 Aloha and welcome to my program, Don't Just Age and Gage. I'm Larry Grimm and I welcome you to this program from Think Tech Hawaii about aging in such a way that you are in charge and you are providing yourself with the most extraordinary elderhood you could possibly have. Is it possible truly that lack of a loss of hearing can create dementia or can contribute to dementia? That is a profound and new insight for me and I am asking Lisa Sales to join us and to provide us some insight into the relationship between loss of hearing and dementia. Hello, Lisa. Hi, Larry. How are you? Fine. Fine, I am and glad so much to have you on this program. Lisa, I've worked with aging population for many years. Three million of our population have what is called dementia and I have never really explored dementia that much except to recognize the difficulty that it presents to patients and to family members as they move through the aging process. So I'm really delighted to have you come on and address that dementia from an aspect that we really don't hear much about because it's so often it's physician initiative and what's going on with the brain in terms of medical approach, how we can medicate it or how we can adjust in some way, diet or whatever, but here we're coming at it from a physical, a physicalness, a physicality, a physical, tell me more, tell me more about this. How does hearing loss affect dementia? Well, there's been tons of research. It's well known that a large portion of our elder population is experiencing hearing loss. And if you use the national data, about half of all adults over the age of 60 in the United States, some type of treatable hearing loss, that's about 38 million people, or about twice the size of New York, New York being the fourth largest state population wise, going forward by the year 2060, that is going to double, well, around 70 more than double to around 74 million people. Due to this increase in aging population, I think we're seeing a lot more research being done to better aging and what the causes and effects are of it. Hearing loss plays a key role. It defines how humans interact with each other all around them. That's really some interesting numbers. Lisa, I went to the AARP website and I found this, which I thought was interesting, paying bills, taking the many pills, doctors prescribed, using the remote control, traveling outside the home, managing life's daily tasks, presents numerous real-world tests of our cognition, mistakes, errors, or subtle declines in performing the well-rehearsed activities of our daily living can be signs of cognitive change that need medical attention. Now, all of those that are listed, Lisa, are word-oriented, they're audio-oriented, how we get instructions to maintain our lives, our daily practice, taking medications, working the remote control, knowing where to go, how to go, and where to get bus stop or whatever I need to get, and then just the other daily tasks are often communicated through word. Yes, absolutely correct. I mean, that's how we have developed as humans. We're very compassionate and communicated people, and when we stop doing that, all kinds of things happen. Probably some of the original research started with Professor Franklin, who's an MD, a PhD, and a board certified otolaryngologist at the Bloomberg School of Public Health. And he's really been the pioneer, I think, in this as far as researching. He has done multiple studies along with his associates and used large databases on hearing and cognition. One thing I didn't do, excuse me, sorry. These studies use some very rigorous methodologies, and their research laid the foundations for all of this. The original research was done over 12 years with 639 patients, I think ages 39 to 98. And it was the beginning to show that there was volume brain loss, that there was a correlation between cognitive decline and hearing decline. They did another study, Dr. Nguyen did, of 234 adult men between the ages of 70 and 79 over nine years. In this particular study, it's the first one of its kind, there have been several now, but it was associated that a modern hearing loss had, with an increased risk of dementia, the odds ratio were 2.67, you just had a moderate mild, not too bad, you could still communicate hearing loss. And a hazard ratio of one and a half percent, 1.55 percent, that's big, that's a big number. Are you familiar with? I read about that, but I didn't quite understand it. Can you explain it to me a little bit better for my limited knowledge? It's hazard ratio is the effect. And the risk, in this case is hearing loss to an outcome, in this case of dementia, in a case of one to one, it's equal risk. In a moderate hearing loss, this one goes to a 1.55 or 55 percent higher risk of dementia with a moderate hearing loss. As a severity of loss increases, so does the risk factors. And it's over, all the years that I've done this, which have been a lot, I have seen it. That's really amazing. So dementia is recognized and often times by family members more so than the patient or the person themselves. And just let me show a list here or read from a list of recognizable symptoms of dementia. Memory loss that disrupts daily life for getting events and repeating yourself or relying on more age to help you remember like sticky notes. Challenges in planning or solving problems. Difficulty completing familiar tasks at home, at work, or at leisure. Confusion with time or place. Maybe not understanding and understanding an event that is happening later or losing track of dates. Probably understanding visual images and spatial relations. New problems with words or speaking or writing. Misplacing things and losing the ability to reach steps. Decreased or poor judgment, withdrawal from work or social activities. Changes in mood and personality. All of these are demonstrations of what we call dementia. And it strikes me again, how word-oriented many of those are. And I begin to wonder, Lisa, when I have been working with some of my patients as a hospice chaplain, was I actually seeing the effects of hearing loss when they couldn't quite get what I was saying and I was going back over again and again as were family members? How often did you see this? If you can't hear it, you can't remember it. So quite a bit. And the more severe the loss is, the greater the correlation between dementia and cognitive decline in hearing loss. We've seen it in literature and published studies in a 2013 published study where the risk factors are mild, moderate and severe. What you saw was a mild loss of 1.89, a moderate loss 3.00, and a severe loss 4.94. That's five times more likely to have dementia than somebody who has no loss or has a well-treated loss. So if a loved one in the household is receiving a lot of the focus of a lot of frustration because it doesn't seem like they're listening, it may be that they just aren't hearing. Yes, that's true in many things. I mean, think about just the person that has hearing aids. I have hearing aids. I don't hear very well without them. If I had some incidents and I had to go in an ambulance to the hospital without my hearing aids, I'm going to have a hard time communicating. And so does everybody else or if they don't have. And so it's hard to even in that instance where you're not looking at that dementia, looking at somebody not being able to comprehend what you're telling them. Hearing loss and aging people has often been the brunt of a lot of jokes too. I mean, you know, people, comedians do stereotype. They just can't hear right. They'll do a kind of a takeoff on some of the loss. I'm wondering, is there a pattern of hearing loss that goes along with aging that is sort of predictable? You can anticipate certain kind of pattern of loss. Oh, sure. The most common losses are sensory no losses. There's some hearing losses that are surgically operable. Doesn't mean you won't still need a hearing aid, but you're surgically operable. But a sensory neural hearing loss, the only treatment for it is getting the appropriate sound pressure in there to stimulate that electrics, electronic response up to the brain. Now you hear with your brain, you don't hear with your ears. They're just kind of the plug to get the thing moving. And when that breaks, and a sensory neural hearing loss is the number one type of loss that we see, and it's more high frequency. So when you couple that with English language, high frequency is 60% of the language, a little more than 60%, the pitch and tonality of women and children. And if you're missing a good part of that or even some of it, then you're in trouble. It's hard. That's that study that says 60% of people over the age of 60, about 60% of them are able to be treated by hearing aids. It was about four years ago, I think that I went for my first hearing test. And that was in my mid 60s. So and then I discovered that I had lost the upper range of the upper range of sound. And I was losing some, I guess it was six years ago, I was also losing some consonants. D, T, S's, Z's, and my auto-long, my ENT doc said, consonants carry all of the information. Yeah, vowels are kind of the power, but the information comes from the consonants. And that's true. And it's 60% of the English language. So when should people get a hearing test? My personal opinion, I believe anybody over the age of 50 should go get a hearing test, get a baseline, know where they're at, even if they don't, I know I don't have, never asked anybody to repeat my entire life, get a baseline, know where you're at. And then every two years, hearing loss, the sooner you treat it, the better the outcomes always. And when you're looking at a mild loss with a 1.89 risk factor for dementia, that's pretty high. That's 2%, you know, one to two. One of the interesting things, Lisa, to the audience, I will tell you, Lisa gave me and advised me on hearing aids and has been my source for hearing ability, to renew my hearing ability. It's kind of odd because as a chaplain in hospice care and in long-term care, my main concern, and as a coach, is my main concern is to listen. And when I found out I wasn't really hearing what I was listening to, it was a blow to my career, actually, if I hadn't gotten better engaged and better connected, I wouldn't be coaching for life and faith like I do online now. But I went for, I did go for the hearing test, discovered that I was losing the upper range of tonality and then of pitch and those consonants. And I would listen to people talk and to begin to identify the holes in my hearing that I would only hear partially what was being said. And it didn't matter how much I got, you know, really intent and paid attention. It was a matter of that my, my ear drum just really wasn't responding to it. So it is particularly important. And then that all feeds into relationships, doesn't it, Lisa? I'm sorry, I didn't catch that last sentence. That feeds into relationships. Oh, absolutely. Absolutely. I mean, what we know in an association, hearing loss affects, it gives you a diminished quality of life. You have more stress. You have anxiety. Hearing loss causes depression. Hearing loss causes emotional and social consequences. And in many different ways, not to mention the other things that hearing loss can affect. Hearing loss can affect. If you have a low frequency hearing loss, it can affect your heart. You're more likely to have cardiovascular events. It's a fact. Manufacturer of blood pressure. You're more likely to fall. You're more likely to have hospitalization. But as far as dementia goes, the literature is very, very consistent in this field, and that it's a trivial risk for dementia. And dementia is exactly what you described it. And the same is when you describe a hearing loss. It affects all those parts of your life. Because if you can't remember it, you can't hear it. You can't remember it. We are, as a people, are so interested in labeling things. And we want to quickly label what we see in our elders being problematic. And to move to dementia as a label is a very easy and available category to put people in. But what I want viewers to take away from this is that, in fact, hearing loss is not a joke. It's not something to play with. That, in fact, what you see in your loved ones may not, in fact, be dementia, but maybe just a need to get their hearing tested and to get some correction to that hearing loss. Let me check on our questions, Lisa. Do other studies support a link between hearing loss and cognitive decline or dementia? Other than what you've cited so far? That relationship began what year? That study began what year? That study was published, I believe, in 2011. It was 12 years. So it began in the 90s. And that's really when we started taking a look at it as a late 90s. And the literature is very consistent. You've got the Lancelot Commission study, which is a study on dementia, has now listed hearing loss as an accountable attribute for dementia. And this is the first time hearing loss has ever been featured prominently in a comprehensive report on dementia. Much of the literature has used non-auditory tasks for their correlation and cognitive decline. There are, in fact, at this point, there's current studies that are saying that somebody with dementia is getting help from hearing instruments. And that's because we know now, through CAT scans and CAT scans and whatever, that hearing aids help build volume. It's kind of like if you were, you know, I had it explained to me once, if you don't use it, you'll lose it, your brain will rust. So it's like if you laid in bed for a month and then decided on the last day of the month, you were going to go dancing, but you didn't go anywhere out for that whole month. You're not going to dance very well and if you don't use your hearing, you're not going to hear very well. Yeah. But it's that exercise of the brain and it really makes a huge difference. So what kind of treatment, it does make sense and if a person really has been diagnosed with dementia, can hearing aids actually reverse that diagnosis? There are studies working with that right now, yes. There's not nothing conclusive, but there are some positive things in that area that the brain function of people with dementia can be improved through hearing aids. I mean, if you've got a mild hearing loss and you still have a 1 to 1.89, almost 1 to 2 risk factor or 2 times more likely, it makes sense. It doesn't mean that you can't hear. It means some things are softer or not as clear. Lisa, can you give us a quick overview of the kind of hearing aid instruments that are available? Oh, goodness. They are, well, you and I wear what is the most commonly fit instrument today, which is a small device that goes behind our ear that's Bluetooth and just a wonderful thing. You can stream with it. You can see all just it's amazing. It's just where it is now and where it was 30 years ago and my practice are hugely different. And some people, I think, honestly believe that hearing aids are what their grandfather had. Well, they're not. They really are not. They don't whistle. They don't squeak. They're very comfortable. You don't have to have your fingers in your ears turning up and down all the time. A whole different world. I mean, and I think that's really been some of the reason people have been hesitant, even if they know they might be having a problem. And humans are great machines. We can just adapt to about anything and keep on going. But it's just amazing. Often I will see people and one of the processes is to do an unaided word test. That means they can't read your lips. But you're looking for what's so that sounds are clear in single syllable words. And I've seen people that can't pass the test can't, you know, out of 25 words, they missed 25 words out of 50 words. They missed 50 words. Yes, you've got your other device there. That's a wonderful device. And when I treat them, I can get their hearing comprehension to 90 to 100 percent. Oh my gosh. Wow. So you're getting, you know, and that being said, you're getting 75 percent of the benefit immediately over the next six months. Your brain's going to build some new pathways. You're going to get another 25 percent benefit, which is what the studies are showing. Um, that it is just amazing what it can do to improve the quality of somebody's life. Right, right. I have, I want to show off my my little devices. I have this Bluetooth device that connects my cell phone directly to my hearing aids so that if I have when I have a call come in on my cell phone, it rings right in my ear. I talk right from my, from my device here into the phone. And I don't even have to pick up my phone. So it's really fascinating. Also anything that I want to play on my phone, it comes audio or even video, it comes right into my hearing aids. I think some smart TVs also will key in on your Bluetooth. Yeah, so it's a wide range of possibilities now that we're, that grandpa never had. No, I mean, what are cochlear implants? Cochlear implants. You've probably seen somebody with a thing maybe on the back of their head around circle. It's an implant into the cochlear to stimulate the nerve for somebody who is deaf. And I've referred many people over the years back at the University of Michigan to have cochlear implants. But it doesn't, unless you're born that way or there's some trauma, it doesn't have to be that way. This is years ago. I remember a gentleman who would come in and see me once a year. And he had a serious sensorineural hearing loss that got worse every year. And I explained to him more than once, you know, you need to treat this now. One day you're going to come in here and I won't be able to help you. And he said, well, it's not bad enough yet. I can still hear. No, he couldn't, but he could see. He finally came in one day and said, okay, I'm ready to get a hearing aid. And I tested him and his ability to understand speech was now zero. Oh, that's sad. Watch that decline go from, and he had worked in, you know, factories where there's stamping plants and huge amounts of noise and no ear protection. But so he had a serious loss, but I watched him go from maybe a 70% understanding to zero over the course of five years. Oh, that's sad. So everybody gets your hearing tested. If you're over 50, especially get your hearing tested. And if you think you have dementia in your family, get that their hearing tested, find out for sure that this is treatable. And if that's part of what goes on in your family. Thanks so much for joining with us. We got to close now. This is Aloha to you. Don't just age, engage. I want people aging to be empowered for an extraordinary elderly. Don't just age, engage Larry Grimm and peace be with you. Aloha and come back in two weeks.