Hearing Loss, Loneliness, and Social Isolation: A Systematic Review
Aishwarya Shukla MPH
Johns Hopkins School of Medicine, Baltimore, Maryland, USA
Johns Hopkins Cochlear Center for Hearing and Public Health, Baltimore, Maryland, USA
Search for more papers by this authorMichael Harper
Johns Hopkins School of Medicine, Baltimore, Maryland, USA
Search for more papers by this authorEmily Pedersen MPH
Johns Hopkins Cochlear Center for Hearing and Public Health, Baltimore, Maryland, USA
Search for more papers by this authorAdele Goman PhD
Johns Hopkins Cochlear Center for Hearing and Public Health, Baltimore, Maryland, USA
Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
Search for more papers by this authorJonathan J. Suen AuD
Johns Hopkins Cochlear Center for Hearing and Public Health, Baltimore, Maryland, USA
Johns Hopkins School of Nursing, Baltimore, Maryland, USA
Search for more papers by this authorCarrie Price MLS
Welch Medical Library, Johns Hopkins University, Baltimore, Maryland, USA
Search for more papers by this authorJeremy Applebaum
Johns Hopkins School of Medicine, Baltimore, Maryland, USA
Search for more papers by this authorMatthew Hoyer
Johns Hopkins School of Medicine, Baltimore, Maryland, USA
Search for more papers by this authorFrank R. Lin MD, PhD
Johns Hopkins Cochlear Center for Hearing and Public Health, Baltimore, Maryland, USA
Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
Department of Otolaryngology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
Search for more papers by this authorCorresponding Author
Nicholas S. Reed AuD
Johns Hopkins Cochlear Center for Hearing and Public Health, Baltimore, Maryland, USA
Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
Department of Otolaryngology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
Nicholas S. Reed, AuD, Department of Otolaryngology, Johns Hopkins School of Medicine, 2024 East Monument Street, Suite 2-700, Baltimore, MD 21211, USA. Email: [email protected]Search for more papers by this authorAishwarya Shukla MPH
Johns Hopkins School of Medicine, Baltimore, Maryland, USA
Johns Hopkins Cochlear Center for Hearing and Public Health, Baltimore, Maryland, USA
Search for more papers by this authorMichael Harper
Johns Hopkins School of Medicine, Baltimore, Maryland, USA
Search for more papers by this authorEmily Pedersen MPH
Johns Hopkins Cochlear Center for Hearing and Public Health, Baltimore, Maryland, USA
Search for more papers by this authorAdele Goman PhD
Johns Hopkins Cochlear Center for Hearing and Public Health, Baltimore, Maryland, USA
Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
Search for more papers by this authorJonathan J. Suen AuD
Johns Hopkins Cochlear Center for Hearing and Public Health, Baltimore, Maryland, USA
Johns Hopkins School of Nursing, Baltimore, Maryland, USA
Search for more papers by this authorCarrie Price MLS
Welch Medical Library, Johns Hopkins University, Baltimore, Maryland, USA
Search for more papers by this authorJeremy Applebaum
Johns Hopkins School of Medicine, Baltimore, Maryland, USA
Search for more papers by this authorMatthew Hoyer
Johns Hopkins School of Medicine, Baltimore, Maryland, USA
Search for more papers by this authorFrank R. Lin MD, PhD
Johns Hopkins Cochlear Center for Hearing and Public Health, Baltimore, Maryland, USA
Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
Department of Otolaryngology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
Search for more papers by this authorCorresponding Author
Nicholas S. Reed AuD
Johns Hopkins Cochlear Center for Hearing and Public Health, Baltimore, Maryland, USA
Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
Department of Otolaryngology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
Nicholas S. Reed, AuD, Department of Otolaryngology, Johns Hopkins School of Medicine, 2024 East Monument Street, Suite 2-700, Baltimore, MD 21211, USA. Email: [email protected]Search for more papers by this authorSponsorships or competing interests that may be relevant to content are disclosed at the end of this article.
Abstract
Objective
Social isolation and loneliness are associated with increased mortality and higher health care spending in older adults. Hearing loss is a common condition in older adults and impairs communication and social interactions. The objective of this review is to summarize the current state of the literature exploring the association between hearing loss and social isolation and/or loneliness.
Data Sources
PubMed, Embase, CINAHL Plus, PsycINFO, and the Cochrane Library.
Review Methods
Articles were screened for inclusion by 2 independent reviewers, with a third reviewer for adjudication. English-language studies of older adults with hearing loss that used a validated measure of social isolation or loneliness were included. A modified Newcastle-Ottawa Scale was used to assess the quality of the studies included in the review.
Results
Of the 2495 identified studies, 14 were included in the review. Most of the studies (12/14) were cross-sectional. Despite the heterogeneity of assessment methods for hearing status (self-report or objective audiometry), loneliness, and social isolation, most multivariable-adjusted studies found that hearing loss was associated with higher risk of loneliness and social isolation. Several studies found an effect modification of gender such that among women, hearing loss was more strongly associated with loneliness and social isolation than among men.
Conclusions
Our findings that hearing loss is associated with loneliness and social isolation have important implications for the cognitive and psychosocial health of older adults. Future studies should investigate whether treating hearing loss can decrease loneliness and social isolation in older adults.
Supporting Information
| Filename | Description |
|---|---|
| ohnbf08778-sup-0001.zipZip archive, 211.4 KB | Supplementary Material |
Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.
References
- 1Hawkley LC, Cacioppo JT. Loneliness and pathways to disease. Brain Behav Immun. 2003; 17(1): 98–105.
- 2Cudjoe TK, Roth DL, Szanton SL, Wolff JL, Boyd CM, Thorpe RJ. The epidemiology of social isolation: National Health and Aging Trends Study. J Gerontol B Psychol Sci Soc Sci. 2018; 75(1): 107–113.
- 3Wenger GC, Davies R, Shahtahmasebi S, Scott A. Social isolation and loneliness in old age: review and model refinement. Ageing Soc. 1996; 16(3): 333–358.
- 4Victor CR, Bowling A. A longitudinal analysis of loneliness among older people in Great Britain. J Psychol. 2012; 146(3): 313–331.
- 5Gopinath B, Rochtchina E, Anstey KJ, Mitchell P. Living alone and risk of mortality in older, community-dwelling adults. JAMA Intern Med. 2013; 173(4): 320–321.
- 6Berkman LF, Syme SL. Social networks, host resistance, and mortality: a nine-year follow-up study of alameda county residents. Am J Epidemiol. 1979; 109(2): 186–204.
- 7Oxman TE, Berkman LF, Kasl S, Freeman DHJr, Barrett J. Social support and depressive symptoms in the elderly. Am J Epidemiol. 1992; 135(4): 356–368.
- 8Shankar A, Hamer M, McMunn A, Steptoe A. Social isolation and loneliness: relationships with cognitive function during 4 years of follow-up in the English Longitudinal Study of Ageing. Psychosom Med. 2013; 75(2): 161–170.
- 9Valtorta NK, Kanaan M, Gilbody S, Ronzi S, Hanratty B. Loneliness and social isolation as risk factors for coronary heart disease and stroke: systematic review and meta-analysis of longitudinal observational studies. Heart. 2016; 102(13): 1009–1016.
- 10Holt-Lunstad J, Smith TB, Layton JB. Social relationships and mortality risk: a meta-analytic review. PLoS Med. 2010; 7(7): e1000316.
- 11Gerst-Emerson K, Jayawardhana J. Loneliness as a public health issue: the impact of loneliness on health care utilization among older adults. Am J Public Health. 2015; 105(5): 1013–1019.
- 12Flowers L, Houser A, Noel-Miller C, et al. Medicare spends more on socially isolated older adults. Insight on the Issues. 2017; 125.
- 13Lin FR, Niparko JK, Ferrucci L. Hearing loss prevalence in the united states. Arch Intern Med. 2011; 171(20): 1851–1853.
- 14Lin FR, Yaffe K, Xia J, et al. Hearing loss and cognitive decline in older adults. JAMA Intern Med. 2013; 173(4): 293–299.
- 15Liljas AE, Carvalho LA, Papachristou E, et al. Self-reported hearing impairment and incident frailty in English community-dwelling older adults: a 4-year follow-up study. J Am Geriatr Soc. 2017; 65(5): 958–965.
- 16Deal JA, Reed NS, Kravetz AD, et al. Incident hearing loss and comorbidity: a longitudinal administrative claims study. JAMA Otolaryngol Head Neck Surg. 2018; 145(1): 36–43.
- 17Livingston G, Sommerlad A, Orgeta V, et al. Dementia prevention, intervention, and care. Lancet. 2017; 390(10113): 2673–2734.
- 18Rutherford BR, Brewster K, Golub JS, Kim AH, Roose SP. Sensation and psychiatry: linking age-related hearing loss to late-life depression and cognitive decline. Am J Psychiatry. 2017; 175(3): 215–224.
- 19Lin FR. Hearing loss in older adults: who’s listening? JAMA. 2012; 307(11): 1147–1148.
- 20Heine C, Browning CJ. The communication and psychosocial perceptions of older adults with sensory loss: a qualitative study. Ageing Soc. 2004; 24(1): 113–130.
- 21Resnick HE, Fries BE, Verbrugge LM. Windows to their world: the effect of sensory impairments on social engagement and activity time in nursing home residents. J Gerontol B Psychol Sci Soc Sci. 1997; 52(3): S13–S144.
- 22Barker AB, Leighton P, Ferguson MA. Coping together with hearing loss: a qualitative meta-synthesis of the psychosocial experiences of people with hearing loss and their communication partners. Int J Audiol. 2017; 56(5): 297–305.
- 23Chen HL. Hearing in the elderly: relation of hearing loss, loneliness, and self-esteem. J Gerontol Nurs. 1994; 20(6): 22–28.
- 24Christian E, Dluhy N. Sounds of silence coping with hearing loss and loneliness. J Gerontol Nurs. 1989; 15(11): 4–9.
- 25Kramer SE, Kapteyn TS, Kuik DJ, Deeg DJ. The association of hearing impairment and chronic diseases with psychosocial health status in older age. J Aging Health. 2002; 14(1): 122–137.
- 26Nachtegaal J, Smit JH, Smits C, et al. The association between hearing status and psychosocial health before the age of 70 years: results from an Internet-based national survey on hearing. Ear Hear. 2009; 30(3): 302–312.
- 27Pronk 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; 50(12): 887–896.
- 28Pronk M, Deeg DJ, Smits C, et al. Hearing loss in older persons: does the rate of decline affect psychosocial health? J Aging Health. 2014; 26(5): 703–723.
- 29Ramage-Morin PL. Hearing Difficulties and Feelings of Social Isolation among Canadians Aged 45 or Older. Ottawa, Canada: Statistics Canada; 2016.
- 30Sung Y, Li L, Blake C, Betz J, Lin FR. Association of hearing loss and loneliness in older adults. J Aging Health. 2016; 28(6): 979–994.
- 31Tomioka K, Ikeda H, Hanaie K, et al. The Hearing Handicap Inventory for Elderly-Screening (HHIE-S) versus a single question: reliability, validity, and relations with quality of life measures in the elderly community, Japan. Qual Life Res. 2013; 22(5): 1151–1159.
- 32Weinstein BE, Ventry IM. Hearing impairment and social isolation in the elderly. J Speech Hear Res. 1982; 25(4): 593–599.
- 33Mick P, Kawachi I, Lin FR. The association between hearing loss and social isolation in older adults. Otolaryngol Head Neck Surgery. 2014; 150(3): 378–384.
- 34Mick P, Pichora-Fuller MK. Is hearing loss associated with poorer health in older adults who might benefit from hearing screening? Ear Hear. 2016; 37(3): e19–e201.
- 35Wells TS, Nickels LD, Rush SR, et al. Characteristics and health outcomes associated with hearing loss and hearing aid use among older adults [published online May 16, 2019]. J Aging Health. doi:10.1177/0898264319848866
- 36Mick P, Parfyonov M, Wittich W, Phillips N, Pichora-Fuller MK. Associations between sensory loss and social networks, participation, support, and loneliness: analysis of the Canadian Longitudinal Study on Aging. Can Fam Physician. 2018; 64(1): e33–e41.
- 37de Jong-Gierveld J, Kamphuls F. The development of a Rasch-type loneliness scale. Appl Psychol Meas. 1985; 9(3): 289–299.
- 38Russell D, Peplau LA, Cutrona CE. The revised UCLA Loneliness Scale: concurrent and discriminant validity evidence. J Pers Soc Psychol. 1980; 39(3): 472.
- 39Peplau LA. Loneliness: A Sourcebook of Current Theory, Research, and Therapy. Vol 36. New York, NY: John Wiley & Sons; 1982.
- 40Charles ST, Carstensen LL. Social and emotional aging. Annu Rev Psychol. 2010; 61(1): 383–409.
- 41Coyle CE, Dugan E. Social isolation, loneliness and health among older adults. J Aging Health. 2012; 24(8): 1346–1363.
- 42Pichora-Fuller MK. Cognitive aging and auditory information processing. Int J Audiol. 2003; 42(suppl 2): 26–32.
10.3109/14992020309074641 Google Scholar
- 43Peelle JE, Troiani V, Grossman M, Wingfield A. Hearing loss in older adults affects neural systems supporting speech comprehension. J Neurosci. 2011; 31(35): 12638–12643.
- 44Tun PA, McCoy S, Wingfield A. Aging, hearing acuity, and the attentional costs of effortful listening. Psychol Aging. 2009; 24(3): 761.
- 45Maltz DN, Borker RA. A cultural approach to male-female miscommunication. In: L Monaghan, JE Goodman, JM Robinson, eds. A Cultural Approach to Interpersonal Communication: Essential Readings. Malden, MA: Wiley-Blackwell; 1982: 168–185.
- 46Ray J, Popli G, Fell G. Association of cognition and age-related hearing impairment in the English Longitudinal Study of Ageing. JAMA Otolaryngol Head Neck Surg. 2018; 144(10): 876–882.
- 47Golub JS, Brewster KK, Brickman AM, et al. Association of audiometric age-related hearing loss with depressive symptoms among Hispanic individuals. JAMA Otolaryngol Head Neck Surg. 2018; 145(2):132-129.
- 48Sindhusake D, Mitchell P, Smith W, et al. Validation of self-reported hearing loss: the Blue Mountains Hearing Study. Int J Epidemiol. 2001; 30(6): 1371–1378.
