1. Fragility and Presbycusis
  2. Non-hearing consequences associated with presbycusis and balance disorders
  3. Social isolation

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

Social isolation

Multiple studies have proven that social isolation predicts mortality, psychiatric disorders, cognitive and physical impairment among older people. Hearing loss produces a functional deficit where understandability and speech discrimination decline, particularly in noisy environments. This sensory deficit gives way as well to a loss of self-esteem and cognitive and emotional alterations, including shame, pity, or anger, and behavioral, such as social distancing and confinement. All this leads to withdrawing from social gatherings and isolating1,2. According to Bowl et al, social isolation can predict mortality due to any reason, as it associates cognitive impairment and depression in older people. They indicate that strategies must be developed to prevent presbycusis-related isolation, which will in turn preclude morbidity associated with social and emotional isolation3.

Pronk et al.4 made a prospective analysis of the impact of the auditory status on loneliness and depression on a population of 3107 elderly people. The objective deficit is measured with audiometric studies in noise (Speech in noise test, SNT). The subjective hearing deficit is measured with the OECD (long-term disability indicator), which consists of three questions: 1) Can you hold a three-person conversation without your hearing aid? 2) Can you hold a two-person conversation without your hearing aid? 3) Can you use a telephone normally? The degree of isolation is measured in the De Jong Gierveld scale, which evaluates the social component (not having frequent contacts or recurrent groups of people) and the emotional component (lack of a confident relationship (partner, best friend)). The following conclusions are drawn:

  1. Men with presbycusis feel significantly more isolated than women with presbycusis. One theory proposed is that men depend more on oral communication than women, and men tend to deny their disease. This leads to greater isolation, as they need to communicate more to feel they belong while they do not ask for help.
  2. In couples where one partner has presbycusis, the relationship suffers more, emotionally, than in terms of closeness. There are significant differences versus couples of two normal-hearing individuals.
  3. People with presbycusis who live with a normal-hearing person feel significantly more isolated than those who do not. This is driven by the constant comparison of one and another’s hearing ability, regardless of the degree of hearing loss suffered.
  4. People with presbycusis and a high educational level feel more isolated than people with presbycusis and a low educational level. This is driven by the first being exposed to more demanding auditory situations (conferences, talks, social gatherings). Therefore, even though the objective deficit may not be too large, they are frustrated by not being able to understand conversation well.
  5. People with presbycusis who do not use hearing support are significantly more isolated than those who do.
  6. The study concludes that hearing aids prevent social isolation for people with presbycusis.

Mick and col.5 evaluated cross-sectionally the relation between hearing loss and social isolation in older people. They used the Social Isolation Score (SIS) to measure social isolation, and the tone audiometry with the average threshold in conversational frequencies to measure hearing impairment. A population of 1453 is subdivided in two age groups: 60-69 years old and 70-84 years old. In the first group, ages 60-69, 20.6% had hearing loss and 11.9% did not. The isolation index was significantly greater (p=0.003) in those who had hearing loss. In the second group, ages 70-84, 19.8% had hearing loss and 15.6% did not. There were no significant differences in the level of isolation. This is attributed to the size of the sample and the greater social and work-related demands in the younger group. However, it was observed that people in the older group who had hearing loss and felt isolated died sooner than those who felt isolated but maintained auditory levels within the range of normalcy.

References

  1. Mick P, Kawachi I, Lin FR. The association between hearing loss and social isolation in older adults. Otolaryngol Head Neck Surg. 2014 Mar;150(3):378-84.
  2. David D, Zoizner G. Self-Stigma and Age-Related Hearing Loss: A Qualitative Study of Stigma Formation and Dimensions. Am J Audiol. 2018 Mar 8;27(1):126-136.
  3. Bowl MR, Sally J. Dawson. Age-Related Hearing Loss. Cold Spring Harb Perspect Med 2019;9:a033217.
  4. Pronk M, Deeg DJ, Smits C, et al. Prospective effects of hearing status on loneliness and depression in older persons: identification of subgroups. Int J Audiol. 2011 Dec;50(12):887-96.
  5. 5. Jan Mick P, Kawachi I, Lin FR. The association between hearing loss and social isolation in older adults. Otolaryngol Head Neck Surg. 2014 Mar;150(3):378-84.