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Joanna Nkyekyer,1 Denny Meyer,2 Andrew Pipingas,3 Nicholas S Reed4 1Australian Research Council Training Centre in Biodevices, Swinburne University of Technology, Melbourne, VIC, Australia; 2Department of Statistics Data Science and Epidemiology, Swinburne University of Technology, Melbourne, VIC, Australia; 3Center for Human Psychopharmacology, Swinburne University of Technology, Melbourne, VIC, Australia; 4Cochlear Center for Hearing and Public Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA Purpose: Our study assessed the efficacy of the simultaneous use of hearing aids and auditory training for improving cognition and psychosocial function in adults with hearing loss, and the relationships between hearing loss, speech perception and cognition. Participants and methods: A 40-person (aged 50–90 years) pilot study in Melbourne, Australia, was conducted. Participants with hearing impairment completed the Geriatric Depression Scale-Short Form, questions about social activity participation, a wide range of cognitive tasks and a speech perception test at baseline, 3 and 6 months. Participants underwent auditory training for 6 months and used hearing aids for 3 months. Results: Correlations and structural equation modeling suggested that several cognitive domains were associated with speech perception at baseline, but only the Incongruent Stroop cognition measure was associated with hearing loss. Hearing aid use reduced problems with communication, but there were no significant improvements in speech perception, social interaction or cognition. The effect of hearing aids and auditory training for improving depressive symptoms was significant with a moderate to large effect size (Cohen’s d=0.87). Conclusion: The small sample size and a relatively high rate of attrition meant that this study was underpowered. However, baseline results suggested relationships between hearing loss, speech perception and cognition, and the hearing intervention provided evidence of reduced depressive symptoms. A full-scale, randomized hearing loss intervention and a longer neuroimaging study with cognitive outcomes measured in the short term as well as after several years of hearing aid use are needed. Keywords: cognition, depression, hearing loss intervention, speech perception

Qun Chen, Andrew J Tarr, Xiaoyu Liu, Yufen Wang, Nathaniel S Reed, Cameron P DeMarsh, John F Sheridan, Ning QuanDivision of Oral Biology, Institute for Behavioral Medicine Research, The Ohio State University, Columbus, OH, USAAbstract: Peripheral immune activation by bacterial mimics or live replicating pathogens is well known to induce central nervous system activation. Sickness behavior alterations are often associated with inflammation-induced increases in peripheral proinflammatory cytokines (eg, interleukin [IL]-1β and IL-6). However, most researchers have used acute high dose endotoxin/bacterial challenges to observe these outcomes. Using this methodology may pose inherent risks in the translational interpretation of the experimental data in these studies. Studies using Escherichia coli have yet to establish the full kinetics of repeated E. coli peripheral injections. Therefore, we sought to examine the effects of repeated low dose E. coli on sickness behavior and local peripheral inflammation in the open field test. Results from the current experiments showed a behavioral dose response, where increased amounts of E. coli resulted in correspondingly increased sickness behavior. Furthermore, animals that received a subthreshold dose (ie, one that did not cause sickness behavior) of E. coli 24 hours prior were able to withstand a larger dose of E. coli on the second day (a dose that would normally cause sickness behavior in mice without prior exposure) without inducing sickness behavior. In addition, animals that received escalating subthreshold doses of E. coli on days 1 and 2 behaviorally tolerated a dose of E. coli 25 times higher than what would normally cause sickness behavior if given acutely. Lastly, increased levels of E. coli caused increased IL-6 and IL-1β protein expression in the peritoneal cavity, and this increase was blocked by administering a subthreshold dose of E. coli 24 hours prior. These data show that progressive challenges with subthreshold levels of E. coli may obviate the induction of sickness behavior and proinflammatory cytokine expression.Keywords: open field, E. coli, sickness behavior, repeated administration

The management of uterine sarcomas continues to present many difficulties. Primary surgery is the optimal treatment but the role of post-operative radiation remains uncertain. In the mid-1980s, the European Organisation for Research and Treatment of Cancer Gynaecological Cancer Group Study proposed a trial to evaluate adjuvant radiotherapy, as previous non-randomised studies had suggested a survival advantage and improved local control when post-operative radiation was administered. The study opened in 1987 taking 13 years to accrue 224 patients. All uterine sarcoma subtypes were permitted. Patients were required to have undergone as a minimum, TAH and BSO and wahsings (166 patients) but nodal sampling was optional. There were 103 leiomyosarcomas (LMS), 91 carcinosarcomas (CS) and 28 endometrial stromal sarcomas (ESS). Patients were randomised to either observation or pelvic radiation, 51 Gy in 28 fractions over 5 weeks. Hundred and twelve were recruited to each arm. The initial analysis has shown a reduction in local relapse (14 versus 24, p = 0.004) but no effect on either OS or PFS. No unexpected toxicity was seen in the radiation arm. No difference in either overall or disease-free survival was demonstrated but there is an increased local control for the CS patients receiving radiation but without any benefit for LMS. Prognostic factor analysis shows that stage, age and histological subtype were important predictors of behaviour which may explain differences between CS and LMS. CS appears to show more kinship to poorly differentiated endometrial carcinomas in behaviour. LMS did not show the same benefit from radiation. These results will help shape future management and clinical trials in uterine sarcomas. [ABSTRACT FROM AUTHOR]

The management of older and unfit women with advanced ovarian cancer requires post-operative chemotherapy but many of these patients are not suitable for high-dose cisplatin-based regimes. Carboplatin has been an easier alternative and can be given in the ambulatory setting. Historical data suggests that oral alkylating agents to be just effective with similar efficacy. In this study we have compared platinum-based carboplatin to the alkylating agent treosulfan in a population unfit to receive high-dose cisplatin. The trial randomised patients to either intravenous carboplatin or treosulfan as single agent. The trial was stopped prematurely after the interim analysis showed improved survival and response rates in the carboplatin arm. We conclude that carboplatin is a safe and effective drug in a population that is unfit for high-dose cisplatin. Treosulfan showed limited activity but may be considered along with other oral drugs in limited circumstances. With the exception of myelosuppression, toxicity was mild in both arms. Carboplatin remains the gold standard in this older and less fit group of patients. [ABSTRACT FROM AUTHOR]

This randomised controlled multicentre trial evaluated the effectiveness of recombinant human erythropoietin (rhEPO) in preventing anaemia and reducing the need for blood or erythrocyte transfusion in 122 ovarian cancer patients receiving platinum-based chemotherapy. The patients were randomly allocated to receive rhEPO 150 U/kg or 300 U/kg subcutaneously, three times a week, or open control. Patients also received up to 6 cycles of carboplatin or cisplatin, alone or in combination with other cytotoxic agents. Intention-to-treat analysis showed that 39.4% of patients in the control group received at least one blood transfusion, compared with 9.2% of patients treated with rhEPO. Patients treated with rhEPO experienced a significantly longer time to first erythrocyte transfusion than the control group and were less likely to experience nadir haemoglobin levels <10 g/dl ( P<0.001 and <0.05, respectively). A haemoglobin decrease <1 g/dl during the first chemotherapy cycle, as well as a low baseline serum erythropoietin concentration, predicted a low transfusion need in rhEPO-treated patients but not in controls. During the study, 103 patients suffered at least one adverse event, but no serious, and only nine non-serious adverse events were considered possibly related to rhEPO therapy. These results indicate that treatment with rhEPO prevents anaemia, it reduces the need for blood or rhEPO erythrocyte transfusion in patients with ovarian cancer receiving platinum-based chemotherapy, and it is well tolerated. A starting dose of 150 U/kg of rhEPO, three times a week, may be recommended. [ABSTRACT FROM AUTHOR]

Purpose: Experiencing difficulty with activities of daily living (ADLs) and instrumental ADLs (IADLs) and/or the consequences of unmet ADL/IADL-related needs is associated with adverse health-related outcomes. The association of hearing loss (HL) with experiencing the consequences of unmet ADL/IADL-related needs is not well understood. We investigated the associations of HL with experiencing ADL/IADL difficulties and the consequences of unmet ADL/IADL-related needs in older adults., Method: We investigated cross-sectional associations between audiometric HL, the number of ADL and IADL difficulties, and the number of consequences of unmet ADL/IADL-related needs among adults aged 65 years and older in the National Health and Aging Trends Study., Results: In 4,724 older adults, 30.5% ( n = 1,736) and 30.9% ( n = 1,727) had self-reported difficulty with ADLs and IADLs, respectively. Of the 2,289 participants who reported difficulty with at least one ADL/IADL, 14.0% ( n = 741) reported experience of at least one consequence of an unmet ADL/IADL-related need. In multivariable ordinal regression analyses, mild ( OR = 1.38, 95% CI [1.1, 1.73]) and moderate or greater ( OR = 1.57, 95% CI [1.17, 2.1]) HL were associated with higher odds of difficulties with additional ADLs. Moderate or greater HL was associated with higher odds of reporting difficulties with additional IADLs ( OR = 1.59, 95% CI [1.19, 2.12]). There was no significant association between HL and higher odds of having additional consequences of unmet needs., Conclusions: Our results show an association between HL and a higher number of ADL and IADL difficulties. Adults with HL may require increased support to address difficulties with daily activities and prevent experiencing related consequences., Supplemental Material: https://doi.org/10.23641/asha.28300049.

Background: Hearing loss is highly prevalent and associated with increased health care utilization. Recognition of hearing loss may play an important role in self-advocacy in difficult communication situations and prevent negative outcomes., Objectives: To investigate the associations between self-recognition of hearing loss and hospitalization outcomes., Research Design and Subjects: This is a cross-sectional analysis of 1766 participants from the National Health and Aging Trends Study., Exposures and Outcomes: The exposure, recognition of hearing loss, was constructed using participants' self-reported functional hearing difficulty, audiometric hearing loss, and self-reported hearing aid use. Primary outcomes included self-reported hospital stay occurrence and number of hospital stays within the last year. Regression models were adjusted for demographic, socioeconomic, and health characteristics and further stratified by severity of hearing loss., Results: Among 1766 participants with hearing loss, those with unrecognized hearing loss [60.1% (n=1062)] had higher but statistically insignificant odds of any hospitalization [odds ratio (OR)=1.32; 95% CI: 0.96, 1.81] or higher count of hospitalizations [incident rate ratio (IRR)=1.13; 95% CI: 0.85, 1.51] compared with those with recognized hearing loss (39.9%, n=704). Among participants with mild hearing loss, those with unrecognized hearing loss demonstrated significantly higher odds of any hospitalization occurrence (OR=2.50; 95% CI: 1.26-4.97) and a higher count of hospitalizations (IRR=2.00, 95% CI: 1.00-4.01) than those with recognized hearing loss. There were no significant differences in hospitalization outcomes among participants with moderate or greater hearing loss., Conclusions: In a nationally representative sample of older adults, individuals with unrecognized hearing loss compared with those with self-recognized hearing loss may be at increased odds of adverse hospitalization outcomes., Competing Interests: The authors declare no conflict of interest., (Copyright © 2025 Wolters Kluwer Health, Inc. All rights reserved.)

Importance: Investigating rural-urban and regional differences in the association between dual sensory loss (concurrent hearing and vision loss) and depression may highlight gaps in sensory loss research and health care services, and by socioeconomic status. Whether urbanicity and region may modify associations between sensory loss and depression is unknown., Objective: To describe the rural-urban and regional differences in the association of dual sensory loss with depression among older adults., Design, Setting, and Participants: This cross-sectional study used data from wave 1 (April 2017-December 2019) of the population-based Longitudinal Aging Study in India (LASI). Participants were recruited from 35 states and union territories in India. LASI incorporated a multistage stratified area probability cluster sampling design to recruit participants 45 years and older and their spouses; 31 447 eligible participants 60 years of age or older were interviewed. Data analyses were conducted from May 17, 2022, to November 11, 2023., Exposures: Sensory loss (no sensory loss, hearing loss only, vision loss only, and dual sensory loss) was determined by respondents' self-reported perceived difficulty regarding hearing and vision function., Main Outcomes and Measures: The Composite International Diagnostic Interview (CIDI-SF) scale was used to identify major episodic depression. Logistic regression was used to estimate the odds ratios (ORs) and 95% CIs of depression comparing participants with vs without sensory loss, adjusting for demographic and clinical covariates. Rural-urban and regional differences were assessed by including interaction terms between these variables and sensory loss., Results: The study analysis included 27 927 participants (mean [SD] age, 68.0 [7.2] years; 14 477 [51%] females and 13 450 [49%] males). The fully adjusted models showed that the odds of depression with dual sensory loss (vs no loss) was higher in urban (OR, 3.16; 95% CI, 2.00-4.99) vs rural (OR, 1.73; 95% CI, 1.31-2.29) residents and among residents in the West (OR, 5.10; 95% CI, 1.74-14.97) vs North (OR, 1.38; 95% CI, 0.81-2.35) regions., Conclusions and Relevance: These findings indicate that sensory loss is associated with depression in older adults, with differences by urbanicity and region. Adults with sensory loss across multiple systems may be an important group to target for intervention.

Purpose: Older adults with communication disabilities (CDs) experience barriers to receiving care and face a paucity of accommodations for their disability. Utilizing someone that supports communication with healthcare providers (communication support persons) may be a way that this group self-supports their disability. We examined if this utilization was independently associated with CDs among older adults. We also sought to understand if socioeconomic factors were associated with utilization., Methods: We used the 2015 National Health and Aging Trends Survey (NHATS) to conduct a cross-sectional analysis of Medicare beneficiaries ( n  = 5954) with functional hearing, expressive, or cognitive difficulties. We calculated a weighted, population prevalence and an adjusted prevalence ratio (APR) controlling for sociodemographic, health and other disability factors., Results: Among community dwelling older adults, having CDs was associated with higher utilization of a communication support person at medical visits (APR: 1.41 [CI: 1.27 - 1.57]). Among adults with CDs, Black adults and women had lower levels of utilization as compared to White adults and men, respectively., Conclusion: Communication support persons may be a way that older adults with CDs self-support their disability. However, not all older adults with CDs bring someone and variation by social factors could suggest that unmet support needs exist.

Lassa virus (LASV) belongs to the Arenavirus family. LASV is endemic in several West Africa countries and causes viral hemorrhagic fevers. The Nigeria CDC has reported that an outbreak in 2024 in 28 states has resulted in 7767 suspected cases of Lassa fever, 971 confirmed cases and 166 confirmed deaths up to 11 August. Since infection with LASV can result in sensorineural hearing loss (SNHL) in up to 30% of patients, there are questions about whether triggering the immune response by immunization with LASV vaccines could potentially cause SNHL, although this has not been shown in clinical trials to date. To address this issue, the Coalition for Epidemic Preparedness Innovations (CEPI) and the Brighton Collaboration (BC) Safety Platform for Emergency vACcines (SPEAC) convened a three-hour webinar on 22 September 2023 to review what is known from both animal studies and human clinical trials and how hearing assessments in future clinical trials can help to assess the risk. This report summarizes the evidence presented and provides considerations for hearing assessment in expanded human trials of LASV vaccine candidates in children and adults., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Cornelia L. Dekker reports a relationship with The Task Force for Global Health that includes: consulting or advisory. Cornelia L. Dekker reports a relationship with Dynavax Technologies, Inc. that includes: equity or stocks. Nicholas S. Reed reports a relationship with Neosensory Inc. that includes: consulting or advisory. Carmen C. Brewer reports a relationship with Emergent Product Development that includes: consulting or advisory. Carmen C. Brewer reports a relationship with International Aids Vaccine Initiative that includes: consulting or advisory. Gideon Akintunde reports a relationship with Emergent BioSolutions Inc. that includes: equity or stocks. Lovelyn Charles reports a relationship with Emergent BioSolutions Inc. that includes: employment. Patricia Fast reports a relationship with International Aids Vaccine Initiative that includes: employment. Daniel D. Pinschewer reports a relationship with HOOKIPA Pharma Inc. that includes: consulting or advisory, equity or stocks, funding grants, and travel reimbursement. Daniel D. Pinschewer reports a relationship with Dodet Bioscience that includes: speaking and lecture fees. Karina A. Top reports a relationship with Coalition for Epidemic Preparedness Innovations that includes: funding grants. Steven B. Black reports a relationship with Coalition for Epidemic Preparedness Innovations that includes: funding grants. Daniel D. Pinschewer has patent with royalties paid to Licensee. Co-author editorial board for Ear and Hearing - CCB If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Objective: To examine associations of traumatic brain injury (TBI) with self-reported and clinical measures of hearing function., Setting: Four US communities., Participants: A total of 3176 Atherosclerosis Risk in Communities Study participants who attended the sixth study visit in 2016-2017, when hearing was assessed., Design: Prospective cohort study. TBI occurring prior to the hearing assessment was defined using self-reported questions and "International Classification of Diseases-9th/10th Edition" (ICD-9/10) codes., Main Measures: Hearing function was assessed by self-reported questionnaires and clinically measured indices (audiometry [4-frequency pure tone average for each ear] and speech-in-noise testing). Linear, logistic, and multinomial logistic models adjusted for sociodemographics, vascular risk factors, and occupational noise exposure were used to examine associations., Results: Participants were a mean age of 79 years, 59% were female, 21% were of self-reported Black race, and 33% had a history of TBI (median time from first TBI to hearing assessment: 39 years (25th-75th percentile = 19-63 years). Compared to participants without TBI, participants with prior TBI had higher age-adjusted prevalence of self-reported hearing loss (42.3% vs 35.3%), tinnitus (28.0% vs 23.8%), hearing aid use (23.4% vs 17.8%), pure tone average > 40 dB (30.6% vs 24.8%), and presence in the lowest quartile of speech-in-noise performance (27.6% vs 22.8%). With further adjustment, and particularly with adjustment for occupational noise exposure, associations with hearing measures were largely no longer statistically significant. In secondary analyses of associations of TBI frequency and severity with hearing function, results were similar to our main analyses, without evidence of dose-dependent associations., Conclusions and Relevance: In this community-based cohort, prior TBI was associated with impaired hearing on both self-reported and clinically measured assessments, but these associations were attenuated after adjustment for occupational noise exposure. These results underscore the importance of the consideration of loud noise exposures, which may confound associations of TBI with hearing, in future studies., Competing Interests: The authors have declared that there are no conflicts of interest in relation to the subject of this study. Dr Lin reports serving as a volunteer board member of the nonprofit, Access HEARS, being a consultant to Frequency Therapeutics and Apple Inc, and being the director of a public health research center funded in part by a philanthropic donation from Cochlear Ltd to the Johns Hopkins Bloomberg School of Public Health., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Objective: To examine if a nationally representative population of older adults with communication disabilities (CDs) have a higher risk of mortality when compared to older adults without these disabilities, independent of sociodemographic, health, and other disability characteristics., Design: Retrospective, cohort study. We conducted a survival analysis using multivariable Cox-proportional hazards regression, adjusting for sociodemographic, health, and other disability characteristics., Setting: Annual data from the National Health and Aging Trends Study (NHATS) (Rounds 2011-2020)., Participants: A nationally representative sample of Medicare beneficiaries 65 years and older with and without any receptive or expressive communication difficulties., Interventions: Not applicable., Main Outcome Measure: Hazard ratios (HR) demonstrated the independent mortality risk by CD, over a ten-year period., Results: The presence of CD was associated with an increased hazard of dying (HR: 2.79, 95% CI: 2.51-3.10). After adjustment, older adults with CD had a 1.46 times higher risk of death compared to those without CD (95% CI: 1.31-1.62)., Conclusions: Older adults with communication disabilities face a significantly higher risk of mortality, independent of health, sociodemographic, and other disability characteristics. These findings underscore the need to include this group when counting people with disability in national surveys, and explore potential factors unique to CDs including access to high quality healthcare contributing to disparate mortality outcomes., (Copyright © 2024. Published by Elsevier Inc.)

Assessing the response to systemic therapy in neuroendocrine tumors (NET) is challenging since morphological imaging response is often delayed and not necessarily reflective of clinical benefit. Peptide receptor radionuclide therapy (PRRT) has a complex mechanism of action, further complicating response assessment. In response to these challenges, the European Neuroendocrine Tumor Society (ENETS) Theranostics Task Force conducted a statement-based survey among experts to identify the current landscape and unmet needs in PRRT response assessment. The survey, presented at the 2022 ENETS Advisory Board (AB) meeting in Vienna, was completed by 70% of AB members, most of whom (81%) were from ENETS Centers of Excellence (CoE). It comprised a set of 13 questions with two substatements in three questions. Six (46%) of the statements achieved more than 75% agreement, while five (39%) additional statements reached over 60% consensus. Key points from the survey include: AB members agreed that lesions deemed equivocal on computed tomography (CT) or magnetic resonance imaging (MRI) should be characterized by somatostatin receptor (SST) positron emission tomography (PET)/CT before being designated as target lesions. It was agreed that interim response assessments should occur after the second or third PRRT cycle. Over half (54%) preferred using both conventional cross-sectional imaging (CT and/or MRI) and hybrid imaging (SST PET/CT) for this purpose. Almost all AB members supported further response assessment 3 months after the final PRRT cycle. A majority (62%) preferred using a combination of conventional cross-sectional imaging and SST PET/CT. For cases showing equivocal progression (ambiguous lesions or nontarget lesions) on CT and/or MRI, further confirmation using SST PET/CT was recommended. A significant majority (74%) preferred assessing pseudo-progression and delayed response by combining SST PET with diagnostic CT and/ or MRI. Though just below the 75% consensus threshold, there was substantial agreement on selecting target lesions based on SST PET/CT uptake intensity and homogeneity. Sixty-nine percent noted the importance of documenting and closely following heterogeneity in lesions in liver, lymph nodes, primary tumors, or other organs. As to the statement on parameters for new response criteria, AB members recommended exploring maximum standard unit value, tumor-to-background ratio, Hounsfield Unit (Choi Criteria), total tumor burden, and novel serum or molecular markers for future response evaluation criteria. Sixty-five percent supported the use of a single SST PET/CT for response assessment of NET lesions treated with PRRT. These findings highlight the importance of integrating advanced imaging techniques and recognizing the need for more nuanced criteria in assessing the efficacy of PRRT in NET patients. This approach aims to enhance the accuracy of treatment monitoring and improve patient outcomes., (© 2024 British Society for Neuroendocrinology.)

Background: Population-based evidence linking sleep characteristics with hearing is limited and how the associations change with age remains unknown. We aim to investigate cross-sectional associations between sleep characteristics and hearing by age in a nationally representative sample of U.S. adults., Methods: We included 3,100 participants aged 40 years and older from the National Health and Nutrition Examination Survey 2015-18. Audiometric hearing thresholds at 0.5, 1, 2 and 4 kilohertz were averaged to calculate better-ear pure-tone average (PTA). Sleep questions were self-reported, including sleep duration on weekdays or workdays, snoring, snorting or stopping breathing, trouble sleeping, and daytime sleepiness. Multivariable-adjusted linear regression with an interaction term between sleep characteristic (categorical) and age (continuous in years) was used. Primary models adjusted for demographic and lifestyle factors with additional adjustment for cardiovascular factors in secondary models., Results: There was no association of reported sleep duration with PTA at age 50; however, compared to those reporting 7-8 h of sleep, there was a borderline-significant association at age 60 (<7 h: 1.72 dB, 95 % confidence interval [CI], -0.21, 3.66; >8 h: 1.25 dB, 95 % CI, -0.01, 2.51), and a significant association at age 70 (<7 h: 2.52 dB, 95 % CI, -0.27, 5.31; >8 h: 2.67 dB, 95 % CI, 0.56, 4.79). No consistent associations for other sleep characteristics were found., Conclusions: Long sleep duration is associated with worse hearing among middle-aged and older adults and the association differs by age. Longitudinal evidence is needed to establish temporality and examine changes in hearing associated with sleep characteristics.

Background: The Aging and Cognitive Health Evaluation in Elders (ACHIEVE) Study was designed to determine the effects of a best-practice hearing intervention on cognitive decline among community-dwelling older adults. Here, we conducted a secondary analysis of the ACHIEVE Study to investigate the effect of hearing intervention on self-reported communicative function., Methods: The ACHIEVE Study is a parallel-group, unmasked, randomized controlled trial of adults aged 70-84 years with untreated mild-to-moderate hearing loss and without substantial cognitive impairment. Participants were randomly assigned (1:1) to a hearing intervention (audiological counseling and provision of hearing aids) or a control intervention of health education (individual sessions with a health educator covering topics on chronic disease prevention) and followed semiannually for 3 years. Self-reported communicative function was measured with the Hearing Handicap Inventory-Elderly Screening version (HHIE-S, range 0-40, higher scores indicate greater impairment). Effect of hearing intervention versus control on HHIE-S was analyzed through an intention-to-treat model controlling for known covariates., Results: HHIE-S improved after 6-months with hearing intervention compared to control, and continued to be better through 3-year follow-up. We estimated a difference of -8.9 (95% CI: -10.4, -7.5) points between intervention and control groups in change in HHIE-S score from baseline to 6 months, -9.3 (95% CI: -10.8, -7.9) to Year 1, -8.4 (95% CI: -9.8, -6.9) to Year 2, and - 9.5 (95% CI: -11.0, -8.0) to Year 3. Other prespecified sensitivity analyses that varied analytical parameters did not change the observed results., Conclusions: Hearing intervention improved self-reported communicative function compared to a control intervention within 6 months and with effects sustained through 3 years. These findings suggest that clinical recommendations for older adults with hearing loss should encourage hearing intervention that could benefit communicative function and potentially have positive downstream effects on other aspects of health., (© 2024 The Author(s). Journal of the American Geriatrics Society published by Wiley Periodicals LLC on behalf of The American Geriatrics Society.)

Objectives: We aimed to investigate the association of older adults' hearing difficulty status with caregiving time. Methods: We used data from two linked surveys of Medicare beneficiaries and family caregivers. Hearing difficulty was defined by hearing aid use and hearing capacity in functional settings. Weighted multivariable linear regression examined the association between hearing difficulty and caregiving time. Stratified analyses were conducted to investigate the moderation effects of caregiving networks and care recipient's dementia status. Results: Among 3003 caregivers, those who assisted older adults with hearing difficulty were observed to spend greater time providing care (β = 1.18, 95% Confidence Interval [CI]: 1.04, 1.32). Stronger associations in magnitude were observed among caregivers without caregiving networks (β = 1.35, 95% CI: 1.13, 1.56) and assisting older adults without dementia (β = 1.22; 95% CI = 1.06, 1.37). Discussion: Hearing difficulty may contribute to greater caregiving time and remains a potential target for caregiver support programs.

Importance: Health-related quality of life is a critical health outcome and a clinically important patient-reported outcome in clinical trials. Hearing loss is associated with poorer health-related quality-of-life in older adults., Objective: To investigate the 3-year outcomes of hearing intervention vs health education control on health-related quality of life., Design, Setting, and Participants: This secondary analysis of a randomized clinical trial included participants treated for hearing loss at multiple US centers between 2018 and 2019 with 3-year follow-up completed in 2022. Eligible participants were aged 70 to 84 years, had untreated hearing loss, and were without substantial cognitive impairment. Participants were randomized (1:1) to hearing intervention or health education control and followed every 6 months., Intervention: Hearing intervention (provision of hearing aids and related technologies, counseling, education) or health education control (individual sessions covering topics relevant to chronic disease, disability prevention)., Main Outcomes and Measures: Three-year change in the RAND-36 physical and mental health component scores over 3 years. The 8 individual domains of health-related quality-of-life were additionally assessed. Outcomes measured at baseline and at 6-month, 1-year, 2-year, and 3-year follow-ups. Intervention effect sizes estimated using a 2-level linear mixed effects model under the intention-to-treat principle., Results: A total of 977 participants were analyzed (mean [SD] age, 76.8 [4.0] years; 523 female [53.5%]; 112 Black [11.5%], 858 White [87.8%]; 521 had a Bachelor's degree or higher [53.4%]), with 490 in the hearing intervention and 487 in the control group. Over 3 years, hearing intervention (vs health education control) had no significant association with physical (intervention, -0.49 [95% CI, -3.05 to 2.08]; control, -0.92 [95% CI, -3.39 to 1.55]; difference, 0.43 [95% CI, -0.64 to 1.51]) or mental (intervention, 0.38 [95% CI, -1.58 to 2.34]; control, -0.09 [95% CI, -1.99 to 1.81]; difference, 0.47 [95% CI, -0.41 to 1.35]) health-related quality of life., Conclusions and Relevance: In this secondary analysis of a randomized clinical trial, hearing intervention had no association with physical and mental health-related quality-of-life over 3 years among older adults with hearing loss. Additional intervention strategies may be needed to modify health-related quality among older adults with hearing loss., Trial Registration: ClinicalTrials.gov Identifier: NCT03243422.

Background: Fatigue is a common complaint among older adults with hearing loss. The impact of addressing hearing loss on fatigue symptoms has not been studied in a randomized controlled trial. In a secondary analysis of the Aging and Cognitive Health Evaluation in Elders (ACHIEVE) study, we investigated the effect of hearing intervention versus health education control on 3-year change in fatigue in community-dwelling older adults with hearing loss., Methods: Participants aged 70-84 years old with untreated hearing loss recruited across 4 study sites in the United States (Forsyth County, North Carolina; Jackson, Mississippi; Minneapolis, Minnesota; Washington County, Maryland) were randomized (1:1) to hearing intervention or health education control and followed for 3 years. Three-year change in fatigue symptoms was measured by 2 instruments (RAND-36 and PROMIS). We estimated the intervention effect as the difference in the 3-year change in fatigue between intervention and control groups using a linear mixed-effects model under the intention-to-treat principle., Results: Participants (n = 977) had a mean age (SD) of 76.8 (4.0) years, were 53.5% female and 87.8% White. Over 3 years, a beneficial effect of the hearing intervention versus health education control on fatigue was observed using the RAND-fatigue score (β = -0.12 [95% CI: -0.22, -0.02]). Estimates also suggested beneficial effect of hearing intervention on fatigue when measured by the PROMIS-fatigue score (β = -0.32 [95% CI: -1.15, 0.51])., Conclusions: Our findings suggest that hearing intervention may reduce fatigue over 3 years among older adults with hearing loss., (© The Author(s) 2024. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)

Purpose: Hearing trouble (HT) impairs communication with health care providers (HCPs) and may lead to negative care experiences that impact health outcomes. The current study aimed to examine how HT influences patient perceptions of provider interactions and whether having an accompanying companion during health care visits modifies perceptions of provider interactions., Method: This cross-sectional study analyzed 9,104 responses from the 2016 Medicare Current Beneficiary Survey., Results: Compared to beneficiaries without HT, those with HT had greater odds of negative perceptions of HCP interactions. Beneficiaries with HT had greater odds of disagreeing with positive statements about care, including provider competence, provider cares to check everything, provider response, and provider rarely in a hurry. Having an accompanying companion during health care visits was not found to significantly modify perceptions of interactions., Conclusion: Findings suggest HT is a modifiable factor impacting health care communication. Implementing simple accommodation strategies in clinical practice can improve nursing care for older adults with HT. [ Journal of Gerontological Nursing, 50 (11), 29-35.].

Competing Interests: DSP reports no conflicts of interest. NSR reports being on the advisory board for Neosensory. DSP is supported by the Alzheimer’s Association (23AARF-1030303), and NSR is supported by NIA/NIH (K23AG065443).

Importance: Vision impairment is a potentially modifiable risk factor for dementia. Although few prior studies have estimated the contribution of vision impairments to dementia, none have reported on multiple objectively measured vision impairments (eg, distance and near visual acuity and contrast sensitivity) in a nationally representative sample of older adults., Objective: To quantify population attributable fractions of dementia from objective vision impairments in older adults, stratified by age, self-reported sex, self-reported race and ethnicity, and educational attainment., Design, Setting, and Participants: This was a population-based cross-sectional analysis in the National Health and Aging Trends Study, which gathers nationally representative information on Medicare beneficiaries aged 65 years and older in the US. A total of 2767 community-dwelling adults eligible for vision and cognitive testing in 2021 were included. Data were analyzed from April to August 2023., Exposures: Near and distance visual acuity impairments were each defined as >0.30 logMAR. Contrast sensitivity impairment was defined as <1.55 logCS. At least 1 vision impairment was defined as impairment to either near acuity, distance acuity, or contrast sensitivity., Main Outcomes and Measures: Adjusted population attributable fractions of prevalent dementia, defined using a standardized algorithmic diagnosis (≥1.5 SDs below mean on 1 or more cognitive domains, self- or proxy-reported dementia diagnosis, or the Ascertain Dementia-8 Dementia Screening Interview Score of probable dementia)., Results: The survey-weighted prevalence of vision impairment among participants aged 71 and older (1575 [54.7%] female and 1192 [45.3%] male; 570 [8.0%] non-Hispanic Black, 132 [81.7%] Hispanic, 2004 [81.7%] non-Hispanic White, and 61 [3.3%] non-Hispanic other) was 32.2% (95% CI, 29.7-34.6). The population attributable fraction of prevalent dementia from at least 1 vision impairment was 19.0% (95% CI, 8.2-29.7). Contrast sensitivity impairment yielded the strongest attributable fraction among all impairments (15.0%; 95% CI, 6.6-23.6), followed by near acuity (9.7%; 95% CI, 2.6-17.0) and distance acuity (4.9%; 95% CI, 0.1-9.9). Population attributable fractions from at least 1 impairment were highest among participants aged 71 to 79 years (24.3%; 95% CI, 6.6-41.8), female (26.8%; 95% CI, 12.2-39.9), and non-Hispanic White (22.3%; 95% CI, 9.6-34.5) subpopulations, with estimates consistent across educational strata., Conclusions and Relevance: The population attributable fraction of dementia from vision impairments ranged from 4.9%-19.0%. While not proving a cause-and-effect relationship, these findings support inclusion of multiple objective measures of vision impairments, including contrast sensitivity and visual acuity, to capture the total potential impact of addressing vision impairment on dementia.

Background: Hearing loss is prevalent and consequential but under-diagnosed and managed. The Medicare Annual Wellness Visit (AWV) health risk assessment elicits patient-reported hearing concerns but whether such information affects documentation, diagnosis, or referral is unknown., Methods: We use 5 years of electronic medical record (EMR) data (2017-2022) for a sample of 13,776 older primary care patients. We identify the first (index) AWV indication of hearing concerns and existing and subsequent hearing loss EMR diagnoses (visit diagnoses or problem list diagnoses) and audiology referrals. For a 20% random sample of AWV notes (n = 474) we compared hearing loss EMR diagnoses to documentation of (1) hearing concerns, (2) hearing loss/aid use, and (3) referrals for hearing care., Results: Of 3845 (27.9%) older adults who identified hearing concerns (mean age 79.1 years, 57% female, 75% white) 24% had an existing hearing diagnosis recorded. Among 474 patients with AWV clinical notes reviewed, 90 (19%) had an existing hearing loss diagnosis. Clinicians were more likely to document hearing concerns or hearing loss/aid use for those with (vs. without) an existing EMR diagnosis (50.6% vs. 35.9%, p = 0.01; 68.9% vs. 37.5%, p < 0.001, respectively). EMR diagnoses of hearing loss were recorded for no more than 40% of those with indicated hearing concerns. Among those without prior diagnosis 38 (9.9%) received a hearing care referral within 1 month. Subgroup analysis suggest greater likelihood of documenting hearing concerns for patients age 80+ (OR:1.51, 95% confidence interval [CI]: 1.03, 2.19) and decreased likelihood of documenting known hearing loss among patients with more chronic conditions (OR: 0.49, 95% CI: 0.27, 0.9), with no differences observed by race., Conclusion: Documentation of hearing loss in EMR and AWV clinical notes is limited among older adults with subjective hearing concerns. Systematic support and incorporation of hearing into EMR and clinical notes may increase hearing loss visibility by care teams., (© 2024 The Author(s). Journal of the American Geriatrics Society published by Wiley Periodicals LLC on behalf of The American Geriatrics Society.)

Importance: Dementia and hearing loss are prevalent and represent public health priorities, but little is known about the prevalence of hearing loss among persons living with dementia at a population level., Objective: To estimate the prevalence of hearing loss and hearing aid use among a nationally representative sample of persons living with dementia., Design, Setting, and Participants: In this cross-sectional study, we analyzed data from Medicare beneficiaries who participated in round 11 of the National Health and Aging Trends Study (NHATS). The analytic sample included participants who had complete audiometric data and a dementia classification, and survey weights were applied to yield nationally representative estimates. Data were collected from June to November 2021, and analyzed from October 12, 2023, to February 27, 2024., Exposures: Audiometric measures of hearing loss and self-reported hearing aid use., Main Outcomes and Measures: National prevalence estimates of possible and probable dementia and hearing loss were estimated by applying NHATS survey weights of sex and age to the population aged 71 years or older based on the US Census Bureau's 2020 American Community Survey data., Results: The analytic sample comprised 2613 NHATS participants (74.6% aged 71-79 years and 25.4% aged ≥80 years; 52.9% female). Overall prevalence of hearing loss among participants with dementia was estimated at 79.4% (95% CI, 72.1%-85.3%). The prevalence of hearing loss increased with age, from 61.1% (95% CI, 37.7%-80.2%) among participants aged 71 to 74 years to 94.2% (95% CI, 88.8%-97.0%) among those aged 85 years or older. Among participants with hearing loss, 21.7% (95% CI, 16.2%-28.3%) reported hearing aid use., Conclusions and Relevance: In this cross-sectional study, the findings suggest that hearing loss is highly prevalent among individuals with dementia, with a low prevalence of hearing aid use. These findings reveal a potential opportunity for intervention.

Purpose: Population-based evidence in the interrelationships among hearing, brain structure, and cognition is limited. This study aims to investigate the cross-sectional associations of peripheral hearing, brain imaging measures, and cognitive function with speech-in-noise performance among older adults., Method: We studied 602 participants in the Aging and Cognitive Health Evaluation in Elders (ACHIEVE) brain magnetic resonance imaging (MRI) ancillary study, including 427 ACHIEVE baseline (2018-2020) participants with hearing loss and 175 Atherosclerosis Risk in Communities Neurocognitive Study Visit 6/7 (2016-2017/2018-2019) participants with normal hearing. Speech-in-noise performance, as outcome of interest, was assessed by the Quick Speech-in-Noise (QuickSIN) test (range: 0-30; higher = better). Predictors of interest included (a) peripheral hearing assessed by pure-tone audiometry; (b) brain imaging measures: structural MRI measures, white matter hyperintensities, and diffusion tensor imaging measures; and (c) cognitive performance assessed by a battery of 10 cognitive tests. All predictors were standardized to z scores. We estimated the differences in QuickSIN associated with every standard deviation ( SD ) worse in each predictor (peripheral hearing, brain imaging, and cognition) using multivariable-adjusted linear regression, adjusting for demographic variables, lifestyle, and disease factors (Model 1), and, additionally, for other predictors to assess independent associations (Model 2)., Results: Participants were aged 70-84 years, 56% female, and 17% Black. Every SD worse in better-ear 4-frequency pure-tone average was associated with worse QuickSIN (-4.89, 95% confidence interval, CI [-5.57, -4.21]) when participants had peripheral hearing loss, independent of other predictors. Smaller temporal lobe volume was associated with worse QuickSIN, but the association was not independent of other predictors (-0.30, 95% CI [-0.86, 0.26]). Every SD worse in global cognitive performance was independently associated with worse QuickSIN (-0.90, 95% CI [-1.30, -0.50])., Conclusions: Peripheral hearing and cognitive performance are independently associated with speech-in-noise performance among dementia-free older adults. The ongoing ACHIEVE trial will elucidate the effect of a hearing intervention that includes amplification and auditory rehabilitation on speech-in-noise understanding in older adults., Supplemental Material: https://doi.org/10.23641/asha.25733679.

Background and Objectives: Prior investigations have not considered whether poor vision biases cognitive testing. However, such research is vital given increasing evidence that vision impairment (VI) may be an important modifiable risk factor for dementia, particularly in low- and middle-income settings where the prevalence of VI is high., Research Design and Methods: This study employed data from 3 784 participants in Wave 1 of the Longitudinal Aging Study in India-Diagnostic Assessment of Dementia (LASI-DAD) who underwent both visual acuity and cognitive function testing. We used multiple indicators and multiple causes models to assess differential item functioning (DIF; eg, bias) in cognitive testing by objectively measured distance and near VI. Multivariable linear regression was used to model the association between VI and cognitive factor scores before and after DIF adjustment. Analyses were performed for general cognition and separate cognitive domains, corresponding to memory, language/fluency, executive functioning, and visuospatial performance. Models were adjusted for demographic, health, and socioeconomic covariates., Results: Participants in our sample were 60 and older. Most participants with VI were 60-69 years old (59.6%) and 50.8% were female. Individuals experiencing both distance and near VI tended to be older, have lower educational attainment, be married, reside in rural settings, and belong to lower consumption and BMI categories. Both distance and near VI were associated with poorer cognition before and after DIF-adjustment. Differences between DIF-unadjusted and -adjusted scores were small compared to the standard error of measurement, indicating no evidence of meaningful measurement differences by VI., Discussion and Implications: In well-conducted large-scale surveys, bias in cognitive testing due to VI is likely minimal. Findings strengthen previous evidence on the association between VI and dementia by showing that such associations are unlikely to be attributable to vision-related measurement error in the assessment of cognitive functioning., Competing Interests: None., (© The Author(s) 2024. Published by Oxford University Press on behalf of The Gerontological Society of America.)

Importance: Hearing loss may contribute to poor functional status via cognitive impairment and social isolation. Hearing aids may play a protective role by attenuating these downstream outcomes. However, population-based evidence is lacking., Objective: To examine the association of hearing loss and hearing aids with functional status., Design, Setting, and Participants: This cross-sectional (2016-2017) and longitudinal (2016-2022) analysis of data from the Atherosclerosis Risk in Communities cohort study included older, community-dwelling adults with complete data. Data were analyzed from June to December 2023., Exposures: The better-hearing ear's pure tone average (BPTA) at speech frequencies (0.5-4 kHz) was modeled categorically (no [BPTA ≤25 dB], mild [26-40 dB], and moderate or greater hearing loss [>40 dB]). Hearing aid use was self-reported., Main Outcomes and Measures: Difficulties in activities of daily living (ADLs; eg, dressing and eating), instrumental activities of daily living (IADLS; eg, household chores and meal preparation), and heavier tasks (eg, walking a quarter of a mile) were self-reported at visit 6. The ability to perform usual activities, walk a half mile, walk up and down stairs, and do heavy housework without help were collected in follow-up surveys. Linear and logistic regression models were used that were adjusted for sociodemographic and health covariates., Results: Among 3142 participants (mean [SD] age, 79.3 [4.6] years; 1828 women [58.2%]), 1013 (32.2%) had no hearing loss, 1220 (38.8%) had mild hearing loss, and 909 (29.0%) had moderate or greater hearing loss. Moderate or greater hearing loss was cross-sectionally associated with difficulty in 1 or more ADLs (odds ratio [OR], 1.27; 95% CI, 1.02-1.58), IADLs (OR, 1.34; 95% CI, 1.05-1.71), and heavier tasks (OR, 1.29; 95% CI, 1.04-1.62) compared with no hearing loss. Over time (mean [SD] follow-up, 1.9 [1.8] years), moderate or greater hearing loss was associated with a faster decline in the number of activities participants were able to do (β = -0.07 per year; 95% CI, -0.09 to -0.06) and greater odds of reporting inability to do 1 or more of the 4 activities (OR, 1.14; 95% CI, 1.05-1.24). Hearing aid users and nonusers did not differ., Conclusions and Relevance: The results of this study suggest that moderate or greater hearing loss was associated with functional difficulties and may contribute to a faster decline in function longitudinally independent of sociodemographic and health covariates. Hearing aids did not change the association among those with hearing loss.

Lung carcinoid tumours are neuroendocrine neoplasms originating from the bronchopulmonary tract's neuroendocrine cells, accounting for only 1%-3% of all lung cancers but 30% of all neuroendocrine tumours. The incidence of lung carcinoids, both typical and atypical, has been increasing over the years due to improved diagnostic methods and increased awareness among clinicians and pathologists. The most recent WHO classification includes a subgroup of lung carcinoids with atypical morphology and higher mitotic count and/or Ki67 labelling index. Despite appropriate surgery, the 5-year survival rate for atypical carcinoids barely exceeds 50%-70%. The role of adjuvant therapy in lung carcinoids is not well-defined, and clinical decisions are generally based on the presence of high-risk features. Long-term follow-up is essential to monitor for recurrence, although the optimal follow-up protocol remains unclear. To address the lack of consensus in clinical management decisions, the European Neuroendocrine Tumor Society (ENETS) initiated a survey among 20 expert centres. The survey identified varied opinions on approaches to imaging, surgery, use of adjuvant therapy, and follow-up protocols. Notably, the absence of dedicated multidisciplinary lung neuroendocrine tumour boards in some centres was evident. Experts agreed on the need for a prospective adjuvant trial in high-risk patients, emphasizing the feasibility of such a study. In conclusion, the study highlights the need for a more uniform adoption of existing guidelines in the management of lung carcinoid tumours and emphasizes the importance of international collaboration to advance research and patient care. Close collaboration between healthcare providers and patients is vital for effective long-term surveillance and management of these rare tumours., (© 2024 British Society for Neuroendocrinology.)

Background: Hearing loss is associated with restricted physical activity (PA) and impaired physical functioning, yet the relationship between severity of hearing impairment (HI) and novel PA measures in older adults with untreated HI is not well understood., Methods: Analyses included 845 participants aged ≥70 years (mean = 76.6 years) with a better-hearing ear pure-tone average (PTA) ≥30 and <70 dB in the Aging and Cognitive Health Evaluation in Elders (ACHIEVE) study who wore an ActiGraph accelerometer for 7 days. Physical functioning measures included grip strength and the Short Physical Performance Battery (SPPB). Linear regression models estimated the association by HI level (moderate or greater [PTA ≥ 40 dB] vs mild [PTA < 40 dB]) and continuous hearing with total daily activity counts, active minutes/day, activity fragmentation, grip strength, and gait speed. Logistic regression models estimated odds ratios (ORs) and 95% confidence intervals (CIs) of poor performance on the SPPB (≤6) and its subtests (≤2). Mixed-effects models estimated differences by HI level in activity by time of day., Results: Participants with moderate or greater HI had poorer physical functioning, particularly balance (OR = 2.17, 95% CI = 1.29-3.67), versus those with mild impairment. There was no association of HI level with activity quantities or fragmentation. For diurnal patterns of activity, participants with moderate or greater HI had fewer activity counts in the afternoon (12:00 pm -05:59 pm)., Conclusions: Older adults with worse hearing had shifted diurnal patterns and poorer balance performance. Exercise programs should be tailored to older adults with different levels of HI to maintain PA and physical functioning, particularly balance control., (© The Author(s) 2024. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)

Objective: The purpose of this study was to determine if dual sensory impairment (DSI) is associated with falls and fear of falling among older adults. Methods: Using data from the 2019 Medicare Current Beneficiary Survey (MCBS), we studied the cross-sectional association of self-reported hearing/vision impairment with self-reported history/number of falls over the past year, fear of falling (scale 1-6), and a fall requiring medical help using weighted multivariable regressions adjusted for demographic and clinical covariates. Results: Among 11,089 Medicare beneficiaries (mean age = 74, 55% female, 9% Black), DSI is associated with increased prevalence (prevalence ratio = 1.45 [1.28-1.65]) and incidence (incidence ratio = 2.21 [1.79-2.75]) rate of falls, and greater odds of a higher fear of falling score (odds ratio = 1.38 [1.08-1.77]). Discussion: DSI is associated with falls among older adults. Consideration of DSI as a marker to initiate fall prevention programs and inclusion of sensory interventions in these programs may be valuable., Competing Interests: Declaration Conflicts of InterestThe author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: NSR serves as an advisor to Neosensory board. All other coauthors have nothing to disclose.

Hearing loss is associated with cognitive/physical health; less is known about mental health. We investigated associations between hearing loss severity, depression, and health-related quality of life among older adults with unaided hearing loss. Data ( N = 948) were from the Aging and Cognitive Health Evaluation in Elders Study. Hearing was measured by pure-tone average (PTA), Quick Speech-in-Noise (QuickSIN) test, and the Hearing Handicap Inventory for the Elderly (HHIE-S). Outcomes were validated measures of depression and health-related quality of life. Associations were assessed by negative binomial regression. More severe hearing loss was associated with worse physical health-related quality of life (ratio: .98, 95% CI: .96, 1.00). Better QuickSIN was associated with higher mental health-related quality of life (1.01 [1.00, 1.02]). Worse HHIE-S was associated with depression (1.24 [1.16, 1.33]) and worse mental (.97 [.96, .98]) and physical (.95 [ .93, .96]) health-related quality of life. Further work will test effects of hearing intervention on mental health., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Dr. Reed reported serving on the scientific advisory boards of Neosensory. Dr. Lin reported being a consultant to Frequency Therapeutics and Apple and being the director of a research center funded in part by a philanthropic gift from Cochlear Ltd to the Johns Hopkins Bloomberg School of Public Health. Dr. Lin is also a board member of the nonprofit Access HEARS. Dr. Sanchez reported industry funding related to consulting or research support from Otonomy Inc., Autifony Therapeutics Ltd., Boehringer Ingelheim, Frequency Therapeutics Ltd., Pipeline Therapeutics, Aerin Medical, Oticon Medical, Helen of Troy Ltd., Sonova Holding AG, and Phonak USA.

Background: Hearing loss, a public health issue in older populations, is closely related to functional decline., Objective: To investigate the longitudinal associations between 4 dietary indices and hearing status., Methods: Data from the Baltimore Longitudinal Study of Aging were used and included 882 participants ≥45 y of age. Dietary intake was assessed using a validated food frequency questionnaire, and 4 dietary scores (Mediterranean-Dietary Approaches to Stop Hypertension Intervention for Neurodegenerative Delay diet [MIND], Mediterranean style diet score [MDS], Alternative Healthy Eating Index [AHEI], and Healthy Eating Index [HEI]) were calculated as averages over time. Hearing status was examined using pure-tone audiometry, and pure-tone average (PTA) of hearing thresholds were calculated at speech-level (PTA (500, 1000, 2000, 4000 Hz) ), low (PTA (500, 1000 Hz) ), and high (PTA (4000, 8000 Hz) ) frequencies, with lower thresholds indicating better hearing. Multivariable linear mixed-effect models were used to examine associations between dietary indices and hearing threshold change over time adjusted for confounders., Results: At baseline, the mean age of participants was 67 y and 55% were female. Over a median of 8 y of follow-up, MDS ≥7 was associated with 3.5 (95% CI: -6.5, -0.4) and 5.0 (95% CI: -9.1, -1.0) dB lower PTA (500, 1000, 2000, 4000 Hz) and PTA (4000, 8000 Hz) , respectively, compared with MDS ≤3; the highest tertile of the AHEI was associated with 2.3 (95% CI: -4.6, -0.1) and 5.0 (95% CI: -8.0, -2.0) dB lower PTA (500, 1000, 2000, 4000 Hz) and PTA (4000, 8000 Hz) ; and each standard deviation increment in HEI was associated with 1.6 dB (95% CI: -2.7, -0.6), 1.1 dB (95% CI: -2.1, -0.1), and 2.1 dB (95% CI: -3.5, -0.6) lower PTA (500, 1000, 2000, 4000 Hz) , PTA (500, 1000 Hz) , and PTA (4000, 8000 Hz) , respectively., Conclusions: Adherence to healthy dietary patterns was associated with better hearing status, with stronger associations at high frequencies. Am J Clin Nutr 20xx;x:xx., (Copyright © 2024 American Society for Nutrition. All rights reserved.)