Association Between Hearing Loss and Impaired Physical Function, Frailty, and Disability in Older Adults

Abstract

IMPORTANCE Several studies have examined the association between hearing loss (HL) and physical function, with inconsistent results. Few used pure-tone thresholds and considered possible confounders in the association.OBJECTIVE To examine the association between hearing loss and impaired lower extremity function, frailty syndrome, and disability in older adults. DESIGN, SETTING, AND PARTICIPANTSThe Seniors-ENRICA-2 is a cohort study that was established in 2015-2017 in Spain. The present study was conducted from December 2015 to June 2017. Data were analyzed from January 2, 2021, to March 10, 2021. This cross-sectional analysis included 1644 community-dwelling individuals aged 65 years or older (range, 66-91 years) of both sexes. Participants had hearing threshold measurements and data on impaired lower extremity function, frailty syndrome, and disability.EXPOSURES Hearing loss defined as pure-tone average greater than 40 dB HL in the better ear for standard frequency (0.5, 1, and 2 kHz), speech frequency (0.5, 1, 2, and 4 kHz), and high frequency (3, 4, and 8 kHz).MAIN OUTCOMES AND MEASURES Impaired lower extremity function was defined with the Short Physical Performance Battery; the frailty syndrome was defined as having at least 3 of the 5 criteria, including weakness, slow walking speed, low physical activity, exhaustion, and weight loss; and disability in instrumental activities of daily living (IADL) was evaluated with the Lawton and Brody scale. RESULTSOf the 1644 participants, 831 were men (50.5%); mean (SD) age was 73.8 (4.3) years. The prevalence of moderate HL was 13.6% at speech frequency. After adjustment for age, sex, lifestyle, comorbidities, impaired cognition, and social isolation, HL in standard frequency was associated with impaired lower extremity function, with an odds ratio (OR) of 2.20 (95% CI, 1.25-3.88); the corresponding estimate for the frailty syndrome was 1.85 (95% CI, 0.98-3.49) and for the IADL disability, was 2.25 (95% CI, 1.29-3.94). When considering speech frequency pure-tone average, HL was also associated with impaired function (OR, 2.59; 95% CI, 1.57-4.28), frailty syndrome (OR, 1.85; 95% CI, 1.06-3.22), and IADL disability (OR, 2.18; 95% CI, 1.32-3.60). CONCLUSIONS AND RELEVANCEIn this cross-sectional analysis of data from the Seniors-ENRICA-2 cohort study, hearing loss was associated with impaired lower extremity function, frailty syndrome, and IADL disability. It may be useful to examine this association with the mechanisms elucidated in further studies.

The Association between Hearing Impairment and Postural Stability in Older Adults: A Systematic Review and Meta-analysis

“…Seventeen of the included studies examined postural stability in older adults with hearing impairment ( Bruce et al, 2019a ; Chen et al, 2015 ; Gorecka et al, 2018 ; Kamil et al, 2016 ; Koh et al., 2015 ; Kowalewski et al, 2018 ; Mikkola et al, 2015 ; Sakurai et al, 2021 , 2022 ; Szeto et al, 2021 ; Thomas et al, 2018 ; Tomioka et al., 2015 ; Viljanen et al, 2009a , 2009b ; Vitkovic et al, 2016 ; Wollesen et al, 2018 ; Yévenes-Briones et al, 2021 ). One study investigated the association between hearing impairment and physical activity ( Gispen et al, 2014 ).…”

“…For a study to be included, it needed to utilise an objective measure of postural stability; however, the measure used varied greatly between studies. The most consistent was the time taken to complete the 5x sit to stand (5xSTS) test ( Bruce et al, 2019a , 2019b ; Chen et al., 2015 ; Deal et al, 2016 ; Kamil et al, 2016 ; Martinez-Amezcua et al, 2021 ; Mikkola et al, 2015 ; Wollesen et al, 2018 ; Yévenes-Briones et al, 2021 ). This was followed by the Short Physical Performance Battery ( Chen et al, 2015 ; Deal et al, 2016 ; Martinez-Amezcua et al., 2021 ; Mikkola et al, 2015 ; Wollesen et al, 2018 ; Yévenes-Briones et al, 2021 ).…”

“…The most consistent was the time taken to complete the 5x sit to stand (5xSTS) test ( Bruce et al, 2019a , 2019b ; Chen et al., 2015 ; Deal et al, 2016 ; Kamil et al, 2016 ; Martinez-Amezcua et al, 2021 ; Mikkola et al, 2015 ; Wollesen et al, 2018 ; Yévenes-Briones et al, 2021 ). This was followed by the Short Physical Performance Battery ( Chen et al, 2015 ; Deal et al, 2016 ; Martinez-Amezcua et al., 2021 ; Mikkola et al, 2015 ; Wollesen et al, 2018 ; Yévenes-Briones et al, 2021 ). Gait speed was also measured in a number of studies, with variations in path length (ranging from 2.4 m to 10 m) and pace instructions (comfortable or fast pace) ( Chen et al, 2015 ; Deal et al, 2016 ; Huang et al, 2019 ; Mikkola et al, 2015 ; Sakurai et al., 2021 , 2022 ; Szeto et al., 2021 ; Tomioka et al, 2015 ; Viljanen et al, 2009a ; Wollesen et al, 2018 ).…”

“…Thirteen of the 25 included studies investigated differences in standing balance across hearing impairment groups. Four of these studies included standing balance as part of the SPPB however did not analyse the standing balance component individually ( Chen et al, 2015 ; Deal et al, 2016 ; Martinez-Amezcua et al, 2021 ; Yévenes-Briones et al, 2021 ). Barozzi et al (2005) included an assessment of standing balance with feet together and eyes closed; however, they only included participants with hearing impairment and no comparator group and included no analysis of standing balance as an isolated measure.…”

“…Since these reviews, several studies have examined the association between hearing impairment postural stability and falls ( Bruce et al, 2019a , 2019b ; Deal et al, 2017 ; Gorecka et al, 2018 ; Huang et al, 2019 ; Kamil et al, 2016 ; Martinez-Amezcua et al, 2021 ; Thomas et al, 2018 ; Vitkovic et al., 2016 ; Yévenes-Briones et al, 2021 ). Findings from these studies continue to report mixed outcomes, therefore a systematic review and meta-analysis that includes the results of these more recent studies is warranted.…”