Summary: A new study shows that providing hearing aids and personalized audiology care helps older adults maintain social connections, reducing feelings of loneliness over time. Participants who received hearing interventions retained more diverse and meaningful relationships than those given only general healthy aging guidance.
The research also found a slight improvement in loneliness scores among the hearing aid group, while loneliness slightly worsened for those without treatment. These findings suggest that treating hearing loss may be a powerful tool in addressing the growing epidemic of social isolation in aging populations.
Key Facts:
- Social Retention: Hearing aid users maintained one more close social connection over three years.
- Loneliness Link: Hearing loss treatment slightly reduced loneliness, while untreated individuals reported worsening feelings.
- Policy Implication: Results support Medicare coverage for hearing aids to improve aging Americans’ well-being.
Source: NYU Langone
Providing hearing aids and advice on their use may preserve social connections that often wane as we age, a new study shows.
Its authors say that this approach could help ease the loneliness epidemic that older Americans face.
According to the U.S. Centers for Disease Control and Prevention, more than a quarter of seniors say they have little or no contact with others, and a third report feeling lonely. Experts have linked such isolation in part to hearing loss, which can interfere with communication and relationship building.
The 2023 U.S. Surgeon General’s Advisory named improving social connection as great a priority as targeting tobacco use, obesity, and addiction.
Led by researchers at NYU Langone Health as part of the ACHIEVE clinical trial, the study revealed that those treated for hearing loss retained one additional social connection on average over a three-year period when compared with those who received no hearing therapies and were instead educated about healthy aging.
Publishing online May 12 in the journal JAMA Internal Medicine, the work further showed that those given hearing aids had more diverse relationships, with networks that had many different types of connections (e.g., family members, friends, and acquaintances).
They also maintained deeper, higher quality bonds than those who were not treated for hearing loss.
“Our findings add to evidence that helping aging patients hear better can also enrich their social lives and boost their mental and physical well-being,” said study lead author Nicholas Reed, AuD, PhD, a member of the NYU Grossman School of Medicine’s Optimal Aging Institute.
Experts have linked both loneliness and hearing loss to depression, heart disease, and early death, among other concerns, adds Reed, also a faculty member in the Departments of Otolaryngology-Head and Neck Surgery and Population Health at NYU Grossman School of Medicine. A 2023 report on the ACHIEVE trial showed that hearing interventions may slow cognitive decline among those at highest risk for dementia.
“These results support efforts to incorporate hearing aid coverage into Medicare as a means of addressing the nation’s social isolation epidemic, which is especially risky for the elderly,” said ACHIEVE trial co-principal investigator Josef Coresh, MD, PhD.
“Making sure Americans can continue engaging with their family and friends as they age is a critical part of maintaining their quality of life,” added Coresh, also the Terry and Mel Karmazin Professor in the Department of Population Health.
For the study, the research team collected data about older adults with untreated hearing loss across four sites in Maryland, North Carolina, Minnesota, and Mississippi.
The study is among the largest to date to explore if hearing care can help prevent weakening of social networks, having included nearly 1,000 men and women ages 70 through 84.
Half of the participants received hearing aids, counseling sessions and personalized instruction with an audiologist, and when needed, tools such as adaptors that connect hearing aids to televisions.
The other half of the participants were given instruction about exercise, strategies for communicating with healthcare providers, and further resources for healthy aging.
To measure social isolation, the researchers assessed how regularly participants spent time with others, the size and variety of their social networks and the roles they played in them, and the depth of their connections.
Loneliness was calculated using a 20-question scoring system that evaluates how often a person feels disconnected from others. After the initial data was collected, the team followed up at six months and then every year for three years.
Among the other findings, the study revealed that before treatment, participants in both groups reported feeling equally lonely. Three years after the intervention took place, loneliness scores slightly improved among those who had received hearing care, while scores slightly worsened among those who did not.
Hearing aids and their related audiology appointments cost an average of $4,700, which is usually paid out of pocket, notes Coresh, who is the founding director of the Optimal Aging Institute.
Also a professor in the Department of Medicine, Coresh says the authors plan to continue following the participants for another three years and to repeat the study with a more diverse group of people—the patients were mostly White.
He cautions that the participants received concierge-level hearing care that provided more resources and time with audiologists than is typically offered to the public. Damaged hearing aids, for example, were replaced within days instead of weeks.
Funding: Funding for the study was provided by National Institutes of Health grants R01AG055426, R01AG060502, U01HL096812, U01HL096814, U01HL096899, U01HL096902, and U01HL096917.
In addition to Reed and Coresh, NYU Langone researcher James Pike, MBA, was involved in the study.
Frank Lin, MD, PhD, at Johns Hopkins University in Baltimore, is study senior author and the co-principal investigator of the ACHIEVE trial along with Coresh.
Other study co-investigators are Jinyu Chen, MS; Alison Huang, PhD, MPH; Ziheng Chen, BS; Thomas Cudjoe, MD, MPH; Jennifer Deal, PhD, MHS; Christine Mitchell, ScM; Esther Oh, MD, PhD; and Jennifer Schrack, PhD, at Johns Hopkins University; Michelle Arnold, AuD, PhD; Theresa Chisolm, PhD; and Victoria Sanchez, AuD, PhD, at the University of South Florida in Tampa; Sheila Burgard, MS; David Couper, PhD; and Lisa Gravens-Mueller, MS, at the University of North Carolina in Chapel Hill; Adele Goman, PhD, at Edinburgh Napier University in the United Kingdom; Nancy Glynn, PhD, and Theresa Gmelin, MSW, MPH, at the University of Pittsburgh in Pennsylvania; Kathleen M. Hayden, PhD, at Wake Forest University in Winston-Salem, North Carolina; Thomas Mosley Jr, PhD, at the University of Mississippi in Jackson; and James Pankow, PhD, MPH, at the University of Minnesota in Minneapolis.
About this loneliness and auditory neuroscience research news
Author: Shira Polan
Source: NYU Langone
Contact: Shira Polan – NYU Langone
Image: The image is credited to Neuroscience News
Original Research: Open access.
“Hearing Intervention, Social Isolation, and Loneliness A Secondary Analysis of the ACHIEVE Randomized Clinical Trial” by Nicholas Reed et al. JAMA Internal Medicine
Abstract
Hearing Intervention, Social Isolation, and Loneliness A Secondary Analysis of the ACHIEVE Randomized Clinical Trial
Importance
Promoting social connection among older adults is a public health priority. Addressing hearing loss may reduce social isolation and loneliness among older adults.
Objective
To describe the effect of a best-practice hearing intervention vs health education control on social isolation and loneliness over a 3-year period in the Aging and Cognitive Health Evaluation in Elders (ACHIEVE) study.
Design, Setting, and Participants
This secondary analysis of a multicenter randomized controlled trial with 3-year follow-up was completed in 2022 and conducted at 4 field sites in the US (Forsyth County, North Carolina; Jackson, Mississippi; Minneapolis, Minnesota; Washington County, Maryland).
Data were analyzed in 2024. Participants included 977 adults (aged 70-84 years who had untreated hearing loss without substantial cognitive impairment) recruited from the Atherosclerosis Risk in Communities study (238 [24.4%]) and newly recruited (de novo; 739 [75.6%]). Participants were randomized (1:1) to hearing intervention or health education control and followed up every 6 months.
Interventions
Hearing intervention (4 sessions with certified study audiologist, hearing aids, counseling, and education) and health education control (4 sessions with a certified health educator on chronic disease, disability prevention).
Main Outcomes and Measures
Social isolation (Cohen Social Network Index score) and loneliness (UCLA Loneliness Scale score) were exploratory outcomes measured at baseline and at 6 months and 1, 2, and 3 years postintervention. The intervention effect was estimated using a 2-level linear mixed-effects model under the intention-to-treat principle.
Results
Among the 977 participants, the mean (SD) age was 76.3 (4.0) years; 523 (53.5%) were female, 112 (11.5%) were Black, 858 (87.8%) were White, and 521 (53.4%) had a Bachelor’s degree or higher.
The mean (SD) better-ear pure-tone average was 39.4 dB (6.9). Over 3 years, mean (SD) social network size reduced from 22.6 (11.1) to 21.3 (11.0) and 22.3 (10.2) to 19.8 (10.2) people over 2 weeks in the hearing intervention and health education control arms, respectively.
In fully adjusted models, hearing intervention (vs health education control) reduced social isolation (social network size [difference, 1.05; 95% CI, 0.01-2.09], diversity [difference, 0.19; 95% CI, 0.02-0.36], embeddedness [difference, 0.27; 95% CI, 0.09-0.44], and reduced loneliness [difference, −0.94; 95% CI, −1.78 to −0.11]) over 3 years.
Results were substantively unchanged in sensitivity analyses that incorporated models that were stratified by recruitment source, analyzed per protocol and complier average causal effect, or that varied covariate adjustment.
Conclusions and Relevance
This secondary analysis of a randomized clinical trial indicated that older adults with hearing loss retained 1 additional person in their social network relative to a health education control over 3 years.
While statistically significant, it is unknown whether observed changes in social network are clinically meaningful, and loneliness measure changes do not represent clinically meaningful changes. Hearing intervention is a low-risk strategy that may help promote social connection among older adults.
Trial Registration
ClinicalTrials.gov Identifier: NCT03243422
