Hearing Intervention, Social Isolation, and Loneliness
Authors: Nicholas S. Reed, Jinyu Chen, Alison R. Huang, James R. Pike, Michelle Arnold, Sheila Burgard, Ziheng Chen, Theresa Chisolm, David Couper, Thomas K. M. Cudjoe, Jennifer A. Deal, Adele M. Goman, Nancy W. Glynn, Theresa Gmelin, Lisa Gravens-Mueller, Kathleen M. Hayden, Christine M. Mitchell, Thomas Mosley, Esther S. Oh, James S. Pankow, Victoria A. Sanchez, Jennifer A. Schrack, Josef Coresh, Frank R. Lin, Marilyn Albert, Joshua Betz, Alden Gross, Clarice Myers, Richey Sharett, Melissa Minotti, Spencer Bolton, Laura Sherry, Sarah Aguilar, Elizabeth Anderson, Sydney Boelter, Elizabeth Penland Miller, Debbie Ng, Kristi Oeding, Sandra Potter, Katherine Teece, Soni Uccellini, Matthew Waggenspack, Luanne Welch, Jacqueline Weycker, Kerry Witherell, Kevin Sullivan, Latilraka Anderson, Jillian Burt, April Carr, Arkenya Carter, Sarah Faucette, Rachel Foster, Ceola Greenwood, Temeka Griffin, Candace Jones, Dawn McLendon, Stacee Naylor, Jenny Newman, Deidre O'Connor, Tiffany Owens, Jeraline Sims, Allison Thweatt, Tamikia Washington, Bria Backman, Debbie Barr, Joshua Evans, Jamie Hampton, Hailley Humphrey-Rutledge, Kaila Liou, Ashley Mitchell, Susan Smith, Nadine Shelton, Ann Eddins, Emily Moore, Haley Neil, Preyanca Oree, Laura Westermann, Yurun Cai, David Li, Clifford R Jack, David Knopman, Denise Reyes, AJ Spychalla, Kaely Thostenson, Doug Galasko, Julie Buring, Judy Dubno, Tom Greene, Lawrence Lustig, Coryse St. Hillaire-Clarke, Matt Sutterer
Journal: JAMA Internal Medicine (2025)

Importance Promoting social connection among older adults is a public health priority. Addressing hearing loss may reduce social isolation and loneliness among older adults. Objective To describe the effect of a best-practice hearing intervention vs health education control on social isolation and loneliness over a 3-year period in the Aging and Cognitive Health Evaluation in Elders (ACHIEVE) study. Design, Setting, and Participants This secondary analysis of a multicenter randomized controlled trial with 3-year follow-up was completed in 2022 and conducted at 4 field sites in the US (Forsyth County, North Carolina; Jackson, Mississippi; Minneapolis, Minnesota; Washington County, Maryland). Data were analyzed in 2024. Participants included 977 adults (aged 70-84 years who had untreated hearing loss without substantial cognitive impairment) recruited from the Atherosclerosis Risk in Communities study (238 [24.4%]) and newly recruited (de novo; 739 [75.6%]). Participants were randomized (1:1) to hearing intervention or health education control and followed up every 6 months. Interventions Hearing intervention (4 sessions with certified study audiologist, hearing aids, counseling, and education) and health education control (4 sessions with a certified health educator on chronic disease, disability prevention). Main Outcomes and Measures Social isolation (Cohen Social Network Index score) and loneliness (UCLA Loneliness Scale score) were exploratory outcomes measured at baseline and at 6 months and 1, 2, and 3 years postintervention. The intervention effect was estimated using a 2-level linear mixed-effects model under the intention-to-treat principle. Results Among the 977 participants, the mean (SD) age was 76.3 (4.0) years; 523 (53.5%) were female, 112 (11.5%) were Black, 858 (87.8%) were White, and 521 (53.4%) had a Bachelor’s degree or higher. The mean (SD) better-ear pure-tone average was 39.4 dB (6.9). Over 3 years, mean (SD) social network size reduced from 22.6 (11.1) to 21.3 (11.0) and 22.3 (10.2) to 19.8 (10.2) people over 2 weeks in the hearing intervention and health education control arms, respectively. In fully adjusted models, hearing intervention (vs health education control) reduced social isolation (social network size [difference, 1.05; 95% CI, 0.01-2.09], diversity [difference, 0.19; 95% CI, 0.02-0.36], embeddedness [difference, 0.27; 95% CI, 0.09-0.44], and reduced loneliness [difference, −0.94; 95% CI, −1.78 to −0.11]) over 3 years. Results were substantively unchanged in sensitivity analyses that incorporated models that were stratified by recruitment source, analyzed per protocol and complier average causal effect, or that varied covariate adjustment. Conclusions and Relevance This secondary analysis of a randomized clinical trial indicated that older adults with hearing loss retained 1 additional person in their social network relative to a health education control over 3 years. While statistically significant, it is unknown whether observed changes in social network are clinically meaningful, and loneliness measure changes do not represent clinically meaningful changes. Hearing intervention is a low-risk strategy that may help promote social connection among older adults. Trial Registration ClinicalTrials.gov Identifier: NCT03243422