Seniors at risk of dementia who were given hearing aids and counselling had less cognitive decline over a three-year period, a randomized trial finds.
Research published Monday in The Lancet medical journal found that at-risk seniors saw their rate of cognitive decline nearly cut in half over three years if they wore hearing aids, compared to seniors who just received education.
While past research has shown a link between hearing loss and cognitive decline, experts say this study supports the need for seniors to use devices to mitigate the risk.
In Canada, audiologists estimate that around three million people have some degree of hearing loss that could be improved with hearing aids, yet 80 per cent don’t wear them.
“It’s a testament that hearing intervention, it’s not just improving your hearing; there are a lot of cascading effects that we see now,” said the study’s co-principal investigator Dr. Frank Lin.
Lin, a professor at Johns Hopkins University’s School of Medicine and Bloomberg School of Public Health, says the study shows that good hearing “decreases loneliness, improves your social engagement, you become more active [and] it might take a load off your brain.”
The randomized control trial involved 977 participants, who were about 77 years old on average.
Dr. Frank Lin is the study’s lead author and a professor at the Johns Hopkins University School of Medicine and Bloomberg School of Public Health. (Submitted by Johns Hopkins University School of Medicine)
Some people were considered healthy, while others had underlying conditions like high blood pressure and diabetes, which put them at a greater risk for cognitive decline.
Participants were randomly divided into two groups: one that got hearing aids with additional counselling and another that only took part in a successful aging health education class.
Over three years, researchers measured the level of cognitive decline between the two groups.
There was no significant difference in cognition between the two groups overall, nor was there a notable difference for the healthy participants across both groups.
But when researchers looked at the results for just the participants who were at higher risk of dementia, those who got hearing aids slowed their cognitive decline by 48 per cent over the study period.
How is hearing tied to dementia?
According to Lin, researchers suspect that there are three major ways hearing loss can impact the brain.
The first, he said, is related to cognitive load, which means that there’s excessive work being done by the brain to compensate for poor hearing.
“Your brain is constantly getting a much more garbled signal from the ear,” he said. “And we understand now that likely takes a toll on the brain.”
Marilyn Reed is an audiology practice adviser at Baycrest Centre in Toronto. She says the research findings weren’t surprising, but do provide more robust support for the link between cognitive decline and hearing loss. (Jennifer La Grassa/CBC)
The brain is constantly reallocating resources to handle hearing as a result, and that might “come at the expense” of our thinking and memory, Lin said.
A second reason is that if the brain isn’t getting enough auditory input, that can cause parts of it to shrink, said Lin.
And lastly, hearing loss can cause someone to withdraw and not be as socially engaged. This is also thought to contribute to brain atrophy.
“The thing with hearing intervention [is that] it likely targets all those pathways: it reduces load on the brain, provides more stimulation to the brain, [and] at the same time, it helps you be more engaged with your life,” said Lin.
Study limits confounding factors
While these study results aren’t surprising to those in the industry, the methods used provide more robust support for the idea that hearing loss is tied to cognitive function.
There’s been a lot of research recently that shows hearing loss can be an early warning sign for potential decline, said Kathy Pichora-Fuller, a professor emeritus in psychology at the University of Toronto not involved in the study.
But what stands out to the gerontologist and audiologist is that there weren’t as many confounding factors due to the fact that participants were randomly assigned to either group.
This would mean that lifestyle factors were relatively the same between the control and intervention groups.
Typically in studies done with hearing aids, Pichora-Fuller said they compare people who have them with those who don’t.
Reed is shown speaking with a patient who wears a hearing aid. Reed says routine hearing screening should be done for people 50 and older by primary-care doctors in order to better educate people and provide earlier intervention. (Jennifer La Grassa/CBC)
But Pichora-Fuller says people who already own hearing aids are often different: they may be more motivated, socially engaged, wealthier or have a higher education. All of these factors could be what helps preserve their mental state as they age.
“Now we can compare apples to apples,” she said about the new study.
She says it’s also important to know that the participants in this study were not only given hearing aids, but also engaged in continuous audio rehabilitation with an expert.
Barriers to getting hearing aids
Even though the benefits of hearing aids have been clear for some time, those who work in the industry say patients are still reluctant to get them.
“Hearing aids do have a stigma associated with them and it’s very long-standing,” said Marilyn Reed, an audiology practice advisor at Baycrest Centre in Toronto.
“The way to overcome stigma is to really talk about the problem.”
This starts with family doctors, Reed said. Regular screening in people 50 and older in primary care, she said, can reduce shame, educate people and allow for earlier intervention.
Another barrier is cost, said Reed: The most basic hearing aids available in Canada start at around $2,000 a pair.
As for next steps with this research, Lin says they are going to continue to follow the people who started off healthy to track if they eventually see any benefit from the hearing aids.
He says they also plan to do more research on whether there are long-term cognitive benefits with hearing aids and their ability to reduce rates of dementia.
The Canadian government says it will donate up to 200,000 vaccine doses to fight the mpox outbreak in Congo and other African countries.
It says the donated doses of Imvamune will come from Canada’s existing supply and will not affect the country’s preparedness for mpox cases in this country.
Minister of Health Mark Holland says the donation “will help to protect those in the most affected regions of Africa and will help prevent further spread of the virus.”
Dr. Madhukar Pai, Canada research chair in epidemiology and global health, says although the donation is welcome, it is a very small portion of the estimated 10 million vaccine doses needed to control the outbreak.
Vaccine donations from wealthier countries have only recently started arriving in Africa, almost a month after the World Health Organization declared the mpox outbreak a public health emergency of international concern.
A few days after the declaration in August, Global Affairs Canada announced a contribution of $1 million for mpox surveillance, diagnostic tools, research and community awareness in Africa.
On Thursday, the Africa Centres for Disease Control and Prevention said mpox is still on the rise and that testing rates are “insufficient” across the continent.
Jason Kindrachuk, Canada research chair in emerging viruses at the University of Manitoba, said donating vaccines, in addition to supporting surveillance and diagnostic tests, is “massively important.”
But Kindrachuk, who has worked on the ground in Congo during the epidemic, also said that the international response to the mpox outbreak is “better late than never (but) better never late.”
“It would have been fantastic for us globally to not be in this position by having provided doses a much, much longer time prior than when we are,” he said, noting that the outbreak of clade I mpox in Congo started in early 2023.
Clade II mpox, endemic in regions of West Africa, came to the world’s attention even earlier — in 2022 — as that strain of virus spread to other countries, including Canada.
Two doses are recommended for mpox vaccination, so the donation may only benefit 100,000 people, Pai said.
Pai questioned whether Canada is contributing enough, as the federal government hasn’t said what percentage of its mpox vaccine stockpile it is donating.
“Small donations are simply not going to help end this crisis. We need to show greater solidarity and support,” he said in an email.
“That is the biggest lesson from the COVID-19 pandemic — our collective safety is tied with that of other nations.”
This report by The Canadian Press was first published Sept. 13, 2024.
Canadian Press health coverage receives support through a partnership with the Canadian Medical Association. CP is solely responsible for this content.
HALIFAX – The Nova Scotia government says it could be months before it reveals how many people are on the wait-list for a family doctor.
The head of the province’s health authority told reporters Wednesday that the government won’t release updated data until the 160,000 people who were on the wait-list in June are contacted to verify whether they still need primary care.
Karen Oldfield said Nova Scotia Health is working on validating the primary care wait-list data before posting new numbers, and that work may take a matter of months. The most recent public wait-list figures are from June 1, when 160,234 people, or about 16 per cent of the population, were on it.
“It’s going to take time to make 160,000 calls,” Oldfield said. “We are not talking weeks, we are talking months.”
The interim CEO and president of Nova Scotia Health said people on the list are being asked where they live, whether they still need a family doctor, and to give an update on their health.
A spokesperson with the province’s Health Department says the government and its health authority are “working hard” to turn the wait-list registry into a useful tool, adding that the data will be shared once it is validated.
Nova Scotia’s NDP are calling on Premier Tim Houston to immediately release statistics on how many people are looking for a family doctor. On Tuesday, the NDP introduced a bill that would require the health minister to make the number public every month.
“It is unacceptable for the list to be more than three months out of date,” NDP Leader Claudia Chender said Tuesday.
Chender said releasing this data regularly is vital so Nova Scotians can track the government’s progress on its main 2021 campaign promise: fixing health care.
The number of people in need of a family doctor has more than doubled between the 2021 summer election campaign and June 2024. Since September 2021 about 300 doctors have been added to the provincial health system, the Health Department said.
“We’ll know if Tim Houston is keeping his 2021 election promise to fix health care when Nova Scotians are attached to primary care,” Chender said.
This report by The Canadian Press was first published Sept. 11, 2024.
ST. JOHN’S, N.L. – Newfoundland and Labrador‘s chief medical officer is monitoring the rise of whooping cough infections across the province as cases of the highly contagious disease continue to grow across Canada.
Dr. Janice Fitzgerald says that so far this year, the province has recorded 230 confirmed cases of the vaccine-preventable respiratory tract infection, also known as pertussis.
Late last month, Quebec reported more than 11,000 cases during the same time period, while Ontario counted 470 cases, well above the five-year average of 98. In Quebec, the majority of patients are between the ages of 10 and 14.
Meanwhile, New Brunswick has declared a whooping cough outbreak across the province. A total of 141 cases were reported by last month, exceeding the five-year average of 34.
The disease can lead to severe complications among vulnerable populations including infants, who are at the highest risk of suffering from complications like pneumonia and seizures. Symptoms may start with a runny nose, mild fever and cough, then progress to severe coughing accompanied by a distinctive “whooping” sound during inhalation.
“The public, especially pregnant people and those in close contact with infants, are encouraged to be aware of symptoms related to pertussis and to ensure vaccinations are up to date,” Newfoundland and Labrador’s Health Department said in a statement.
Whooping cough can be treated with antibiotics, but vaccination is the most effective way to control the spread of the disease. As a result, the province has expanded immunization efforts this school year. While booster doses are already offered in Grade 9, the vaccine is now being offered to Grade 8 students as well.
Public health officials say whooping cough is a cyclical disease that increases every two to five or six years.
Meanwhile, New Brunswick’s acting chief medical officer of health expects the current case count to get worse before tapering off.
A rise in whooping cough cases has also been reported in the United States and elsewhere. The Pan American Health Organization issued an alert in July encouraging countries to ramp up their surveillance and vaccination coverage.
This report by The Canadian Press was first published Sept. 10, 2024.
