, B. T., Lin, F. R., Mc Kee, A. C., Morris, J. C., Petersen, R. C., Silbert, L. C., Stuble, R. G., Trojanowski, J. Q., Verghese, J., Wilson, D. A., Xu, S., Zhang, L. I. 2015; 11 (1): 70-98

  Abstract

  Recent evidence indicates that sensory and motor changes may precede the cognitive symptoms of Alzheimer's disease (AD) by several years and may signify increased risk of developing AD. Traditionally, sensory and motor dysfunctions in aging and AD have been studied separately. To ascertain the evidence supporting the relationship between age-related changes in sensory and motor systems and the development of AD and to facilitate communication between several disciplines, the National Institute on Aging held an exploratory workshop titled "Sensory and Motor Dysfunctions in Aging and AD." The scientific sessions of the workshop focused on age-related and neuropathologic changes in the olfactory, visual, auditory, and motor systems, followed by extensive discussion and hypothesis generation related to the possible links among sensory, cognitive, and motor domains in aging and AD. Based on the data presented and discussed at this workshop, it is clear that sensory and motor regions of the central nervous system are affected by AD pathology and that interventions targeting amelioration of sensory-motor deficits in AD may enhance patient function as AD progresses.

  View details for DOI 10.1016/j.jalz.2014.04.514

  View details for PubMedID 25022540

• Age-Related Hearing Loss GERIATRIC OTOLARYNGOLOGY Parham, K., Lin, F. R., Blakley, B. W., Sataloff, R., Johns, M., Kost, K. 2015: 40-62

  View details for Web of Science ID 000542912000009

• Association of Hearing Impairment and Mortality in Older Adults JOURNALS OF GERONTOLOGY SERIES A-BIOLOGICAL SCIENCES AND MEDICAL SCIENCES Genther, D. J., Betz, J., Pratt, S., Kritchevsky, S. B., Martin, K. R., Harris, T. B., Helzner, E., Satterfield, S., Xue, Q., Yaffe, K., Simonsick, E. M., Lin, F. R., Hlth ABC Study 2015; 70 (1): 85-90

  Abstract

  Hearing impairment (HI) is highly prevalent in older adults and is associated with social isolation, depression, and risk of dementia. Whether HI is associated with broader downstream outcomes is unclear. We undertook this study to determine whether audiometric HI is associated with mortality in older adults.Prospective observational data from 1,958 adults ≥70 years of age from the Health, Aging, and Body Composition Study were analyzed using Cox proportional hazards regression. Participants were followed for 8 years after audiometric examination. Mortality was adjudicated by obtaining death certificates. Hearing was defined as the pure-tone average of hearing thresholds in decibels re: hearing level (dB HL) at frequencies from 0.5 to 4kHz. HI was defined as pure-tone average >25 dB HL in the better ear.Of the 1,146 participants with HI, 492 (42.9%) died compared with 255 (31.4%) of the 812 with normal hearing (odds ratio = 1.64, 95% CI: 1.36-1.98). After adjustment for demographics and cardiovascular risk factors, HI was associated with a 20% increased mortality risk compared with normal hearing (hazard ratio = 1.20, 95% CI: 1.03-1.41). Confirmatory analyses treating HI as a continuous predictor yielded similar results, demonstrating a nonlinear increase in mortality risk with increasing HI (hazard ratio = 1.14, 95% CI: 1.00-1.29 per 10 dB of threshold elevation up to 35 dB HL).HI in older adults is associated with increased mortality, independent of demographics and cardiovascular risk factors. Further research is necessary to understand the basis of this association and whether these pathways might be amenable to hearing rehabilitation.

  View details for DOI 10.1093/gerona/glu094

  View details for Web of Science ID 000350119900011

  View details for PubMedID 25024235

  View details for PubMedCentralID PMC4296166

• At the interface of sensory and motor dysfunctions and Alzheimer's disease ALZHEIMERS & DEMENTIA Albers, M. W., Gilmore, G. C., Kaye, J., Murphy, C., Wingfield, A., Bennett, D. A., Boxer, A. L., Buchman, A. S., Cruickshanks, K. J., Devanand, D. P., Duffy, C. J., Gall, C. M., Gates, G. A., Granholm, A., Hensch, T., Holtzer, R., Hyman, B. T., Lin, F. R., Mc Kee, A. C., Morris, J. C., Petersen, R. C., Silbert, L. C., Stuble, R. G., Trojanowski, J. Q., Verghese, J., Wilson, D. A., Xu, S., Zhang, L. I. 2015; 11 (1): 70-98

  Abstract

  Recent evidence indicates that sensory and motor changes may precede the cognitive symptoms of Alzheimer's disease (AD) by several years and may signify increased risk of developing AD. Traditionally, sensory and motor dysfunctions in aging and AD have been studied separately. To ascertain the evidence supporting the relationship between age-related changes in sensory and motor systems and the development of AD and to facilitate communication between several disciplines, the National Institute on Aging held an exploratory workshop titled "Sensory and Motor Dysfunctions in Aging and AD." The scientific sessions of the workshop focused on age-related and neuropathologic changes in the olfactory, visual, auditory, and motor systems, followed by extensive discussion and hypothesis generation related to the possible links among sensory, cognitive, and motor domains in aging and AD. Based on the data presented and discussed at this workshop, it is clear that sensory and motor regions of the central nervous system are affected by AD pathology and that interventions targeting amelioration of sensory-motor deficits in AD may enhance patient function as AD progresses.

  View details for DOI 10.1016/j.jalz.2014.04.514

  View details for Web of Science ID 000348632800008

  View details for PubMedID 25022540

  View details for PubMedCentralID PMC4287457

• Factors Associated With the Accuracy of Subjective Assessments of Hearing Impairment EAR AND HEARING Kamil, R. J., Genther, D. J., Lin, F. R. 2015; 36 (1): 164-167

  Abstract

  Self-reported hearing impairment is often used to gauge objective hearing loss in both clinical settings and research studies. The aim of this study was to examine whether demographic factors affect the accuracy of subjective, self-reported hearing in older adults.We examined 3557 participants aged 50 and older in the National Health and Nutrition Examination Survey cycles 1999-2006 and 2009-2010. We examined the relationship between objective and subjective hearing impairment using percent correct classification and misclassification bias in analyses stratified by gender, age group, race/ethnicity, and education.We found that younger participants tended to overestimate and older participants underestimate their hearing impairment. Older women, blacks, and Hispanics were less accurate in self-reporting than their respective younger age groups.The association between subjective and objective hearing differs across gender, age, race/ethnicity, and education, and this observation should be considered by clinicians and researchers employing self-reported hearing.

  View details for Web of Science ID 000346911200017

  View details for PubMedID 25158982

  View details for PubMedCentralID PMC4272625

• Hearing loss and cognitive decline in older adults: questions and answers AGING CLINICAL AND EXPERIMENTAL RESEARCH Bernabei, R., Bonuccelli, U., Maggi, S., Marengoni, A., Martini, A., Memo, M., Pecorelli, S., Peracino, A. P., Quaranta, N., Stella, R., Lin, F. R., Workshop Hearing Loss & Cognitive 2014; 26 (6): 567-573

  Abstract

  The association between hearing impairment, the diagnosis of dementia, and the role of sensory therapy has been proposed for some time, but further research is needed. Current understanding of this association requires the commitment of those experts who can integrate experience and research from several fields to be able to understand the link from hearing to dementia. A workshop whose panelists included experts from many areas, ranging from ear, nose and throat (ENT) to dementia's specialists, was promoted and organized by the Giovanni Lorenzini Medical Science Foundation (Milan, Italy; Houston, TX, USA) to increase the awareness of the relationship between hearing loss and dementia, and included questions and comments following a presentation from the clinical researcher, Frank Lin, who has been evaluating the relationship between hearing loss and cognitive decline since 2009.

  View details for DOI 10.1007/s40520-014-0266-3

  View details for Web of Science ID 000346809400001

  View details for PubMedID 25281432

• Hearing and Vision Care for Older Adults Sensing a Need to Update Medicare Policy JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION Whitson, H. E., Lin, F. R. 2014; 312 (17): 1739-1740

  View details for DOI 10.1001/jama.2014.13535

  View details for Web of Science ID 000344194500009

  View details for PubMedID 25369486

  View details for PubMedCentralID PMC4260264

• HEARING LOSS IS ASSOCIATED WITH POORER RATINGS OF PATIENT-PHYSICIAN COMMUNICATION AND HEALTHCARE QUALITY JOURNAL OF THE AMERICAN GERIATRICS SOCIETY Mick, P., Foley, D. M., Lin, F. R. 2014; 62 (11): 2207-2209

  View details for DOI 10.1111/jgs.13113

  View details for Web of Science ID 000345500700028

  View details for PubMedID 25413192

  View details for PubMedCentralID PMC5393268

• Racial difference in cochlear pigmentation is associated with hearing loss risk. Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology Sun, D. Q., Zhou, X., Lin, F. R., Francis, H. W., Carey, J. P., Chien, W. W. 2014; 35 (9): 1509-14

  Abstract

  The goals of this study are to characterize the distribution of melanin pigmentation in the human cochlea and to investigate differences in pigment content between races.Human temporal bone specimens from the Johns Hopkins Temporal Bone Collection were examined. Demographic, clinical, and audiometric data were analyzed. Melanin pigmentation in the cochlea was quantified in each specimen.Nineteen African-American (AA) and 27 Caucasian specimens were selected for the study. The mean ages were 64 and 70 years for AA and Caucasian specimens, respectively (p = 0.21). At all cochlear turns, AA specimens contained significantly more pigmentation in the stria vascularis (p = 0.0003) and Rosenthal's canal (p < 0.0001) compared with Caucasian specimens. Strial melanin content increased significantly with age. Cochlear pigmentation content was not associated with sex or hearing thresholds.Melanin pigmentation is significantly more abundant in AA cochleae than in Caucasian cochleae. This study provides a detailed description of pigmentation in the cochlea and may help to explain the observed racial differences in hearing thresholds.

  View details for DOI 10.1097/MAO.0000000000000564

  View details for PubMedID 25166018

• Feasibility study to quantify the auditory and social environment of older adults using a digital language processor. Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology Li, L., Vikani, A. R., Harris, G. C., Lin, F. R. 2014; 35 (8): 1301-5

  Abstract

  To investigate the feasibility of using a digital language processor (DLP) to objectively quantify the auditory and social environment of older adults.Thirty-seven participants aged 64 to 91 years residing in a retirement community were asked to wear a DLP to record their auditory and language environment during 1 waking day. Recordings were analyzed with specialized software to derive quantitative estimates such as the number of spoken words heard and percentage of time spent around meaningful speech versus television/radio.Adequate DLP recordings that began before 10 AM and lasted for 10 hours or greater were collected from 24 participants. The mean duration of recording was 13 hours and 13 minutes, and individuals spent a mean of 26.7% (range, 4%-58%) of their waking day near a television or other electronic sounds. The projected mean word count over a maximum of 16 hours was 33,141 with nearly a 14-fold range between the lowest and highest observed values (range, 5120-77,882).High-quality objective data on the auditory environment of older adults can be feasibly measured with the DLP. Findings from this study may guide future studies investigating auditory and language outcomes in older adults.

  View details for DOI 10.1097/MAO.0000000000000489

  View details for PubMedID 25122146

  View details for PubMedCentralID PMC4133745

• Assessing physical functioning in otolaryngology: feasibility of the Short Physical Performance Battery. American journal of otolaryngology Chen, D. S., Blake, C. R., Genther, D. J., Li, L., Lin, F. R. 2014; 35 (6): 708-12

  Abstract

  Objective measures of physical functioning and mobility are considered to be the strongest indicators of overall health and mortality risk in older adults. These measures are not routinely used in otolaryngology research. We investigated the feasibility of using a validated physical performance battery to assess the functioning of older adults seen in a tertiary care otolaryngology clinic.The Short Physical Performance Battery was performed on 22 individuals aged 50 years or older enrolled in the Studying Multiple Outcomes after Aural Rehabilitative Treatment (SMART) study at Johns Hopkins.We successfully administered the SPPB to 22 participants, and this testing resulted in minimal participant and provider burden with respect to time, training, and space requirements. The mean time to complete 5 chair stands was 13.0 ± 3.8 seconds. The mean times for the side-by-side, semi-tandem, and tandem stands were 10.0 ± 0.0, 9.5 ± 2.1, and 8.8 ± 3.2 seconds, respectively. Mean walking speed was 1.1 ± 0.3 meters per second, and composite SPPB scores ranged from 6 to 12 (mean = 10.45, S.D. = 1.6).Our results demonstrate the feasibility of implementing a standardized physical performance battery to assess physical functioning in a cohort of older adults seen in a tertiary otolaryngology clinic. We provide detailed instructions, references, and analytic methods for implementing the SPPB in future otolaryngology studies involving older adults.

  View details for DOI 10.1016/j.amjoto.2014.07.014

  View details for PubMedID 25179123

  View details for PubMedCentralID PMC4252972

• Association Between Hearing Impairment and Lower Levels of Physical Activity in Older Adults JOURNAL OF THE AMERICAN GERIATRICS SOCIETY Gispen, F. E., Chen, D. S., Genther, D. J., Lin, F. R. 2014; 62 (8): 1427-1433

  Abstract

  To determine whether hearing impairment, highly prevalent in older adults, is associated with activity levels.Cross-sectional.National Health and Nutritional Examination Survey (2005-06).Individuals aged 70 and older who completed audiometric testing and whose physical activity was assessed subjectively using questionnaires and objectively using body-worn accelerometers (N=706).Hearing impairment was defined according to the speech-frequency (0.5-4 kHz) pure-tone average in the better-hearing ear (normal <25.0 dB, mild 25.0-39.9 dB, moderate or greater ≥40 dB). Main outcome measures were self-reported leisure time physical activity and accelerometer-measured physical activity. Both were quantified using minutes of moderate-intensity physical activity and categorized as inactive, insufficiently active, or sufficiently active. Ordinal logistic regression analyses were conducted and adjusted for demographic and cardiovascular risk factors.Individuals with moderate or greater hearing impairment had greater odds than those with normal hearing of being in a lower category of physical activity as measured according to self-report (OR=1.59, 95% CI=1.11-2.28) and accelerometry (OR=1.70, 95% CI=0.99-2.91). Mild hearing impairment was not associated with level of physical activity.Moderate or greater hearing impairment in older adults is associated with lower levels of physical activity independent of demographic and cardiovascular risk factors. Future research is needed to investigate the basis of this association and whether hearing rehabilitative interventions could affect physical activity in older adults.

  View details for DOI 10.1111/jgs.12938

  View details for Web of Science ID 000340482800002

  View details for PubMedID 25041032

  View details for PubMedCentralID PMC4134370

• Association between Hearing Impairment and Frailty in Older Adults JOURNAL OF THE AMERICAN GERIATRICS SOCIETY Kamil, R. J., Li, L., Lin, F. R. 2014; 62 (6): 1186-1188

  View details for DOI 10.1111/jgs.12860

  View details for Web of Science ID 000337624300029

  View details for PubMedID 24925554

  View details for PubMedCentralID PMC4141776

• Long-Term Use of Cochlear Implants in Older Adults: Results From a Large Consecutive Case Series OTOLOGY & NEUROTOLOGY Choi, J. S., Contrera, K. J., Betz, J. F., Blake, C. R., Niparko, J. K., Lin, F. R. 2014; 35 (5): 815-820

  Abstract

  To investigate rates of long-term use of cochlear implants in a large, consecutive case series of older adults (≥60 yr).Consecutive case series.Tertiary referral center.Approximately 447 individuals 60 years or older who received their first CI from 1999 to 2011. We successfully contacted 397 individuals (89%) to ascertain data on the individual's daily CI use averaged over the past 4 weeks.Cochlear implantation.Regular CI use was defined as 8 hours or greater of use per day. We investigated the time from implantation to the date when an individual reported discontinuing regular CI use.The overall rate of regular CI use at 13.5 years of follow-up was 82.6% (95% CI, 72.5%-89.3%). Individuals who received a CI at 60 to 74 years had significantly higher rates of regular CI use at 13.5 years of follow-up (91.1% [95% CI, 83.2%-95.4%], n = 251) than individuals who received a CI at 75 years or older (55.7% [95% CI, 24.9%-78.1%], n = 146). The rate of discontinuing regular CI use (<8 hr/d) increased on average by 7.8% (95% CI, 3.0%-12.8%) per year of age at implantation.Rates of long-term CI use in older adults at more than 10 years of follow-up exceed 80%. The rate of discontinuing regular CI use was strongly associated with older age at implantation. These results suggest that early implantation of older adults, once critically low levels of speech recognition are present, is associated with greater usage of the device.

  View details for DOI 10.1097/MAO.0000000000000327

  View details for Web of Science ID 000336218700017

  View details for PubMedID 24608374

  View details for PubMedCentralID PMC4090065

• Association Between Hearing Loss and Healthcare Expenditures in Older Adults JOURNAL OF THE AMERICAN GERIATRICS SOCIETY Foley, D. M., Frick, K. D., Lin, F. R. 2014; 62 (6): 1188-1189

  View details for DOI 10.1111/jgs.12864

  View details for Web of Science ID 000337624300030

  View details for PubMedID 24925555

  View details for PubMedCentralID PMC4058650

• Association Between Hearing Impairment and Self-Reported Difficulty in Physical Functioning JOURNAL OF THE AMERICAN GERIATRICS SOCIETY Chen, D. S., Genther, D. J., Betz, J., Lin, F. R. 2014; 62 (5): 850-856

  Abstract

  To determine whether hearing impairment, defined by using objective audiometry, is associated with multiple categories of self-reported physical functioning in a cross-sectional, nationally representative sample of older adults.Multivariate secondary analysis of cross-sectional data.The 2005-06 and 2009-10 cycles of the National Health and Nutrition Examination Survey.Adults aged 70 and older who completed audiometric testing (N = 1,669).Hearing was measured using pure-tone audiometry. Physical functioning was assessed using a structured interview.In a model adjusted for age and demographic and cardiovascular risk factors, greater hearing impairment (per 25 dB hearing level (HL)) was associated with greater odds of physical disability in activities of daily living (odds ratio (OR) = 1.4, 95% confidence interval (CI) = 1.1-1.9), instrumental activities of daily living (OR = 1.6, 95% CI = 1.2-2.2), leisure and social activities (OR = 1.5, 95% CI = 1.1-2.0), lower extremity mobility (OR = 1.4, 95% CI = 1.1-1.7), general physical activities (OR = 1.3, 95% CI = 1.1-1.6), work limitation (OR = 1.4, 95% CI = 1.0-1.9), walking limitation (OR = 1.6, 95% CI = 1.3-2.0), and limitation due to memory or confusion (OR = 1.4, 95% CI = 1.1-1.8). Hearing impairment was not associated with limitations in amount or type of work done (OR = 1.2, 95% CI = 1.0-1.6).Hearing impairment in older adults is independently associated with greater disability and limitations in multiple self-reported categories of physical functioning.

  View details for DOI 10.1111/jgs.12800

  View details for Web of Science ID 000336385300008

  View details for PubMedID 24779559

  View details for PubMedCentralID PMC4084895

• Rates of Long-Term Cochlear Implant Use in Children OTOLOGY & NEUROTOLOGY Contrera, K., Choi, J., Blake, C., Betz, J., Niparko, J., Lin, F. R. 2014; 35 (3): 426-430

  Abstract

  To determine the rate of long-term cochlear implant (CI) use in children.Consecutive case series.Tertiary referral center.Approximately 474 patients younger than 18 years who received a first CI from 1999 to 2011.Cochlear implantation.Regular CI use, defined as using the CI for 8 hours or greater per day.We successfully contacted and obtained follow-up data on 402 patients (85%) via email, telephone, and postal survey. The rate of regular CI use was 93.2% (95% CI, 90.0-95.4) at 5 years postimplantation and 87.7% (95% CI, 82.9-91.3) at 10 years postimplantation. The mean number of hours of use per day was 12.0 hours (SD, 4.1 h). Cox proportional hazard regression analysis demonstrated a linear association between the age at implantation and the risk of discontinuing regular CI use. Rates of CI discontinuation increased by 18.2% per year of age at implantation (95% CI, 7.2%-30.4%). Reported reasons for CI use less than 8 hours per day include poor hearing benefit (53.2%), social pressure (21.3%), and recurrent displacement of the transmitter coil (17.0%).High rates of regular CI use are sustained after childhood implantation, and younger age at implantation is associated with a higher rate of continued device usage.

  View details for DOI 10.1097/MAO.0000000000000243

  View details for Web of Science ID 000331732300012

  View details for PubMedID 24518403

  View details for PubMedCentralID PMC3927162

• The Association between Hearing Loss and Social Isolation in Older Adults OTOLARYNGOLOGY-HEAD AND NECK SURGERY Mick, P., Kawachi, I., Lin, F. R. 2014; 150 (3): 378-384

  Abstract

  To determine if age-related hearing loss is associated with social isolation and whether factors such as age, gender, income, race, or hearing aid use moderated the association.Cross-sectional.Randomly sampled United States communities.Cross-sectional data on adults 60 to 84 years old from the 1999 to 2006 cycles of the National Health and Nutrition Examination Survey were analyzed. The dependent variable was social isolation, which was defined using the social isolation score (SIS), a 4-point composite index consisting of items pertaining to strength of social network and support. SIS scores ≥2 were considered indicative of social isolation. The independent (predictor) variable was the pure tone average of speech frequency (0.5-4 kHz) hearing thresholds in the better-hearing ear. Covariates included potential medical, demographic, and otologic confounders. We used multivariate logistic regression to evaluate the association between hearing loss and the odds of having social isolation. An exploratory analysis was performed to assess the strength of associations between hearing loss and individual items of the SIS scale.Greater hearing loss was associated with increased odds of social isolation in women aged 60 to 69 years (odds ratio [OR], 3.49 per 25-dB of hearing loss; 95% confidence interval, 1.91, 6.39; P < .001). Effect modification by gender was significant in this age group (P = .003). Hearing loss was not significantly associated with social isolation in other age and gender groups.Greater hearing loss is associated with increased odds of being social isolated in a nationally representative sample of women aged 60 to 69 years.

  View details for DOI 10.1177/0194599813518021

  View details for Web of Science ID 000331705800009

  View details for PubMedID 24384545

• Hearing loss and dementia - who is listening? AGING & MENTAL HEALTH Lin, F. R., Albert, M. 2014; 18 (6): 671-673

  View details for DOI 10.1080/13607863.2014.915924

  View details for Web of Science ID 000338007500001

  View details for PubMedID 24875093

  View details for PubMedCentralID PMC4075051

• Hearing Loss and Depression in Older Adults JOURNAL OF THE AMERICAN GERIATRICS SOCIETY Mener, D. J., Betz, J., Genther, D. J., Chen, D., Lin, F. R. 2013; 61 (9): 1627-1629

  View details for DOI 10.1111/jgs.12429

  View details for Web of Science ID 000324307200029

  View details for PubMedID 24028365

  View details for PubMedCentralID PMC3773611

• Cochlear implantation in older adults: long-term analysis of complications and device survival in a consecutive series. Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology Chen, D. S., Clarrett, D. M., Li, L., Bowditch, S. P., Niparko, J. K., Lin, F. R. 2013; 34 (7): 1272-7

  Abstract

  To analyze the postoperative complications associated with cochlear implant (CI) surgery in a large consecutive case series of older adults (≥ 60 yr).Retrospective case review.Tertiary referral center.Approximately 445 individuals aged 60 years and older who received a first CI between 1999 and 2011.Cochlear implantation.Postoperative complications classified as major (meningitis, immediate postoperative facial weakness, device failure, flap dehiscence, and surgical removal) and minor (surgical site infection, balance problems, delayed postoperative facial weakness, and facial nerve stimulation).The mean age at implantation was 72.7 years (60-94.9 yr), and the median duration of follow-up was 4.8 years (0.1-12.5 yr). There were 42 minor complications in 41 patients (9.2%) and 36 major complications in 21 patients (4.7%). Seventeen patients (3.8%) required surgical device removal, 15 of whom underwent reimplantation. A Kaplan-Meier analysis of rates of device explantation demonstrated that at 5 and 10 years after CI, respectively, 95.4% and 93.1% of patients retained their original CI. When comparing complications between patients aged 60 to 74 years and those aged 75 years and older, there was a higher prevalence of balance problems lasting more than 1 month in the older group (9.5% versus 4.9%, p = 0.05).Our results indicate that the safety profile of cochlear implantation in an older population is comparable to that of younger adults and children. We suggest that concerns for increased postoperative complications in patients of advanced age do not need to be a primary consideration when determining CI candidacy.

  View details for DOI 10.1097/MAO.0b013e3182936bb2

  View details for PubMedID 23921942

  View details for PubMedCentralID PMC3744620

• Current concepts in age-related hearing loss: Epidemiology and mechanistic pathways HEARING RESEARCH Yamasoba, T., Lin, F. R., Someya, S., Kashio, A., Sakamoto, T., Kondo, K. 2013; 303: 30-38

  Abstract

  Age-related hearing loss (AHL), also known as presbycusis, is a universal feature of mammalian aging and is characterized by a decline of auditory function, such as increased hearing thresholds and poor frequency resolution. The primary pathology of AHL includes the hair cells, stria vascularis, and afferent spiral ganglion neurons as well as the central auditory pathways. A growing body of evidence in animal studies has suggested that cumulative effect of oxidative stress could induce damage to macromolecules such as mitochondrial DNA (mtDNA) and that the resulting accumulation of mtDNA mutations/deletions and decline of mitochondrial function play an important role in inducing apoptosis of the cochlear cells, thereby the development of AHL. Epidemiological studies have demonstrated four categories of risk factors of AHL in humans: cochlear aging, environment such as noise exposure, genetic predisposition, and health co-morbidities such as cigarette smoking and atherosclerosis. Genetic investigation has identified several putative associating genes, including those related to antioxidant defense and atherosclerosis. Exposure to noise is known to induce excess generation of reactive oxygen species (ROS) in the cochlea, and cumulative oxidative stress can be enhanced by relatively hypoxic situations resulting from the impaired homeostasis of cochlear blood supply due to atherosclerosis, which could be accelerated by genetic and co-morbidity factors. Antioxidant defense system may also be influenced by genetic backgrounds. These may explain the large variations of the onset and extent of AHL among elderly subjects. This article is part of a Special Issue entitled "Annual Reviews 2013".

  View details for DOI 10.1016/j.heares.2013.01.021

  View details for Web of Science ID 000323094400004

  View details for PubMedID 23422312

  View details for PubMedCentralID PMC3723756

• Association of Hearing Loss With Hospitalization and Burden of Disease in Older Adults JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION Genther, D. J., Frick, K. D., Chen, D., Betz, J., Lin, F. R. 2013; 309 (22): 2322-2324

  View details for DOI 10.1001/jama.2013.5912

  View details for Web of Science ID 000320176000017

  View details for PubMedID 23757078

  View details for PubMedCentralID PMC3875309

• The Impact of Visual Field Loss and Hearing Loss on Social Function Chen, B., Zebardast, N., Lin, F., Ramulu, P., Friedman, D. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2013

  View details for Web of Science ID 000436232902426

• Hearing loss and gait speed among older adults in the United States GAIT & POSTURE Li, L., Simonsick, E. M., Ferrucci, L., Lin, F. R. 2013; 38 (1): 25-29

  Abstract

  Previous studies have suggested that hearing loss, which is highly prevalent but undertreated in older adults, may be associated with gait and physical functioning. Determining if hearing loss is independently associated with gait speed is critical toward understanding whether hearing rehabilitative interventions could help mitigate declines in physical functioning in older adults.We analyzed cross-sectional data from the 1999 to 2002 cycles of the National Health and Nutritional Examination Survey during which participants 50-69 years (n=1180) underwent hearing and gait speed assessments. Hearing was defined by a pure tone average of hearing thresholds at 0.5-4kHz tones in the better-hearing ear. Gait speed was obtained in a timed 20-ft (6.1m) walk. Linear and logistic regression models were used to examine the association between hearing loss and gait speed while adjusting for demographic and cardiovascular risk factors. Analyses incorporated sampling weights to yield results generalizable to the U.S. population.In a model adjusted for demographic and cardiovascular risk factors, a hearing loss was associated with slower gait speed (-0.05m/s per 25dB of hearing loss [95% CI: -0.09 to -0.02]) and an increased odds of having a gait speed <1.0m/s (OR=2.0 per 25dB of hearing loss, 95% CI: 1.2-3.3). The reduction in gait speed associated with a 25dB hearing loss was equivalent to that associated with an age difference of approximately 12 years.Greater hearing loss is independently associated with slower gait speed. Further studies investigating the mechanistic basis of this association and whether hearing rehabilitative interventions could affect gait and physical functioning are needed.

  View details for DOI 10.1016/j.gaitpost.2012.10.006

  View details for Web of Science ID 000319906300005

  View details for PubMedID 23177614

  View details for PubMedCentralID PMC3845825

• Development and Validation of a Falls-Grading Scale JOURNAL OF GERIATRIC PHYSICAL THERAPY Davalos-Bichara, M., Lin, F. R., Carey, J. P., Walston, J. D., Fairman, J. E., Schubert, M. C., Barron, J. S., Hughes, J., Millar, J. L., Spar, A., Weber, K. L., Ying, H. S., Zackowski, K. M., Zee, D. S., Agrawal, Y. 2013; 36 (2): 63-67

  Abstract

  The recording of fall events is usually subjective and imprecise, which limits clinical practice and falls-related research. We sought to develop and validate a scale to grade near-fall and fall events on the basis of their severity represented by the use of health care resources, with the goal of standardizing fall reporting in the clinical and research settings.Qualitative instrument development was based on a literature review and semistructured interviews to assess face and content validity. We queried older individuals and health care professionals with expertise in the care of patients at risk of falling about clinically important differences to detect and how to optimize the scale's ease of use. To assess the scale's interrater reliability, we created 30 video-vignettes of falls and compared how health care professionals and volunteers rated each of the falls according to our grading scale.We developed the illustrated 4-point Hopkins Falls Grading Scale (HFGS). The grades distinguish a near-fall (grade 1) from a fall for which an individual did not receive medical attention (grade 2), a fall associated with medical attention but not hospital admission (grade 3), and a fall associated with hospital admission (grade 4). Overall, the HFGS exhibited good face and content validity and had an intraclass correlation coefficient of 0.998.The 4-point HFGS demonstrates good face and content validity and high interrater reliability. We predict that this tool will facilitate the standardization of falls reporting in both the clinical and research settings.

  View details for DOI 10.1519/JPT.0b013e31825f6777

  View details for Web of Science ID 000316917500002

  View details for PubMedID 22810170

  View details for PubMedCentralID PMC3867809

• Comprehensive Management of Presbycusis: Central and Peripheral OTOLARYNGOLOGY-HEAD AND NECK SURGERY Parham, K., Lin, F. R., Coelho, D. H., Sataloff, R. T., Gates, G. A. 2013; 148 (4): 537-539

  Abstract

  The prevailing otolaryngologic approach to treatment of age-related hearing loss (ARHL), presbycusis, emphasizes compensation of peripheral functional deficits (ie, hearing aids and cochlear implants). This approach does not address adequately the needs of the geriatric population, 1 in 5 of whom is expected to consist of the "old old" in the coming decades. Aging affects both the peripheral and central auditory systems, and disorders of executive function become more prevalent with advancing age. Growing evidence supports an association between age-related hearing loss and cognitive decline. Thus, to facilitate optimal functional capacity in our geriatric patients, a more comprehensive management strategy of ARHL is needed. Diagnostic evaluation should go beyond standard audiometric testing and include measures of central auditory function, including dichotic tasks and speech-in-noise testing. Treatment should include not only appropriate means of peripheral compensation but also auditory rehabilitative training and counseling.

  View details for DOI 10.1177/0194599813477596

  View details for Web of Science ID 000318362800003

  View details for PubMedID 23396589

  View details for PubMedCentralID PMC3860740

• Hearing Loss and Cognitive Decline in Older Adults JAMA INTERNAL MEDICINE Lin, F. R., Yaffe, K., Xia, J., Xue, Q., Harris, T. B., Purchase-Helzner, E., Satterfield, S., Ayonayon, H. N., Ferrucci, L., Simonsick, E. M., Hlth ABC Study Grp 2013; 173 (4): 293-299

  Abstract

  BACKGROUND Whether hearing loss is independently associated with accelerated cognitive decline in older adults is unknown. METHODS We studied 1984 older adults (mean age, 77.4 years) enrolled in the Health ABC Study, a prospective observational study begun in 1997-1998. Our baseline cohort consisted of participants without prevalent cognitive impairment (Modified Mini-Mental State Examination [3MS] score, ≥80) who underwent audiometric testing in year 5. Participants were followed up for 6 years. Hearing was defined at baseline using a pure-tone average of thresholds at 0.5 to 4 kHz in the better-hearing ear. Cognitive testing was performed in years 5, 8, 10, and 11 and consisted of the 3MS (measuring global function) and the Digit Symbol Substitution test (measuring executive function). Incident cognitive impairment was defined as a 3MS score of less than 80 or a decline in 3MS score of more than 5 points from baseline. Mixed-effects regression and Cox proportional hazards regression models were adjusted for demographic and cardiovascular risk factors. RESULTS In total, 1162 individuals with baseline hearing loss (pure-tone average >25 dB) had annual rates of decline in 3MS and Digit Symbol Substitution test scores that were 41% and 32% greater, respectively, than those among individuals with normal hearing. On the 3MS, the annual score changes were -0.65 (95% CI, -0.73 to -0.56) vs -0.46 (95% CI, -0.55 to -0.36) points per year (P = .004). On the Digit Symbol Substitution test, the annual score changes were -0.83 (95% CI, -0.94 to -0.73) vs -0.63 (95% CI, -0.75 to -0.51) points per year (P = .02). Compared to those with normal hearing, individuals with hearing loss at baseline had a 24% (hazard ratio, 1.24; 95% CI, 1.05-1.48) increased risk for incident cognitive impairment. Rates of cognitive decline and the risk for incident cognitive impairment were linearly associated with the severity of an individual's baseline hearing loss. CONCLUSIONS Hearing loss is independently associated with accelerated cognitive decline and incident cognitive impairment in community-dwelling older adults. Further studies are needed to investigate what the mechanistic basis of this association is and whether hearing rehabilitative interventions could affect cognitive decline.

  View details for DOI 10.1001/jamainternmed.2013.1868

  View details for Web of Science ID 000319610400009

  View details for PubMedID 23337978

  View details for PubMedCentralID PMC3869227

• The Prevalence of Concurrent Hearing and Vision Impairment in the United States JAMA INTERNAL MEDICINE Swenor, B. K., Ramulu, P. Y., Willis, J. R., Friedman, D., Lin, F. R. 2013; 173 (4): 312-313

  View details for DOI 10.1001/jamainternmed.2013.1880

  View details for Web of Science ID 000319610400014

  View details for PubMedID 23338042

  View details for PubMedCentralID PMC3875214

• Cochlear Implant Rehabilitation in Older Adults: Literature Review and Proposal of a Conceptual Framework JOURNAL OF THE AMERICAN GERIATRICS SOCIETY Clark, J. H., Yeagle, J., Arbaje, A. I., Lin, F. R., Niparko, J. K., Francis, H. W. 2012; 60 (10): 1936-1945

  Abstract

  To review studies investigating cochlear implant (CI) outcomes in older adults, and to develop a conceptual framework demonstrating important interactions between characteristics of hearing disability, aging, and the CI intervention.Review of English literature with titles containing the words "cochlear implant" and generic term referring to older adults or numerical value for age greater than 65.Hearing loss is a prevalent consequence of aging and poses special challenges for older adults. Particularly when superimposed on other age-related conditions, presbycusis (age-related hearing loss) places older adults at risk for social isolation and associated psychological and general health sequelae. The increasing cognitive demand of verbal communication and the diminished sense of social and physical connectedness can contribute to a feeling of vulnerability and poor health that worsens with advancing presbycusis. This cascade of downstream effects of hearing loss has implications for the self-assessment of health-related quality of life (HRQoL) and resulting estimates of associated costs. There is accumulating evidence of a potential role for CI in older adults with poor word understanding despite conventional hearing aid use. This review of the literature provides strong evidence of the benefits of restoring communication capacity in the deaf and hard-of-hearing geriatric population. There is, however, a lack of attention to communication performance in the real world and HRQoL outcomes, and significant gaps in knowledge regarding how CI rehabilitation interacts with changing psychosocial and functional status with aging.A broader conceptual framework than is currently available for the role of CI rehabilitation in the management of severe-to-profound hearing loss in older adults is proposed. It is posited that the use of such a model in future investigations is needed to guide multidisciplinary investigations into the unique challenges of hearing loss in older adults and may open new opportunities for innovation.

  View details for DOI 10.1111/j.1532-5415.2012.04150.x

  View details for Web of Science ID 000309740400020

  View details for PubMedID 22974240

  View details for PubMedCentralID PMC3902638

• Cochlear Implantation in Older Adults MEDICINE Lin, F. R., Chien, W. W., Li, L., Clarrett, D. M., Niparko, J. K., Francis, H. W. 2012; 91 (5): 229-241

  Abstract

  Cochlear implants allow individuals with severe to profound hearing loss access to sound and spoken language. The number of older adults in the United States who are potential candidates for cochlear implantation (CI) is approximately 150,000 and will continue to increase with the aging of the population. Should CI be routinely recommended for these older adults, and do these individuals benefit from CI? We reviewed our 12-year experience with CI in adults aged ≥60 years (n = 445) at Johns Hopkins Medical Institutions to investigate the impact of CI on speech understanding and to identify factors associated with speech performance. Complete data on speech outcomes at baseline and 1 year post-CI were available for 83 individuals. Our results demonstrate that CI in adults aged ≥60 years consistently improved speech understanding scores, with a mean increase of 60.0% (SD 24.1) on HINT (Hearing in Noise Test) sentences in quiet. The magnitude of the gain in speech scores was negatively associated with age at implantation, such that for every increasing year of age at CI the gain in speech scores was 1.3 percentage points less (95% confidence interval [95% CI], 0.6-1.9) after adjusting for age at hearing loss onset. Conversely, individuals with higher pre-CI speech scores (HINT scores between 40% and 60%) had significantly greater post-CI speech scores by a mean of 10.0 percentage points (95% CI, 0.4-19.6) than those with lower pre-CI speech scores (HINT <40%) after adjusting for age at CI and age at hearing loss onset. These results suggest that older adult CI candidates who are younger at implantation and with higher preoperative speech scores obtain the highest speech understanding scores after CI, with possible implications for current United States Medicare policy. Finally, we provide an extended discussion of the epidemiology and impact of hearing loss in older adults. Future research of CI in older adults should expand beyond simple speech outcomes to take into account the broad cognitive, social, and physical functioning outcomes that are likely detrimentally affected by hearing loss and may be mitigated by CI.

  View details for DOI 10.1097/MD.0b013e31826b145a

  View details for Web of Science ID 000308670000001

  View details for PubMedID 22932787

  View details for PubMedCentralID PMC3518393

• Timing of Cochlear Implantation and Parents' Global Ratings of Children's Health and Development OTOLOGY & NEUROTOLOGY Clark, J. H., Wang, N., Riley, A. W., Carson, C. M., Meserole, R. L., Lin, F. R., Eisenberg, L. S., Tobey, E. A., Quittner, A. L., Francis, H. W., Niparko, J. K., CDaCI Invest Team 2012; 33 (4): 545-552

  Abstract

  To assess children's health-related quality of life (HRQL) and development after cochlear implant (CI) surgery and compare improvements between different age of implantation categories.Prospective, longitudinal study comparing outcomes of deaf children post-CI with hearing controls.Six US CI centers.Deaf children who received CI (n = 188) and hearing children of comparable ages (n = 97).CI before 5 years of age.Parental ratings of global HRQL and development, as assessed over the first 4 years of follow-up using visual analog scales. Development scores assess parental views of children's growth and development, motor skills, ability to express themselves and communicate with others, and learning abilities. Associations of baseline child and family characteristics with post-CI HRQL and development were investigated using multivariable analysis, controlling for factors that influence post-CI language learning.Baseline deficits of CI candidates relative to hearing controls were larger in development than HRQL. Development scores improved significantly by 4 years after CI, particularly in the youngest CI recipients. Developmental deficits of older CI recipients with early, extended hearing aid use were only partially remediated by CI. Overall, no significant health deficits were observed in CI children after 4 years. Cognition and speech recognition were positively associated with both HRQL and development.Parental perspectives on quality of their child's life and development provide practical insight into the optimal timing of interventions for early-onset deafness. Validity of parental global assessments is supported by clinical measures of speech perception and language learning and comparison with a well-validated health status instrument.

  View details for DOI 10.1097/MAO.0b013e3182522906

  View details for Web of Science ID 000304315900012

  View details for PubMedID 22588232

  View details for PubMedCentralID PMC3677526

• Hearing Loss in Older Adults Who's Listening? JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION Lin, F. R. 2012; 307 (11): 1147-1148

  View details for DOI 10.1001/jama.2012.321

  View details for Web of Science ID 000301708000021

  View details for PubMedID 22436953

  View details for PubMedCentralID PMC3518399

• Hearing Loss and Falls Among Older Adults In the United States ARCHIVES OF INTERNAL MEDICINE Lin, F. R., Ferrucci, L. 2012; 172 (4): 369-371

  View details for DOI 10.1001/archinternmed.2011.728

  View details for Web of Science ID 000300739500019

  View details for PubMedID 22371929

  View details for PubMedCentralID PMC3518403

• Prevalence of Hearing Aid Use Among Older Adults in the United States ARCHIVES OF INTERNAL MEDICINE Chien, W., Lin, F. R. 2012; 172 (3): 292-293

  View details for DOI 10.1001/archinternmed.2011.1408

  View details for Web of Science ID 000300223800030

  View details for PubMedID 22332170

  View details for PubMedCentralID PMC3564585

• Association of Skin Color, Race/Ethnicity, and Hearing Loss Among Adults in the USA JARO-JOURNAL OF THE ASSOCIATION FOR RESEARCH IN OTOLARYNGOLOGY Lin, F. R., Maas, P., Chien, W., Carey, J. P., Ferrucci, L., Thorpe, R. 2012; 13 (1): 109-117

  Abstract

  Epidemiologic studies of hearing loss in adults have demonstrated that the odds of hearing loss are substantially lower in black than in white individuals. The basis of this association is unknown. We hypothesized that skin pigmentation as a marker of melanocytic functioning mediates this observed association and that skin pigmentation is associated with hearing loss independent of race/ethnicity. We analyzed cross-sectional data from 1,258 adults (20-59 years) in the 2003-2004 cycle of the National Health and Nutritional Examination Survey who had assessment of Fitzpatrick skin type and pure-tone audiometric testing. Audiometric thresholds in the worse hearing ear were used to calculate speech- (0.5-4 kHz) and high-frequency (3-8 kHz) pure-tone averages (PTA). Regression models were stratified by Fitzpatrick skin type or race/ethnicity to examine the association of each factor with hearing loss independent of the other. Models were adjusted for potential confounders (demographic, medical, and noise exposure covariates). Among all participants, race/ethnicity was associated with hearing thresholds (black participants with the best hearing followed by Hispanics and then white individuals), but these associations were not significant in analyses stratified by skin color. In contrast, in race-stratified analyses, darker-skinned Hispanics had better hearing than lighter-skinned Hispanics by an average of -2.5 dB hearing level (HL; 95% CI, -4.8 to -0.2) and -3.1 dB HL (95% CI, -5.3 to -0.8) for speech and high-frequency PTA, respectively. Associations between skin color and hearing loss were not significant in white and black participants. Our results demonstrate that skin pigmentation is independently associated with hearing loss in Hispanics and suggest that skin pigmentation as a marker of melanocytic functioning may mediate the strong association observed between race/ethnicity and hearing loss.

  View details for DOI 10.1007/s10162-011-0298-8

  View details for Web of Science ID 000299092200009

  View details for PubMedID 22124888

  View details for PubMedCentralID PMC3254716

• Implications of Hearing Loss for Older Adults Lin, F. KARGER. 2012: 4-6

  View details for Web of Science ID 000314769900004

• Hearing Loss Prevalence in the United States ARCHIVES OF INTERNAL MEDICINE Lin, F. R., Niparko, J. K., Ferrucci, L. 2011; 171 (20): 1851-1852

  View details for DOI 10.1001/archinternmed.2011.506

  View details for Web of Science ID 000297056300014

  View details for PubMedID 22083573

  View details for PubMedCentralID PMC3564588

• Hearing Loss and Cognition in the Baltimore Longitudinal Study of Aging NEUROPSYCHOLOGY Lin, F. R., Ferrucci, L., Metter, E., An, Y., Zonderman, A. B., Resnick, S. M. 2011; 25 (6): 763-770

  Abstract

  To determine the relationship between hearing loss and cognitive function as assessed with a standardized neurocognitive battery. We hypothesized a priori that greater hearing loss is associated with lower cognitive test scores on tests of memory and executive function.A cross-sectional cohort of 347 participants ≥ 55 years in the Baltimore Longitudinal Study of Aging without mild cognitive impairment or dementia had audiometric and cognitive testing performed in 1990-1994. Hearing loss was defined by an average of hearing thresholds at 0.5, 1, 2, and 4 kHz in the better-hearing ear. Cognitive testing consisted of a standardized neurocognitive battery incorporating tests of mental status, memory, executive function, processing speed, and verbal function. Regression models were used to examine the association between hearing loss and cognition while adjusting for confounders.Greater hearing loss was significantly associated with lower scores on measures of mental status (Mini-Mental State Exam), memory (Free Recall), and executive function (Stroop Mixed, Trail Making B). These results were robust to analyses accounting for potential confounders, nonlinear effects of age, and exclusion of individuals with severe hearing loss. The reduction in cognitive performance associated with a 25 dB hearing loss was equivalent to the reduction associated with an age difference of 6.8 years.Hearing loss is independently associated with lower scores on tests of memory and executive function. Further research examining the longitudinal association of hearing loss with cognitive functioning is needed to confirm these cross-sectional findings.

  View details for DOI 10.1037/a0024238

  View details for Web of Science ID 000296664800009

  View details for PubMedID 21728425

  View details for PubMedCentralID PMC3193888

• Hearing Loss and Cognition Among Older Adults in the United States JOURNALS OF GERONTOLOGY SERIES A-BIOLOGICAL SCIENCES AND MEDICAL SCIENCES Lin, F. R. 2011; 66 (10): 1131-1136

  Abstract

  To investigate the association between hearing loss and cognitive function in a nationally representative sample of older adults.We analyzed data from the 1999 to 2002 cycles of the National Health and Nutritional Examination Survey during which participants aged 60-69 years (n = 605) underwent both audiometric and cognitive testing. Hearing loss was defined by a pure tone average of hearing thresholds at 0.5, 1, 2, and 4 kHz in the better hearing ear. Cognitive testing consisted of the Digit Symbol Substitution Test (DSST), a nonverbal test that assesses executive function and psychomotor processing. Data on hearing aid use, demographics, and medical history were obtained from interviews. Regression models were used to examine the association between hearing loss and cognition while adjusting for confounders. Analyses incorporated sampling weights to yield results that are generalizable to the U.S. population.Greater hearing loss was significantly associated with lower scores on the DSST after adjustment for demographic factors and medical history (DSST score difference of -1.5 [95% confidence interval: -2.9 to -0.23] per 10 dB of hearing loss). Hearing aid use was positively associated with cognitive functioning (DSST score difference of 7.4 [95% confidence interval: -0.62 to 15.4]). The reduction in cognitive performance associated with a 25 dB hearing loss was equivalent to the reduction associated with an age difference of 7 years.Hearing loss is independently associated with lower scores on the DSST. Further research is needed to determine whether hearing loss is a modifiable risk factor or an early marker of cognitive decline.

  View details for DOI 10.1093/gerona/glr115

  View details for Web of Science ID 000294969400012

  View details for PubMedID 21768501

  View details for PubMedCentralID PMC3172566

• Hearing Loss Prevalence and Risk Factors Among Older Adults in the United States JOURNALS OF GERONTOLOGY SERIES A-BIOLOGICAL SCIENCES AND MEDICAL SCIENCES Lin, F. R., Thorpe, R., Gordon-Salant, S., Ferrucci, L. 2011; 66 (5): 582-590

  Abstract

  Hearing loss has been associated with cognitive and functional decline in older adults and may be amenable to rehabilitative interventions, but national estimates of hearing loss prevalence and hearing aid use in older adults are unavailable.We analyzed data from the 2005-2006 cycle of the National Health and Nutritional Examination Survey, which is the first cycle to ever incorporate hearing assessment in adults aged 70 years and older. Audiometry was performed in 717 older adults, and data on hearing aid use, noise exposure, medical history, and demographics were obtained from interviews. Analyses incorporated sampling weights to account for the complex sampling design and yield results that are generalizable to the U.S. population.The prevalence of hearing loss defined as a speech frequency pure tone average of more than 25 dB in the better ear was 63.1% (95% confidence interval: 57.4-68.8). Age, sex, and race were the factors most strongly associated with hearing loss after multivariate adjustment, with black race being substantially protective against hearing loss (odds ratio 0.32 compared with white participants [95% confidence interval: 0.19-0.53]). Hearing aids were used in 40.0% (95% confidence interval: 35.1-44.8) of adults with moderate hearing loss, but in only 3.4% (95% confidence interval: 0.8-6.0) of those with a mild hearing loss.Hearing loss is prevalent in nearly two thirds of adults aged 70 years and older in the U.S. population. Additional research is needed to determine the epidemiological and physiological basis for the protective effect of black race against hearing loss and to determine the role of hearing aids in those with a mild hearing loss.

  View details for DOI 10.1093/gerona/glr002

  View details for Web of Science ID 000290070300014

  View details for PubMedID 21357188

  View details for PubMedCentralID PMC3074958

• Measuring communicative performance with the FAPCI instrument: Preliminary results from normal hearing and cochlear implanted children INTERNATIONAL JOURNAL OF PEDIATRIC OTORHINOLARYNGOLOGY Clark, J. H., Aggarwal, P., Wang, N., Robinson, R., Niparko, J. K., Lin, F. R. 2011; 75 (4): 549-553

  Abstract

  To develop preliminary "growth curves" of Functioning after Pediatric Cochlear Implantation (FAPCI) scores using a cross-sectional sample of normal hearing children and to compare these curves to trajectories of FAPCI scores in children receiving cochlear implants.Quantile regression was used to develop growth curves from the FAPCI scores of a cross-sectional sample of 82 normal hearing children (age range 7 months-5 years). Trajectories of FAPCI scores from a longitudinal cohort of 75 children with cochlear implants (age range 1-5 years) were compared to these growth curves.FAPCI scores were positively associated with increasing age in normal hearing children with a rapid increase in scores observed at earlier ages followed by a plateau at age 3 years. FAPCI trajectories for cochlear-implanted children varied with age at implantation and did not reach a plateau until age 5-6 years.Normal hearing children demonstrated increasing FAPCI scores with age, and these preliminary growth curves allow for the interpretation of a cochlear-implanted child's FAPCI scores in comparison to normal hearing children. Additional research using a larger, longitudinal cohort of normal hearing children will be needed to develop definitive normative FAPCI trajectories.

  View details for DOI 10.1016/j.ijporl.2011.01.015

  View details for Web of Science ID 000289402100019

  View details for PubMedID 21296432

  View details for PubMedCentralID PMC3062731

• Malignant Otitis Externa Caused by <i>Aspergillus fumigatus</i>: A Case Report OTOLOGY & NEUROTOLOGY Clark, J. H., Lin, F. R., Salaria, S. N., Stewart, C., Francis, H. W. 2011; 32 (3): E22-E23

  View details for DOI 10.1097/MAO.0b013e3181e3dec7

  View details for Web of Science ID 000288239800004

  View details for PubMedID 21765381

• Hearing Loss and Incident Dementia ARCHIVES OF NEUROLOGY Lin, F. R., Metter, E., O'Brien, R. J., Resnick, S. M., Zonderman, A. B., Ferrucci, L. 2011; 68 (2): 214-220

  Abstract

  To determine whether hearing loss is associated with incident all-cause dementia and Alzheimer disease (AD).Prospective study of 639 individuals who underwent audiometric testing and were dementia free in 1990 to 1994. Hearing loss was defined by a pure-tone average of hearing thresholds at 0.5, 1, 2, and 4 kHz in the better-hearing ear (normal, <25 dB [n = 455]; mild loss, 25-40 dB [n = 125]; moderate loss, 41-70 dB [n = 53]; and severe loss, >70 dB [n = 6]). Diagnosis of incident dementia was made by consensus diagnostic conference. Cox proportional hazards models were used to model time to incident dementia according to severity of hearing loss and were adjusted for age, sex, race, education, diabetes mellitus, smoking, and hypertension.Baltimore Longitudinal Study of Aging.Six hundred thirty-nine individuals aged 36 to 90 years.Incident cases of all-cause dementia and AD until May 31, 2008.During a median follow-up of 11.9 years, 58 cases of incident all-cause dementia were diagnosed, of which 37 cases were AD. The risk of incident all-cause dementia increased log linearly with the severity of baseline hearing loss (1.27 per 10-dB loss; 95% confidence interval, 1.06-1.50). Compared with normal hearing, the hazard ratio (95% confidence interval) for incident all-cause dementia was 1.89 (1.00-3.58) for mild hearing loss, 3.00 (1.43-6.30) for moderate hearing loss, and 4.94 (1.09-22.40) for severe hearing loss. The risk of incident AD also increased with baseline hearing loss (1.20 per 10 dB of hearing loss) but with a wider confidence interval (0.94-1.53).Hearing loss is independently associated with incident all-cause dementia. Whether hearing loss is a marker for early-stage dementia or is actually a modifiable risk factor for dementia deserves further study.

  View details for DOI 10.1001/archneurol.2010.362

  View details for Web of Science ID 000287330300009

  View details for PubMedID 21320988

  View details for PubMedCentralID PMC3277836

• Trends in the Management of Vestibular Schwannomas at Johns Hopkins 1997-2007 LARYNGOSCOPE Tan, M., Myrie, O. A., Lin, F. R., Niparko, J. K., Minor, L. B., Tamargo, R. J., Francis, H. W. 2010; 120 (1): 144-149

  Abstract

  To assess trends in the management of unilateral vestibular schwannomas over an 11-year period and to identify disease- and provider-related influences.Retrospective chart review.Subjects presented to the Department of Otolaryngology-Head and Neck Surgery and the Department of Neurosurgery for management of unilateral vestibular schwannoma from 1997 through 2007, with at least two visits within the first year of presentation. The proportion of patients for whom initial management consisted of observation, surgical resection, or radiation therapy was determined, and the relative influence of study year, patient age, hearing status, and tumor size was analyzed.Over the study period there was an increase in the proportion of cases that were observed with follow-up scanning (10.5% to 28.0%) and recommended for radiation (0% to 4.0%), whereas the proportion of operated cases declined (89.5% to 68.0%). There were no changes in mean age or hearing status at diagnosis, but mean tumor size declined significantly. Compared to those undergoing surgery, patients choosing observation and radiation therapy were on average 11.7 and 4.5 years older, respectively. Tumors that were surgically removed were on average 11.6 mm larger than those that were observed. The increasing frequency over time of observation relative to surgery was significant even after controlling for age, hearing status, and tumor size.Among patients managed by our center, there has been a significant shift in management of vestibular schwannomas over the last decade, with increasing tendency towards observation. This trend implies changing provider philosophy and patient expectations.

  View details for DOI 10.1002/lary.20672

  View details for Web of Science ID 000273245900026

  View details for PubMedID 19877188

• Improvement in autophony symptoms after superior canal dehiscence repair. Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology Crane, B. T., Lin, F. R., Minor, L. B., Carey, J. P. 2010; 31 (1): 140-6

  Abstract

  Autophony, or the unusually loud or disturbing sound of a patient's own voice, can be a prominent and disabling symptom of superior canal dehiscence (SCD) syndrome. The current study measures autophony symptoms before and after SCD plugging to quantify the benefits of surgery.Patients undergoing SCD plugging between September 2007 and October 2008 completed a questionnaire before and 3 months after surgery. The questionnaire consisted of 26 statements to assess the disability caused by the sound of the patient's own voice. Patients graded each item on a scale from 0 (never) to 4 (almost always) to how often they noted a symptom or experience. Typical statements included "hearing my voice has interfered with my ability to work" and "hearing my voice has caused me to avoid social situations." An autophony index (AI) was generated to grade patient symptoms.Tertiary referral center.Nineteen adults with SCD.Superior canal dehiscence plugging via a middle fossa approach.Change in AI.Preoperatively, the mean AI was 42 +/- 27 (mean +/- SD; range, 0-86; 1 patient had no autophony symptoms). Postoperative AI decreased 89% to 9 +/- 22, a significant (p < 0.01) decline. Of the 18 patients with preoperative autophony, 13 had complete postoperative resolution. In 3 remaining patients, the AI decreased but did not resolve. One of these had bilateral SCD with contralateral autophony. One patient's mild autophony remained unchanged, and another patient with coexisting patulous eustachian tube AI increased after SCD plugging.In patients with significant autophony symptoms, SCD plugging improved 94% of patients. A simple 5-item AI is provided that will be useful in grading autophony symptoms.

  View details for DOI 10.1097/mao.0b013e3181bc39ab

  View details for PubMedID 20050268

• Is Routine Dissection of Level II-B and V-A Necessary in Patients with Papillary Thyroid Cancer Undergoing Lateral Neck Dissection for FNA-Confirmed Metastases in Other Levels WORLD JOURNAL OF SURGERY Farrag, T., Lin, F., Brownlee, N., Kim, M., Sheth, S., Tufano, R. P. 2009; 33 (8): 1680-1683

  Abstract

  The purpose of the present study was to determine the utility of routine dissection of level II-B and level V-A in patients with papillary thyroid cancer (PTC) undergoing lateral neck dissection for ultrasound-guided fine-needle aspiration (FNA)-confirmed lateral nodal metastasis in at least one neck nodal level.In a retrospective review, we studied the charts of 53 consecutive patients (February 2002-December 2007) with PTC who had undergone therapeutic lateral neck dissection that included at least level II-(A and B) and/or level V-(A and B). The levels were designated as such in situ prior to surgical pathology specimen processing. Reports of the preoperative FNA cytopathologic findings, the extent of lateral neck dissection by levels, and the postoperative final histopathologic examination were reviewed.A total of 53 patients underwent therapeutic lateral neck dissection for FNA-confirmed nodal metastasis of PTC at a minimum of one lateral neck level. All 53 patients had preoperative ultrasonography and FNA confirmation of lateral neck disease: 46 patients had PTC, 5 had the tall cell variant of PTC, and 2 had the follicular variant of PTC on final surgical pathology. Ten patients underwent neck dissection at the time of thyroidectomy, and 43 patients underwent neck dissection for lateral neck recurrence/persistence of PTC following a previous thyroidectomy and radioactive iodine +/- previous neck dissection. A total of 46 patients underwent unilateral neck dissection and 7 patients underwent bilateral neck dissection; thus 60 neck dissection specimens were evaluated. Level II (A and B) was excised in 59/60 neck dissections, with 33 of 59 specimens (33/59 = 60%) positive for metastasis. Level II-B was positive 5 times (5/59; 8.5-95% CI: 2.4, 20.4), and each time level II-B was positive, level II-A was also grossly (and histopathologically--seen at the time of surgery) positive for metastasis. Level III was excised 58 times and was positive in 38 specimens (38/58 = 66%). Level IV was excised 58 times and was positive in 29 specimens (29/58 = 50%). Level V (A and B) was excised 40 times and was positive in 16 specimens (16-40 = 40%). Level V-A did not account for any of the positive level V results (0%).Cervical lateral neck metastases in PTC occur in a predictable pattern, with levels III, II-A, and IV most commonly involved. Patients with PTC who undergo lateral neck dissection for FNA-confirmed nodal metastases might harbor disease in level II-B, especially if level II-A is involved. We recommend elective dissection of level II-B only when level II-A is involved, based on FNA confirmation, or when it is grossly involved on intraoperative evaluation. Routine dissection of level V-B is recommended in this patient population, while elective dissection of level V-A is not necessary.

  View details for DOI 10.1007/s00268-009-0071-x

  View details for Web of Science ID 000268779000021

  View details for PubMedID 19506945

• Correlation of Plasma 25-Hydroxyvitamin D Levels With Severity of Primary Hyperparathyroidism and Likelihood of Parathyroid Adenoma Localization on Sestamibi Scan ARCHIVES OF OTOLARYNGOLOGY-HEAD & NECK SURGERY Kandil, E., Tufaro, A. P., Carson, K. A., Lin, F., Somervell, H., Farrag, T., Dackiw, A., Zeiger, M., Tufano, R. P. 2008; 134 (10): 1071-1075

  Abstract

  To determine the relationship between preoperative plasma 25-hydroxyvitamin D (25[OH]D) levels and severity of primary hyperparathyroidism (PHPT) and to explore whether presurgical 25(OH)D levels could predict the likelihood of positive results on technetium Tc 99m sestamibi scintigraphy.Retrospective analysis.Tertiary university referral center.A total of 421 consecutive patients underwent preoperative sestamibi scintigraphy and parathyroid exploration. Patients with cholecalciferol (vitamin D) deficiency, defined as plasma levels lower than 25 ng/mL, were compared with patients having no vitamin D deficiency. We explored the relationship between 25 (OH)D levels and intact parathyroid hormone (iPTH) levels, alkaline phosphatase (ALKP) levels, adenoma weight, binary sestamibi scan results, and postoperative serum calcium levels (at 1 week and 6 months).We hypothesized that severity of hypovitaminosis D would correlate with severity of PHPT and predict the likelihood of a positive finding on sestamibi scan.Concentrations of iPTH and ALKP and parathyroid adenoma weight were significantly higher in patients with lower 25(OH)D levels (P < .01 for all). Patients with hypovitaminosis D had a greater percentage decrease in serum calcium levels 1 week and 6 months postoperatively (P < .05). Median 25(OH)D levels were lower in patients with positive sestamibi scan results (P < .001).Patients with hypovitaminosis D present with more advanced indices of PHPT. Parathyroid sestamibi scanning is more likely to show positive results for this subset of patients who may then benefit from sestamibi scan-directed surgical intervention.

  View details for DOI 10.1001/archotol.134.10.1071

  View details for Web of Science ID 000259985900008

  View details for PubMedID 18936353

• Assessing the use of speech and language measures in relation to parental perceptions of development after early cochlear implantation OTOLOGY & NEUROTOLOGY Lin, F. R., Wang, N., Fink, N. E., Quittner, A. L., Eisenberg, L. S., Tobey, E. A., Niparko, J. K., CDaCI Investigat Team 2008; 29 (2): 208-213

  Abstract

  Clinicians and investigators use multiple outcome measures after early cochlear implantation (CI) to assess auditory skills, speech, and language effects. Are certain outcome measures better associated with optimal childhood development from the perspective of parents? We studied the association between several commonly used outcome instruments and a measure of parental perceptions of development to gain insight into how our clinical tests reflect parental perceptions of a child's developmental status.Cross-sectional analysis.Six academic centers.One hundred eighty-eight deaf children (<6 yr) 1 year after CI activation enrolled in the longitudinal Childhood Development after CI study.Measures of auditory skills, speech, and language. Parental perceptions of development quantified with a visual analogue scale (visual analogue scale-development).Nonparametric and parametric regression methods were used to model the relationship between outcome measures and visual analogue scale-development scores.All outcome measures were positively associated with parental perceptions of development, but more robust associations were observed with language measures and a parent-report scale of auditory skills than with a selected measure of closed-set speech. For speech and language data, differences were observed in the trajectories of associations among younger (2-3 yr) versus older (4-5 yr) children.Our results demonstrate the importance of measuring multiple outcome measures after early pediatric CI. The degree to which an outcome measure reflects childhood development as perceived by parents may be affected by the child's age. Measures that are based on parental report and broader outcome measures focused on verbal language offer the potential for a fuller understanding of the true effectiveness of early implantation.

  View details for DOI 10.1097/MAO.0b013e31812f6fa6

  View details for Web of Science ID 000252840700020

  View details for PubMedID 18309575

  View details for PubMedCentralID PMC2730755

• Development of a communicative performance scale for pediatric cochlear implantation. Ear and hearing Lin, F. R., Ceh, K., Bervinchak, D., Riley, A., Miech, R., Niparko, J. K. 2007; 28 (5): 703-12

  Abstract

  Verbal communicative competence is the main objective after early cochlear implantation in deaf children. However, there are currently no validated instruments to assess a child's real-world communicative abilities. We adopted a rigorous methodological approach to systematically develop the Functioning after Pediatric Cochlear Implantation instrument (FAPCI), a family-centered communicative performance scale based on a conceptual model of functioning established by the World Health Organization.Qualitative instrument development was based on a systematic review of the literature, focus groups, and semistructured interviews with the parents of 2- to 5-yr-old children with cochlear implants and deafness experts. Further refinement and testing of the psychometric validity of the draft instrument was conducted using factor analysis and a cross-sectional sample of 75 parents of children with cochlear implants. Nonparametric and parametric regressions were then performed to investigate the association of FAPCI scores with duration of cochlear implant use to provide preliminary evidence for the instrument's nomological validity.The final 23-item, parent-proxy FAPCI instrument represents a unidimensional scale of the real-world communicative performance of 2- to 5-yr-old children with cochlear implants. The scale demonstrated excellent reliability (Cronbach's alpha >or=0.86), and there was strong evidence supporting the instrument's nomological validity. FAPCI scores were positively associated with duration of implant use (p < .001), and 4 yr of implant use were required before maximal FAPCI scores were achieved.Verbal communication is a critical developmental domain that allows for optimal future emotional, cognitive, and behavioral growth. The FAPCI instrument is the first validated instrument ever designed to assess real-world communicative performance of a child with a cochlear implant. The systematic approach taken to development may enable FAPCI to be sensitive to other communication-related disorders commonly seen in childhood or to serve as a model for the development of other disorder-specific instruments.

  View details for DOI 10.1097/AUD.0b013e31812f71f4

  View details for PubMedID 17804984

• Comment on "Measuring health-related quality of life after pediatric cochlear implantation: A systematic review" by Lin and Niparko [Int. J. Pediatr. Otorhinolaryngol. 70 (2006) 1695-1706] - Response INTERNATIONAL JOURNAL OF PEDIATRIC OTORHINOLARYNGOLOGY Lin, F. R., Niparko, J. K. 2007; 71 (4): 677

  View details for DOI 10.1016/j.ijporl.2007.01.001

  View details for Web of Science ID 000245418000028

• The role of pre-operative CT-guided FNAB for parapharyngeal space tumors OTOLARYNGOLOGY-HEAD AND NECK SURGERY Farrag, T. Y., Lin, F. R., Koch, W. M., Califano, J. A., Cummings, C. W., Farinola, M. A., Tufano, R. P. 2007; 136 (3): 411-414

  Abstract

  To determine the role of computed tomography (CT)-guided fine needle aspiration biopsy (FNAB) in surgical planning for parapharyngeal space (PPS) tumors.Chart review of 49 consecutive patients with surgically treated PPS tumors from 1995 to 2005.Twenty-nine patients had CT-guided FNAB. A cytopathologic diagnosis that was the same as final pathology was rendered in 14 (48%) patients; suggestive but not conclusive in 6 (21%) patients; discordant in 3 (10%) patients; and 6 (21%) patients had a nondiagnostic result. Fourteen of 15 patients who had a final histopathologic finding of pleomorphic adenoma had a correct or highly suggestive preoperative FNAB diagnosis. The positive predictive value for CT-guided FNAB to identify benign tumors is 90%, (18 of 20) but to identify malignant PPS tumors is 75% (3 of 4).CT-guided FNAB of PPS tumors is helpful to predict the nature of the PPS tumors (especially benign), which allows the surgeon and patient to plan for treatment, accordingly.

  View details for DOI 10.1016/j.otohns.2006.10.006

  View details for Web of Science ID 000244793200014

  View details for PubMedID 17321869

• Neck management in patients undergoing postradiotherapy salvage laryngeal surgery for recurrent/persistent laryngeal cancer LARYNGOSCOPE Farrag, T. Y., Lin, F. R., Cummings, C. W., Koch, W. M., Flint, P. W., Califano, J. A., Broussard, J., Bajaj, G., Tufano, R. P. 2006; 116 (10): 1864-1866

  Abstract

  To determine a plan for the management of cervical lymph nodes in patients undergoing salvage laryngeal surgery (SLS) for recurrent/persistent laryngeal cancer after primary radiotherapy (RT).: Retrospective chart review.Charts of 51 consecutive patients who had salvage total or supracricoid laryngectomy with or without neck dissection for recurrent/persistent laryngeal squamous cell carcinoma after primary RT from 1988 to 2005 in our institution were reviewed. No patients received concomitant or neo-adjuvant chemotherapy. Thirty-four patients underwent SLS along with unilateral or bilateral neck dissection, whereas 17 patients underwent the SLS without neck dissection. Reports of preRT and preSLS staging of the primary tumor and the neck, recorded using the TNM system, were reviewed. Reports of the final histopathologic examination for the excised laryngeal cancer and cervical lymph nodes were reviewed.Thirty-four patients underwent SLS with unilateral or bilateral neck dissection. The preRT staging of the primary tumor for those 34 patients showed that 32 (94%) were staged T-1 (14) and T-2 (18), whereas the preSLS staging of the primary tumor for those 34 patients showed that 29 (85%) were staged T-3 and T-4. The postSLS final histopathologic examination of the excised lymph nodes in those 34 patients demonstrated that 30 (88%) did not have any evidence of nodal metastasis. On comparing patients with and without nodal metastasis (on their postSLS final histopathology), we found that the preSLS neck staging, based on computed tomographic (CT) scanning of the neck, was significantly associated with the negative/positive postSLS status of nodal metastasis (P = .006). Of 29 patients staged preSLS as N-0, 28 (97%) patients did not have nodal metastasis on their postSLS final pathology (negative predictive value = 97%, confidence interval, 82.2-99.9). PreRT neck staging, preRT and preSLS staging of the primary tumor, along with laryngeal subsite involvement (supraglottis, glottis, subglottis) did not significantly correlate with the status of neck metastasis on final postSLS histopathology (P = .68, 0.78, 0.49, and 0.42, respectively). None of the 34 patients had any neck tumor recurrence in the postSLS follow-up period (median, 3 yr). In addition, all 17 patients who underwent SLS without neck dissection were staged N-0 both before RT as well as preSLS, and none developed neck disease in the postSLS follow-up period (median, 2.5 yr).Management of the neck in patients undergoing salvage total or supracricoid laryngectomy for laryngeal cancer recurrence/persistence after primary RT should be based on the preSLS CT staging of the neck. Patients staged N-0 preSLS are not likely to harbor occult nodal metastasis and therefore may not require elective neck dissection.

  View details for DOI 10.1097/01.mlg.0000234917.08822.cd

  View details for Web of Science ID 000240933900028

  View details for PubMedID 17003711

• Measuring health-related quality of life after pediatric cochlear implantation: a systematic review. International journal of pediatric otorhinolaryngology Lin, F. R., Niparko, J. K. 2006; 70 (10): 1695-706

  Abstract

  The measurement of health-related quality of life (HRQL) in children presents conceptual and methodological challenges owing to the multidimensionality of the required information and limitations in patient self-report. HRQL results provide a broad measure of treatment impact from the patient and family perspective and are crucial to guiding clinical and policy decisions. The objective of this study was to evaluate how HRQL in children with cochlear implants has been measured in published studies in order to draw conclusions that could inform future investigations of this area of clinical research.We searched PubMed, EMBASE, CINAHL, PsychoInfo, and Web of Science databases using a defined search string and hand-searched reference lists of relevant articles and personal files. Retrieved citations were reviewed in two stages, a title and abstract screen followed by review of the full-length article. Inclusion criteria for studies were: (1) original peer-reviewed research article; (2) enrolled subjects <18 years old with cochlear implants; (3) use of a HRQL instrument that incorporated components of physical, mental, and social health; and (4) in English. Data from full-length articles were extracted by a single-investigator.We retrieved 671 citations with our search strategy, and 10 citations were found to be eligible for inclusion. All studies used a cross-sectional design, and three types of HRQL instruments were used: generic questionnaires, ad hoc instruments designed specifically for the purposes of the study, and the parents views and experiences with pediatric CI questionnaire. Heterogeneity in study design and instruments prevented a quantitative, meta-analysis of the data.Studies that used well-validated, generic HRQL instruments supported conclusions that were less subject to potential bias from the perspective of the clinician investigator. Most studies did not use well-defined cohorts with respect to age at implantation and duration of implant use, and conclusions in these studies were also subject to potential bias. No well-validated, deafness-specific HRQL instruments are currently available. Future research should be done with existing, generic HRQL instruments and with strict study inclusion criteria. Suggested generic HRQL instruments are discussed.

  View details for DOI 10.1016/j.ijporl.2006.05.009

  View details for PubMedID 16806501

• Importance of routine evaluation of the thyroid gland prior to open partial laryngectomy ARCHIVES OF OTOLARYNGOLOGY-HEAD & NECK SURGERY Farrag, T. Y., Lin, F. R., Cummings, C. W., Sciubba, J. J., Koch, W. M., Flint, P. W., Tufano, R. P. 2006; 132 (10): 1047-1051

  Abstract

  To determine the incidence and presentation of synchronous thyroid lesions in a patient population undergoing open partial laryngectomy (OPL), and to determine whether routine preoperative evaluation of the thyroid gland prior to OPL is useful to identify synchronous thyroid lesions in order to reduce the need for reoperation in this complex patient population.Retrospective medical chart review.Academic institution.Sixty-seven consecutive patients with laryngeal tumors who had undergone OPL from 1996 to 2005.Charts of 67 consecutive patients with laryngeal tumors who underwent OPL in 1996 to 2005 have been reviewed for synchronous thyroid lesions. For all patients, reports of (1) complete preoperative examination findings, (2) inpatient course, (3) postoperative follow-up, and (4) postoperative final histopathologic findings were reviewed. For patients with synchronous thyroid lesions, reports of (1) thyroid evaluation and imaging and (2) preoperative (fine-needle aspiration), (3) intraoperative (frozen section), and (4) postoperative (final) histopathologic results for the thyroid lesions were reviewed.Incidence of synchronous thyroid lesions and laryngeal cancer in patients undergoing OPL.Eight (11.9%) of 67 (95% confidence interval, 5.3%-22.2%) patients with laryngeal tumors who underwent OPL had evidence of synchronous thyroid lesions. All 8 patients had squamous cell carcinoma of the larynx and underwent either supracricoid or supraglottic laryngectomy. In these 8 patients, synchronous thyroid lesions were incidentally detected. Four patients had papillary thyroid carcinoma, 1 had squamous metaplasia, and 3 had follicular thyroid tissue that was negative for malignancy on final pathologic examination. In 2 patients, the thyroid lesions were detected preoperatively (prior to OPL); in another 2 patients, thyroid masses were detected intraoperatively; and in 4 patients, the thyroid disease was identified postoperatively on histopathologic examination of excised cervical lymph nodes. In 2 patients, thyroidectomy was performed as a second operation after the OPL, and 1 of them had transient vocal fold paralysis for 2 months. Thyroid ultrasonography was performed in 4 patients. In 3 patients, the ultrasonography was performed after the OPL final pathologic findings indicated the presence of metastatic thyroid disease in cervical lymph nodes. Ultrasonography revealed intrathyroidal lesions in all 3 patients.Patients with laryngeal tumors who will be undergoing OPL might have occult synchronous thyroid lesions. Thyroid surgery in patients with previous OPL may have an increased potential for complication owing to postsurgical changes in the central neck region. Routine preoperative evaluation of the thyroid gland, especially with ultrasonography, to screen for occult synchronous thyroid lesions is recommended for all patients with laryngeal tumors who will be undergoing OPL. Eradication of any thyroid cancer detected preoperatively by fine-needle aspiration should be performed at the same time as OPL. Pros and cons of total thyroidectomy for indeterminate thyroid nodules should be discussed with this patient population.

  View details for DOI 10.1001/archotol.132.10.1047

  View details for Web of Science ID 000241287500003

  View details for PubMedID 17043249

• A safe and cost-effective short hospital stay protocol to identify patients at low risk for the development of significant hypocalcemia after total thyroidectomy LARYNGOSCOPE Nahas, Z. S., Farrag, T. Y., Lin, F. R., Belin, R. M., Tufano, R. P. 2006; 116 (6): 906-910

  Abstract

  The objective of this retrospective chart review was to determine if serial postoperative serum calcium levels early after total thyroidectomy can be used to develop an algorithm that identifies patients who are unlikely to develop significant hypocalcemia and can be safely discharged within 24 hours after surgery.Records of 135 consecutive patients who underwent total/completion thyroidectomy and were operated on by the senior author from 2001 to 2005 have been reviewed. For the entire study group, reports of the early postoperative serum calcium levels (6 hours and 12 hours postoperatively), final thyroid pathology, preoperative examination, inpatient course, and postoperative follow up were reviewed. An endocrine medicine consultation was obtained for all patients while in the hospital after surgery. For patients who developed significant hypocalcemia, reports of their management and the need for readmission or permanent medications for hypoparathyroidism were reviewed. According to the change in serum calcium levels between 6 hours and 12 hours postoperatively, patients were divided into two groups: 1) positive slope (increasing) and 2) nonpositive (nonchanging/decreasing).All patients with a positive slope (50/50) did not develop significant hypocalcemia in contrast to only 59 of 85 patients (69.4%) with a nonpositive slope (P < .001, positive predictive value of positive slope in predicting freedom from significant hypocalcemia = 100%, 95% confidence interval = 92.9-100). In the nonpositive slope group, 61 patients had a serum calcium level > or =8 mg/dL at 12 hours postoperatively (< or =0.5 mg/dL below the low end of normal), and 53 (87%) of these patients remained free of significant hypocalcemia in contrast to only 6 (25%) of 24 patients with serum calcium level <8 mg/dL at 12 hours postoperatively (sensitivity = 90%, positive predictive value = 87%). In addition, of the eight patients who developed significant hypocalcemia in the nonpositive slope group with a serum calcium level > or =8 mg/dL at 12 hours postoperatively, 7 (88%) patients developed the signs and symptoms during the first 24 hours after total thyroidectomy. Readmission and permanent need for calcium supplementation happened in two patients, respectively, all with serum calcium levels <8 mg/dL at 12 hours after total thyroidectomy. The compressive and/or symptomatic large multinodular goiter as an indication for thyroidectomy was associated with developing significant hypocalcemia (P < .05). There was no statistically significant correlation between the development of significant hypocalcemia and gender, age, thyroid pathology other than goiter, or neck dissection.Patients with a positive serum calcium slope (t = 6 and 12 hours) after total thyroidectomy are safe to discharge within 24 hours after surgery with patient education with or without calcium supplementation. In addition, patients with a nonpositive slope and a serum calcium level > or =8 mg/dL at 12 hours postoperatively (< or =0.5 mg/dL below the low end of normal) are unlikely to develop significant hypocalcemia, especially beyond 24 hours postoperatively, and therefore can be safely discharged within 24 hours after total thyroidectomy with patient education and oral calcium supplementation. Our management algorithm identifies those patients at low risk of developing significant hypocalcemia early in the postoperative course after total thyroidectomy to allow for a short hospital stay and safe discharge.

  View details for DOI 10.1097/01.mlg.0000217536.83395.37

  View details for Web of Science ID 000238031200012

  View details for PubMedID 16735895

• The utility of evaluating true vocal fold motion before thyroid surgery Farrag, T. Y., Samlan, R. A., Lin, F. R., Tufano, R. P. WILEY. 2006: 235-238

  Abstract

  The objective of this study was to evaluate the utility of screening laryngoscopic examination in evaluating vocal fold (VF) mobility before thyroid surgery.The authors conducted a retrospective chart review of 340 patients who have undergone thyroid surgery from January 1998 to June 2005 and had preoperative laryngoscopy by mirror, fiberoptic, or videostroboscopic examination. Reports of preoperative voice change or complaint and reports of preoperative VF examination, including the method of examination, were recorded. For patients with VF motion impairment, reports of the intraoperative condition of the recurrent laryngeal nerve (RLN), preoperative diagnosis based on fine needle aspiration, and final postoperative histopathologic examination results were recorded.Twenty-two patients were found to have preoperative VF motion impairment, of which seven (32%) patients were asymptomatic with no detectable subjective or objective voice problems. This differs significantly from the hypothesis that patients with VF motion impairment are always symptomatic (P=.009). Using voice symptoms as a screening test to predict VF motion impairment in 340 patients reveals that the sensitivity was 68%, specificity was 91%, positive predictive value (PPV) was 31%, and negative predictive value (NPV) was 98%. Among the 22 patients with preoperative VF motion impairment, five (72%) of the seven asymptomatic patients had benign, slowly progressive disease on their final histopathology reports. Six of these asymptomatic patients had their preoperative VF evaluation by fiberoptic examination, whereas one patient had indirect mirror laryngoscopy. Of 22 patients with preoperative VF motion impairment, five (22.5%) patients had abnormal VF mobility contralateral to the thyroid lesion on their preoperative evaluation, and only two of them had nerve injury reported after a previous thyroid surgery. This result differs significantly from the hypothesis that impaired mobility is ipsilateral to the side of the lesion (P=.05).Patients without voice complaints can have VF motion impairment. Patients can also have VF motion impairment contralateral to the thyroid lesion. Preoperative VF examination helps counsel patients appropriately about the risks of surgery and helps outline a plan for the extent of surgery while minimizing the medicolegal ramifications of iatrogenic RLN injury.

  View details for DOI 10.1097/01.mlg.0000191472.02720.1f

  View details for Web of Science ID 000235566100014

  View details for PubMedID 16467711

• Angular vestibulo-ocular reflex gains correlate with vertigo control after intratympanic gentamicin treatment for Meniere's disease. The Annals of otology, rhinology, and laryngology Lin, F. R., Migliaccio, A. A., Haslwanter, T., Minor, L. B., Carey, J. P. 2005; 114 (10): 777-85

  Abstract

  The objective of our study was to determine whether angular vestibulo-ocular reflex (aVOR) gains correlated with vertigo control after intratympanic gentamicin treatment for Meniere's disease.We conducted a prospective study of 18 subjects with unilateral Meniere's disease treated with intratympanic gentamicin injection and followed all subjects for 1 year. We measured the gain of the aVOR elicited by rapid rotary head thrusts in each of the canal planes for each subject before and after treatment with intratympanic gentamicin by using magnetic search coils to record eye movements.During the follow-up period, 11 subjects ("single-treatment group"; 61%) had control of their vertigo with a single gentamicin injection. The remaining 7 subjects ("multiple-treatment group"; 39%) experienced recurrent vertigo that required a second injection of gentamicin at a mean of 6 months after the first treatment. The 11 subjects in the single-treatment group had significantly greater reduction of labyrinthine function after the first treatment, as measured by change in ipsilateral horizontal canal gain, than did the 7 subjects with vertigo recurrence. Changes in caloric asymmetry did not correlate with vertigo control.Our results suggest that successful treatment of Meniere's disease is closely related to attenuation of semicircular canal function as measured by horizontal canal aVOR gains.

  View details for DOI 10.1177/000348940511401007

  View details for PubMedID 16285268

  View details for PubMedCentralID PMC4477784