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Commentary: Here’s why seniors with hearing loss need to treat it early

Hearing loss has an adverse impact on not only patients’ quality of life, but also their brains, says ENT surgeon Dr Rebecca Heywood.

Commentary: Here’s why seniors with hearing loss need to treat it early

An elderly woman walking alone in Singapore. (File photo: CNA/Syamil Sapari)

SINGAPORE: “I feel very depressed and have low self-esteem. Because I can't hear other peoples’ words clearly, I answer questions incorrectly at gatherings, which prompts ridicule from my friends. I often feel tired from having to concentrate harder on what people are saying.” 

This is how my 72-year-old patient with age-related hearing loss in both ears felt before she got treated.

“His hearing loss has made him isolated. He cannot participate in life.” And this, from a family member of another patient.

These testimonies are stories that I hear all too often from seniors living with hearing loss. The effects run deep across many aspects of their lives.

Most people do not realise how agonising living with hearing loss can be – and how it is linked to other ailments. Hearing loss is a risk factor for dementia and cognitive decline globally.

Sep 21 is World Alzheimer’s Day. This year’s theme, “Never too early, never too late”, aims to highlight the importance of delaying, and hopefully even preventing dementia.

Dementia is on the rise as our population in Singapore ages. According to the Institute of Mental Health, one in 10 adults aged 60 and above have dementia.

Here in Singapore, my research team showed in a longitudinal study that older adults with hearing loss are 2.3 times more likely to develop cognitive impairment or dementia. What’s more, we found that older adults in Singapore with mild age-related hearing loss achieved poorer scores in memory and thinking tests.

These findings are alarming considering that 93 per cent of seniors in Singapore have some degree of hearing loss.

LINK BETWEEN HEARING LOSS AND COGNITIVE DECLINE

There are several mechanisms by which hearing loss and cognitive decline are thought to be linked.

Having to decipher what people are saying from a quieter and degraded sound signal puts an extra burden on the brain’s finite resources. Deprivation of sensory input leads to changes in brain structure.

The depression, anxiety and isolation that come with hearing loss are all risk factors for dementia. The symptoms that my patients describe are not just affecting their quality of life, these symptoms are affecting their brains.

The big question that researchers have been asking is whether the damage has already been done, or if treating hearing loss can slow down or reverse cognitive decline. Finally, there is some evidence now that points to the latter.

The ACHIEVE study, led by Dr Frank Lin of Johns Hopkins University and published in the Lancet in July 2023, shows that hearing rehabilitation reduced the rate of cognitive decline in patients at risk of it by 48 per cent over three years - a huge impact. This gives us hope that treating hearing loss has the potential to reduce the burden of dementia on families, caregivers and the healthcare system.

THE CHALLENGE OF GETTING SENIORS TO SEEK HELP

Despite this good news, one of the biggest challenges in Singapore is getting older adults to get treatment for hearing loss. Long thought to be a normal part of ageing that we should just accept, it takes time to change attitudes towards managing hearing loss.

Many seniors are concerned about costs and possibly burdening their sandwich generation kids. Hearing aids can range from S$800 (US$586) to S$8,000 per piece, while getting cochlear implants - a surgically implanted electronic device - can cost S$30,000 to S$60,000. They also don’t know where and how to access hearing services.

These are all valid concerns and they have been taken on board. In the last decade, access to hearing services has improved through community-based and mobile hearing clinics. There is means-tested government funding available that makes hearing aids affordable. Cochlear implants are subsidised in public hospitals and covered by several insurance companies privately, meaning that these expensive devices are also accessible.

Other common worries are that hearing aids don’t work, and that they are noisy. This is a misconception that comes from trying poor-quality hearing devices and not getting them fitted properly by a qualified professional.

Many patients wait until their hearing is very bad before they try hearing aids. This makes it harder to adapt to them because the brain has forgotten common sounds. In fact, it is best to get hearing aids when you can still hear people talking but can’t clearly catch what they are saying.

Yet seniors are still reluctant to seek help for hearing loss. They don’t want to admit that they have a disability. They think they will look old if they are seen wearing a hearing device.

The difference after treating hearing loss was best described by one of my patients aged 67 with moderate age-related hearing loss in both ears. She said: “Once I got the hearing aids, I realised that it was the hearing loss that made me feel old. Not the hearing aids. The hearing aids allowed me to be myself again.”

Most hearing loss can be treated with hearing aids, though cochlear implantation may be required for more severe cases. My 72-year-old patient said: “My cochlear implant has changed the quality of my life. I have a better relationship with my family, and I have more confidence in myself. I have signed up for various activities such as ink painting and have made many new friends.”

The effects of treating hearing loss are life-changing. In fact, they are brain-changing.

Dr Rebecca Heywood is an Ear, Nose and Throat (ENT) surgeon at Nuffield ENT, Singapore.

Source: CNA/ch
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