Article Archive
January/February 2022

Hearing Loss: The Link Between Depression and Loss of Hearing
By Lindsey Getz
Today’s Geriatric Medicine
Vol. 15 No. 1 P. 6

Finding ways to help patients is crucial.

For older adults, hearing loss can have a detrimental impact on quality of life. Safety can also be compromised; for example, if older adults can’t hear a vehicle backing up or a tea kettle whistling, it can lead to safety hazards. Hearing loss can also cause older adults to miss out on areas of enjoyment in life—music, grandchildren’s voices, even sounds of nature. And research has also shown a link between hearing loss and depression—something that’s important for caretakers and physicians who work with older adults to remember as they help these individuals to navigate health care decisions.

A study conducted by the National Institute on Deafness and Other Communication Disorders found that 11% of adults with hearing loss also experience depression, compared with only 5% of the general population. And a systematic review and meta-analysis of studies on hearing loss and depression published in the April 2020 issue of The Gerontologist found that hearing loss was associated with a statistically significant increased risk for depression in older adults.

Nicholas Reed, AuD, an audiologist specializing in geriatrics at Johns Hopkins Bloomberg School of Public Health, says the connection between hearing loss and depression likely stems from a communication barrier. Individuals with hearing loss struggle with communication both on the phone and in person (particularly in loud situations, such as restaurants or parties)—and that can lead to isolation, even if they are physically present.

“From a clinical standpoint, when we think about the link between hearing loss and depression, it’s really about the link between the need for hearing and communication—and without communication, there being social isolation and loneliness. Depression is the big-picture outcome of all that.”

Reed says that from an anecdotal standpoint, most people can relate—even within their own family structures. If you’ve ever been seated at a loud table with an older relative, it’s easy to witness how they often become excluded from the conversations simply because they can’t hear.

“When you have hearing loss, it is very difficult to follow noisy conversations,” Reed says. “It becomes fatiguing and, frankly, easier to just tune out sometimes. But that’s how an older adult can be surrounded by people and still become isolated—which can lead to depression.”

In a study published in the March 2021 issue of The Journals of Gerontology and coauthored by Reed, researchers found that older adults with moderate or greater hearing loss had 2.4 times higher odds of depressive symptoms compared with those with normal hearing.

“What is interesting about this study is that we’re using pure tone audiology and why that’s so powerful is that most people don’t know they have hearing loss,” Reed explains. “They don’t report it, and they don’t do anything about it. So, these are cleaner metrics. The measures were objective audiometry instead of self-reported data.”

Barbara Kelley, executive director of Hearing Loss Association of America, agrees that the natural potential for hearing loss to lead to social isolation is what likely sets older adults on the path to depression.

“Going to family gatherings or being thrown into situations with a lot of noise becomes exhausting—and sometimes downright demoralizing,” Kelley explains. “You have to bluff your way through a conversation and might provide the wrong response, which can lead to assumptions such as it being an early sign of dementia. It can be a very frustrating situation and can lead older adults to stop participating in social activities.”

The Impact of the Pandemic
While there isn’t much research on the link between mask-wearing, hearing loss, and depression, it’s easy to understand how mask wearing might make communication more challenging.

“There is a serious acoustic effect of wearing a mask that makes communication even more difficult,” says Reed. “Though there’s no data on the exact impact, I think it’s fair to say that if an individual has hearing loss, they’ll struggle even more so with hearing someone who’s wearing a mask. It would be fairly safe to conclude that this is another communication barrier that can lead to isolation.”

According to Kelley, most people—even those without hearing loss—rely on at least some level of lipreading, particularly in noisy situations. Mask wearing makes that impossible.

“Sound is definitely muffled when someone is wearing a mask, and then you also add in six feet of distance that we’re supposed to stand from one another—it’s easy to see how quickly that can become a problem,” Kelley says. “At the height of the pandemic, older adults had issues hearing loved ones on the phone or even being able to hear what their doctors told them—and that is very isolating.”

Catherine Palmer, PhD, president of the American Academy of Audiology, a professor at the University of Pittsburgh, and director of audiology for the UPMC Health System, says masks affect communication by removing those facial and lipreading cues and decreasing sounds in a frequency area—specifically, the pitch—that’s important for speech.

“The other issue with masks, especially the ones that loop around the ears, is that straps can catch a behind-the-ear hearing aid and pull it off when removing the mask,” she adds. “This has been the cause of many lost and damaged hearing aids over the past year and a half. People with behind-the-ear hearing aids may want to use a mask that does not have loops around the ears.”

However, one potential upside, Palmer says, is that mask wearing seems to have encouraged individuals with mild hearing loss to pursue amplification sooner. It was mask wearing that made these individuals realize they were struggling. This is important, since signs of early hearing loss often go unidentified, according to various studies.

Since the pandemic, new solutions have been imperative.

“For our patients with severe to profound hearing loss, masks may cut them off from communicating,” Palmer says. “We have added tablets to all of our clinics that run the free live transcription program—Google Live Transcribe—so we can have speech to text transcription in real time. We also work with our patients to download apps to their Android or iPhone smartphones or iPad/tablet to run these transcription programs to support communication.”

Assisting Patients With Hearing Loss
Given the link between hearing loss and depression, finding ways to help patients is important. But first and foremost, hearing loss must be something that becomes part of the patient conversation.

“Too often, I hear from individuals who say that hearing loss was never brought into the conversation—or even worse, they brought it up and their doctor said it was a ‘normal part of aging,’” Kelley says. “Geriatricians and primary care physicians that work with older adults should be regularly referring patients for hearing screenings or complete audiological evaluations. There are answers out there, but they first need to be medically checked. A medical reason such as wax build-up will obviously be treated differently from true hearing loss—but this is not something to be ignored or pushed off.”

Reed agrees that with so many advances in hearing loss technology, there are many ways doctors can help patients.

“Geriatricians have one of the most powerful tools in their back pocket—and that’s the increasing accessibility of hearing aids,” Reed says. “While there was a time where quality hearing aids were incredibly expensive, now there are some really good amplifiers available over the counter, and the Food and Drug Administration’s over-the-counter hearing aids are on their way. Patients are able to access them without prescription or testing—and some are easy to fit. I think this is a game changer. Doctors can recommend that this is something patients can do right away to make a difference in their quality of life.”

Geriatricians can also promote the importance of good communication and the value of treating hearing loss, Palmer says.

“The majority of individuals being seen in a geriatrician’s office will have impactful hearing loss,” Palmer says. “Patients with untreated hearing loss are not able to fully participate in care decisions. Geriatricians can use simple, low-cost, noncustom amplifiers with their patients right in their office. This improves communication in real time, especially with masks, and the patients can engage in their care plan.”

According to Palmer, this gives patients a positive experience of what it’s like to be able to hear better—and this may carry over into their day-to-day lives.

“For some patients, the simple noncustom amplifier may be all they need, and others may want to pursue a more customized solution working with an audiologist depending on their lifestyle and listening needs,” she adds. “The key to successful amplification use is full-time use. In this way, the person fully adapts to the amplified sound and the brain considers this normal. This means using amplification during all waking hours—except when getting wet. Even in a quiet home, there is always sound around and this keeps the brain stimulated.”

— Lindsey Getz is an award-winning freelance writer in Royersford, Pennsylvania.