Bamini Gopinath

Prevalence of age-related hearing loss in older adults: Blue Mountains Study.

A recent article in the Archives investigated the prevalence of hearing loss among US adults aged 20 to 69 years, based on data from the National Health and Nutrition Examination Survey (NHANES, 1999-2004). A hearing loss prevalence of 16.1% was observed in this study. In addition, associations between demographic characteristics, noise exposure, cardiovascular risk factors, and hearing loss were assessed. Potential associations between the severity of hearing loss and the described risk factors were not explored. We aimed to confirm the associations between severity of hearing loss and the risk factors assessed by Agrawal et al and to compare our prevalence findings with theirs.

Physical Activity and Sedentary Behaviors and Health-Related Quality of Life in Adolescents

OBJECTIVE: Our goal was to assess cross-sectional and longitudinal associations between physical activity and sedentary behaviors (television viewing, computer and video-game usage, and reading) with health-related QoL. METHODS: Of 2353 children surveyed (median age: 12.7 years), 1216 were resurveyed 5 years later, and 475 were newly recruited into the study (N = 1691). Children completed detailed activity questionnaires. Health-related QoL was assessed by using the Pediatric Quality of Life Inventory (PedsQL). RESULTS: Cross-sectionally, after multivariable adjustment, adolescents in the highest versus lowest tertile of time spent in outdoor physical activity and television viewing had a higher (Ptrend = .001) and lower (Ptrend = .0003) total PedsQL score, respectively. Adolescents who remained in the highest tertiles compared with those in the lowest tertiles of total physical activity over the 5 years had significantly higher scores in the following areas: total (Ptrend = .04), physical summary (Ptrend = .0001), and social (Ptrend = .02) domains. Conversely, those in the highest versus lowest tertile of screen-viewing time during follow-up reported significantly lower values in the following areas: total score (6.34-unit difference), physical summary (4.86-unit difference), psychosocial summary (7.09-unit difference), and emotional (8.33-unit difference) and school (9.78-unit difference) domains. CONCLUSIONS: Regular physical activity over the long-term was associated with higher perceived health-related QoL among adolescents. Conversely, lower PedsQL scores were observed among those who spent the most time in screen-viewing activities. Improved understanding of these relationships could help in developing interventions to promote general well-being among adolescents.

Severity of age-related hearing loss is associated with impaired activities of daily living

BACKGROUND age-related hearing loss is a common chronic condition; hence, it is important to understand its influence on the functional status of older adults. We assessed the association between hearing impairment with activity limitations as assessed by the activities of daily living (ADL) scale. METHODS a total of 1,952 Blue Mountains Hearing Study participants aged ≥60 years had their hearing levels measured using pure-tone audiometry. A survey instrument with questions on functional status as determined by the Older Americans Resources and Services ADL scale was administered. RESULTS one hundred and sixty-four (10.4%) participants reported ADL difficulty. A higher proportion of hearing impaired than non-impaired adults reported difficulties in performing three out of the seven basic ADL and six out of the seven instrumental ADL tasks. After multivariable adjustment, increased severity of hearing loss was associated with impaired ADL (P(trend )= 0.001). Subjects with moderate to severe hearing loss compared with those without, had a 2.9-fold increased likelihood of reporting difficulty in ADL, multivariate-adjusted odds ratio (OR): 2.87 [95% confidence interval (CI): 1.59-5.19]. Participants aged <75 years with hearing loss compared with those without, had 2-fold higher odds of impaired ADL. Having worn or wearing a hearing aid was also associated with a 2-fold increased likelihood of impaired ADL. CONCLUSION functional status as measured by a common ADL scale is diminished in older hearing impaired adults. Our findings suggest that severely diminished hearing could make the difference between independence and the need for formal support services or placement.

Associations Between Hearing Impairment and Mortality Risk in Older Persons: The Blue Mountains Hearing Study

PURPOSE To assess whether hearing loss predicts an increased risk of mortality. METHODS The Blue Mountains Hearing Study examined 2956 persons (49+ years) during 1997 to 2000. The Australian National Death Index was used to identify deaths until 2005. Hearing loss was defined as the pure-tone average (0.5-4 kHz) of air-conduction hearing thresholds greater than 25 dB HL. Associations between hearing loss and mortality risk were estimated using Cox regression and structural equation modeling (SEM). RESULTS When we used Cox regression, we discovered that hearing loss was associated with increased risk of cardiovascular (hazard ratio [HR] 1.36, 95% confidence interval [CI] 1.08-1.84) and all-cause (AC) mortality (HR 1.39, 95% CI 1.11-1.79) after adjustment for age and sex but not after multivariable adjustment. SEM pathway analysis, however, revealed a greater AC mortality risk (HR 2.58, 95% CI 1.64-4.05) in persons with hearing loss, which was mediated: cognitive impairment (HR 1.45, 95% CI 1.08-1.94) and walking disability (HR 1.63, 95% CI 1.24-2.15). These variables increased mortality both directly and indirectly through effects on self-rated health. CONCLUSIONS Hearing loss was associated with increased AC mortality via three mediating variables: disability in walking, cognitive impairment, and self-rated health. It is important to recognize that persons with combined disabilities are at increased risk of cardiovascular and AC mortality.

Depressive symptoms in older adults with hearing impairments: the Blue Mountains Study.

1. Scheffer AC, Schuurmans MJ, van Dijk N et al. Fear of falling: Measurement strategy, prevalence, risk factors and consequences among older persons. Age Ageing 2008;37:19–24. 2. Friedman SM, Munoz B, West SK et al. Falls and fear of falling: Which comes first? A longitudinal prediction model suggests strategies for primary and secondary prevention. J Am Geriatr Soc 2002;50:1329–1335. 3. Legters K. Fear of falling. Phys Ther 2002;82:264–272. 4. Podsiadlo D, Richardson S. ‘‘The Timed Up & Go’’: A test of basic functional mobility for frail elderly persons. J Am Geriatr Soc 1991;39:142–149. 5. Brodaty H, Pond D, Kemp NM et al. The GPCOG: A new screening test for dementia designed for general practice. J Am Geriatr Soc 2002;50: 530–534. 6. Lord SR, Ward JA, Williams P et al. Physiological factors associated with falls in older community-dwelling women. J Am Geriatr Soc 1994;42:1110– 1117. 7. Fried LP, Bandeen-Roche K, Kasper JD et al. Association of comorbidity with disability in older women: The Women’s Health and Aging Study. J Clin Epidemiol 1999;52:27–37.

Relationship of Type 2 diabetes to the prevalence, incidence and progression of age-related hearing loss

Aims  Type 2 diabetes and associated microvascular abnormalities are postulated to affect hearing. Our study reports on the relationship between Type 2 diabetes and the prevalence, 5‐year incidence and progression of hearing impairment in a representative, older, Australian population.

Higher regular fat dairy consumption is associated with lower incidence of metabolic syndrome but not type 2 diabetes

BACKGROUND AND AIMS Limited evidence suggests habitual dairy consumption to be protective against metabolic syndrome (MetSyn) and type 2 diabetes among older adults. We assessed the association of baseline consumption of dairy products with the incidence of MetSyn and type 2 diabetes among a cohort of Australian adults aged 49 years and over. METHODS AND RESULTS A validated 145-item semi-quantitative food frequency questionnaire was used to assess food and nutrient intake at baseline. Ten-year incidence of MetSyn and type 2 diabetes were obtained from 1807 and 1824 subjects respectively. Odds ratios (OR) were calculated by discrete time logistic regression modelling. Compared with subjects in the lowest intake quartile of regular fat dairy products, those in the highest quartile had a 59% lower risk of MetSyn (multivariate adjusted OR: 0.41; 95% CI: 0.23-0.71; p(trend) = 0.004), after adjustment for risk factors. Among obese subjects, an association between a high intake of regular fat dairy foods and reduced risk of type 2 diabetes was also found (age and sex adjusted OR 0.37; 95% CI: 0.16-0.88; p(trend) = 0.030), but the association did not persist after adjustment for additional confounders. There was no association between total dairy consumption and risk of MetSyn or type 2 diabetes. CONCLUSIONS We found an inverse association between regular fat dairy consumption and risk of MetSyn among Australian older adults. Further studies are warranted to examine the association between weight status, dairy consumption and risk of type 2 diabetes.

Incidence and Predictors of Hearing Aid Use and Ownership Among Older Adults With Hearing Loss

PURPOSE The reasons are not clear as to why people who need hearing aids and possess them do not use them. We aimed to describe the incidence and predictors of hearing aid ownership and use among older adults. METHODS We included 2,015 Blue Mountains Hearing Study participants aged ≥55 years who were examined between 1997 and 1999 and 2002 and 2004. Hearing levels were measured with pure-tone audiometry. RESULTS The 5-year incidence of hearing aid use and ownership was 8.1% and 8.5%, respectively. Age was associated with incident hearing aid ownership and use, multivariable-adjusted odds ratio (OR) per decade increase in age of 1.79 (95% confidence interval [CI], 1.21-2.64) and of 1.66 (95% CI, 1.15-2.40), respectively. Any level of hearing loss (HL) at baseline predicted a 2.8-fold increased likelihood of using a hearing aid at follow-up. Hearing handicap was associated with 7% increased likelihood of incident aid use. Key reasons provided for not obtaining/using a hearing aid were: not recommended one (8.0%), its high cost (1.7%), and believing that they did not need one (9.0%). CONCLUSIONS Incident hearing aid ownership and usage was relatively low among hearing impaired adults. Age, question-defined hearing handicap, and measured HL were significant predictors of incident hearing aid use/ownership.

Dual Sensory Impairment in Older Age

Objectives: Hearing and visual impairments are commonly viewed separately in research and service provision, but they often occur together as dual sensory impairment or DSI in older populations. This article examines the frequency and effects of DSI in older age and notes limitations in the evidence. Methods: Search of electronic databases of published papers. Results: DSI diminishes communication and well-being and can cause social isolation, depression, reduced independence, mortality, and cognitive impairment. Discussion: Although intuitively DSI may be expected to have additional impacts over single sensory impairment, research findings are inconclusive. Services and supports required by people with DSI are simply a combination of those required by people with single vision and hearing loss, taking account of the unique communication difficulties posed by DSI.

Hearing-impaired adults are at increased risk of experiencing emotional distress and social engagement restrictions five years later

BACKGROUND we aimed to assess both cross-sectional and temporal links between measured hearing impairment and self-perceived hearing handicap, and health outcomes. METHODS in total, 811 Blue Mountains Hearing Study participants (Sydney, Australia) aged ≥55 years were examined twice (1997-99 and 2002-04). Hearing levels were measured with pure-tone audiometry. The shortened version of the hearing handicap inventory (HHIE-S) was administered, scores ≥8 defined hearing handicap. RESULTS baseline hearing impairment was strongly associated with 7 of the 10 HHIE-S questions, 5 years later. Individuals with and without hearing impairment at baseline reported that they felt embarrassed and/or frustrated by their hearing problem, and that it hampered their personal/social life, multivariable-adjusted OR: 11.5 (CI: 3.5-38.1), OR: 6.3 (CI: 2.5-15.7) and OR: 6.0 (CI: 2.1-17.5), respectively, 5 years later. Hearing-impaired, compared with non-hearing-impaired adults had a significantly higher risk of developing moderate or severe hearing handicap, OR: 3.35 (CI: 1.91-5.90) and OR: 6.60 (CI: 1.45-30.00), respectively. Cross-sectionally (at wave 2), hearing handicap increased the odds of depressive symptoms and low self-rated health by 80 and 46%, respectively. CONCLUSION older, hearing-impaired adults were significantly more likely to experience emotional distress and social engagement restrictions (self-perceived hearing handicap) directly due to their hearing impairment.