Factors Associated With Self-Perceived Hearing Handicap in Adults From Hispanic/Latino Background: Findings From the Hispanic Community Health Study/Study of Latinos.

OBJECTIVES: We sought to determine what factors, including acculturation (language and social contact preferences), were associated with self-perceived hearing handicap among adults from Hispanic/Latino background. We utilized the Aday-Andersen behavioral model of health services utilization to frame our hypotheses that predisposing characteristics (age, sex, education, city of residence, Hispanic/Latino background, and acculturation), enabling resources (annual income and current health insurance coverage), and need (measured hearing loss and self-reported hearing loss) would be related to clinically-significant self-perceived hearing handicap as measured by the Hearing Handicap Inventory - Screening (HHI-S) version. DESIGN: We analyzed baseline data collected from 2008 to 2011 as part of the multisite Hispanic Community Health Study/Study of Latinos. Data were from 6585 adults with hearing loss (defined by a worse-ear 500, 1000, 2000, and 4000 Hz pure-tone average [PTA] of ≥25 dB HL and/or a 4000, 6000, and 8000 Hz high-frequency PTA of ≥25 dB HL) aged 18 to 74 years from various Hispanic/Latino backgrounds. We conducted a series of multivariable logistic regression models examining the roles of independent variables of interest representing predisposing, enabling, and need indicators on the occurrence of clinically-significant self-perceived hearing handicap (e.g., HHI-S score > 8). RESULTS: Among included participants, 953 (14.5%) had an HHI-S score >8. The final model revealed significant associations between predisposing characteristics, enabling resources, need, and HHI-S outcome. Predisposing characteristics and need factors were associated with higher odds of reporting self-perceived hearing handicap (HHI-S score >8) including acculturation as measured by the Short Acculturation Scale for Hispanics (odds ratio [OR] = 1.28, 95% confidence interval [CI]: 1.09-1.50), female sex (OR = 1.72, 95% CI: 1.27-2.33), and poorer worse ear 500, 1000, 2000, and 4000 Hz PTA (OR = 1.02, 95% CI: 1.01-1.03); suggesting that a 5-decibel increase in a person's PTA was consistent with 10% higher odds of a HHI-S score of >8. Greater enabling resources were associated with lower odds of reporting clinically-significant self-perceived hearing handicap: compared with individuals with income <$10,000/year, the multivariable-adjusted OR among individuals with income $40,000 to $7500/year was 0.55 (95% CI: 0.33-0.89) and among individuals with income >$75,000/year was 0.28 (95% CI: 0.13-0.59]; p-trend < 0.0001). CONCLUSIONS: Our findings suggest there are associations between predisposing, enabling and need variables consistent with the Aday-Andersen model and self-perceived hearing handicap among adults from Hispanic/Latino background. The influence of language and culture on perceived hearing loss and associated handicap is complex, and deserves more attention in future studies. Our findings warrant further investigation into understanding the role of language and language access in hearing health care utilization and outcomes, as the current body of literature is small and shows mixed outcomes.

Hearing Aid Prevalence and Factors Related to Use Among Older Adults From the Hispanic Community Health Study/Study of Latinos.

Importance: Hearing loss is highly prevalent in the rapidly growing and aging Hispanic/Latino population in the United States. However, little is known or understood about hearing aid use among US adults from Hispanic/Latino backgrounds. Objective: To describe hearing aid prevalence and factors associated with hearing aid use among US adults of Hispanic/Latino backgrounds. Design, Setting, and Participants: Cross-sectional data were collected between 2008 and 2011 from 4 field centers (Bronx, New York; Chicago, Illinois; Miami, Florida; and San Diego, California) as part of the multisite Hispanic Community Health Study/Study of Latinos. Included individuals were adults aged 45 to 76 years with hearing loss (pure-tone average ≥25 dB HL) from randomly selected households in the 4 field centers and were from self-reported Hispanic/Latino backgrounds, including Central American, Cuban, Dominican, Mexican, Puerto Rican, South American, and mixed or other backgrounds. Analysis, including age- and background-weighted prevalence estimates and multivariate logistic regression using survey methodology, was conducted from 2017 to 2018. Main Outcomes and Measures: The primary outcome of interest was self-reported hearing aid use. The a priori hypothesis was that hearing aid prevalence estimates among included Hispanic/Latino adults would be less than recently published estimates of the general US population, and that poorer hearing, higher perceived need, older age, and higher acculturation would be associated with hearing aid use. Results: Of 1898 individuals with hearing loss, 1064 (56.1%) were men, and the mean (SE) age was 60.3 (0.3) years. A total of 87 (4.6%) included individuals reported hearing aid use. Increased odds of self-reported use was associated with poorer measured hearing (odds ratio [OR], 1.06; 95% CI, 1.03-1.09), higher Hearing Handicap Inventory-Screening scores (OR, 1.06; 95% CI, 1.03-1.08), access to health insurance coverage (OR, 2.30; 95% CI, 1.20-4.37), and place of residence (OR, 2.42; 95% CI, 1.17-5.02) in an adjusted logistic regression model. Conclusions and Relevance: Findings revealed underuse of hearing aids among adults from Hispanic/Latino backgrounds. A primary factor related to use was lack of health insurance, which suggests that access influenced hearing aid use. Changes to policy and clinical service provision are needed to increase hearing aid use among aging Hispanic/Latino adults in the United States.

Can Nutrition or Inflammation Moderate the Age-Cognition Association Among Older Adults?

Objectives: Previous research has shown that nutrition can influence cognitive abilities in older adults. We examined whether nutritional factors or inflammatory biomarkers moderate the age-cognition association. Method: Analyses included 1,308 participants (age ≥60) from the National Health and Nutrition Examination Survey III. Macronutrients (% of calories from fat, protein, and carbohydrates), micronutrients/amino acids (blood serum values: Vitamins B12, C, D, E, folate, iron, homocysteine, and ß-carotene), and inflammatory biomarkers (serum C-reactive protein, plasma fibrinogen, and serum ferritin) were examined as moderators with cognition. Cognition was measured by six tasks: immediate and delayed story recall, immediate and delayed word memory, digit subtraction, and questions about place/orientation. Results: Higher values of serum folate were significantly associated with better cognitive scores. Specifically, the interaction between age-cognition and folate indicated the associations of higher age and lower global cognition and lower immediate story recall were weaker in those with higher folate values (p's < .05). A significant interaction between age and plasma fibrinogen indicated that the association between age and worse digit subtraction was stronger with values >3.1 g/L. Discussion: Folate and fibrinogen were significant moderators between age and cognition. Further research into the relationship between nutrition, inflammation, and cognitive aging is needed.

Nutraceutical intervention improves older adults' cognitive functioning.

Interventions to improve the cognitive health of older adults are of critical importance. In the current study, we conducted a double-blind, placebo-controlled clinical trial using a pill-based nutraceutical (NT-020) that contained a proprietary formulation of blueberry, carnosine, green tea, vitamin D3, and Biovin to evaluate the impact on changes in multiple domains of cognitive functioning. One hundred and five cognitively intact adults aged 65-85 years of age (M=73.6 years) were randomized to receive NT-020 (n=52) or a placebo (n=53). Participants were tested with a battery of cognitive performance tests that were classified into six broad domains--episodic memory, processing speed, verbal ability, working memory, executive functioning, and complex speed at baseline and 2 months later. The results indicated that persons taking NT-020 improved significantly on two measures of processing speed across the 2-month test period in contrast to persons on the placebo whose performance did not change. None of the other cognitive ability measures were related to intervention group. The results also indicated that the NT-020 was well tolerated by older adults, and the presence of adverse events or symptoms did not differ between the NT-020 and placebo groups. Overall, the results of the current study were promising and suggest the potential for interventions like these to improve the cognitive health of older adults.

How activation, entanglement, and searching a semantic network contribute to event memory.

Free-association norms indicate that words are organized into semantic/associative neighborhoods within a larger network of words and links that bind the net together. We present evidence indicating that memory for a recent word event can depend on implicitly and simultaneously activating related words in its neighborhood. Processing a word during encoding primes its network representation as a function of the density of the links in its neighborhood. Such priming increases recall and recognition and can have long-lasting effects when the word is processed in working memory. Evidence for this phenomenon is reviewed in extralist-cuing, primed free-association, intralist-cuing, and single-item recognition tasks. The findings also show that when a related word is presented in order to cue the recall of a studied word, the cue activates the target in an array of related words that distract and reduce the probability of the target's selection. The activation of the semantic network produces priming benefits during encoding, and search costs during retrieval. In extralist cuing, recall is a negative function of cue-to-distractor strength, and a positive function of neighborhood density, cue-to-target strength, and target-to-cue strength. We show how these four measures derived from the network can be combined and used to predict memory performance. These measures play different roles in different tasks, indicating that the contribution of the semantic network varies with the context provided by the task. Finally, we evaluate spreading-activation and quantum-like entanglement explanations for the priming effects produced by neighborhood density.

A Comparison of Cognitive and Everyday Functional Performance among Older Adults With and Without Hypertension.

Secondary data analyses examined the differences in cognitive and instrumental activities of daily living (IADL) performance among hypertensive individuals taking one of four classes of antihypertensive medications, hypertensive individuals not taking any antihypertensive medications, and normotensive individuals (N=770). After adjusting for covariates, significant group differences were evident on all measures (speed of processing, motor speed, reaction time, ps < .05) except memory and Timed IADL (ps > .05). Follow-up a priori planned comparisons compared hypertensive individuals not on medications to each of the four antihypertensive medication groups. Results indicated that only those on beta blockers (BB) were significantly slower in speed of processing (ps < .05). A priori planned comparisons also revealed that normotensive individuals had better cognitive performance on measures of processing speed, motor speed, and reaction time than hypertensive individuals regardless of antihypertensive medication use. Additionally, normotensive individuals performed significantly better on memory (Digit and Spatial Span) than individuals with hypertension on medications. No differences were found between groups on memory (Hopkins Verbal Learning Test) or Timed IADL performance. With regard to antihypertensive medications, the use of BBs was associated with slowed processing speed. These analyses provide empirical evidence that hypertension primarily impacts speed of processing, but not severe enough to affect IADL performance. Given the contribution of processing speed to memory and executive function performance, this is an important finding. Clinicians need to take into consideration the potential negative impact that BBs may have on cognition when determining the best treatment of hypertension among older adult patients.

Negative life events and cognitive performance in a population of older adults.

OBJECTIVE: This study examined the association between negative life events in the past year and cognitive performance in a population of older adults. METHODS: Secondary data analysis was conducted on 428 participants from the Charlotte County Healthy Aging Study. Participants completed tests of episodic memory, attention, and psychomotor speed and endorsed the presence and severity of 24 life events. Life events were examined in the aggregate as well as individually. RESULTS: Hierarchical multiple regression results suggest no significant relationship between the aggregate frequency and severity measures of negative life events and cognitive performance. At the individual-event level, individuals who experienced the injury or illness of a friend during the past year and rated it as having more of an effect on their lives performed better on all three cognitive tasks. However, individuals who reported having less money to live on over the past year and rated the event as having more of an effect on their lives performed more poorly on the psychomotor speed tasks. DISCUSSION: The findings support previous research indicating that using estimates of individual stressors rather than aggregate stress measures increases the predictive validity of stress measurement. Furthermore, the individual negative life events can have both a positive and a negative effect, which nullify one another when using the sum score of events.

The University of South Florida free association, rhyme, and word fragment norms.

Preexisting word knowledge is accessed in many cognitive tasks, and this article offers a means for indexing this knowledge so that it can be manipulated or controlled. We offer free association data for 72,000 word pairs, along with over a million entries of related data, such as forward and backward strength, number of competing associates, and printed frequency. A separate file contains the 5,019 normed words, their statistics, and thousands of independently normed rhyme, stem, and fragment cues. Other files provide n x n associative networks for more than 4,000 words and a list of idiosyncratic responses for each normed word. The database will be useful for investigators interested in cuing, priming, recognition, network theory, linguistics, and implicit testing applications. They also will be useful for evaluating the predictive value of free association probabilities as compared with other measures, such as similarity ratings and co-occurrence norms. Of several procedures for measuring preexisting strength between two words, the best remains to be determined. The norms may be downloaded from www.psychonomic.org/archive/.

Are implicitly activated associates selectively activated?

What constitutes a word's associative past? Words differ in how many associates they activate in memory and, following a brief encounter, those with fewer associates are more likely to be recalled in the presence of related cues. The issue addressed in the present article is whether associative set size effects are produced through the selective activation of strong associates or through the activation of both strong and weak associates. The set size of the strongest associates was varied factorially with the set size of the associates of these associates. We assume that associate set size indexes a word's weaker associates. Experiments 1 and 2 showed that recall varied inversely with both target and associate set sizes. Such results held over variations in study time and participant age. Experiment 3 showed that weak associates of the target had a greater effect on recall when there were more connections among the strongest associates in the set. The findings suggest that activation is not strength selective but includes both weak and strong associates.

Spreading activation or spooky action at a distance?

How do preexisting connections among a word's associates facilitate its cued recall and recognition? A spreading-activation model assumes activation spreads to, among, and from a studied word's associates, and that its return is what strengthens its representation. An activation-at-a-distance model assumes strengthening is produced by the synchronous activation of the word's associates. The spread model predicts that connections among the studied word's associates will have a greater effect on memory when more of its associates return activation. The distance model predicts that total connections are important, not their direction. The results of cued recall experiments supported the distance model in showing that that connections among the associates facilitated recall regardless of the number of returning connections.