Page 27 - IJPS-8-1

International Journal of
Population Studies Hearing loss, hearing aids, and cognitive function

Table 2. Mixed model estimates of age‑related changes in cognitive function associated with self‑reported hearing loss and
hearing aid use in U.S. older adults, HRS 1998 – 2018
Non‑Hispanic White (n=15,319) Non‑Hispanic Black (n=3,235) Hispanic (n=1,991)
Age −0.11 (0.01)*** −0.14 (0.02)*** −0.10 (0.03)***
Age 2 −0.01 (0.00)*** −0.01 (0.00)*** −0.01 (0.00)***
Hearing loss −0.24 (0.03)*** −0.32 (0.06)*** −0.13 (0.05)**
Age*Hearing loss 0.01 (0.00)*** 0.02 (0.01)*
Hearing aid −0.84 (0.14)*** −0.14 (0.22) −1.82 (0.50)***
Age*Hearing aid 0.08 (0.03)** 0.29 (0.10)**
Age *Hearing aid −0.00 (0.00)* −0.01 (0.00)*
2
Constant 17.46 (0.18)*** 13.93 (0.40)*** 16.82 (0.36)***
Random-effects parameters
Variance (age) 0.05 (0.00) 0.04 (0.00) 0.05 (0.01)
Variance (intercept) 7.22 (0.18) 11.34 (0.52) 10.84 (0.62)
Covariance (age, intercept) −0.16 (0.02) −0.20 (0.04) −0.24 (0.05)
Residual variance 7.57 (0.05) 9.03 (0.14) 8.18 (0.16)
BIC 371,899.30 71,148.27 43,088.90
AIC 371,569.60 70,894.50 42,844.77
HRS, Health and Retirement Study; BIC, Bayesian information criterion; AIC, Akaike information criterion. All models included sex, marital status,
household size, geographic region, education, employment, wealth, smoking status, alcohol consumption, ADLs, disease diagnoses, and indicators for
attrition (mortality during the study and number of waves present). *P<0.05, **P<0.01, ***P<0.001.

function than those who reported better hearing, that the magnitude of the health differential remains stable
regardless of race or ethnicity. Much of the previous across age (Haas and Rohlfsen, 2010).
research examining longitudinal changes in hearing Finally, the findings for hearing aid use differed by
loss and cognitive status has assessed hearing ability at racial/ethnic group. The results suggested that wearing
only one point in time (Alattar, Bergstrom, Laughlin, hearing aids may be protective for White older adults in
et al., 2019; Deal, Betz, Yaffe, et al., 2017; Deal, Sharrett, slowing cognitive decline among those in the early old age.
Albert, et al., 2015; Ge, McConnell, Wu, et al., 2021; Lin, This general finding is consistent with previous research
Yaffe, Xia, et al., 2013), thus limiting our understanding showing that individuals experience a more gradual
of age-related changes in hearing status and cognition. In decrease in episodic memory decline after beginning to
addition, studies that have included multiple measures of wear hearing aids compared to before (Maharani, Dawes,
both hearing and cognitive function (Maharani, Dawes, Nazroo, et al., 2018a). Hearing aid use appears particularly
Nazroo, et al., 2018b; 2019) did not account for differences beneficial for Hispanics – those who report either excellent
related to race and/or ethnicity. Our analysis extends this or poor aided hearing experience a small improvement
research by showing that the association between hearing in cognitive functioning from ages 65 to 75. In contrast,
and cognition is patterned differently by race/ethnicity. our results suggest that self-reported hearing aid use is not

Although hearing loss has a negative association with particularly impactful for cognitive functioning among
cognitive function at baseline (age 65) for all three groups, Black adults. We suspect this finding may be due, in part,
the impact of hearing loss on cognitive decline wanes to the relatively low prevalence of hearing aid use among
with age for both White and Black adults. This pattern is Black adults (5.5%), which has been well documented.
generally consistent with the age-as-leveler hypothesis The research has shown that the average delay in adopting
(House, Lepkowski, Kinney, et al., 1994), which suggests hearing aids following hearing aid candidacy is nearly
that stressors (e.g., hearing loss) may be more impactful 10 years, ranging from 8.6 years for White adults to
for health (e.g., cognition) at earlier ages, but dimmish at 15.2 years for non-White adults (Simpson, Matthews,
older ages. For Hispanic older adults, however, we found Cassarly, et al., 2019). Thus, the low/delayed adoption
that the association between level of hearing and cognitive of hearing aids among Black adults may result in these
function persisted across age. This pattern is consistent individuals missing the cognitive benefits associated with
with the notion of persistent inequality, which suggests hearing aids.

Volume 8 Issue 1 (2022) 21 https://doi.org/10.36922/ijps.v8i1.1308