The dynamic relationship between hearing loss, quality of life, socioeconomic position and depression and the impact of hearing aids: answers from the English Longitudinal Study of Ageing (ELSA)

Abstract

Purpose The adverse impact of hearing loss (HL) extends beyond auditory impairment and may affect the individuals' psychosocial wellbeing. We aimed to examine whether there exists a causal psychosocial pathway between HL and depression in later life, via socioeconomic factors and quality of life, and whether hearing aids usage alleviates depressive symptoms over time. Methods We examined the longitudinal relationship between HL and depressive symptoms (CES-D) applying dynamic cross-lagged mediation path models. We used the full dataset of participants aged 50–89 years (74,908 person-years), from all eight Waves of the English Longitudinal Study of Ageing (ELSA). Their quality of life (CASP-19) and their wealth were examined as the mediator and moderator of this relationship, respectively. Subgroup analyses investigated differences among those with hearing aids within different models of subjectively and objectively identified HL. All models were adjusted for age, sex, retirement status and social engagement. Results Socioeconomic position (SEP) influenced the strength of the relationship between HL and depression, which was stronger in the lowest versus the highest wealth quintiles. The use of hearing aids was beneficial for alleviating depressive symptoms. Those in the lowest wealth quintiles experienced a lower risk for depression after the use of hearing aids compared to those in the highest wealth quintiles. Conclusion HL poses a substantial risk for depressive symptoms in older adults, especially those who experience socioeconomic inequalities. The early detection of HL and provision of hearing aids may not only promote better-hearing health but could also enhance the psychosocial wellbeing of older adults, particularly those in a lower SEP.

A precision medicine tool to understand who responds best to hearing aids in late‐life depression

“…Recent evidence suggests that hearing rehabilitation may not only improve hearing ability and quality of life but can also have beneficial effects on depression. For example, naturalistic studies of neuropsychiatric status have shown depressive symptom improvement after treatment with both hearing aids and cochlear implants 11‐13 . One study comparing hearing treatment to a wait list control group observed increased self‐reported quality‐of‐life and decreased depressive symptoms post hearing aid prescription, 14 but wait list groups are in general weak controls that may result in an overestimation of treatment effects.…”

“…For example, naturalistic studies of neuropsychiatric status have shown depressive symptom improvement after treatment with both hearing aids and cochlear implants. [11][12][13] One study comparing hearing treatment to a wait list control group observed increased self-reported quality-of-life and decreased depressive symptoms post hearing aid prescription, 14 but wait list groups are in general weak controls that may result in an overestimation of treatment effects. A recent randomized controlled trial found improvement in depressive symptoms after 4-week of aural rehabilitation, 15 but did not select participants with clinically significant depressive symptoms, thus limiting the generalizability of such results to a population with MDD.…”

Association of all Cause and Cause-Specific Mortality With Hearing Loss Among US Adults: A Secondary Analysis Study

“…HL can cause many problems, and communication barriers that accompany HL may lead to disability and psychological inferiority, which results in lower self-esteem and even worsen mental health [ 25 , 26 ]. At the same time, a recent study also found a longitudinal relationship between HL and depression [ 27 ].…”

“…A recent study showed that older people with severe HL have a 20% increased risk of death compared to people with normal hearing [ 18 ]. In addition, a number of studies have shown that HL has a significant negative impact on the health status, social isolation and physical functions of the older adults [ 19 – 27 ]. One of the studies presented that HL can also cause communication difficulties, which not only affect work efficiency, but also negatively affect cognition and emotions [ 19 – 24 ].…”

Socioeconomic position and hearing loss: current understanding and recent advances

“…Particularly among older adults, who may no longer be employed, measures of SEP related to wealth or accumulated assets may be more appropriate than income. For example, in a study assessing the relationship between hearing loss, SEP, and depression using data from the English Longitudinal Study of Aging, SEP was measured by educational level and wealth [16]. In this example, wealth was thought to be the most appropriate indicator for the older adult population's SEP as it also captures retired individuals or those in later stages of active employment [16].…”