Hearing Aid Use Lowers Fall Risk: Interview with Laura Campos, AuD, PhD

Hello, and welcome to another episode of this Week in Hearing. I’m Brian Taylor. Our topic this week is hearing aid use and lowering the risk of falls. And with us to discuss this important topic is Dr. Laura Campos. Dr. Campos is a clinical audiologist at the University of Colorado Health Lone Tree Medical Center and a clinical faculty member at CU Anschutz, which is in Aurora, Colorado. And she is also the lead author of a recent study that examined the use of hearing aids for reducing the risk of falls in older adults. And that’s something that we’re going to spend a lot of time talking about today. So with that all said, welcome to this Week in Hearing. Laura, it’s great to have you with us. Hi, thank you. It’s great to be here. Yeah. All right. So before we dive into our topic of hearing aid use and lowering of the risk of falls, I thought it would be helpful if you could tell us a little bit about your background and your role at CU Anschutz I wear two different hats these days. One is more clinical audiology, and that’s what I do with UC Health or University of Colorado Hospital, where I clinically see patients for diagnostics, hearing aids and cochlear implants and vestibular evaluation. So I kind of run the gamut of adult diagnostics and rehab. And then I’ve been doing that clinically for about twelve years now. And then I also kind of switched and did my PhD and research through CU Anschutz. And so the publication that just came out recently was the culmination of the work for My. So I have the research side with the medical campus in Aurora. Yeah, got it. So thank you again for taking time out of your busy schedule to be with us. Before we dive into your article, tell us a little bit why the risk of falling is something that we should pay attention to and why it’s such a big deal. Yeah, absolutely. So I think there’s a lot to consider related to falls with what it can do systemically, especially for when we, as audiologists, see so many older adults. Right. And we probably kind of think about it a little bit ancillary to, okay, they might have a fall risk, and does that mean they have some sort of vestibular issue? But really for older adults, as they get older, research shows that our fall risk goes up substantially. And if an older adult experiences a fall, the literature would say that they are substantially. More likely to never make it back home, that they might end up being released into some sort of rehab hospital or some sort of care facility, but never back on their own. And the cost of falls can be very substantial, especially for Medicare, the cost of treating falls every year. When I started doing my research, I found this astronomical that it costs health care more to treat falls than smoking or obesity. So they are a very costly part of our health care system. They are the leading cause of traumatic brain injuries in older adults. They are the leading cause of hip fractures in older adults. The leading cause of any sort of injury that causes hospitalization is falls. So anything that we can consider or identify that would potentially reduce somebody’s fall risk can have this potential really big savings on society, on healthcare dollars overall. That’s good to know. Could you tell us a little bit about the relationship between hearing loss and fall risks? Yeah, absolutely. So it’s only starting to be more understood, right? There’s still a lot of questions there, but there has been some really good data, and a lot of it even out of Johns Hopkins with some of the cognition sort of studies that we’re all fairly familiar with. I’m sure that shows that hearing loss, specifically meta-analysis of multiple different research studies together, that hearing loss puts somebody at a greater risk of experiencing a fall, specifically 2.4 times higher risk of an older adult of experiencing a fall than their normal-hearing peer counterpart. There’s a lot that we can say. Yes, hearing loss puts somebody at a higher risk for falls, but we’re still trying to understand the underlying reasons and mechanisms for that. Good to know. Tell us a little bit about how hearing aids might reduce the risk of falling. What’s the theory behind that? Yeah, so there’s a few different theories, right? We still don’t completely know what that reasoning or the mechanism is. But some of the leading theories that have been kind of put out there so far are related to, one, just the general effects of aging, right? If we have presbycusis, which might be causing cochlear decline, might be something related to metabolic changes in the inner ear, well, would those same oxidative stress, metabolic changes, any of that that are affecting the cochlea and affecting presbycusis, would those also be affecting the vestibular system and balance at the same time, right? So there’s kind of that general aging causing hearing loss and balance issues is one possible reason. The other would be humans actually have some ability to echolocate, not as well as bats or anything like that, but if we think about bats being able to use frequency, ultra high frequencies to get a good sense of where they are in their environment, humans can do that somewhat too. And the research says right now that we need to hear anywhere from 2000-4000 Hz is the really key components for humans to be able to spatially orient and echolocate ourselves. Well, what are the frequencies that people end up losing with a typical kind of presbycuisis type of hearing loss? Those higher frequencies. So if we are losing and not getting as much access to those higher frequencies, are we also then losing some of that ability to echolocate and spatially orient ourselves in space? So then that theory becomes, well if that’s the cause of the reduction in balance and the increased fall risk, well, if we give people those high frequencies back via hearing aids, are we then improving that kind of spatial orientation ability there? And then the final potential consideration is also cognition, the same reason that we know about cognitive decline and hearing loss causing this greater cognitive load. Right? So we have to use more executive function to just communicate when we have hearing loss. Well, is that then causing us to not have the ability to prevent falls? So if we’re using more executive function, more frontal lobe to communicate, are we less likely to be able to maneuver around a hazard or less likely to be able to say, oh, there’s a carpet over there, a rug over there that I might trip over? So there’s also that kind of the executive function aspect of it causing more increase in falls and again, potentially hearing aids addressing that. Right. If we’re reducing that cognitive load, are we also improving somebody’s ability to just mitigate their falls? Exactly. No, that makes sense. Let’s focus on your recently published article in the Journal of the American Geriatric Society, what some of us know as JAGS. And for those that really want to take a deep dive on what we’re going to talk about next, we’ll have a link in the show notes that take you to the article that we’re going to discuss next. But Laura, can you tell us first about your recently published study? What were some of the questions that you were trying to answer by conducting this study? Yeah, I mean, getting back to kind of that previous question of we have pretty good literature that would say there’s this link between increased fall risk and hearing loss, but the studies so far have been really mixed as far as does aiding that hearing loss and addressing that hearing loss really try to bring somebody’s fall risk back into the more expected level? So that’s what I was trying to answer, is, how much do hearing aids really address that increased fall risk issue that we see with hearing loss? And so the way that we went about doing it, myself and my team is looking at, we use the fall risk questionnaire, which is a pretty well known questionnaire, to evaluate somebody’s fall risk. And it’s actually, since we used it in the study, it actually was also adopted by the CDC as kind of part of their quote unquote study program for training people to address fall risk. They use it as well. So it’s a really ubiquitous screening tool for fall risk. And so what we did was sent out the questionnaire via email mostly. We also collected some in the clinic, but we sent it out to any individual that we saw at our UC health clinics that had documented sensorineural hearing loss. So the goal was really, we want to look at these older adults. So they had to be 60 or older who have enough hearing loss to be a hearing aid candidate. Now, whether they wore hearing aids or not, we ask. But essentially, anybody with a more typical presbycusis type of hearing loss, they had to have thresholds of 35 DB or worse at at least two frequencies. So if they’re a candidate for hearing aids, we asked them about their fall risk, they completed this questionnaire. And then we asked them, do you wear hearing AIDS? And if so, how frequently do you wear hearing aids? How long have you worn them? How many hours a day? And then we collected some other kind of demographic information about other comorbidities as well. And then the goal of that was to look at, okay, so the people that since everybody has aidable hearing loss, the hearing aid wearers versus the non wearers, what was the difference in their fall prevalence? So how frequently they were reporting they had a fall and their fall risk based on the questionnaire that they completed? What was the name of that questionnaire again? The fall risk questionnaire. FRQ okay, I think our listeners will be interested in that. So tell us, what did you find? What were the results of the study? Yeah, so we looked at it several different ways, but kind of getting down at the meat of what we were looking at was we were doing some regression models that look, we essentially got ODS ratios. So the ODS of either experiencing a fall or being at risk for falls and for people. Not super familiar with that. ODS ratios would say anything less than one means it’s kind of a protective function that you have less than a significantly less likelihood of whatever that outcome is. So in our case, falls, right. If your ODS ratios, your outcomes were less than one, then you’re less likely to experience a fall. If they were more than one, then you would be more likely to experience a fall. So what we found was the hearing aid wearers were significantly less likely to experience a fall about it depended on the model we were looking at, but usually anywhere from 50% to 60% lower likelihood of experiencing falls and or being at risk for falls than the same match kind of cohort that didn’t wear hearing AIDS. The other interesting thing we looked at was consistency of hearing aid use. So since we had asked about how many hours a day people are wearing their hearing AIDS and how many years they’ve worn them, we were able to kind of tease out even further the hearing aid wearers. Okay, but some people might have said, yes, I wear a hearing aid, but I wear it for 1 hour a day, or yes, I wear a hearing aid. But they were in their trial period, so they haven’t really necessarily gotten adapted to it yet. And so we looked at okay, let’s really dive down at the consistent users, the people that have been wearing their hearing AIDS for longer and at least 4 hours a day, and they were at an even stronger reduced risk of falling or having a risk of falls. So we even kind of see this dose response relationship right, of the more consistent users had an even stronger protective function. Now, again, just based on the study design, all we can say is there’s these associations, right? We don’t know any sort of causality yet, but it’s definitely an interesting finding. For sure. Yeah, really interesting. So tell us, we have a lot of clinicians out there that watch this. How could they apply the findings of this study in their own clinical practice? What would you advise them to do? Well, I have a lot of patients that will ask me if we’re in a consultation or maybe just right at the end of an audiogram where maybe I’m telling them they’re a hearing aid candidate. I think a lot of us have already implemented some sort of discussion about cognition or cognitive decline into our counseling. And I just kind of add this right along with it, right of if I’m saying you are a hearing aid candidate, I know you may or may not be quite ready for hearing AIDS yet, but keep in mind the other ancillary issues that hearing loss may cause or has been associated with. We know that untreated hearing loss have an association with cognitive decline. And there is some research showing that. It is also associated with balls. So I kind of add it in there of cognitive decline and falls. And then hearing AIDS have been shown to potentially associated with not having as much of that cognitive decline or reducing that fall risk. And the other thing that’s really interesting is that dosage effect the number of hours a person or the more consistent they wear them. I would think that that’s an important message, especially during the initial follow up where a person’s getting acclimated to hearing AIDS, the importance of wearing them all the time. Yeah, absolutely. And I do have that discussion kind of at those later dates, those later follow up visits for so many reasons. Right. Acclamation and adjustment to it. And I don’t know that we have enough of the data yet to give any specific recommendations from this paper other than to say, yeah, the people that wore them at least 4 hours a day, they reported wearing them at least 4 hours. That’s one limitation, too, is we didn’t have the data logging data to really say what they were doing, but that’s at least what the patients were reporting. That seemed to be kind of the the knee point of getting that stronger effect. Right. 4 hours. Yeah. It’s good to know. Last question for you, Laura, and that is what are some of the unanswered questions here around this issue that you’re trying to look at in your own lab? Your own clinic? Yeah, I’m still really wanting to dive down more at the underlying mechanism of is it really this sort of access to high frequencies and ability to really use that to help with the balance aspect of things versus is it more cognitive changes, neuroplastic changes that are causing these differences? So that’s really where I want to look next is what’s the kind of deep dive of causing this, but also just to be able to draw stronger conclusions, I want to look at it. Rather than asking a survey, let’s get some specific outcome measures, potentially either with data in hearing AIDS from accelerometers and or some sort of postureography data to really look at over time, longitudinally, potentially even in some sort of randomized trial. What is it looking like from somebody prior to hearing aid use, getting fit with hearing AIDS and then moving forward, how do we see and track this? That’s great. No, so a lot of unanswered questions, a lot of fertile territory for research. That’s great. So, dr. Laura Campos, University of Colorado School of Medicine, thank you for your time and your expertise. Appreciate being on the program today. Yeah, absolutely. Thanks for having me.