The effect of hearing aids on mortality
Authors: Katharine K Brewster, Carly Maitlin
Journal: The Lancet Healthy Longevity (2024)

Hearing loss is a common and undertreated health condition in older adults that has been consistently associated with cognitive decline, dementia, and poor physical health.1Huang AR Jiang K Lin FR Deal JA Reed NS Hearing loss and dementia prevalence in older adults in the US.JAMA. 2023; 329: 171-173Crossref Scopus (14) Google Scholar, 2Martinez-Amezcua P Powell D Kuo PL et al.Association of age-related hearing impairment with physical functioning among community-dwelling older adults in the US.JAMA Netw Open. 2021; 4e2113742Crossref PubMed Scopus (35) Google Scholar Fortunately, hearing aids can now be obtained over the counter for individuals with perceived mild-moderate hearing loss, both reducing financial barriers and improving accessibility to hearing care for many Americans. Yet, it remains poorly understood whether rehabilitation with hearing aids can reduce the risk of mortality and improve overall physical health. Janet S Choi and colleagues3Choi JS Adams ME Crimmins EM Lin FR Ailshire JA Association between hearing aid use and mortality in adults with hearing loss in the USA: a mortality follow-up study of a cross-sectional cohort.Lancet Healthy Longev. 2024; 5: e66-e75Google Scholar used data from a study cohort in the US National Health and Nutrition Examination Survey to evaluate the association between hearing aid use and all-cause mortality. They observed a dose–response relationship between hearing loss and mortality risk, in which more severe hearing loss was associated with higher risk of mortality. In parallel, after adjusting for demographics, medical history, and level of hearing loss risk, they also found that mortality risk was lower among regular hearing aid users than in never users. Overall, these results suggest that wearing hearing aids consistently might contribute to a reduced mortality risk. Consistent with this hypothesis, they found no difference in adjusted mortality risk between non-regular hearing aid users and never users. Such findings are supported by several previous epidemiological studies revealing an association between hearing loss and all-cause mortality.3Choi JS Adams ME Crimmins EM Lin FR Ailshire JA Association between hearing aid use and mortality in adults with hearing loss in the USA: a mortality follow-up study of a cross-sectional cohort.Lancet Healthy Longev. 2024; 5: e66-e75Google Scholar, 4Liljas AE Wannamethee SG Whincup PH et al.Hearing impairment and incident disability and all-cause mortality in older British community-dwelling men.Age Ageing. 2016; 45: 662-667Crossref PubMed Scopus (30) Google Scholar However, studies examining the links between hearing aid use and reduced mortality have been mixed;4Liljas AE Wannamethee SG Whincup PH et al.Hearing impairment and incident disability and all-cause mortality in older British community-dwelling men.Age Ageing. 2016; 45: 662-667Crossref PubMed Scopus (30) Google Scholar, 5Amieva H Ouvrard C Meillon C Rullier L Dartigues JF Death, depression, disability, and dementia associated with self-reported hearing problems: a 25-year study.J Gerontol A Biol Sci Med Sci. 2018; 73: 1383-1389Crossref PubMed Scopus (87) Google Scholar, 6Dawes P Cruickshanks KJ Fischer ME Klein BE Klein R Nondahl DM Hearing-aid use and long-term health outcomes: hearing handicap, mental health, social engagement, cognitive function, physical health, and mortality.Int J Audiol. 2015; 54: 838-844Crossref PubMed Google Scholar, 7Jiang F Mishra SR Shrestha N et al.Association between hearing aid use and all-cause and cause-specific dementia: an analysis of the UK Biobank cohort.Lancet Public Health. 2023; 8: e329-e338Summary Full Text Full Text PDF PubMed Scopus (17) Google Scholar while some have found an association between hearing aid use and reduced mortality risk, others have found no protective effects of hearing aids. Compared with these previous studies, strengths of Choi and colleagues' study include the long follow-up period (median 10·4 years [range 0·1–20·8]) and the use of objective audiometric testing, as opposed to self-reported hearing loss, which can be subject to bias. Another strength is the evaluation of hearing aid compliance, as hearing aid use rates are typically low. However, the mechanism behind the association between hearing aids and reduced mortality remains to be elucidated. For example, it is possible that individuals with access to hearing care are healthier and have a higher socioeconomic status, which are factors that might be independently associated with reduced risk of mortality.8McKee MM Choi H Wilson S DeJonckheere MJ Zazove P Levy H Determinants of hearing aid use among older Americans with hearing loss.Gerontologist. 2019; 59: 1171-1181Crossref Scopus (30) Google Scholar Alternatively, given the consistent links between hearing loss and cognitive decline, another plausible explanation for this association is that hearing aids improve mortality risk by reducing the risk of dementia. However, a recently published, large randomised controlled trial (ACHIEVE) found that hearing aids did not reduce 3-year cognitive decline.9Lin FR Pike JR Albert MS et al.Hearing intervention versus health education control to reduce cognitive decline in older adults with hearing loss in the USA (ACHIEVE): a multicentre, randomised controlled trial.Lancet. 2023; 402: 786-797Summary Full Text Full Text PDF PubMed Scopus (10) Google Scholar Finally, hearing treatment might improve mortality risk by improving loneliness, depression, and frailty, all of which are risk factors for poor health.10Shukla A Harper M Pedersen E et al.Hearing loss, loneliness, and social isolation: a systematic review.Otolaryngol Head Neck Surg. 2020; 162: 622-633Crossref PubMed Scopus (203) Google Scholar Given the inconsistent results in the literature, further studies are needed to evaluate whether, and how, hearing aids might reduce mortality risk. Longitudinal studies measuring audiometric hearing loss, hearing aid use, comprehensive neuropsychological evaluations, and potential confounders could further investigate the effects of hearing aids on mortality. Further randomised controlled trials can also be conducted to evaluate the effects of hearing loss on health outcomes. For example, although the ACHIEVE study found no improvement in cognition in the combined cohort, they observed a 48% reduction in cognitive decline following hearing aid use in a study subgroup at increased risk of impairment.9Lin FR Pike JR Albert MS et al.Hearing intervention versus health education control to reduce cognitive decline in older adults with hearing loss in the USA (ACHIEVE): a multicentre, randomised controlled trial.Lancet. 2023; 402: 786-797Summary Full Text Full Text PDF PubMed Scopus (10) Google Scholar As such, it would be interesting to evaluate the effects of hearing aids in a clinical trial among individuals with pre-existing cognitive decline or poor physical health, who are at heightened risk of functional decline and mortality. Evaluating the effects of hearing aids in a high-risk population might better identify the protective effect of hearing aids. Overall, results from Choi and colleagues found that hearing aids might be associated with increased mortality, and this risk could be mitigated by consistent hearing aid use. However, replication of these results is needed to understand whether hearing loss is a modifiable risk factor for mortality and dementia. Larger longitudinal studies and randomised controlled studies, studying populations at a heightened risk of poor health outcomes, would be useful to evaluate the effect of hearing aid use on cognitive, physical, and mental functioning in older adults. KKB reports a Brain and Behavior Research Foundation–Young Investigator Award. Association between hearing aid use and mortality in adults with hearing loss in the USA: a mortality follow-up study of a cross-sectional cohortRegular hearing aid use was associated with lower risks of mortality than in never users in US adults with hearing loss when accounting for age, hearing loss, and other potential confounders. Future research is needed to investigate the potential protective role of hearing aid use against mortality for adults with hearing loss. Full-Text PDF Open Access