Fragility and Presbycusis

Aging and the needs of older people: Health strategies for healthy aging

ISBN: 978-84-09-30541-4

Rubén Polo, Manuel Manrique

Depression

Ageing may also be associated with higher risk of depression (Freeman et al., 2016), including sadness, low self-esteem, guilt, lack of interest in the day to day, disrupted sleep, or appetite, which have impact on the ability to focus (World Health Organization, 2018).

Approximately 15% of older adults have mild symptoms of depression and between 1% to 5% have severe depression disorders (Fiske, Wetherell and Gatz, 2009). In fact, scientific research has proven that hearing loss and depression among older adults (Keidser and Seeto 2017, Rosso et al. 2013) are associated with changes to the psychosocial experience and the impairment of cortical activity, which is a plausible explanation of these concomitant disorders. The association between hearing loss and depression in older adults has been studied and justified widely in the context of the potential influence of psychosocial changes suffered with age. Kiely, Anstey and Luszcz (2013) initially found that the severity of the depressive symptoms was associated with hearing loss in older adults, but it became negligible (that is, it was justified) when difficulty in daily functioning and the degree of daily social interaction were built into the model. Then, evidence shows a sharper decline in hearing when older adults are more socially and emotionally isolated (Pronk et al. 2014). If left untreated, hearing loss may cause chronic stress, eventually leading to depression as an additional stress factor (West, 2017). Therefore, hearing loss may worsen already existing difficulties around psychosocial and functional abilities in older people, thereby increasing the likelihood of depression. At the same time, the most recent evidence shows that psychosocial factors (i.e.: decreased engagement in social activities or access to a social network) do not have any influence whatsoever on the association between hearing loss and depression in older adults (Cosh et al., 2018). The authors suggested that older adults may be accepting hearing loss as part of the regular experience of growing old, and therefore, adapt to auditory changes by modifying/improving their communication skills or using hearing aids to mitigate hearing loss, which in turn mitigates the potential negative impact of hearing loss on psychosocial experiences potentially preceding depression. (Cosh et al., 2018).

Therefore, it is unclear if a psychosocial mechanism in older age explains the association between hearing loss and depression in older adults. Blake J. Lawrence et al. (2019), have undertaken a meta-analysis and systematic literature review to clarify this point. They seek to reveal the association between comorbidity and the potential influence of psychosocial or health aspects that may account for this link in older age.

The most recent evidence suggests that the deterioration of neuropathological mechanisms associated with auditory perception and the regulation of the emotional state may be the reason accounting for the association between hearing loss and depression in older adults. Rutherford, Brewster, Golub, Kim and Roose (2018) have thoroughly reviewed neuroimaging studies showing similar patterns and reduced activity of the limbic system (responsible for emotions and behavior), the frontal cortex (the regulator of emotions, reasoning, and planning), and the auditory cortex in older people with hearing loss or depression. These initial findings suggest a common, neuronal degeneration associated with hearing loss and depression in older adults. However, more evidence is needed to better understand the physiopathology underlying hearing loss and depression in older adults.

To this date, epidemiological studies have frequently reported on the association between hearing loss and depression. Some cross-sectional studies report on the association between hearing loss and depression in older age (Behera et al., 2016; Keidser and Seeto, 2017; Lee and Hong, 2016), while others report on the inexistence of such association (Bergdahl et al., 2005; Chou and Chi, 2005). Similar evidence can be found in cohort studies, in which initial outcomes show that hearing loss is associated with a higher probability of depression among older adults (Forsell, 2000); but later studies have rejected these findings. Contradictory findings in the literature may be due to methodological differences between studies, and the limitations of epidemiological research. Epidemiology is a research method that enables the study of certain health aspects in broad population samples, when a controlled clinical trial is not feasible (i.e.: examine dietary patterns across different countries) or ethical (i.e.: examine the effect of tobacco use on health). However, epidemiological studies are often influenced by biases that undermine the reliability of the outcome. Most statistically significant epidemiological findings are usually not replicated in controlled, randomized trials (which are scientifically more robust) later, as reported by Ioannidis (2016). In fact, large epidemiological longitudinal studies examining changes to health aspects (i.e.: the US national epidemiological survey on health and nutrition) often find statistically significant correlations among all variables of interest (Patel, Ioannidis, Cullen and Rehkopf, 2015). However, considering these limitations, a meta-analysis, and a systematic review of epidemiological studies (cross-sectional and cohort) may shed some light on the association between health aspects (hearing loss and depression) while highlighting the strengths and weaknesses of the existing evidence and offering recommendations for clinical practice going forward.

Prior studies on the association between hearing loss and depression have objectively measured hearing loss with a PTA audiometry (Hidalgo et al., 2009; Kiely et al., 2013). However, some studies report on subjective hearing loss only, measured with results reported by patients themselves (Boorsma et al., 2012; Saito et al., 2010).

Some studies included a percentage of participants with cognitive decline (Perlmutter, Bhorade, Gordon, Hollingsworth and Baum, 2010). Cognitive decline has been described as an abnormal deficit of cognitive function, given the age and educational level. In older adults it may range from mild cognitive impairment to dementia (Albert et al., 2011). There is increasingly more evidence emphasizing the association between hearing loss and cognitive decline in older individuals (Loughrey, Kelly, Kelley, Brennan and Lawlor, 2017). Besides, a decline in cognitive function has been associated with depression (Wang and Blazer, 2015). Therefore, one might expect a stronger association between hearing loss and depression in older adults, which would prove the existence of the cognitive decline as well (Rutherford et al., 2018).

The experience of participants with hearing aids varies across studies (Chou, 2008; Pronk et al., 2011; Rosso et al., 2013). Hearing aids may mitigate the symptoms of depression associated with hearing loss in older adults (Choi et al., 2016; Manrique-Huarte, Calavia, Irujo, Girón and Manrique-Rodríguez, 2016), which could impact the association between hearing loss and depression in observational research.

Besides, a substantial percentage of research does not include results adjusted to the extrinsic influence of covariates (i.e.: health/psychosocial aspects), which undermines the validity of the findings (Al Sabahi, Al Sinawi, Al Hinai, and Youssef, 2014; Chou and Chi, 2005; Hidalgo et al., 2009).

It is also broadly accepted that one cannot infer causality with cross-sectional studies. Therefore, the time-related association between hearing loss and depression cannot be established by this method. Meta-analytical evidence with a reduced number of studies initially showed an association between hearing loss and depression in older adults (Huang, Dong, Lu, Yue, and Liu, 2010). However, more studies have been published since and the inconsistent findings call for a systematic review and a meta-analysis of the evidence.

Based on all this, Blake J. Lawrence et al. (2019) undertook a systematic review and meta-analysis primarily intended to summarize the available evidence and offer a summarized estimation of the effect an association between hearing loss and depression has on older adults. Secondarily, they sought to examine whether the characteristics of the study (the design, outcome metrics) or the participants (demographics, health) could have impact on the association between hearing loss and depression. A systematic, thorough review of the literature was undertaken by this author, and all available evidence was included in the study to offer a rigorous estimation of the association between hearing loss and depression in older people.

The findings of this systematic review and meta-analysis (Blake J. Lawrence et al., 2019) indicate that hearing loss entails a probability of depression 1.47 times greater in older people.

It is more likely for older adults with hearing loss to feel emotionally and socially lonely (Contrera, Sung, Betz, Li and Lin, 2017; Pronk et al., 2014), have poor cognitive function (Jayakody, Friedland, Eikelboom, Martins and Sohrabi, 2018; Loughrey et al., 2017) and experience difficulty in daily functioning (Gopinath et al., 2012), which are in turn independently associated with more depression symptoms in older age (Hörnsten, Lövheim, Nordström and Gustafson, 2016; Luanaigh and Lawlor, 2008; Wang and Blazer, 2015). As a result, hearing loss may worsen the already existing difficulties associated with the psychosocial and functional abilities in older age, thereby increasing the likelihood of depression.

As part of the stress paradigm, (Pearlin, Menaghan, Lieberman and Mullan, 1981), the extent of social support could explain the association between hearing loss and depression in older adults (West, 2017). In a broad longitudinal study (N > 6000) with American adults (age ≥50), West (2017) observed that hearing loss appears as a factor of chronic stress in older adults without sufficient social support, which leads to the spread of depression as an additional stress factor. Kiely and col. had reported in a previous study (2013) about the association between hearing loss and depression as something that totally justified the social interaction and engagement in mind-stimulating activities. Few studies in this meta-analysis have measured or controlled for social support. Therefore, it has not been possible to investigate this association in the current review. However, the findings of the meta-analysis indicate that older adults with hearing loss have a greater probability of depression. The latest studies suggest that appropriate social support could mitigate the severity of depressive symptoms.

It has been suggested that neuropathological changes in an aged brain are mechanisms potentially associated with hearing loss and depression in older adults as well (Rutherford et al., 2018). The limbic system and the auditory cortex activity are impaired in people with hearing loss, in response to emotionally positive and negative auditory stimuli (Husain, Carpenter-Thompson and Schmidt 2014; Rutherford et al., 2018). Neuroimaging evidence shows the reduced activation of the frontal cortex as well in older adults with hearing loss (Boyen, Langers, de Kleine and van Dijk, 2013; Husain et al., 2011) and depression (Murrough et al., 2016). These preliminary studies suggest homogeneous neuropathological mechanisms that could favor hearing loss and depression in older people, even though much remains unknown about the cortical pathways associated with hearing loss and depression in older age. Nevertheless, higher quality research combining imaging, audiology and neuropsychology is needed to understand better these associations and establish the time-related association between these two comorbidities.

The general association between hearing loss and depression was significantly, broadly heterogeneous. However, the differences in the study and the characteristics of participants do not justify the variance of this effect. When sufficient co-variates are measured and controlled, cohort studies (as opposed to cross-sectional studies) reveal more significant evidence, because time-related comorbidities of other health disorders can be inferred from them. Cross-sectional studies are subject to methodological limitations as well, including the respondent’s biased response and convenience sampling (Sedgwick, 2013), which could artificially boost the link between results when measured at a specific point in time. Therefore, the cross-sectional association between hearing loss and depression could diminish when measured constantly over a period. In any case, assuming both the effects of cross-sectionalism and the cohort, this meta-analysis showed a significant association between hearing loss and depression. The findings of this review suggest that older people tend to suffer from hearing loss-related depression more likely, and that this association may be constant over time.

Measuring the outcome subjectively could provoke a biased response, and the subsequent over- or under-rating of the severity of the health disorder (Daltroy, Larson, Eaton, Phillips and Liang, 1999; Dowling, Bolt, Deng and Li, 2016). Previous studies have suggested that using hearing aids could improve the symptoms of depression associated with hearing loss (Manrique-Huarte et al., 2016). However, this review did not uncover any differences whatsoever in the association between hearing loss and depression irrespective of the objective or subjective measures of hearing loss, or the prior use of hearing aids by a portion of the participants. In a wide community study (N>100,000), Keidser, Seeto, Rudner, Hygge and Rönnberg (2015) found that regardless of the measure used to assess hearing loss or the use of hearing aids by participants, the severity of the hearing loss was associated with more symptoms of depression. As described by Ioannidis (2016), not even the most rigorously and thoroughly executed cohort studies can always establish the time-related association between the variables of interest. Given the current observational findings, one can hardly establish whether an individual’s hearing loss precedes the onset of depression or health ailments increase the feeling of depression and have negative impact on the perception of their hearing. It is also important to observe that most research included in this review did not report on the exact proportion of the sample who used hearing aids. Besides, there is a discrepancy between owners and users of hearing aids, since up to 24% of hearing aid owners reported they had never used their hearing aids (Hartley, Rochtchina, Newall, Golding and Mitchell, 2010). Therefore, owners and users of hearing aids are probably represented incorrectly in this meta-analysis. This may have contributed to the null findings. Taking these caveats into account, the outcome of the author’s preliminary analysis suggests that hearing loss reported by patients themselves may be a sufficient measure of hearing loss and its association with depression in older age, and that hearing aids may not mitigate the symptoms of depression associated with hearing loss.

Hearing loss is associated with a decline in the cognitive function of older adults (Jayakody et al., Loughrey et al., 2017), and cognitive impairment has been associated with greater levels of depression in older age (Wang and Blazer, 2015). Therefore, we expected a greater probability of depression among the studies including participants with hearing loss and cognitive impairment and those who reported their results unadjusted to the covariates. On one side, the current findings suggest that older people with hearing loss and cognitive impairment are not necessarily facing greater odds of depression, compared with individuals with hearing loss but without cognitive impairment. The association between hearing loss and depression may not be influenced by differences in demographics or health at an individual or group level. However, in line with the null effect of hearing aids, few studies reported on the percentage of their sample and the severity of the cognitive impairment or deficit, examined through the lenses of their connection to hearing loss and depression. Therefore, it remains unclear what percentage of the participants in this meta-analysis had cognitive impairment, which must be considered when interpreting the results.

The sensitivity analysis did not account for the heterogeneous joint effect of hearing loss and depression either. Some studies were removed from the joint effect as they had reported beta coefficients that should have been converted into OR for this meta-analysis, because their large sample (N>20,000) and their high weight could bias the relation, and because they examined hearing loss and depression in older individuals who lived institutionalized (i.e.: home for the elderly, hospitals) where they are more likely to suffer from severe hearing loss and depression (Boorsma et al., 2012; Cosh et al., 2018; Keidser and Seeto, 2017; Kiely et al., 2013; Krsteska, 2012; Pronk et al., 2011; Rosso et al., 2013; Yasuda et al., 2007). However, the association between hearing loss and depression remained relevant, with heterogeneity varying between mild and broad after each sensitivity analysis. These findings suggest that the relation between hearing loss and depression had not been artificially boosted by the statistical methods used to convert the size of the study effect for the meta-analysis (particularly with large sample studies) or influenced by a potentially clearer association between hearing loss and depression, which is often found in older adults living in an institution. The association between hearing loss and depression was ratified by scant evidence (Schünemann et al., 2013). In fact, the evidence was reduced, considering the limitations resulting from including only observational studies, which lack the methodological rigor of a more robust design (such as clinical trials). Among the GRADE criteria, (Schünemann et al., 2013), only the risk of bias was brought down a notch upon realization that more than half of the studies included did not report on the results adjusted for the covariates. That said, the author’s analysis in this study and meta-analysis did not show any difference whatsoever between studies with adjusted results or otherwise. It is important to highlight that the lack of consistency in the evidence did not diminish despite high heterogeneity (I2 = 83.26%) within the joint effect. The heterogeneity of the meta-analysis must be considered within each corpus of evidence (Schünemann et al., 2013), and most studies (>70%) in this meta-analysis reported on minor and medium effects with overlapped standard deviations. We therefore conclude that the differences when estimating the study effect were relatively consistent across studies, which validated the statistically significant, constant association found between hearing loss and depression and reported in this meta-analysis.

There are limitations to this review. Many different results and cut-off points have been used to measure depression and hearing loss. There are studies that have not offered sufficient detail to establish the specific method used. There is only one study (Saito et al., 2010) that reported on the subjective link between hearing loss and depression with a validated, standardized questionnaire (i.e.: The Hearing Handicap Inventory in the Elderly). The remainder of the studies used a range of questions and criteria answered by the patient themselves. The variability of methodologies used to report on the studies has led to a basic classification of variables by the author, which may very well account for the author’s null findings, in part, and which has limited our capacity to investigate if the severity of the hearing loss or the depression caused the variance within the total effect. The beta coefficient conversion by Kiely and collaborators (2013) to an OR for this meta-analysis artificially boosted a non-significant finding, to such an extent that it became a considerable, significant association between hearing loss and depression. Eliminating Kiely and collaborators (2013) had no impact on the global effect. Still, the statistical difference across effects should be considered. In fact, current findings are limited to older adults (age≥60) while the evidence suggests that younger adults may have more severe depression symptoms in connection to their hearing loss (Keidser and Seeto, 2017). In order to better understand these concomitant health disorders over a lifetime, the researchers would like to systematically review and meta-analyze the association between hearing loss and depression in populations of younger adults and adolescents. Furthermore, we urge to interpret the findings of the analysis conducted by the authors with caution and to follow the design of randomized, controlled trials in studies going forward. This will yield more consistent evidence about whether hearing aids improve the symptoms of depression in older adults with hearing loss and whether cognitive decline is associated or not with the relation between hearing loss and depression. We also recommend epidemiological studies to adopt more rigorous designs going forward, and to measure, report and control consistently for the influence of using and owning a hearing aid, the course and degree of cognitive decline, the severity of the depression and the hearing loss, and more broadly, the overall health and demographic characteristics (age, years with hearing loss), which may very likely have impact on the association between hearing loss and depression in older age. The findings of this review indicate that aural rehabilitation with hearing aids may not alleviate the symptoms of depression associated with the hearing loss. Some recent evidence suggests that social support could moderate the association between hearing loss and depression in older age (West, 2017). Therefore, one could think that older people would benefit from educational training (Preminger and Meeks, 2010) and psychosocial therapy (Lindsey, 2016) to equip themselves with the resources needed to deal with changes to their health and quality of life. Adults with severe and profound hearing loss reported not having received psychosocial therapy as part of their aural rehabilitation, despite wanting the referral (Hallam, Ashton, Sherbourne and Gailey, 2006). However, it is important to point out the stigma of depression and health disorders among many elderly people (Conner et al., 2010). It often inhibits them from seeking help, and it makes it harder for audiologists and geriatricians to identify when they might need and benefit from an intervention. The Royal College of Psychiatrists in the UK, for one, reported that close to half of all older adults hospitalized with depression did not have that diagnosis included in their medical history at the moment of hospitalization, and it had not been included in their discharge papers for their General Practitioner (Hood, Plummer and Quirk, 2018). Audiologists would benefit from training to understand better the psychosocial difficulties experienced by older individuals with hearing loss (Ekberg, Grenness and Hickson, 2014) and identify and discuss mental health more confidently with their older patients. The widespread use of depression screening tools (i.e.: The Geriatric Depression Scale, GDS) among healthcare professionals working with older individuals would raise awareness about depression in this population, and more people would benefit from psychologists and psychiatrists specialized in depression (Smarr and Keefer, 2011).

Finally, it is important to note the size of the effect found in this meta-analysis. Hearing loss is associated with a probability of depression 1.47 times greater. Based on the recommended conventions, (Chen et al., 2010), the effect is minimal. When the probability of depression increases however slightly, a small percentage of older people may have depressive symptoms associated with their hearing loss, but not the majority of them; even when the association is statistically significant. In the population at large, we tend to link depression to negative vital events (such as the loss of a loved one, loss of earnings), extended periods of stress, personality disorders, drug abuse, and poor diet (Beck and Alford, 2009). These factors may be worse for older people who see their overall health decline or have a negative perception of aging (Freeman et al., 2016). Healthcare professionals (audiologists in particular) working with older people with hearing loss must be aware of the heterogeneous etiology of depression, and understand that some, but not all older patients will show symptoms of depression associated with their hearing loss.

In conclusion, a systematic, broad review and meta-analysis (Blake J. Lawrence et al., 2019) have identified 35 studies about hearing loss and depression in older people. This review includes two main findings. First, hearing loss is associated with a probability of depression 1.47 times greater in older adults, despite the minimal association. Second, the association between hearing loss and depression may not be influenced by how hearing loss is measured, the use of hearing aids or demographic and/or health aspects. These findings are reinforced by the evidence of a large sample (N>145,000) of older adults, globally representative. A percentage of older adults can develop depressive symptoms associated with hearing loss. We urge healthcare professionals and general practitioners working with them to be cognizant and better informed of the depression suffered with aging.

References

  • Albert, M. S., DeKosky, S. T., Dickson, D., Dubois, B., Feldman, H. H., Fox, N. C.,…Phelps, C. H. (2011). The diagnosis of mild cognitive impairment due to Alzheimer’s disease: Recommendations from the National Institute on Aging-Alzheimer’s Association workgroups on diagnostic guidelines for Alzheimer’s disease. Alzheimer’s & Dementia, 7, 270–279. doi:10.1016/j. jalz.2011.03.008
  • Al-Sabahi, S. M., Al Sinawi, H. N., Al-Hinai, S. S., & Youssef, R. M. (2014). Rate and correlates of depression among elderly people attending primary health care centres in Al-Dakhiliyah governorate, Oman. Eastern Mediterranean Health Journal = La Revue de Sante de la Mediterranee Orientale = al-Majallah al-Sihhiyah li-sharq al-mutawassit, 20, 181–189. doi:10.26719/2014.20. 3.181
  • Beck, A. T., & Alford, B. A. (2009). Depression: causes and treatment. Philadelphia: University of Pennsylvania Press. Behera, P., Sharan, P., Mishra, A. K., Nongkynrih, B., Kant, S., & Gupta, S. K. (2016). Prevalence and determinants of depression among elderly persons in a rural community from northern India. The National Medical Journal of India, 29, 129–135.
  • Bergdahl, E., Gustavsson, J. M., Kallin, K., von Heideken Wågert, P., Lundman, B., Bucht, G., & Gustafson, Y. (2005). Depression among the oldest old: The Umeå 85+ study. International Psychogeriatrics, 17, 557–575. doi:10.1017/ S1041610205002267
  • Boorsma, M., Joling, K., Dussel, M., Ribbe, M., Frijters, D., van Marwijk, H. W.,van Hout, H. (2012). The incidence of depression and its risk factors in Dutch nursing homes and residential care homes. The American Journal of Geriatric Psychiatry, 20, 932–942. doi:10.1097/JGP.0b013e31825d08ac
  • Boyen, K., Langers, D. R., de Kleine, E., & van Dijk, P. (2013). Gray matter in the brain: Differences associated with tinnitus and hearing loss. Hearing Research, 295, 67–78. doi:10.1016/j. heares.2012.02.010
  • Chen, H., Cohen, P., & Chen, S. (2010). How big is a big odds ratio? Interpreting the magnitudes of odds ratios in epidemiological studies. Communications in Statistics-Simulation and Computation, 39, 860–864. doi:10.1080/03610911003650383
  • Choi, J. S., Betz, J., Li, L., Blake, C. R., Sung, Y. K., Contrera, K. J., & Lin, F. R. (2016). Association of using hearing aids or cochlear implants with changes in depressive symptoms in older adults. JAMA Otolaryngology– Head & Neck Surgery, 142, 652–657. doi:10.1001/jamaoto.2016.0700
  • Chou, K. L. (2008). Combined effect of vision and hearing impairment on depression in older adults: Evidence from the English Longitudinal Study of Ageing. Journal of Affective Disorders, 106, 191–196. doi:10.1016/j.jad.2007.05.028
  • Chou, K. L., & Chi, I. (2005). Prevalence and correlates of depression in Chinese oldest-old. International Journal of Geriatric Psychiatry, 20, 41–50. doi:10.1002/gps.1246
  • - Conner, K. O., Copeland, V. C., Grote, N. K., Koeske, G., Rosen, D., Reynolds, C. F. 3rd, & Brown, C. (2010). Mental health treatment seeking among older adults with depression: The impact of stigma and race. The American Journal of Geriatric Psychiatry, 18, 531–543. doi:10.1097/JGP.0b013e3181cc0366
  • Contrera, K. J., Sung, Y. K., Betz, J., Li, L., & Lin, F. R. (2017). Change in loneliness after intervention with cochlear implants or hearing aids. The Laryngoscope, 127, 1885–1889. doi:10.1002/ lary.26424
  • Cosh, S., von Hanno, T., Helmer, C., Bertelsen, G., Delcourt, C., & Schirmer, H.; SENSE-Cog Group. (2018). The association amongst visual, hearing, and dual sensory loss with depression and anxiety over 6 years: The Tromsø Study. International Journal of Geriatric Psychiatry, 33, 598–605. doi:10.1002/gps.4827
  • Daltroy, L. H., Larson, M. G., Eaton, H. M., Phillips, C. B., & Liang, M. H. (1999). Discrepancies between self-reported and observed physical function in the elderly: The influence of response shift and other factors. Social Science & Medicine (1982), 48, 1549–1561. doi:10.1016/S0277-9536(99) 00048-9
  • Dowling, N. M., Bolt, D. M., Deng, S., & Li, C. (2016). Measurement and control of bias in patient reported outcomes using multidimensional item response theory. BMC Medical Research Methodology, 16, 63. doi:10.1186/s12874-016-0161-z
  • Fiske, A., Wetherell, J. L., & Gatz, M. (2009). Depression in older adults. Annual Review of Clinical Psychology, 5, 363–389. doi:10.1146/annurev.clinpsy.032408.153621
  • Forsell, Y. (2000). Predictors for depression, anxiety and psychotic symptoms in a very elderly population: Data from a 3-year follow-up study. Social Psychiatry and Psychiatric Epidemiology, 35, 259–263. doi:10.1007/s001270050237
  • Freeman, A. T., Santini, Z. I., Tyrovolas, S., Rummel-Kluge, C., Haro, J. M., & Koyanagi, A. (2016). Negative perceptions of ageing predict the onset and persistence of depression and anxiety: Findings from a prospective analysis of the Irish Longitudinal Study on Ageing (TILDA). Journal of Affective Disorders, 199, 132–138. doi:10.1016/j.jad.2016.03.042
  • Gopinath, B., Schneider, J., McMahon, C. M., Teber, E., Leeder, S. R., & Mitchell, P. (2012). Severity of age-related hearing loss is associated with impaired activities of daily living. Age and Ageing, 41, 195–200. doi:10.1093/ageing/afr155
  • Hallam, R., Ashton, P., Sherbourne, K., & Gailey, L. (2006). Acquired profound hearing loss: Mental health and other characteristics of a large sample. International Journal of Audiology, 45, 715–723. doi:10.1080/14992020600957335
  • Hartley, D., Rochtchina, E., Newall, P., Golding, M., & Mitchell, P. (2010). Use of hearing AIDS and assistive listening devices in an older Australian population. Journal of the American Academy of Audiology, 21, 642–653. doi:10.3766/jaaa.21.10.4
  • Hidalgo, J. L-T., Gras, C. B., Lapeira, J. T., Verdejo, M. Á. L., del Campo, J. M. d. C., & Rabadán, F. E. (2009). Functional status of elderly people with hearing loss. Archives of Gerontology and Geriatrics, 49, 88–92. doi:10.1016/j.archger.2008.05.006
  • Hood, C., Plummer, K., & Quirk, A. (2018). Survey of depression reporting in older adults admitted to acute hospitals. London, United Kingdom: Royal College of Psychiatrists.
  • Hörnsten, C., Lövheim, H., Nordström, P., & Gustafson, Y. (2016). The prevalence of stroke and depression and factors associated with depression in elderly people with and without stroke. BMC Geriatrics, 16, 174–180. doi:10.1186/s12877-016-0347-6
  • Huang, C. Q., Dong, B. R., Lu, Z. C., Yue, J. R., & Liu, Q. X. (2010). Chronic diseases and risk for depression in old age: A metaanalysis of published literature. Ageing Research Reviews, 9, 131–141. doi:10.1016/j.arr.2009.05.005
  • Husain, F. T., Carpenter-Thompson, J. R., & Schmidt, S. A. (2014). The effect of mild-to-moderate hearing loss on auditory and emotion processing networks. Frontiers in Systems Neuroscience, 8, 10. doi:10.3389/fnsys.2014.00010
  • Husain, F. T., Medina, R. E., Davis, C. W., Szymko-Bennett, Y., Simonyan, K., Pajor, N. M., & Horwitz, B. (2011). Neuroanatomical changes due to hearing loss and chronic tinnitus: A combined VBM and DTI study. Brain Research, 1369, 74–88. doi:10.1016/j.brainres.2010.10.095 Ioannidis, J. P. (2016). Exposure-wide epidemiology: Revisiting Bradford Hill. Statistics in Medicine, 35, 1749–1762. doi:10.1002/sim.6825
  • Jayakody, D. M. P., Friedland, P. L., Eikelboom, R. H., Martins, R. N., & Sohrabi, H. R. (2018). A novel study on association between untreated hearing loss and cognitive functions of older adults: Baseline non-verbal cognitive assessment results. Clinical Otolaryngology, 43, 182–191. doi:10.1111/coa.12937
  • Keidser, G., & Seeto, M. (2017). The influence of social interaction and physical health on the association between hearing and depression with age and gender. Trends in Hearing, 21, 2331216517706395. doi:10.1177/2331216517706395
  • Keidser, G., Seeto, M., Rudner, M., Hygge, S., & Rönnberg, J. (2015). On the relationship between functional hearing and depression. International Journal of Audiology, 54, 653–664. doi:10.3109/1 4992027.2015.1046503
  • Kiely, K. M., Anstey, K. J., & Luszcz, M. A. (2013). Dual sensory loss and depressive symptoms: The importance of hearing, daily functioning, and activity engagement. Frontiers in Human Neuroscience, 7, 837. doi:10.3389/fnhum.2013.00837
  • Krsteska, R. (2012). Hearing and visual impairments as risk factors for late-life depression. Journal of Special Education and Rehabilitation, 13, 46–59. doi:10.2478/v10215-011-0018-2
  • Lawrence, BJ, Jayakody, DMP, Bennett, RJ, Eikelboom, RH, Gasson, N and Friedland, PL. Hearing Loss and Depression in Older Adults: A Systematic Review and Meta-analysis. Gerontologist, 2019, Vol. XX, No. XX, 1–18 doi:10.1093/geront/gnz009
  • Lee, S., & Hong, G-R. S. (2016). Predictors of depression among community-dwelling older women living alone in Korea. Archives of Psychiatric Nursing, 30, 513–520. doi:10.1016/j. apnu.2016.05.002
  • Lindsey, H. (2016). Mental well-being tightly linked to hearing health. The Hearing Journal, 69, 14–16. doi:10.1097/01. HJ.0000481804.36451.e4
  • Loughrey, D. G., Kelly, M. E., Kelley, G. A., Brennan, S., & Lawlor, B. A. (2017). Association of age-related hearing loss with cognitive function, cognitive impairment, and dementia: A systematic review and meta-analysis. JAMA Otolaryngology– Head & Neck Surgery, 144, 115–126. doi:10.1001/ jamaoto.2017.2513
  • Luanaigh, C. O., & Lawlor, B. A. (2008). Loneliness and the health of older people. International Journal of Geriatric Psychiatry, 23, 1213–1221. doi:10.1002/gps.2054
  • Manrique-Huarte, R., Calavia, D., Huarte Irujo, A., Girón, L., & Manrique-Rodríguez, M. (2016). Treatment for hearing loss among the elderly: Auditory outcomes and impact on quality of life. Audiology & Neuro-otology, 21(Suppl 1), 29–35. doi:10.1159/000448352
  • Murrough, J. W., Abdallah, C. G., Anticevic, A., Collins, K. A., Geha, P., Averill, L. A.,…Charney, D. S. (2016). Reduced global functional connectivity of the medial prefrontal cortex in major depressive disorder. Human Brain Mapping, 37, 3214–3223. doi:10.1002/hbm.23235
  • Patel, C. J., Ioannidis, J. P., Cullen, M. R., & Rehkopf, D. H. (2015). Systematic assessment of the correlations of household income with infectious, biochemical, physiological, and environmental factors in the United States, 1999-2006. American Journal of Epidemiology, 181, 171–179. doi:10.1093/aje/kwu277
  • Pearlin, L. I., Lieberman, M. A., Menaghan, E. G., & Mullan, J. T. (1981). The stress process. Journal of Health and Social Behavior, 22, 337–356. doi:10.2307/2136676
  • Perlmutter, M. S., Bhorade, A., Gordon, M., Hollingsworth, H. H., & Baum, M. C. (2010). Cognitive, visual, auditory, and emotional factors that affect participation in older adults. The American Journal of Occupational Therapy, 64, 570–579. doi:10.5014/ ajot.2010.09089
  • Preminger, J. E., & Meeks, S. (2010). Evaluation of an audiological rehabilitation program for spouses of people with hearing loss. Journal of the American Academy of Audiology, 21, 315–328. doi:10.3766/jaaa.21.5.4
  • Pronk, M., Deeg, D. J., Smits, C., van Tilburg, T. G., Kuik, D. J., Festen, J. M., & Kramer, S. E. (2011). Prospective effects of hearing status on loneliness and depression in older persons: Identification of subgroups. International Journal of Audiology, 50, 887–896. doi:10.3109/14992027.2011.599871
  • Pronk, M., Deeg, D. J., Smits, C., Twisk, J. W., van Tilburg, T. G., Festen, J. M., & Kramer, S. E. (2014). Hearing loss in older persons: Does the rate of decline affect psychosocial health? Journal of Aging and Health, 26, 703–723. doi:10.1177/0898264314529329
  • Rosso, A. L., Eaton, C. B., Wallace, R., Gold, R., Stefanick, M. L., Ockene, J. K., Michael, Y. L. (2013). Geriatric syndromes and incident disability in older women: Results from the women’s health initiative observational study. Journal of the American Geriatrics Society, 61, 371–379. doi:10.1111/jgs.12147
  • Rutherford, B. R., Brewster, K., Golub, J. S., Kim, A. H., & Roose, S. P. (2018). Sensation and psychiatry: Linking agerelated hearing loss to late-life depression and cognitive decline. The American Journal of Psychiatry, 175, 215–224. doi:10.1176/ appi.ajp.2017.17040423
  • Saito, H., Nishiwaki, Y., Michikawa, T., Kikuchi, Y., Mizutari, K., Takebayashi, T., & Ogawa, K. (2010). Hearing handicap predicts the development of depressive symptoms after 3 years in older community-dwelling Japanese. Journal of the American Geriatrics Society, 58, 93–97. doi:10.1111/j.1532-5415.2009.
  • Schunemann, H., Brozek, J., & Oxman, A. (2013). GRADE handbook for grading quality of evidence and strength of recommendations. Updated October 2013, The GRADE Working Group. Available from gdt.gradepro.org/app/handbook/handbook.html
  • Sedgwick, P. (2013). Convenience sampling. British Medical Journal, 347, 1–2. doi:10.1136/bmj.f6304
  • Smarr, K. L., & Keefer, A. L. (2011). Measures of depression and depressive symptoms: Beck Depression Inventory-II (BDI-II), Center for Epidemiologic Studies Depression Scale (CES-D), Geriatric Depression Scale (GDS), Hospital Anxiety and Depression Scale (HADS), and Patient Health Questionnaire-9 (PHQ-9). Arthritis Care & Research, 63 (Suppl 11), S454–S466. doi:10.1002/acr. 20556
  • Wang, S., & Blazer, D. G. (2015). Depression and cognition in the elderly. Annual Review of Clinical Psychology, 11, 331–360. doi:10.1146/annurev-clinpsy-032814-112828
  • West, J. S. (2017). Hearing impairment, social support, and depressive symptoms among U.S. adults: A test of the stress process paradigm. Social Science & Medicine (1982), 192, 94–101. doi:10.1016/j.socscimed.2017.09.031 World Health Organization. (2018). Mental disorders: Key facts. Geneva, Switzerland: World Health Organization. Available from who.int/news-room/fact-sheets/detail/mental-disorders
  • Yasuda, M., Horie, S., Albert, S. M., & Simone, B. (2007). The prevalence of depressive symptoms and other variables among frail aging men in New York City’s Personal Care Services program. The Journal of Men’s Health & Gender, 4, 165–170. doi:10.1016/j.jmhg.2007.02.006