Hearing Loss, Hearing Aids, and Functional Status

Importance Hearing loss may contribute to poor functional status via cognitive impairment and social isolation. Hearing aids may play a protective role by attenuating these downstream outcomes. However, population-based evidence is lacking. Objective To examine the association of hearing loss and hearing aids with functional status. Design, Setting, and Participants This cross-sectional (2016-2017) and longitudinal (2016-2022) analysis of data from the Atherosclerosis Risk in Communities cohort study included older, community-dwelling adults with complete data. Data were analyzed from June to December 2023. Exposures The better-hearing ear’s pure tone average (BPTA) at speech frequencies (0.5-4 kHz) was modeled categorically (no BPTA ≤25 dB, mild 26-40 dB, and moderate or greater hearing loss gt;40 dB). Hearing aid use was self-reported. Main Outcomes and Measures Difficulties in activities of daily living (ADLs; eg, dressing and eating), instrumental activities of daily living (IADLS; eg, household chores and meal preparation), and heavier tasks (eg, walking a quarter of a mile) were self-reported at visit 6. The ability to perform usual activities, walk a half mile, walk up and down stairs, and do heavy housework without help were collected in follow-up surveys. Linear and logistic regression models were used that were adjusted for sociodemographic and health covariates. Results Among 3142 participants (mean SD age, 79.3 4.6 years; 1828 women 58.2%), 1013 (32.2%) had no hearing loss, 1220 (38.8%) had mild hearing loss, and 909 (29.0%) had moderate or greater hearing loss. Moderate or greater hearing loss was cross-sectionally associated with difficulty in 1 or more ADLs (odds ratio OR, 1.27; 95% CI, 1.02-1.58), IADLs (OR, 1.34; 95% CI, 1.05-1.71), and heavier tasks (OR, 1.29; 95% CI, 1.04-1.62) compared with no hearing loss. Over time (mean SD follow-up, 1.9 1.8 years), moderate or greater hearing loss was associated with a faster decline in the number of activities participants were able to do (β = −0.07 per year; 95% CI, −0.09 to −0.06) and greater odds of reporting inability to do 1 or more of the 4 activities (OR, 1.14; 95% CI, 1.05-1.24). Hearing aid users and nonusers did not differ. Conclusions and Relevance The results of this study suggest that moderate or greater hearing loss was associated with functional difficulties and may contribute to a faster decline in function longitudinally independent of sociodemographic and health covariates. Hearing aids did not change the association among those with hearing loss.