Article Archive
January/February 2023

Hearing: Hearing Loss Affects Physical Function
By Lindsey Getz
Today’s Geriatric Medicine
Vol. 16 No. 1 P. 30

Does hearing loss have an impact on physical function? Do older adults with a hearing impairment struggle more with issues such as gait speed and balance? Recently, a growing amount of research seems to indicate that there’s a connection between hearing loss and physical function—and there may be several reasons for that link.

With hearing loss being common among older adults, it’s important that providers keep its link to physical ability in mind.

Growing Body of Research
“The recent robust history of research in this area does appear to broadly show that hearing loss has some association with a more rapid decline of physical function, including slower gait speed and poor stability,” says Nicholas Reed, AuD, an audiologist specializing in geriatrics at Johns Hopkins Bloomberg School of Public Health. “The question now is why—and I think there are a few possible answers that the research points us toward.”

One of those, Reed says, is the link between acoustic inputs needed for complex movement. In other words, our ability to hear is one component of our ability to physically move.

In a study published in the Journal of the American Academy of Audiology called “The Association Between Hearing Loss, Postural Control, and Mobility in Older Adults,” the severity of hearing impairment was connected to a higher prevalence of difficulties in walking and falls. Multisensory processes that influence the auditory system and postural control were suggested as possible explanations for this connection.

The Social Isolation Connection
Reed says that another potential factor in the link between hearing loss and physical function is social isolation. Research has already pointed toward a strong link between depression, isolation, and hearing loss, which Today’s Geriatric Medicine has previously reported on.

It may very well be that increased isolation is contributing to faster physical decline. If those with hearing loss aren’t getting out as much, they may naturally begin to see a decline in physical function.

In another study published in JAMA Network Open, “Association of Age-Related Hearing Impairment With Physical Functioning Among Community-Dwelling Older Adults in the US,” hearing impairment was shown to be associated with poorer performance, faster decline in physical function, and reduced walking endurance.

The lead author of that study, Pablo Martinez Amezcua, MD, PhD, an assistant professor at Johns Hopkins, believes the reason is likely multifaceted—the link between hearing and movement and increased social isolation both coming into play.

“For older adults, light-intensity activities are the main source of physical activity; things like walking in the neighborhood or running basic errands,” he explains. “Some people with hearing loss tend to avoid social interactions and spend more time at home. That reduces the opportunities for being physically active. We also have found that hearing loss is associated with poorer balance and slower gait speed, and these associations seem to be at least partially due to a direct pathway between poorer hearing and more difficulty to move with ease. We rely on our senses to do things, and hearing is important for movement, the auditory cues from the environment help us to move.”

Willa Brenowitz, PhD, MPH, an epidemiologist who studies risk factors for dementia and aging, has also been exploring the impact of hearing impairment on physical function and agrees there may be numerous factors at play.

“There is definitely that potential for an indirect link to social isolation,” she agrees. “Hearing loss could make communication and navigating one’s environment more difficult for some older adults and that in turn could lead to increased isolation and eventually physical decline.”

But Brenowitz says that the inner ear—and its link to vestibular function and balance—is also a consideration that can’t be discounted.

“Some of the research does indicate that balance is affected but I think that the broad degeneration of the inner ear that we know can be part of aging may also be a factor,” she continues. “Even so, I believe that all of our senses are impacted by aging so understanding why that’s more pronounced in some people than others is an area we still need to research.”

Reed agrees that looking more closely at the inner ear as a whole is warranted.

“The cochlea, responsible for hearing, and the vestibular system share a common space so we can’t overlook the connection between the two—and also how that might impact function,” Reed explains. “While one is dedicated to hearing and the other to balance, there’s still a link.”

Keeping This Connection in Mind (Regardless of Causation)
While understanding the why behind the connection between hearing loss and physical function might not be fully understood at this point, experts say this is still an issue that needs to be on providers’ radar.

“When we think about hearing loss, how it might impact physical activity may not be the first thing that we think about,” says Martinez Amezcua. “But the consequences of hearing loss go
beyond poor communication and isolation.”

The link between hearing loss and physical decline is not likely to be overt. And it’s also likely to be an occurrence that happens over time. For these reasons, it is something that might be overlooked until it’s more severe.

“I think it’s important to remember that it’s not this one-to-one association,” Reed says. “It’s not like your patients will develop hearing loss and then have a noticeable decline in physical function. Instead, we’re going to see this happen gradually. Patients will experience hearing loss, then they may start to have communication issues followed by some isolation. And gradually, you may also notice that decline in physical function.”

Brenowitz says that even without understanding the exact cause, providers should recognize that there’s a researched association—and it is worth consideration.

“I think it warrants keeping an eye out,” she adds. “If a patient is diagnosed with hearing loss, then doctors might want to pay closer attention to that patient’s physical function.”

Prevention and Intervention
The research linking hearing loss to physical decline could be just another potential reason for doctors to talk about rehabilitative services, Brenowitz suggests.

Martinez Amezcua agrees, noting that this may be an important area for further research.

“Whether hearing loss treatment, such as hearing aids, may improve physical activity is not clear,” he says.

Right now, Brenowitz says, “the research does not tell us whether hearing aids will improve physical function, but hearing aids can improve hearing and verbal communication for many experiencing age-related hearing loss.”

“We need studies to understand how hearing aids may help adults with hearing loss,” Martinez Amezcua says. “Now that hearing aids can be purchased over the counter, we should pay closer attention to this topic.”

As far as what to take from the research to date, Reed says intervention and prevention are the two key takeaways right now.

“I think if we can start considering hearing loss earlier on in the patient’s life and trying to intervene as early as possible, that can make a difference for the patient’s entire wellbeing,” Reed says. “Physical function is just one potential impact, but we know there are others that are even better researched. We want to see hearing care start earlier—before it’s a more serious problem.”

Brenowitz agrees that being proactive is key. Conducting basic hearing assessments, even in patients who do not report any hearing difficulties, she says, is part of that preventative mindset.

“I think gathering information on hearing ability could easily become part of the general assessment that geriatricians and other providers perform,” she concludes. “Before needing to bring in audiology, there are some basic assessments that can be done. It’d be great to see hearing assessments become more of a regular part of care.”

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