Hearing Aid Use Attenuates the Association Between Hearing Loss and Frailty: A 2003-2018 NHANES Cross Sectional...

To examine the association between objectively measured hearing ability and frailty using the accumulation of deficits model in adults aged ≥ 65 years and assess if the strength of this association differs by sex and hearing aid use.

NHANES data pooled from six cycles (2003-2018) formed the analytic sample (n = 2644). Hearing ability was examined continuously using an audiometrically determined hearing threshold. Frailty was defined using a 52-item frailty index (Rockwood's model) and was treated continuously and categorically. Analysis consisted of adjusted linear regression and multinomial logistic regression models. We tested for effect measure modification by sex and hearing aid use, with the latter analysis limited to those with at least mild hearing loss.

The weighted prevalence of frailty was 22.5%. A modest association between hearing ability and frailty was observed in covariate adjusted models. Each 10 dB (dB) increase in hearing threshold (poorer hearing) was associated with 24% higher odds of being frail compared to being robust (odds ratio 1.24, 95% confidence interval (CI) 1.14, 1.34). A 10 dB increase in hearing threshold was associated with a 6.9% increase in frailty index score (95% CI: 1.8, 12.2). Sex did not modify the observed association (p = 0.436), but hearing aid use did (p = 0.031). For non-hearing aid users, each 10 dB increase in hearing threshold corresponded to a 17.9% (95% CI: 1.9, 36.5%) higher frailty index score. For hearing aid users, the corollary result was null at -4.2% (95% CI: -10.1, 2.2%).

This study demonstrated a positive association between hearing threshold and frailty, such that poorer hearing (higher thresholds) was associated with greater frailty. Hearing aid use attenuated this association, highlighting the need for better access to hearing care and informing the development of frailty screening tools.