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HEARING LOSS, MENTAL HEALTH, AND COGNITION: MAKING THE CONNECTION

by Kristine D’Cunha, M.A., and Jill Copley, Au.D.


Good physical health, good mental health, and good hearing all contribute to a good quality of life. As we age, we may see changes in these areas. We would like to discuss some of these in this article.

First, a few definitions.

• Health, as defined by the World Health Organization, is “a state of complete physical, mental, and social well-being and not merely the absence of disease and infirmity.”

• Mental health encompasses “emotional, psychological, and social well-being, influencing cognition, perception, and behavior. It, likewise, determines how an individual handles stress, interpersonal relationships, and decision-making,” per the CDC.

• Chronic illness, according to the CDC, is defined broadly as “conditions that last 1 year or more and require ongoing medical attention or limit activities of daily living or both.”

How do these connect? Joseph Gallo, M.D., a physician at Johns Hopkins has said, “There’s ample clinical and epidemiologic evidence that shows the risk for depression is higher among those who suffer from chronic illnesses.” There are many reasons for this, such as changing one’s lifestyle to go to multiple appointments, loss of income because one cannot work, or losing the ability to be around friends because one cannot get out of the house easily.

We often think of chronic disease as something like diabetes, Parkinson’s, or Alzheimer’s. However, we think that hearing loss is also a chronic condition if we look at the CDC’s definition. Let’s first consider depression. There’s plenty of research to show the connection between hearing loss and depression.

• One study found that 11.4% of adults with self-reported hearing impairment had moderate to severe depression, while a greater percentage—19.1%—had mild depressive symptoms.

• Another study found that the likelihood for developing depression increased by 5% with every drop in incremental hearing ability (based on a test of understanding in background noise) for adults under age 70.

• The connection between hearing loss and depression is particularly striking for hearing-impaired older adults: About one in five have symptoms of clinical depression, per a 2019 study.

Hearing loss and depression can affect relationships, causing:

• Frustration

• Resentment due to frequently compensating for a partner's hearing loss (as in serving as a translator and telling them what they did not hear)

• Loneliness, i.e., the hearing partner feels that they are missing out on companionship.

• Curtailing of social activities and withdrawal from social interaction and isolation.

• Decrease in intimate talk, joking with family.

• Decrease in shared activities such as watching TV.

What about anxiety? Anxiety can be defined as intense, excessive, and persistent worry and fear about everyday situations.

• A recent study found that people with hearing loss often experience anxiety as well as depression. This is because when we cannot hear well, we do not know if someone said something to us or not, and this causes stress.

• Think about how the following situations might cause high anxiety. You are not sure of what your doctor said to you. You missed what your employer said to you.

• The fact is that depression and anxiety as they relate to hearing loss are very circular and can feed off one another.

Finally, we’ll mention a few things about dementia and Alzheimer’s, which affect cognition. Frank Lin, M.D., Ph.D., from Johns Hopkins, has done a lot of research looking at hearing loss and the relationship with dementia. Here are some of his findings:

• In a study that tracked 639 adults for nearly 12 years, Dr. Lin and his colleagues found that mild hearing loss doubled dementia risk. Moderate loss tripled the risk, and people with a severe hearing impairment were five times more likely to develop dementia.

• “Brain scans show us that hearing loss may contribute to a faster rate of atrophy in the brain,” Lin says. “Hearing loss also contributes to social isolation. You may not want to be with people as much, and when you are, you may not engage in conversation as much. These factors may contribute to dementia.” (These are also signs of depression.)

• Longitudinal studies of community-dwelling older adults have demonstrated that hearing impairment is independently associated with a 30-40% rate of accelerated cognitive decline.

Additionally, a study published by the Lancet Commission shows that hearing loss is the #1 modifiable risk factor against preventing dementia (as opposed to something like genetics that is not modifiable). (As an aside, obesity is the other major risk factor.)

The Good and Positive News:

Now that we’ve shown how hearing loss, depression, anxiety, and cognition all relate to each other, what can we do to break this cycle? The good news is that all these conditions can be treated.

• First, have a regular healthcare provider that knows your full history. Accept treatment for any major health issues, such as diabetes and obesity.

• Talk to someone if you feel you have depression or anxiety. This could be a family member, a doctor, a psychiatrist, a support group, or a spiritual advisor. Consider medication if the symptoms are severe.

• Have your hearing and cognitive abilities checked, and wear hearing aids if you have hearing loss. (Most of the Total Hearing Care locations provide cognitive screenings and can refer you to a specialist if there is a concern.)

Remember the beginning – all of these are important to your quality of life. Treat yourself well!

Total Hearing Care has been serving the Dallas area since 1987. It is currently owned by Dr. Jill Copley who purchased the practice in 2015 after the previous long-time owner retired. We have five locations and seven audiologists, along with several assistants, to serve our patients. Our mission is to make a positive difference in the lives of people who seek to improve their hearing and communication abilities. We achieve this by listening to and understanding the needs of each patient, including their overall physical and psychological health. Kristine D’Cunha, M.A., previously presented parts of this article at a health presentation at Celebration.

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