Strategies used during the cognitive evaluation of older adults with dual sensory impairment: a scoping review.

BACKGROUND: Dual sensory impairment (DSI), the combination of visual and hearing impairments, is associated with increased risk for age-related cognitive decline and dementia. Administering cognitive tests to individuals with sensory impairment is challenging because most cognitive measures require sufficient hearing and vision. Considering sensory limitations during cognitive test administration is necessary so that the effects of sensory and cognitive abilities on test performance can be differentiated and the validity of test results optimized. OBJECTIVE: To review empirical strategies that researchers have employed to accommodate DSI during cognitive testing of older adults. METHODS: Seven databases (MEDLINE, Embase, Web of Science, CINAHL, PsycINFO, Global Health and the Evidence-Based Medicine Reviews databases) were searched for relevant articles integrating the three concepts of cognitive evaluation, aging, and DSI. Given the inclusion criteria, this scoping review included a total of 67 papers. RESULTS: Twenty-eight studies reported five categories of strategies for cognitive testing of older adult participants with DSI: the assistance of experts, the modification of standardized test scoring procedures, the use of communication strategies, environmental modifications, and the use of cognitive tests without visual and/or auditory items. CONCLUSIONS: The most used strategy reported in the included studies was drawing on the assistance of team members from related fields during the administration and interpretation of cognitive screening measures. Alternative strategies were rarely employed. Future research is needed to explore the knowledge-to-practice gap between research and current clinical practice, and to develop standardized testing strategies.

Associations Between Cardiovascular Risk Factors and Audiometric Hearing: Findings From the Canadian Longitudinal Study on Aging.

OBJECTIVES: The objectives of the study were to determine, among a population-based sample of Canadian adults, if risk factors for cardiovascular disease (alone and in combination) were associated with hearing loss. Cross-sectional and longitudinal associations (the latter with about 3 years of follow-up) were examined. Risk factors considered included diabetes, dyslipidemia, hypertension, obesity, and smoking. We also aimed to determine if associations were modified by sex and age group (45 to 54, 55 to 64, 65 to 74, and 75 to 86 years old at baseline). DESIGN: A secondary analysis of data collected for the Canadian Longitudinal Study on Aging was performed. Data were collected in two waves, the first between 2012 and 2015, and the second between 2015 and 2018. Hearing was measured using screening air-conduction pure-tone audiometry. The outcome of interest was defined as the mid-frequency (1000, 2000, 3000, and 4000 Hz) pure-tone average for both ears. Diabetes was defined based on self-reported physician diagnosis, use of diabetes medications, or a hemoglobin A1c level ≥6.5%. Dyslipidemia was determined by blood lipid profile as defined using the Canadian guidelines for the diagnosis and treatment of dyslipidemia (low-density lipoprotein cholesterol ≥3.5 mmol/L or non-high-density lipoprotein cholesterol ≥4.3 mmol/L). Hypertension was determined by self-reported physician diagnosis or an average systolic blood pressure ≥140 mm Hg or an average diastolic blood pressure ≥90 mm Hg. Obesity was defined as a waist-to-height ratio ≥0.6. Smoking history was determined by self-report (current/former/never-smoker). Two composite measures of cardiovascular risk were also constructed: a count of the number of risk factors and a general cardiovascular risk profile (Framingham) score. Independent associations between risk factors for cardiovascular disease and hearing were determined using multivariable regression models. Survey weights were incorporated into the analyses. All results were disaggregated by sex. Effect modification according to age was determined using multiplicative interaction terms between the age group and each of the risk factor variables. A complete case (listwise deletion) approach was performed for the primary analysis. We then repeated the multivariable regression analyses using multiple imputation using chained equations to determine if the different approaches to dealing with missing data qualitatively changed the outcomes. RESULTS: In longitudinal analyses, hypertension and the general cardiovascular risk profile score were associated with greater loss of hearing over the 3-year follow-up period for both sexes. In addition, smoking in males and obesity in females were associated with faster rates of hearing decline. In cross-sectional analyses, smoking, obesity, diabetes, and composite measures were each independently associated with worse hearing for both sexes (although for females, obesity was only associated with hearing loss in the 55 to 64-year-old age group). The results were similar for the complete case and multiple imputation approaches, but more cross-sectional associations were observed using multiple imputation. CONCLUSIONS: Diabetes, obesity, hypertension, and smoking were associated with hearing loss. Higher combinations of risk factors increased the risk of hearing loss. Further studies are needed to confirm age and sex differences and whether interventions to address these risk factors could slow the progression of hearing loss in older adults.

Word recognition for temporally and spectrally distorted materials: the effects of age and hearing loss.

OBJECTIVES: The purpose of Experiment 1 was to measure word recognition in younger adults with normal hearing when speech or babble was temporally or spectrally distorted. In Experiment 2, older listeners with near-normal hearing and with hearing loss (for pure tones) were tested to evaluate their susceptibility to changes in speech level and distortion types. The results across groups and listening conditions were compared to assess the extent to which the effects of the distortions on word recognition resembled the effects of age-related differences in auditory processing or pure-tone hearing loss. DESIGN: In Experiment 1, word recognition was measured in 16 younger adults with normal hearing using Northwestern University Auditory Test No. 6 words in quiet and the Words-in-Noise test distorted by temporal jittering, spectral smearing, or combined jittering and smearing. Another 16 younger adults were evaluated in four conditions using the Words-in-Noise test in combinations of unaltered or jittered speech and unaltered or jittered babble. In Experiment 2, word recognition in quiet and in babble was measured in 72 older adults with near-normal hearing and 72 older adults with hearing loss in four conditions: unaltered, jittered, smeared, and combined jittering and smearing. RESULTS: For the listeners in Experiment 1, word recognition was poorer in the distorted conditions compared with the unaltered condition. The signal to noise ratio at 50% correct word recognition was 4.6 dB for the unaltered condition, 6.3 dB for the jittered, 6.8 dB for the smeared, 6.9 dB for the double-jitter, and 8.2 dB for the combined jitter-smear conditions. Jittering both the babble and speech signals did not significantly reduce performance compared with jittering only the speech. In Experiment 2, the older listeners with near-normal hearing and hearing loss performed best in the unaltered condition, followed by the jitter and smear conditions, with the poorest performance in the combined jitter-smear condition in both quiet and noise. Overall, listeners with near-normal hearing performed better than listeners with hearing loss by ~30% in quiet and ~6 dB in noise. In the quiet distorted conditions, when the level of the speech was increased, performance improved for the hearing loss group, but decreased for the older group with near-normal hearing. Recognition performance of younger listeners in the jitter-smear condition and the performance of older listeners with near-normal hearing in the unaltered conditions were similar. Likewise, the performance of older listeners with near-normal hearing in the jitter-smear condition and the performance of older listeners with hearing loss in the unaltered conditions were similar. CONCLUSIONS: The present experiments advance our understanding regarding how spectral or temporal distortions of the fine structure of speech affect word recognition in older listeners with and without clinically significant hearing loss. The Speech Intelligibility Index was able to predict group differences, but not the effects of distortion. Individual differences in performance were similar across all distortion conditions with both age and hearing loss being implicated. The speech materials needed to be both spectrally and temporally distorted to mimic the effects of age-related differences in auditory processing and hearing loss.

Do circadian rhythms affect adult age-related differences in auditory performance?

Time-of-day effects have been identified as a possible confound in research on age-related differences in cognitive performance. Circadian rhythms have been related to time-of-day variations in sensory measures; however, more is known about the effect of circadian rhythms on vision than on hearing, and virtually nothing is known about whether time-of-day effects are potential confounds in studies of auditory aging. The purpose of the current study was to determine whether age-related differences in performance on auditory tasks are affected by time of day. A set of four auditory experiments was repeated three times over the course of one day with a group of Evening-type younger adults and a group of Morning-type older adults. The results replicated previous findings of age-related differences, but time of day did not affect the basic results. Thus, time of day does not confound the results observed in typical laboratory experiments investigating auditory aging.

The effect of hearing loss and hearing aids on the use of information and communication technologies by community-living older adults.

Innovations in information and communication technologies are changing society, but only 1 in 15 Canadian seniors used a computer at the turn of the millennium (Statistics Canada, 2000). Furthermore, about 1 in 5 Canadian seniors has difficulty hearing, seeing, or communicating. The primary goal of the study was to investigate the relationship between hearing impairment and the use of information and communication technologies by older adults. A questionnaire about use of technologies was administered to 135 older adults and hearing was measured using audiometry. Hearing was found to be related to the extent of use of communication technologies, especially newer and more specialized technologies. Those with hearing loss who did not use a hearing aid did not use other technologies as much as peers with good hearing or hearing-aid users. Overall, the extent of and ability to use information and communication technologies was greater for the study sample than in previous findings for a national sample; however, the patterns of usage of various technologies and the factors influencing use were similar in the two samples. Recommendations are made for future research, health education programs, and universal design.

Effect of age on F0 difference limen and concurrent vowel identification.

PURPOSE: To investigate the effect of age on voice fundamental frequency (F0) difference limen (DL) and identification of concurrently presented vowels. METHOD: Fifteen younger and 15 older adults with normal audiometric thresholds in the speech range participated in 2 experiments. In Experiment 1, F0 DLs were measured for a synthesized vowel. In Experiment 2, accuracy in identifying concurrently presented vowel pairs was measured. Vowel pairs were formed from 5 synthesized vowels with F0 separations ranging from 0 to 4 semitones. RESULTS: Younger adults had smaller (better) F0 DLs than older adults. For the older group, age was significantly correlated with F0 DLs. Younger adults identified concurrent vowels more accurately than older adults. When the vowels in the pairs had different formants, both age groups benefited similarly from F0 separation. Interestingly, when both constituent vowels had identical formants, F0 separation was deleterious, especially for older adults. Pure-tone average threshold did not correlate significantly with either F0 DL or accuracy in concurrent vowel identification. CONCLUSION: Age-related declines were confirmed for F0 DLs, identification of concurrently spoken vowels, and benefit from F0 separation between vowels with identical formants. This pattern of findings is consistent with age-related deficits in periodicity coding.