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Hearing loss and falls


Objectively measured hearing loss appears to be associated with a self-reported history of falling, researchers found.

For every 10-decibel increase in hearing loss, the odds of having fallen in the previous year were higher, even after adjustment for potential confounders (OR 1.6, 95% CI 1.2 to 1.9), according to Frank Lin, MD, PhD, of Johns Hopkins University, and Luigi Ferrucci, MD, PhD, of the National Institute on Aging, both in Baltimore.

"Further prospective research is needed to determine whether hearing loss is a modifiable risk factor for falls that may be amenable to hearing rehabilitative strategies that remain underused," they wrote in a research letter in the Feb. 27 issue ofArchives of Internal Medicine.

Although the study could not establish a causal relationship between hearing loss and falling, the possibility that it exists is important because hearing loss is common but undertreated in older adults. A recent study by Lin and another colleague showed that only 14% of older adults with hearing loss used a hearing aid.

In the current study, Lin and Ferrucci examined data from the National Health and Nutrition Examination Survey (NHANES) collected from 2001 to 2004. The analysis included 2,017 participants ages 40 to 69, all of whom underwent audiometric testing and objective vestibular balance testing and completed an interviewer-administered questionnaire on fall history in the preceding year.

Overall, 14.3% of the participants had a hearing loss greater than 25 decibels, and 4.9% reported falling in the year before the survey.

In an unadjusted model, every 10-decibel increase in hearing loss was associated with a 40% increase in the likelihood of reporting a fall. The relationship remained the same after adjustment for age, sex, race, education, smoking, diabetes, hypertension, and stroke.

Further adjustment for vestibular balance function -- which has also been associated with falling -- slightly strengthened the magnitude of the association.

Restricting the analysis to participants with a hearing loss of 40 decibels or less -- which excluded those with moderate or severe hearing loss -- did not change the results.

The findings are consistent with previous studies that have used both subjective and objective assessments of hearing loss. Not all studies have shown such a relationship, however, possibly because of differences in methodology, according to the researchers.

They noted that if there is a causal relationship between hearing loss and falling, possible mechanisms could include concomitant dysfunction of the cochlear and vestibular sense organs, which are both found in the inner ear; limited awareness of the surrounding environment caused by missing some auditory cues; or effects on cognitive load and shared attention, which are involved in postural control.

Lin and Ferrucci acknowledged that the cross-sectional design and the use of retrospective self-report for the assessment of fall history were limitations of the study.

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