Effect of Hearing Intervention Versus Health Education Control on Fatigue: A Secondary Analysis of the ACHIEVE Study.

BACKGROUND: 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. METHODS: 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. RESULTS: 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 (ß = -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 (ß = -0.32 [95% CI: -1.15, 0.51]). CONCLUSIONS: Our findings suggest that hearing intervention may reduce fatigue over 3 years among older adults with hearing loss.

Accuracy of self- and proxy-rated hearing among older adults with and without cognitive impairment.

BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.

An examination of electrophysiological release from masking in young and older adults.

The effect of age on release from masking (RFM) was examined using cortical auditory evoked potentials (CAEPs). Two speech-in-noise paradigms [i.e., fixed speech with varying signal-to-noise ratios (SNRs) and fixed noise with varying speech levels], similar to those used in behavioral measures of RFM, were employed with competing continuous and interrupted noises. Young and older normal-hearing adults participated (N = 36). Cortical responses were evoked in the fixed speech paradigm at SNRs of -10, 0, and 10 dB. In the fixed noise paradigm, the CAEP SNR threshold was determined in both noises as the lowest SNR that yielded a measurable response. RFM was demonstrated in the fixed speech paradigm with a significant amount of missing responses, longer P1 and N1 latencies, and smaller N1 response amplitudes in continuous noise at the poorest -10 dB SNR. In the fixed noise paradigm, RFM was demonstrated with significantly lower CAEP SNR thresholds in interrupted noise. Older participants demonstrated significantly longer P2 latencies and reduced P1 and N1 amplitudes. There was no evidence of a group difference in RFM in either paradigm.

Effect of presentation level and age on release from masking: Behavioral measures.

The effect of presentation level and age on release from masking (RFM) was examined. Two speech-in-noise paradigms [i.e., fixed speech with varying signal-to-noise ratios (SNRs) and fixed noise with varying speech levels] were employed with competing continuous and interrupted noises. Young and older normal-hearing adults participated (N = 36). Word recognition was assessed at three presentation levels (i.e., 20, 30, and 40 dB sensation level) in SNRs of -10, 0, and 10 dB. Reception thresholds for sentences (RTSs) were determined at three presentation levels (i.e., 55, 65, and 75 dB sound pressure level). RTS SNRs were determined in both noises. RFM was computed by subtracting word recognition scores in continuous noise from interrupted noise and RTS SNRs in interrupted noise from continuous noise. Significant effects of presentation level, group, and SNR were seen with word recognition performance. RFM increased with increasing sensation level, was greater in younger adults, and was superior at -10 dB SNR. With RTS SNRs, significant effects of presentation level and group were found. The findings support the notion that RFM is a level dependent auditory temporal resolution phenomenon and older listeners display a deficit relative to younger listeners.

Evidence of a speech evoked electrophysiological release from masking in noise.

In this study, a release from masking (RFM) was sought with cortical auditory evoked potentials (CAEPs) elicited by speech (/da/) in competing continuous and interrupted noises. Two paradigms (i.e., fixed speech with varying signal-to-noise ratios and fixed noise with varying speech levels) were employed. Shorter latencies and larger amplitudes were observed in interrupted versus continuous noise at equivalent signal-to-noise ratios. With fixed speech presentation, P1-N1-P2 latencies were prolonged and peak N1 and P2 amplitudes decreased and more so with continuous noise. CAEP thresholds were lower in interrupted noise. This is the first demonstration of RFM with CAEPs to speech.

Author Impact Metrics in Communication Sciences and Disorder Research.

Purpose: The purpose was to examine author-level impact metrics for faculty in the communication sciences and disorder research field across a variety of databases. Method: Author-level impact metrics were collected for faculty from 257 accredited universities in the United States and Canada. Three databases (i.e., Google Scholar, ResearchGate, and Scopus) were utilized. Results: Faculty expertise was in audiology (24.4%; n = 490) and speech-language pathology (75.6%; n = 1,520). Women comprised 68.1% of faculty, and men comprised 31.9% of faculty. The percentage of faculty in the field of communication sciences and disorders identified in each database was 10.5% (n = 212), 44.0% (n = 885), and 84.4% (n = 1,696) for Google Scholar, ResearchGate, and Scopus, respectively. In general, author-level impact metrics were positively skewed. Metric values increased significantly with increasing academic rank (p < .05), were greater for men versus women (p < .05), and were greater for those in audiology versus speech-language pathology (p < .05). There were statistically significant positive correlations between all author-level metrics (p < .01). Conclusions: These author-level metrics may serve as a benchmark for scholarly production of those in the field of communication sciences and disorders and may assist with professional identity management, tenure and promotion review, grant applications, and employment.