Center for the Future of the Health Professions April 2022 digest
Posted: April 1, 2022
This month, The Center for the Future of the Health Professions will be posting another monthly op-ed column for 2022. Our columns represent strong, informed, and focused opinions on issues that affect the future of the health professions. As mentioned in the past, the center was developed to provide state, local, and national policymakers and health system stakeholders with accurate, reliable, and comprehensive data and research about the healthcare workforce to effectively plan for a sustainable future and make the best use of available resources.
This month features a discussion around hearing loss and comorbidities: considerations for healthcare education and patient care in the U.S. This month’s feature is authored by Tabitha Parent-Buck, AuD, professor and chair of audiology and speech-language pathology, program director, entry-level doctor of audiology program at A.T. Still University. Dr. Parent Buck has published in the areas of hearing aid technology, otoacoustic emissions, vestibular evaluations, and pharmacology. In addition, she has conducted numerous presentations on the AuD movement, otoacoustic emissions, pharmacology for audiologists, web-based educational tools, frequency compression hearing aids, neuroanatomy, genetics, and embryology. Dr. Parent Buck is a past-president of the Academy of Doctors of Audiology.
Hearing loss and comorbidities: Considerations for healthcare education and patient care
The relationship between hearing and balance disorders and other medical conditions is not new. Audiology education has emphasized the importance of understanding a patient’s overall health, communication needs, fall risk, and factors impacting the quality of life. The term comorbidities is common in audiology literature, and there is a realization that hearing loss is not an isolated sensory disorder. Statistics from the National Institute on Deafness and Other Communication Disorders highlight that 30 million people in the U.S. aged 12 years or older have bilateral hearing loss. In addition, approximately 25% of individuals aged 65-74 and 50% of those over 75 years of age have disabling hearing loss.8 Research studies and meta-analyses from across the globe have linked the following conditions to hearing loss: social isolation, depression, falls, cardiovascular disease, diabetes, cognitive impairment and dementia, anemia, psoriasis, rheumatoid arthritis, kidney disease, and others.1-2, 5-7, 9 In the last decade, increased focus has been placed on the interrelationship of hearing loss and cognitive decline and on balance disorders, falls, and hospitalizations. The COVID-19 pandemic has added yet another layer of attention to the negative impact of hearing on the ease of communication and positive interpersonal interactions. With the use of masks during the pandemic, communicating with any level of existing hearing loss, and even with normal hearing, has been challenging. As we look toward the future, it is critical to consider hearing and balance function for patients of all ages, with various healthcare team members making referrals to audiologists and audiologists making referrals to other healthcare providers for evaluation and management of comorbid conditions.
The education of future doctors of audiology finds a highly appropriate home within A.T. Still University (ATSU), with its vital mission focused on “a commitment to continue its osteopathic heritage and focus on whole-person healthcare.” Whole person healthcare across the professions, including audiology, is more critical than ever. The doctor of audiology programs at ATSU provide students with the breadth of knowledge to work collaboratively with other healthcare team members to assess and manage patients with hearing loss and comorbid conditions. In addition, there are interprofessional opportunities for students across disciplines to learn with and from one another regarding hearing loss and various health conditions. Healthcare education must continue to promote the knowledge and confidence of future graduates to engage in the multidisciplinary care of patients.
It is not feasible to delve into all of the comorbidities in this article, but looking at just a couple will show a great deal of interplay between the conditions. For example, let us begin by considering hearing loss and falls. The Centers for Disease Control and Prevention reports that one out of four older adults falls each year, and one out of five falls leads to serious injury (e.g., hip fractures, traumatic brain injury).3 Individuals who have fallen or are afraid of falling may reduce their activities. This reduction in daily activities can correspond with increased weakness, increased chances of falling, and other social isolation and depression issues. Falls and mobility restrictions are also among the conditions associated with hearing loss. So now we have links between hearing loss and falls, and both hearing loss and falls can increase social isolation and depression.
Now let us add cognitive decline to the picture. A 2011 study by Frank Lin and colleagues spotlight the relationship between hearing loss and dementia. The prospective study of 639 individuals over approximately 12 years concluded that “hearing loss is independently associated with incident all-cause dementia”.6 Research evidence linking hearing loss and cognitive decline has continued to grow. In 2020, an update from the Lancet Commission on Dementia Prevention, Intervention and Care described 12 potentially modifiable risk factors accounting for approximately 40% of worldwide dementia, and hearing loss is at the top of the list for midlife factors. Depression, social isolation, and physical inactivity make the list of later life factors.7 So, once again, the interrelationship of hearing loss with several comorbid conditions is evident. Hearing loss is a modifiable risk factor for dementia and other problems. More work needs to be done to identify hearing loss, counsel patients, and modify the risk factor.
The interactions between comorbid conditions can be a bit convoluted, and there is not always direct evidence of which conditions came first or which ones are modifiable. The evolving big picture is the importance of increased awareness by patients, audiologists, and all healthcare providers, regarding the comorbidities and the benefits of patients receiving hearing and balance assessment and management in conjunction with other care. Understanding the hearing and balance status and providing amplification or other management strategies may mitigate some of the impacts. Management of hearing loss can also improve the communication between patients and other healthcare providers during office visits. It is becoming quite common for patient intake processes in hospitals or medical offices to gather information about patients’ falls or fear of falling. A recent 2022 article in the AMA Journal of Ethics describes why primary care clinicians should routinely examine the mouth.4 It is excellent to see falls and oral disease receiving attention. With substantial evidence about hearing loss and comorbid conditions, it is also time for healthcare providers to ask about ears routinely. This can be done with a simple question or short hearing loss questionnaire and also by recommending an annual hearing evaluation.
References
- Abrams H. (2017) Hearing loss and associated comorbidities: What do we know? Hear
Rev 24 (12):32–35.
- Besser J, Stropahl M, Urry E, Launer S. (2018) Comorbidities of hearing loss and
the implications of multimorbidity for audiological care. Hear Res 369:3–14.
- Centers for Disease Control and Prevention. (2021). Facts about Falls. Retrieved from
https://www.cdc.gov/falls/facts.html
- Feierabend-Peters, J., & Silk, H. (2022). Why Should Primary Care Clinicians Learn to
Routinely Examine the Mouth? AMA Journal of Ethics, 24(1), 19–26.
- Hall III, J. W. (2019). Comorbid Conditions Associated with Hearing Loss: Another
Challenge in Educating AuD Students. Audiology Today, 31(3), 74–75.
- Lin, F. R., Metter, E. J., O’Brien, R. J., Resnick, S. M., Zonderman, A. B., & Ferrucci, L.
(2011). Hearing loss and incident dementia. Archives of neurology, 68(2), 214–
220. https://doi.org/10.1001/archneurol.2010.362
- Livingston G, Huntley J, Sommerlad A, et al. Dementia prevention, intervention, and
care: 2020 report of the Lancet Commission. The Lancet 2020.
- National Institute on Deafness and Other Communication Disorders. (2021). Quick
Statistics About Hearing. Retrieved from https://www.nidcd.nih.gov/health/statistics/quick-statistics-hearing
- Tsimpida, D., Kontopantelis, E., Ashcroft, D. M., & Panagioti, M. (2021). 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). Social Psychiatry and Psychiatric Epidemiology. https://doi.org/10.1007/s00127-021-02155-0