The hearing of people aged in their 90s is rarely studied but a Swedish audiology team who researched this age group has found widespread major hearing difficulties and encouraged urgent action to improve mental and physical health.
Lead author, Dr Åsa Winzell Juhlin, a PhD student at Sahlgrenska Academy at the University of Gothenburg and an audiologist at Gothenburg’s Hearing Care Center, said researchers tested the hearing of 91 people aged 90 and 95. They reported findings in the International Journal of Audiology.
They found none had normal hearing, 80% had hearing loss to a degree that indicated the need for hearing aids or other intervention, and 30% had occluding ear wax in one or both ears which can further impair hearing and cause problems when using hearing aids.
More specifically, 98% had some degree of hearing loss in their better ear, with 83% having a potentially disabling hearing loss of moderate degree or worse, according to WHO criteria. Differences between the two age groups indicated increasing hearing loss, primarily at frequencies ≥ 2 kHz.
“Our results indicate that hearing loss affects virtually everyone at the age of 90 years and older,” Dr Juhlin said. “Eight out of 10 individuals in this age group have a hearing loss of moderate degree or worse, potentially limiting their activities and their ability to hear speech, both in quiet as well as in noisy environments.
“In the 90+ age group, hearing health is extremely important for both physical and mental health. Hearing loss can lead to increased isolation, depression, dementia and increased risk of falls. At the same time, this group is basically unexplored in terms of hearing ability where standardised tests are used.
“Those aged 80 and over often have a completely different cognitive function and less co-morbidity. Those over 90, on the other hand, are often in residential care, are not always tested or diagnosed for hearing loss, often have difficulty handling hearing aids and do not get much support.”
The study used standardised pure-tone audiometry (air- and bone-conduction), tympanometry and otoscopy including assessments of middle ear status which were rarely used in those over 90.
Most previous studies had been based on small sample sizes, subjective hearing assessments, reviews of medical records or screening tests performed by non-audiologists.
Included severely ill and care residents
Tests were conducted in each participant’s home, nursing home or residential care.
Dr Juhlin said the power of the study was not its size, as numbers were limited due to the COVID-19 pandemic, but the fact it did not exclude severely ill people or people in residential care, and that test methods were the same as in other age groups.
Researchers found the gender difference that existed among younger elderly (65-79 years), where hearing was more impaired in men than women, was much less pronounced in the over 90s.
“We need to have a better focus on hearing for the very elderly, use hearing aids where possible, but also work more with the acoustic environment,” Dr Juhlin said, adding that the number of octogenarians and nonagenarians was expected to increase rapidly, particularly in developed countries.
The researchers said age-related hearing loss was known to be progressive but whether it continued to progress into very high age or whether it slowed was debatable.
“We noted a difference in hearing ability when comparing individuals aged 90 and 95 years,” she said. “For instance, in the “younger” age group (90 years old), we found the majority had a moderate degree of hearing loss in their better ear, whereas of those in the older age group (95 years old) a majority had a moderately severe degree of hearing loss.” These findings may imply that hearing continues to decline after age 90 but more slowly, she added.
“We suggest healthcare workers should be encouraged to frequently ask questions regarding hearing health and to regularly perform otoscopic examinations to exclude the presence of occluding ear wax,” Dr Juhlin said.
“Furthermore, audiologists need to adapt their work in consideration of the diverse mental and physical health of those belonging to this age group. Finally, this study has also shown that standardised pure-tone audiometry is a feasible method to use in a home setting for this population, which encourages diagnostic and rehabilitative measures outside the clinic.”
The high prevalence of dementia in this age group however meant future research was needed to add objective hearing tests to the audiological test battery that were feasible outside the clinical environment.
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