Hearing health

Hearing loss is a common condition and often considered inevitable as we age. In fact, it is the third most commonly reported chronic condition, estimated to be twice as prevalent as prevalent as the likes of diabetes and cancer¹.

Although hearing loss is often seen as more of a nuisance and something you can learn to accept, we're learning more and more about the significant positive impact that timely hearing care can have on your quality of life. How it can improve the ability to communicate with the world around you and give back a greater level of independence.

IMPROVED WELL-BEING AND CONFIDENCE 

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A well-managed hearing loss enables the individual to reconnect with family, friends, and colleagues, reducing the feeling of isolation while fostering improved social interactions and confidence. Our social interactions are incredibly important and ensuring the ability to connect to your loved ones and the world around you is vital for maintaining existing relationships and forming new ones. The longest study on aging has even shown that we live longer and healthier lives when we have meaningful social relationships².

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By seeking hearing care, people generally report a greater willingness to participate in social activities, pursue hobbies, and engage more fully in their community which lowers the feeling of loneliness. Being able to better hear and respond promotes a greater independence and self-reliance, contributing to a more satisfying and autonomous lifestyle. Pursuing what matters most.

By breaking the cycle of isolation and enabling communication, hearing care directly contributes to an improved mental health. By addressing hearing difficulties, individuals often experience fewer symptoms of depression and anxiety^{3, 4}, and the use of hearing aids is shown to also have potential benefits in supporting better brain health through reduced listening effort⁵.

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INCREASE IN PRODUCTIVITY

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Having a hearing loss addressed has alsoshown an increased benefit in people's professional life. Proper hearing loss strategies and devices such as hearing aids can lead to more effective teamwork and job performance due to an improved ability to actively take part in important conversations.

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On a personal level, the ability to hear clearly can increase enjoyment and participation in various life events, ensuring that users don't miss out on meaningful moments. Hearing aids also enhance safety by enabling individuals to hear alarms, traffic, and other important environmental cues. This can prevent accidents and allow people to feel more secure when navigating various settings.

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Socioeconomic benefits

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On a societal level, well-managed hearing loss has significant socioeconomic benefits. Effective management strategies, such as timely diagnosis, use of hearing aids, and inclusive communication practices, can greatly reduce healthcare costs by maintaining a higher productivity and participation in the workforce, contributing to economic stability for society.

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In educational settings, proper management helps ensure that students with hearing loss receive equitable learning opportunities, leading to better educational outcomes and broader career options.

Recent evidence on the holistic impact of hearing loss on health is showing how addressing hearing loss earlier might also have an impact on adjacent conditions with a big societal burden such as cognitive decline^{6, 7}. The benefits of timely hearing care therefore suggests a much greater socioeconomic impact than previously thought.

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On the forefront of innovation

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To continue to bring hearing care benefits, new advancements also need to be made within hearing care offerings. Technological developments in recent years have paved the way for new innovations in hearing health, providing more convenient, powerful, and intelligent solutions.

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The newest technologies offer higher standards in sound quality, individualization, and connectivity – including a seamless integration withdigital devices and ecosystems, enriching daily experiences and access to information, and loved ones.

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Talk to your primary health practitioner if you're concerned about your hearing.

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Will dementia ever be preventable?  

Researchers, academics, scientists, doctors– everyone who works with the brain – are putting their heads together to find out. As it stands today, major actors in public health, like the WHO and the CDC, have been developing strategies to protect against cognitive decline. The task now is to find the best possible ways to practically implement these activities and maximise their impact.  

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The wealth of data about cognitive function in later life has left us more informed than ever about the risk factors of dementia. A total of 14 potentially modifiable risk factors have been identified by researchers, which potentially could reduce the number of dementia cases worldwide by 45% if eradicated.

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These findings, published by the Lancet Commission in a 2024 report^[1], both expanded our knowledge and provided a foundation for various prevention strategies and initiatives. But what about that other 55%? The risks that make up this percentage are currently unknown, but it is suspected that they could be those factors that are harder to quantify, such as genetic predisposition.

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There is still a sizeable question mark around the entire story of dementia risk factors. But the insight into those that are potentially modifiable gives us tangible direction about where to direct efforts to make a real difference.

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The 14 potentially modifiable risk factors from the 2024 report on dementia prevention, intervention, and care by the Lancet Commission are:

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• ‍Less education
• Hearing loss
• High LDL cholesterol
• Depression
• Traumatic brain injury
• Physical inactivity
• Diabetes
• Smoking
• Hypertension
• Obesity
• Excessive alcohol
• Social isolation
• Air pollution
• Visual loss

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HOW EARLY SHOULD WE PLAN FOR LATER LIFE?

Some of the 14 factors are what many of us would assume them to be – things that pose a risk to health generally –smoking, alcohol, diabetes. Whereas others extend way past what might generally be assumed to lead to cognitive decline – air pollution, hypertension, and even social isolation.

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Thinking about the things that might put us at risk of eventually developing dementia is one thing. Considering when these factors actually become risks is another. By putting the risk factors into a life-course model, we can see that many of these risk factors start way earlier than we expect – and we mean way earlier.

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The risk factor that comes first in the life course, and accounts for 5% is less education. This leaves us with a strong reason to believe that a predisposition for dementia might begin much earlier than is often talked about. To have a maximum impact, 11 of the 14 risk factors would need to be addressed in early to mid-life and together account for over half of the 45% total risk. Sitting in this age range is one of the most significant risk factors for developing dementia: hearing loss.

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ENTER: HEARING AIDS

The line of thinking is that by eliminating hearing loss, we could on that basis alone reduce the number of dementia cases by 7%, according to The Lancet authors. This is where hearing aids come in. In their review, the authors included multiple studies examining the influence of hearing aids on cognitive decline in people with hearing loss. The consensus was that hearing aid use is protective against hearing loss. Seemingly, of all the factors protecting against cognitive decline in people with hearing loss, hearing aid use was found to be one of the largest.

“Eliminating hearing loss could alone potentially reduce the number of dementia cases by up to 7% – making it one of the most significant potentially modifiable risk factors”

This 7% reduction in dementia prevalence stole the spotlight when the paper was published, and for good reason. However, other researchers in the field have commented on, and in some cases, countered this statistic. In a 2024 article, authors Dawes and Munro challenge this statistic by stating it is a proportional factor to the number of people with hearing loss compared to the other issues in each country^[2]. Meaning, in some countries addressing hearing loss might have a proportionally smaller impact on dementia cases compared to some of the other risk factors. It’s an important point to consider.

However, the argument remains that regardless of the potential change in risk across the world, addressing untreated hearing loss continues to have an important role in reducing the prevalence and burden of dementia.

Of course, it is natural to read about all of the ways we might be putting ourselves at risk for developing dementia and start to fret. However, what we can take away from this model is the reassurance that many of these risk factors are also preventable. Which is why it is fundamental that people at all ages of life are made aware about the risks and when they may become at risk.

Then, we can prepare. As the authors themselves state “It is never too early and never too late in the life course for dementia prevention.”

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ACTION ON EVERY FRONT

As is the case with our overall health, there is no one, sure-fire route to a life lived in perfect health, or with perfect cognitive function in later life. However, like with many other health issues and diseases, many of the risk factors of dementia can be reduced by leading a healthy life.

Caring for our body, and our brain, is something that needs to happen holistically, with consideration for the many influencing factors. Preventing dementia is not something that happens in a silo. It requires action from every level, starting at with the individual and extending all the way to public health policy.

“It is never too early and never too late in the life course for dementia prevention”

Let’s take hearing care as the prime example. The Lancet paper’s authors suggest initiatives ranging from what people with hearing loss can do themselves, all the way to how governments can rethink their public health strategies. And they’re not the only ones. The authors behind the World Alzheimer Report, in their 2023 edition, also highlight the game-changing influence of treating hearing loss with hearing aids to slow cognitive decline in a way that is cost-effective and scalable.

Their suggestions echo those of The Lancet, in an encouragement to governments and healthcare systems to improve access to hearing devices, particularly in lower- and idle-income countries[3].

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Recommendations backed by The Lancet authors’ findings:

• ‍Individuals themselves should ensure they get their hearing checked and wear the hearing aids they are prescribed.
• Strategies, initiatives, and policies that encourage individuals to get their hearing checked before retirement age
• Scrutinization of the risk of hearing loss throughout the life course
• Helping individuals overcome the challenges that they encounter when trying to wear hearing aids.

Following this advice can put individuals and audiologists alike in a stronger position to minimise the risk associated with hearing loss.

Publications like the 14-risk factor model for developing dementia only strengthen the

LISTEN TO THIS mission. By sharing findings like these, our ambition is to put information into the hands of those who can do something about it and mobilise collective action. After all, nothing works harder than our brains – it’s the least we can do to say thank you.

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Watch the video on 14 Dementia Risk Factors in our previous issue.

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Keep an eye out for the next edition of this BEYOND THE DATA series for a new research digest in the escalating hearing and brain health story. Read more insights on hearing and brain health.

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Sign up to our newsletter to be notified about the latest news and research.

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Want to know more about the role of hearing within dementia prevention?    

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Keep an eye out for the next edition of the BEYOND THE DATA series for a new research digest in the escalating hearing and brain health story. Read more insights on hearing and brain health.

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Sign up to our newsletter to be notified about the latest news and research.

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Avid followers of audiology news might have noticed that the frequency of research on hearing loss and dementia seems to be increasing. This is a trend that’s been gaining momentum over the past decade and is showing no sign of slowing down.

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Since the beginning of 2023, in fact, approximately 14,200 studies on this topic have been published¹. And with each new publication, the bank of evidence supporting the link between hearing and brain health becomes more and more robust.

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One of this year’s first major studies comes from the University of Southern Denmark (SDU). Published in January 2024, it’s the largest of its kind to date –participated in by a total of 573,088 people over the age of 50.

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The study took place in the region of Southern Denmark from 2003 to 2017 where researchers focused on the link between hearing loss and developing dementia. Information on participant hearing was collected from hearing clinics and combined with dementia data. The median follow-up time of the participants was 10 years (range, 0.25 to 15.0 years)²,which is considerably higher than the norm.

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A spotlight on hearing intervention

The findings of the SDU study build upon, and strengthen, those of its predecessors: that hearing loss is associated with cognitive decline, specifically the development of dementia.

The study’s researchers found hearing loss was associated with a 7% higher risk of dementia, which increases to 20% when left untreated. These findings further support the theory that hearing loss may increase the risk of developing dementia, especially when hearing aids aren’t used – study authors suggest that treating hearing loss with hearing aids may reduce this risk³.

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“We found that the risk of developing dementia was 20% higher for people who didn’t wear hearing aids compared to people with normal hearing. This suggests that wearing a hearing aid can prevent or delay the development of dementia.”⁴

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Manuella Lech Cantuaria

Assistant Professor, Department of Clinical Research

University of Southern Denmark

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Not only does this insight add to existing evidence, but it can also be leveraged in the growing case for better dementia prevention strategies that require a deeper understanding of the link between hearing loss and dementia.  

Another insight to be gleaned from this study lies in the way it was set up. Following more than half a million people during a total of 14 years is unprecedented in studies of hearing health and dementia risk. As the authors state, this choice of study design allowed for a more representative study population than many studies that came before it.

Asa result, the SDU study can be seen as an important contribution to the body of evidence thanks to its size, follow-up period and representative sample. Studies of this kind work towards ensuring everyone in the field is working from the best possible vantage point.  

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Inclusion / exclusion criteria

• Included all residents of Southern Denmark 50+ years old
• Excluded individuals who:
  • had dementia before baseline
  • did not leave in the region five years before baseline
  • had an incomplete address history
  • had missing covariate information

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Data collection method

• Compared data from public hearing rehabilitation clinics on people’s hearing with register-based data on the development of dementia during the study period
• Collected individual-level data of covariates (country of origin, cohabitation, education, income, occupational status) in collaboration with Statistics Denmark

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Further study results

• Individuals with hearing loss had up to a 13% higher risk of developing dementia compared to people with normal hearing
• Individuals who used hearing aids had a 6% increased risk of developing dementia, which is down from the 20% high risk for people who had hearing loss but didn’t wear hearing aids

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Next steps in brain health research

So where does this new research leave us? Well, the question now perhaps is no longer whether there’s a relationship between hearing health and brain health. But rather, how does hearing loss affect the brain? And, perhaps even more pressingly – how can the cognitive risks associated with hearing loss be reduced?

With these questions in mind, we can expect to see more and more high-quality studies examining the specific effects of hearing loss on the brain. As well as the influence that wearing hearing aids may have on this.

The authors of the SDU article themselves state the importance of more research around the connection between dementia and hearing loss. And part of the LISTEN TO THIS mission is to monitor the field as it develops and highlight the essential updates as and when they happen.

Ultimately, we may well reach a point out in the future where it can be confidently claimed that using hearing aids will reduce the risk of developing dementia for people with hearing loss.

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Looking to the future

Keep an eye out for the next edition of this BEYOND THE DATA series for a new research digest in the escalating hearing and brain health story. Read more insights on hearing and brain health.

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Sign up to our newsletter to be notified about the latest news and research.

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Hearing. That precious gift of sound helping us to connect to the people and world around us. A sense so common to everyday life it’s easy to take for granted. So much so that hearing loss is often just seen as a nuisance or an inevitable consequence of ageing.  

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But the fact is hearing loss is more than a loss of sound; it can be a serious loss of health. Because when it remains unaddressed, it can negatively impact so many aspects of our lives. Potentially bringing mental, emotional, physical, or cognitive health issues¹.

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Evidence shows how hearing loss can lead to social isolation, loneliness and depression, physical problems with balance, and cognitive decline – even a greater risk of dementia and other chronic diseases². And yet, many people still underestimate the impact of hearing loss.

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Untreated and underserved

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Today, more than 1.5 billion people experience some degree of hearing loss. And by 2050 this number is set to grow to 2.5 billion. It’s also estimated that 5% of the current global population – some 430 million people – require care and rehabilitation to address their hearing loss. Which if untreated could impact their quality of life².

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Statistics like these highlight how there’s a significant and growing number of people with hearing loss who are being untreated or underserved. A reality which is ultimately impacting both the health of individuals and the health of society.

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According to the World Health Organization, for example, unaddressed hearing loss poses an annual cost of over $980 billion. A figure that includes costs related to health care, education, productivity losses, and societal costs². But this may only be scratching the surface. Because the more we learn about hearing loss, the more we can expect figures like these to keep rising.

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A time to act

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The good news, of course, is that addressing hearing loss with hearing aids can help to improve hearing and speech. As these are solutions that come with virtually no health risks and can only have a positive impact on our ability to communicate and engage with others¹.  

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But good hearing care isn’t just about the immediate need to treat and manage hearing loss. It’s also about long-term preventative health – particularly when it comes to reducing associated health risks such as cognitive decline and dementia.

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The question then is are we doing enough? If we know that hearing aids can help prevent serious health problems and improve quality of life, shouldn’t everyone else know this too?

This is exactly the mission of LISTEN TO THIS. We want to get the urgent story out there that an underserved population with hearing loss is an opportunity to not only deliver better hearing care but better health care. That by joining forces, we can keep uncovering more evidence while finding innovative new solutions.

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Together, and with your support, we can help to bring hearing care to everyone who needs it. One ear at a time.

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Want to know more about the growing link between hearing and brain health?

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Check out the story so far here.

As the old adage goes – nothing is permanent except change. That’s the simple reality when it comes to hearing. As we get older, the inner ear structures that process sound for the brain gradually break down or become damaged. And unlike other parts of the body, our inner ear cells can’t regenerate, leading to a potential decline in hearing.

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It’s perhaps no surprise then that more than 65% of the global population above the age of 60 experience some degree of hearing loss. And within this age group, 25% are experiencing moderate or higher-grade hearing loss¹.

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As most audiologists will know, age-related hearing loss can be a challenging and frustrating reality for people. Not only for those who have it, but also for the loved ones around them. And its impact can go far beyond a declining sense.

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FAR REACHING CONSEQUENCES

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Today, there’s a wealth of evidence indicating how the impact of unaddressed or untreated hearing loss in adults can have a significant impact on overall health – particularly when it comes to quality of life. But just how far reaching can these consequences be?

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No matter the degree or stage of hearing loss, it can impact our social, mental, emotional, cognitive, even physical health. Some of the most immediate challenges lie within everyday listening and communication – affecting a person’s ability to talk, share and connect with others in their day-to-day life.

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With compromised communication can come social isolation and loneliness. Studies show that an impaired ability to comprehend auditory information and maintain conversations may lead to an avoidance of potentially embarrassing social situations by the affected individual². And it’s this gradual withdrawal from the world which can lead to a growing sense of loneliness.

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Hearing loss and comorbidities

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The knock of effect of social isolation and loneliness, of course, can be an increased risk of other psychological or cognitive health issues. Ranging from stress, anxiety, and depression to serious cognitive decline and dementia³.

As we’ve explored in other articles on LISTEN TO THIS, hearing loss has been identified as the biggest potentially modifiable risk factor for dementia – accounting for more cases of dementia than other risk factors such as high blood pressure, smoking or head injuries.⁴

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On top of this, many studies shed light on the range of other comorbidities linked to hearing loss, including cardiovascular diseases, diabetes, mobility restrictions, stroke, arthritis, and cancer. For all these conditions, the prevalence appears to be larger in people experiencing hearing loss, while some studies have found increased rates in those with a hearing loss.⁵

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from individual to societal

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It’s clear that hearing loss has the potential to negatively impact a person’s quality of life – whether physically, mentally, or socially. And now there’s good evidence to indicate that its affect can be felt even further in terms of poorer education attainment, employment opportunities, economic independence, and productivity in the workplace.⁶

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In this HEARING FOR LIFE series, we’ll deep dive into all these implications and more around life quality – examining just how an untreated hearing loss can affect not only our bodies and brains but also the people, environments, and communities around us.

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In part two, we’ll further explore the connection between hearing loss and physical health – looking at the potentially adverse health outcomes.  

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Want to know more about the role of hearing within dementia prevention?    

We spotlight the issue here

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Every three seconds. That’s the rate as which someone in the world develops dementia today. And looking ahead, the number of people living with this disease is projected to soar from 55 million in 2020 to more than 139 million by 2050¹.

The reality is that while many of us are living longer, healthier lives thanks to continual improvements in health and social care, the global population is seeing an increasingly larger proportion of older people. A demographic often at higher risk of developing dementia.

According to recent data, dementia is the seventh leading cause of death and one of the major causes of disability and dependency among older people globally². All of which begs the question, just what can be done to turn the tide?

Reducing the risks

On paper, dementia is the umbrella term for several diseases affecting memory, thinking, behaviour and the ability to perform everyday activities. But in real terms, it’s a condition that could potentially overwhelm society – not only impacting those living with it but caregivers, families, communities, and healthcare systems.  

Though there’s been some advances in recent years in terms of access to care, dementia is still an under-diagnosed and under-treated disease without a cure³. Identifying effective prevention strategies that can reduce the population-level risks of dementia is becoming a growing priority for governments around the world.  

Because while the numbers are rising, dementia isn’t an inevitable part of aging. The research consistently indicates that it can be delayed or prevented by targeting a series of modifiable risk factors – both big and small.

Hearing loss has been identified as the single largest potentially modifiable risk factor for dementia

According the 2020 Lancet report on dementia prevention, there are 12 potentially modifiable risk factors. These include everything from smoking, obesity and diabetes to excessive alcohol, air pollution, and hearing impairment – the latter identified as the single largest factor.  

The theory is that if we can modify all these risk factors then we might prevent or delay up to 40% of dementia cases worldwide⁴. And given the evidence available, the Lancet report is keen to stress that it’s never too early nor too late in the life course for dementia prevention.

Together acting early

It’s clear that lifestyle factors such as education, diet, exercise, and social interaction are hugely important in reducing the risks of dementia. Yet the reality is that not all risk factors are easily modifiable by individuals on their own – despite their best intentions.

And considering the eye-watering projections for dementia – the annual cost of dementia is now above US$ 1.3 trillion and is expected to rise to US$ 2.8 trillion by 2030⁵ – public health bodies, policymakers and more will need to work decisively together to reduce the human and economic costs of dementia.

One area where we can expect to see a movement towards greater preventative management is within the world of hearing and audiology. Particularly since recent research now offers tantalizing evidence that treating hearing loss could slow the rate of cognitive decline for high-risk adults by almost 50%⁶.

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An ear to the future

If the science keeps showing that hearing intervention can significantly modify cognitive decline, then we can expect a bright new future where digital tools, ambitious care partnerships, and innovative support services are widespread within audiology.

This, of course, will mean more advanced hearing solutions, such as new in-ear sensors and vocal biomarker technologies – utilizing brain health data to empower end-users in self-monitoring and early intervention.

But perhaps more importantly we’ll see a major change in the way audiology care is delivered – with greater awareness around holistic hearing health, increased access to hearing and cognitive screenings, and ultimately better patient outcomes.

Together, healthcare providers, policymakers, NGOs, and institutions can drive the movement towards better hearing health

To help drive this change, we’ll need a new partnership landscape of healthcare providers, policymakers, NGOs, and institutions – all advocating for hearing health as a critical factor of our overall health. This will enable earlier, more accurate screenings for dementia as well as better assessments for cognitive decline interventions.

Shifting the narrative

All signs point to a potential large-scale shift and movement in how society considers the value of hearing and hearing solutions – that proactive hearing management and the interventions could play a key role in reducing or even preventing the risk of developing dementia.

As this shift happens, audiology experts will not only be in position to empower more people to take care of their hearing and cognitive health. They’ll be at the vanguard of prevention – enabling better health outcomes for patients and caregivers while helping alleviate the long-term societal costs of dementia.

Welcome to the future of hearing health.  

As the hearing and dementia story evolves, what will this mean for patients?

We explore the implications here

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As a hearing care professional, you’ll know how crucial it is to have clear and carefully planned discussions with your patients. Because for many, talking about their hearing needs or concerns can be a sensitive topic.

And now, with new research further supporting the link between hearing loss and dementia, cognition is fast becoming the hot topic in audiology. But does this mean everyone should be talking about it with patients?

If you’ve asked yourself this question let’s talk…

Do I really need to be thinking about dementia?

Jumping headfirst into a dialogue about dementia and any potential risk factors would be an alarming prospect for any patient. That’s why it’s always best to start and focus the discussion firmly around hearing care and its holistic benefits, including:

• How we hear and understand with our brain – as well as our ears
• How cognition is a key part of processing speech and interpreting sounds
• How helping your hearing can help to maintain good cognitive function
• How good hearing health can positively impact your overall quality of life

In this way, any conversation around hearing intervention can be framed as a positive and natural part of supporting good hearing health, good cognitive health, and overall wellbeing.

What if a patient brings up the cognition topic?    

If you’re talking with patients about any noticeable hearing difficulties, conversation strains, or tiredness after socialising, then cognition is in many ways already part of that discussion.    

But with new research and ongoing studies, we know more about the relationship between hearing and cognitive health than ever before:

• Hearing loss is the single largest potentially modifiable risk factor for dementia¹
• Hearing aid users are at a significantly lower risk of developing all-cause dementia²
• Hearing aids have been shown to slow the rate of cognitive decline by 48%³

However, for patients, what’s perhaps more important is that any facts like these become a catalyst to help them feel informed and empowered to take a proactive role around their hearing health.  

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How exactly can hearing loss affect the brain?

A common patient question might be how does hearing loss impact the brain? Or rather, how can helping your hearing, help your brain? According to Johns Hopkins professor Dr Frank R. Lin, there are three main pathways from hearing loss to cognitive impairment:

• The first is related to cognitive load, meaning that poor hearing can overwork the brain at the expense of thinking and memory
• The second is down to brain structure and function – that if the brain isn't getting enough auditory input, parts of it may shrink
• Thirdly, that hearing loss can cause someone to become socially isolated, another possible contributor to brain atrophy

The theory, of course, is that good hearing can target all these pathways: reducing load on the brain, providing more stimulation, and helping you be more engaged in life.

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Should I be looking out for signs of decline?

It’s well documented that dementia is an under-diagnosed disease due in large part to hesitancy and stigma⁴. And that there are a range of common early signs of cognitive decline⁵ which can be detected.

But as a hearing care professional, it’s important to keep in mind that talking about cognitive health with a patient doesn’t constitute a thorough evaluation or diagnosis.

However, if you’re spending time with a patient over several visits, this could be a good opportunity for staying alert to hearing and cognitive issues that may require a screening, referral, or further consultation.

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Want to know more?‍

Look out for future LET’S TALK stories where we’ll be diving deeper into some practical tools and knowhow to help you integrate cognition into your clinical conversations.

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