What's in a name? A systematic review and meta-analysis to assess the effectiveness of non-medical amplification devices in adults with mild and moderate hearing losses.

OBJECTIVE: To assess non-medical amplification devices in adults with mild-to-moderate hearing loss, and the impact of device features on outcomes. DESIGN: A prospectively registered systematic review. STUDY SAMPLE: Ten studies evaluating personal sound amplification products (PSAPs), and four evaluating smartphone amplification applications (or apps). Devices were classified as "premium" or "basic" based on the number of compression channels (≥16 or <16, respectively). RESULTS: Meta-analyses showed that premium PSAPs improved speech intelligibility in noise performance compared to unaided, whereas basic PSAPs and smartphone apps did not. Premium PSAPs performed better than basic hearing aids. Premium hearing aids performed better than premium and basic PSAPs, smartphone apps, and basic hearing aids. Although data could not be pooled, similar findings were also found for quality of life, listening ability, cognition, feasibility, and adverse effects. CONCLUSIONS: Premium PSAPs appear to be an effective non-medical amplification device for adults with mild-to-moderate hearing loss. Given the overlap in features available, it may be that this is a key consideration when drawing comparisons between devices, rather than the device being named a PSAP or hearing aid. Nevertheless, the extent to which PSAPs are effective without audiological input remains to be determined.

How are hearing loss and physical activity related? Analysis from the English longitudinal study of ageing.

Although cross-sectional studies suggest that hearing loss in middle- and older-aged adults is associated with lower physical activity, longitudinal evidence is limited. This study aimed to investigate the potential bi-directional association between hearing loss and physical activity over time. Participants were from the English Longitudinal Study of Ageing (N = 11,292) who were 50-years or older at baseline assessment (1998-2000). Individuals were followed-up biannually for up to 20-years (2018-2019) and were classified as ever reporting hearing loss (n = 4946) or not reporting hearing loss (n = 6346). Data were analysed with Cox-proportional hazard ratios and multilevel logistic regression. The results showed that baseline physical activity was not associated with hearing loss over the follow-up. Time (i.e., wave of assessment) by hearing loss interactions showed that physical activity declined more rapidly over time in those with hearing loss, compared to those without (Odds Ratios = 0.94, 95% Confidence Intervals; 0.92-0.96, p < .001). These findings highlight the importance of addressing physical activity in middle- and older-aged adults with hearing loss. As physical activity is a modifiable behaviour that can reduce the risk of developing chronic health conditions, individuals with hearing loss may need additional, tailored support to be more physically active. Mitigating the decline in physical activity could be essential to support healthy ageing for adults with hearing loss.

Hearing difficulties and memory problems: the mediating role of physical health and psychosocial wellbeing.

OBJECTIVE: To investigate whether the association between hearing difficulties and self-reported memory problems is mediated by physical health and psychosocial wellbeing. DESIGN: A cross-sectional study. Path analyses were used to test potential theoretical models (psychosocial-cascade, common cause) of the association between hearing difficulties and memory problems, adjusting for age. STUDY SAMPLE: A sample of 479 adults (18-87 years) completed self-reported outcome measures. RESULTS: Half the participants reported clinically significant hearing difficulties and 30% self-reported memory problems. In the direct model, reporting hearing difficulties was associated with a greater likelihood of reporting memory problems (ß = 0.17, p = 0.007, 95% Confidence Intervals [CI] = 0.00, 0.01). Hearing difficulties were also associated with poorer physical health, but this did not mediate the association with memory. Psychosocial factors, however, fully mediated the relationship between hearing difficulties and memory problems (ß = 0.03, p = 0.019, 95% CI = 0.00, 0.01). CONCLUSIONS: Adults with hearing difficulties may be more likely to self-report memory problems, irrespective of age. This study supports the psychosocial-cascade model, as the association between self-reported hearing and memory problems was explained entirely by psychosocial factors. Future studies should investigate these associations using behavioural measures, as well as explore whether interventions can reduce the risk of developing memory problems in this population.

The impact of presentation modality on cognitive test performance for adults with hearing loss.

BACKGROUND: There is a growing body of evidence demonstrating hearing loss in middle-aged and older adults is independently associated with an increased risk of developing cognitive-decline and dementia. Verbal memory is one of the most common functions to decline early in Alzheimer's disease, the most common form of dementia Whilst the exact mechanisms underlying this association remain unclear, poorer test performance may reflect an overarching sensory deficit, as, for instance, most verbal memory tests are predominantly delivered auditorily. Therefore, this study aimed to investigate whether different modes of presentation (i.e., visual, or auditory) influence verbal memory screening test performance in those who failed a hearing screener. METHOD: The study was conducted via online video-conferencing due to the COVID-19 pandemic. Participants (N= 63) completed a validated hearing screener, which was a digit-in-noise test delivered via the hearWHO smartphone application. Three cognitive tests were also administered: (1) the Modified Telephone Interview for Cognitive Status (TICS-M), presented auditorily; (2) the Hopkins Verbal Learning Test (HVLT), presented visually; and (3) a verbal fluency task as a control. All tests have been used as dementia screening tests. RESULT: Separate ANCOVAs revealed that, when controlling for age, gender, and education level, adults who failed the hearing screener performed more poorly on the TICS-M compared to individuals who passed (p<.001). No differences between hearing groups were found for the other cognitive tests administered (p≥ .132). CONCLUSION: This study provides support for the notion that the presentation mode of cognitive tests may account for some of the deficits observed in older adults with hearing loss. As such, researchers and clinicians should be mindful of the sensory deficits experienced by individuals when interpreting cognitive test performance, to avoid the overestimation of cognitive deficits and dementia in adults with hearing loss.

A qualitative study assessing the barriers and facilitators to physical activity in adults with hearing loss.

OBJECTIVES: Growing epidemiological evidence has shown hearing loss is associated with physical inactivity. Currently, there is a dearth in evidence investigating why this occurs. This study aimed to investigate the barriers and facilitators to physical activity in middle-aged and older adults with hearing loss. DESIGN: Individual semi-structured qualitative interviews. METHODS: A phenomenological approach was taken. Ten adults (≥40 years) were interviewed via videoconferencing. The interview schedule was underpinned by the capability, opportunity, motivation and behaviour (COM-B) model. Reflexive thematic analysis was used to generate themes, which were subsequently mapped onto the COM-B model and behaviour change wheel. RESULTS: Nine hearing loss specific themes were generated, which included the following barriers to physical activity: mental fatigue, interaction with the environment (acoustically challenging environments, difficulties with hearing aids when physically active) and social interactions (perceived stigma). Environmental modifications (digital capabilities of hearing aids), social support (hearing loss-only groups) and hearing loss self-efficacy were reported to facilitate physical activity. CONCLUSIONS: Middle-aged and older adults with hearing loss experience hearing-specific barriers to physical activity, which has a deleterious impact on their overall health and well-being. Interventions and public health programmes need to be tailored to account for these additional barriers. Further research is necessary to test potential behaviour change techniques.

Test Your Health at Home: Comparing Online Screening Tests of Hearing, Cognition, and Cardiovascular Health.

PURPOSE: The purpose of this study was to investigate the extent to which validated online screening measures of cognitive impairment, psychosocial well-being, and cardiovascular health are associated with a validated hearing screener in a sample of adults based in the United Kingdom. METHOD: Sixty-one adults (43 female; M age = 44.7 years) participated in a cross-sectional study delivered remotely. Participants completed the hearWHO smartphone application, a digits-in-noise hearing screener, and the Modified Telephone Interview for Cognitive Status (TICS-M), a screening tool for cognitive impairment. Psychosocial well-being (social isolation and loneliness) and cardiovascular health were assessed through self-report. RESULTS: Separate independent analyses of variance, with age, gender, and education as covariates, demonstrated participants who failed the hearWHO screener had poorer scores on the TICS-M, engaged in less physical activity, and reported more sedentary behavior and greater social isolation. Multivariate regression analyses revealed that lower TICS-M scores, having obtained less education, identifying as female, and reporting greater sedentary behavior and social isolation were the strongest predictors of lower hearWHO scores. CONCLUSIONS: The results from this study suggest that poorer hearing, as measured by the hearWHO screener, is independently associated with having worse cognitive function, more time spent being sedentary, and greater social isolation. Thus, this study demonstrates the potential of online screening measures to identify additional health conditions that confer risk to chronic disease as hearing loss manifests. This could help to inform the development of tailored treatment and support to improve an individual's readiness to seek help for and manage both their general and hearing health. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.19251956.