Impact of the COVID-19 Pandemic on Older Adults: Rapid Review.

BACKGROUND: The COVID-19 pandemic has drastically changed the lives of countless members of the general population. Older adults are known to experience loneliness, age discrimination, and excessive worry. It is therefore reasonable to anticipate that they would experience greater negative outcomes related to the COVID-19 pandemic given their increased isolation and risk for complications than younger adults. OBJECTIVE: This study aims to synthesize the existing research on the impact of the COVID-19 pandemic, and associated isolation and protective measures, on older adults. The secondary objective is to investigate the impact of the COVID-19 pandemic, and associated isolation and protective measures, on older adults with Alzheimer disease and related dementias. METHODS: A rapid review of the published literature was conducted on October 6, 2020, through a search of 6 online databases to synthesize results from published original studies regarding the impact of the COVID-19 pandemic on older adults. The Human Development Model conceptual framework-Disability Creation Process was used to describe and understand interactions between personal factors, environmental factors, and life habits. Methods and results are reported following the Preferred Reporting Items for Systematic Reviews and Meta-analyses Statement. RESULTS: A total of 135 records were included from the initial search strategy of 13,452 individual studies. Of these, 113 (83.7%) studies were determined to be of level 4 according to the levels of evidence classification by the Centre for Evidence-Based Medicine. The presence of psychological symptoms, exacerbation of ageism, and physical deterioration of aged populations were reported in the included studies. Decreased social life and fewer in-person social interactions reported during the COVID-19 pandemic were occasionally associated with reduced quality of life and increased depression. Difficulties accessing services, sleep disturbances, and a reduction of physical activity were also noted. CONCLUSIONS: Our results highlight the need for adequate isolation and protective measures. Older adults represent a heterogeneous group, which could explain the contradictory results found in the literature. Individual, organizational, and institutional strategies should be established to ensure that older adults are able to maintain social contacts, preserve family ties, and maintain the ability to give or receive help during the current pandemic. Future studies should focus on specific consequences and needs of more at-risk older adults to ensure their inclusion, both in public health recommendations and considerations made by policy makers.

Effects of Age at Cochlear Implantation on Vocabulary and Grammar: A Review of the Evidence.

Purpose The increasing prevalence of pediatric cochlear implantation over the past 25 years has left little doubt that resulting improvements in hearing offer significant benefits to language development for many deaf children. Furthermore, given the documented importance of access to language from birth, there has been strong support for providing congenitally deaf children with implants as early as possible. Earliest implantation, in many ways, has become the "gold standard" in pediatric cochlear implantation, on the assumption that it is the key to language development similar to that of hearing children. Empirical evidence to support this assumption, however, appears more equivocal than generally is believed. This article reviews recent research aimed at assessing the impact of age at implantation on vocabulary and grammatical development among young implant users. Method Articles published between 2003 and 2018 that included age at implantation as a variable of interest and in which it was subjected to statistical analysis were considered. Effect sizes were calculated whenever possible; we conducted a multivariate meta-analysis to compare outcomes in different language domains. Results Taken together, findings from 49 studies suggest that age at implantation is just one of a host of variables that influence vocabulary and grammatical development, its impact varying with several factors including whether age at implantation is treated as a dichotomous or continuous variable. Results from a meta-analysis showed significant differences across language domains. Conclusion The pattern of results obtained indicates the importance of considering various child, family, and environmental characteristics in future research aimed at determining how early "early implantation" needs to be and the extent to which age at implantation, duration of implant use, and other factors influence language and language-related outcomes. Supplemental Material https://doi.org/10.23641/asha.9789041.

Effects of Age at Cochlear Implantation on Learning and Cognition: A Critical Assessment.

Purpose Age at cochlear implantation frequently is assumed to be a key predictor of pediatric implantation benefits, but outcomes related to learning and cognition appear inconsistent. This critical assessment examines relevant literature in an effort to evaluate the impact of age at implantation in those domains for individuals who received their devices as children. Method We examined 44 peer-reviewed articles from 2003 to 2018 considering age at implantation and conducted statistical analyses regarding its impact on several domains, including literacy, academic achievement, memory, and theory of mind. Results Across 167 assessments in various experiments and conditions, only 21% of the analyses related to age at implantation yielded evidence in favor of earlier implantation, providing greater benefits to academic achievement, learning, or cognition compared to implantation later in childhood. Among studies that considered cognitive processing (e.g., executive function, memory, visual-spatial functioning), over twice as many analyses indicated significant benefits of earlier implantation when it was considered as a discrete rather than a continuous variable. Conclusion Findings raise methodological, practical, and theoretical questions concerning how "early" is defined in studies concerning early cochlear implantation, the impact of confounding factors, and the use of nonstandard outcome measures. The present results and convergent findings from other studies are discussed in terms of the larger range of variables that need to be considered in evaluating the benefits of cochlear implantation and question the utility of considering age at implantation as a "gold standard" with regard to evaluating long-term outcomes of the procedure as a medical treatment/intervention for hearing loss. Supplemental Material https://doi.org/10.23641/asha.8323625.

Aural Rehabilitation for Older Adults with Hearing Loss: Impacts on Quality of Life-A Systematic Review of Randomized Controlled Trials.

BACKGROUND: Few systematic reviews have been conducted regarding aural rehabilitation for adults with hearing loss, with none specifically targeting the older adult population. With prevalence rates of hearing loss being highest in older adults, examining the effects of aural rehabilitation on this population is warranted. PURPOSE: To evaluate the effects of aural rehabilitation on quality of life in an older adult population presenting with hearing loss. ELIGIBILITY CRITERIA: Studies with adults presenting with hearing loss, ≥50 yr of age, with or without hearing aids, receiving interventions such as auditory training, speech-reading, communication strategies training, speech tracking, counseling, or a combination of approaches, and measuring outcomes related to quality of life, in an individual or group format, with or without significant others and with no limitations as to year of publication. STUDY SELECTION: Searches in six databases, as well as results from hand-searching, gray literature, and cross-referencing of articles, yielded 386 articles. Of the 145 assessed as full-text articles for eligibility, 8 studies met inclusion criteria. STUDY APPRAISAL: A component-based risk of bias assessment, as recommended by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. RESULTS: No effect sizes were found in group interventions measuring outcomes related to quality of life, such as mental and emotional functions, environmental factors, participation restrictions, and activity limitations. An intervention effect regarding participation was found for a self-administered home training program, but an effect size was unavailable. Small-to-medium effect sizes were found in one of two individual communication training programs, for which outcomes related to quality of life, such as emotional functions, activities, participation, and environmental factors were measured. The results of the component-based risk of bias assessment indicated that the quality of reporting was poor, thus compromising the internal validity of included primary studies. CONCLUSIONS: Our results indicate that the combined body of evidence in support of aural rehabilitation for older adults with hearing loss is not sufficient to draw any firm conclusions. We identify a need for more rigorous research to guide clinical decision-making.

Auditory performance and subjective benefits in adults with congenital or prelinguistic deafness who receive cochlear implants during adulthood.

OBJECTIVES: (1) To describe auditory performance and subjective benefits in adults with congenital or prelingual deafness who received a cochlear implant (CI) during adolescence or adulthood, and (2) to examine the benefits as experienced by these CI users. METHODS: Twenty-one adults aged 23-65 years participated in the study. All had a congenital or prelingual deafness (onset before age 3). They received a CI between the age of 16 and 61 years (mean age: 31). Speech recognition scores before and after implantation were computed and a questionnaire on subjective benefits (French adaptation of the Adult Cochlear Implant Questionnaire, designed by Zwolan and collaborators (1996, Self-report of CI use and satisfaction by prelingually deafened adults. Ear and Hearing, 17(3): 198-210) was administered. Semi-structured interviews were subsequently conducted with a subsample of seven participants. RESULTS: Speech recognition scores after implantation ranged from 0 to 95%. Despite large inter-individual variability, most participants expressed high levels satisfaction and overall usefulness. Correlational analyses showed that speech recognition performance was moderately associated with subjective benefits. Data from the interviews revealed that the underlying sources of satisfaction with the implant are related to the discovery and enjoyment of environmental sounds, easier lip-reading, and improvement of self-confidence during communicative interactions. DISCUSSION/CONCLUSION: CI benefits are mostly subjective in this particular population: descriptive and qualitative approaches allow us to obtain a nuanced portrait of their experience and provide us with important elements that are not easily measurable with tests and scores.

Language achievement in children who received cochlear implants between 1 and 2 years of age: group trends and individual patterns.

This study examined receptive and expressive vocabulary and grammar achievement of French-speaking children (n = 27) who received a cochlear implant (CI) between the age of 1 and 2. Standardized measures of language achievement were administered and the language levels attained by children with CIs were compared with that of the normative sample of same-age hearing peers for each measure. As a group, children exhibited language levels within normal limits in all standardized language measures. Examination of individual patterns revealed four different language profiles ranging from normal language levels in all domains to general language delay. Half the participants displayed language levels on par with similar-age peers at the word level; less than half the children obtained average performance at the sentence level. In three of these profiles, comprehension of sentences was impaired. Moreover, the age at implantation was not associated with language achievement. Findings suggest that receiving a CI between the age of 1 and 2 years does not ensure that language abilities will be within normal limits after up to 6 years of experience with the implant.