Starkey Research & Clinical Blog

Hearing Aid Use Decreases Perceived Loneliness

Weinstein, B., Sirow, L. & Moser, S. (2016).  Relating hearing aid use to social and emotional loneliness in older adults. American Journal of Audiology 25, 54-61.

This editorial discusses the clinical implications of an independent research study and does not represent the opinions of the original authors.

Social isolation and loneliness have been linked to increased risk of cognitive decline, cardiovascular disease, increased inflammatory response to stress, depression and other physical and mental health problems (Cacioppo et al., 2000; Hawkley & Cacioppo, 2010; Steptoe et al., 2004).  Estimates suggest that between 10% and 40% of community-dwelling older adults experience social isolation and loneliness, with rural areas having an even higher prevalence of reported loneliness (Nicholson, 2012; Dahlberg & McKee, 2014).

Weinstein and Ventry (1982) were among the first to study the effect of hearing loss on subjective social isolation, finding that self-reported hearing loss was highly correlated with feelings of loneliness and inferiority, reduced interest in leisure activities and withdrawal from others. In a longitudinal study on aging, Pronk and her colleagues found that self-reported hearing loss was associated with increased social and emotional loneliness and they observed that hearing aid users had better scores than non-hearing aid users (Pronk, et al., 2013). These reports raise a number of questions. For instance, if hearing aid use reduces social isolation and loneliness, will associated health problems, such as cognitive decline, be reduced as well? Such an outcome would have widespread implications for the health and well-being of the older population at large.

The goals of the current study by Weinstein and her colleagues were to determine whether first-time hearing aid use reduces social and emotional loneliness. They also examined loneliness in individuals with mild hearing loss and those with moderate to severe hearing loss, before and after intervention with hearing aids, to determine if the effects were dose related.

Forty adults who ranged in age from 62 to 92 years participated in four experimental sessions. At the first session, they completed audiological and speech-in-noise testing, followed by hearing aid selection. Pure tone testing was conducted with standard audiometric procedures and the QuickSIN test (Killion, et al., 2004) was used to evaluate speech recognition in noise. Otoacoustic emission testing was also completed. At the second session, subjects were fitted and trained with binaural hearing aids, real-ear verification measures were conducted and working memory was evaluated with the Reading Span test (Daneman & Carpenter, 1980).  Also at this appointment, the DG Loneliness Scale (DeJong Gierveld & Kamphuis, 1985) was administered, which measures two specific sub-sets of loneliness: emotional loneliness and social loneliness. Subjects returned for a third session one week after the hearing aid fitting and a fourth session at approximately 4-6 weeks after the fitting.

The authors observed a significant decrease in overall loneliness and perceived emotional loneliness after 4-6 weeks of hearing aid use; a reduction in social loneliness that did not achieve statistical significance was also seen.  A sub-group of subjects with more severe hearing loss showed significant decreases in overall loneliness as well as social and emotional loneliness after hearing aid use. This group demonstrated poorer scores pre- and post-fitting, compared to the mild hearing loss group.  There was no significant predictive relationship between age and the measures of social and emotional loneliness and no dose-related effect of hearing loss.  These were not surprising outcomes: health status and functional limitations are more strongly related to social isolation and loneliness than age, and prior studies showed correlations between social isolation/loneliness and perceived hearing loss, as opposed to audiometric thresholds (Hornsby & Kipp, 2016; Pronk et al., 2013).

Subjects were also classified into two groups as “lonely” or “not lonely”, relative to normative data. Prior to hearing aid fitting, 55% were classified as “not lonely” and 45% were classified as “lonely”. After hearing aid use, there was a significant decline in loneliness, with 72.5% of the subjects classified as “not lonely” and 27.5% classified as “lonely”.

The outcomes of this study complement and support our observations as clinical audiologists.  We frequently see the adverse effects of hearing loss on the quality of relationships and social interaction. Hearing loss and subsequent difficulty communicating in groups causes strained conversation and frustration among all participants and increases mental fatigue in the hearing-impaired individual (as reported by Hornsby (2013) and Pronk et al (2013)). This frustration and fatigue often results in avoidance of social interaction.  Therefore, even individuals with a large network of friends and family can experience isolation and loneliness if they struggle to participate in groups or fear that they annoy others with requests for repetition and misinterpretations of conversation.  Most audiologists have heard patients explain that they avoid plays, parties or particular restaurants because they know they will struggle to understand conversation.  Older hearing-impaired adults are even more likely avoid social engagement, because multiple sensory impairments or a decline in cognitive resources may make the use of compensatory strategies like the use of visual cues and context more challenging, thereby increasing frustration and fatigue.

Most clinicians probably discuss social activities and challenges with their new patients in the process of obtaining a detailed initial history. Weinstein and her colleagues suggest that audiologists should also consider implementing a discussion of social network size and a measure of social and emotional loneliness in their evaluation procedures. They suggest the 6-item DG Loneliness Scale, as a brief, yet reliable and valid tool to measure social and emotional loneliness (DeJong Gierveld & Van Tilburg, 2006). It is important to consider both aspects of social activity, as some people with small social networks consider themselves lonely whereas others do not.

Social and emotional loneliness are linked to higher risk of an array of physical and mental health problems, including cognitive decline. Hearing loss is known to increase the risk of social isolation and loneliness, but the results reported by Weinstein and her colleagues suggest that hearing aid use may mitigate this effect, by facilitating more consistent and satisfying social engagement. More study of the potential social and emotional benefits of hearing aid use is needed, especially with regard to how it may reduce the risk of cognitive decline in older adults, by way of a reduction in social and emotional loneliness.

 

References

Cacioppo, J., Ernst, J., Burleson, M., McClintock, M., Malarkey, W., Hawkley, L. & Berntson, G. (2000). Lonely traits and concomitant physiological processes: the MacArthur social neuroscience studies. International Journal of Psychophysiology 35, 143-154.

Dahlberg, L. & McKee, K. (2014). Correlates of social and emotional loneliness in older people: Evidence from an English community study. Aging and Mental Health 18, 504-514.

Daneman, M. & Carpenter, P. (1980). Individual differences in working memory and reading. Journal of Verbal Learning and Verbal Behavior 19, 450-466.

DeJong Gierveld, J. & Kamphuis, F. (1985). The development of a Rasch-type loneliness scale. Applied Psychological Measurement 9, 289-299.

DeJong Gierveld, J. & Van Tilburg, T. (2006). A 6-item scale for overall, emotional and social loneliness. Research on Aging 28, 582-598.

Hawkley, L. & Cacioppo, J. (2010). Loneliness matters: A theoretical and empirical review of consequences and mechanisms. Annals of Behavioral Medicine 40, 218-227.

Hawthorne, G. (2008). Perceived social isolation in a community sample: Its prevalence and correlates with aspects of peoples’ lives. Social Psychiatry and Psychiatric Epidemiology 43, 140-150.

Hornsby, B. (2013). The effects of hearing aid use on listening effort and mental fatigue associated with sustained speech processing demands. Ear and Hearing 34 (5), 523-534.

Hornsby, B. & Kipp, A. (2016). Subjective ratings of fatigue and vigor in adults with hearing loss are driven by perceived hearing difficulties not degree of hearing loss. Ear and Hearing 37 (1), 1-10.

Killion, M., Niquette, P., Gudmundsen, G., Revit, L. & Banerjee, S. (2004). Development of a quick speech-in-noise test for measuring signal-to-noise ratio loss in normal hearing and hearing-impaired listeners. The Journal of the Acoustical Society of America 116, 2395-2405.

Lin, F.  (2011). Hearing loss and cognition among older adults in the United States. The Journals of Gerontology A: Biological Sciences and Medical Sciences 66 (10), 1131-1136.

Lin, F., Yaffe, K., & Xia, J. (2013). Hearing loss and cognitive decline in older adults. Journal of the American Medical Association Internal Medicine 173 (4), 293-299.

Nicholson, N. (2012). A review of social isolation. The Journal of Primary Prevention 33, 137-152.

Perlman, D. (1987). Further reflections on the present state of loneliness research. Journal of Social Behavior and Personality 2, 17-26.

Pronk, M., Deeg, D. & Kramer, S. (2013). Hearing status in older persons: A significant determinant of depression and loneliness? Results from the Longitudinal Aging Study Amsterdam. American Journal of Audiology 22, 316-320.

Steptoe, A., Owen, N., Kunz-Ebrecht, S. & Brydon, L. (2004). Loneliness and neuroendocrine, cardiovascular and inflammatory stress responses in middle-aged men and women. Psychoneuroendocrinology 29, 593-611.

Weinstein, B. & Ventry, I. (1982). Hearing impairment and social isolation in the elderly. Journal of Speech and Hearing Research 25, 593-99.

Weinstein, B., Sirow, L. & Moser, S. (2016).  Relating hearing aid use to social and emotional loneliness in older adults. American Journal of Audiology 25, 54-61.