Columns

November’s Senior Power columns are about Dementia, Alzheimer’s (a form of dementia), their caregivers, and — this week — the very significant dementia-hearing relationship. 

“The problems of deafness are deeper and more complex… than those of blindness. Deafness is a much worse misfortune. For it means the loss of the most vital stimulus — the sound of the voice that brings language, sets thoughts astir and keeps us in the intellectual company of humankind.” (Helen Keller in Scotland: A Personal Record Written by Herself (1933.) Helen Adams Keller (1880-1968) knew that, in her words, “Blindness cuts us off from things, but deafness cuts us off from people.”  

Studies suggest — some would say demonstrate — that hearing loss, which is prevalent in more than 30% of adults age 60+, may be a risk factor for dementia. Hearing loss can be a precursor to cognitive dementia and possibly Alzheimer's. It is the social isolation plus the strain on the brain trying to fill in the missing information. 

A recent Charlie Rose program consisted of an impressive roundtable of hearing loss experts. Johns Hopkins University School of Medicine Division of Otology’s Frank Lin, M.D., Ph.D. and University of Iowa Professor of Audiology Ruth Bentler, Ph.D., and others. While the effect of hearing loss experienced by old people and the importance of access to hearing aids (assistive listening devices) were mentioned, they were downplayed. The subject was cochlear implants and how they now can repair damaged, lost, or “never had” hearing. 

The cochlear has only 15k "hair cells," non-regenerative electro-mechanical transducers of the ear. A cochlear implant is a small, complex electronic device that can help to provide a sense of sound to a person who is profoundly deaf or severely hard-of-hearing. The National Institute on Deafness and Other Communication Disorders (NIDCD)’s Internet site is a good source of information about the cochlear. Paula Span writes of “A different kind of hearing aid” (November 11, 2013 New York Times.) She includes reference to Medicare’s stance regarding hearing aids. “…younger seniors and those with higher speech scores do better with implants. After prolonged hearing loss, ‘the pathways in the brain that handle auditory processing may begin to atrophy,’ according to Dr. Lin, so while ‘the attitude among a lot of people is, Let’s wait until it gets really bad,’ results are better if you do not. Medicare will undertake a national study of cochlear implants in older people, so that policy could change, eventually. Meanwhile, the absurdity of Medicare’s willingly paying $70,000 to $80,000 for implant surgery and all the associated costs at the Cleveland Clinic, but not $4,000 to $5,000 for a digital hearing aid, continues.” 

A research study released in 2011, Hearing Loss and Dementia Linked in Study, by Johns Hopkins researchers and supported by the intramural research program of the National Institute on Aging suggested that seniors with hearing loss are significantly more likely to develop dementia over time than those who retain their hearing. The findings could lead to new ways to combat dementia, a condition that affects millions of people worldwide and carries heavy societal burdens. 

The reason for the link between dementia and hearing loss is unknown, but the investigators suggest that a common pathology may underlie both or that the strain of decoding sounds over the years may overwhelm the brains of people with hearing loss, leaving them more vulnerable to dementia. They also speculated that hearing loss could lead to dementia by making individuals more socially isolated, a known risk factor for dementia and other cognitive disorders. Not surprising, then, are three conditions that have been found to be conducive to delaying dementia: early music involvement, multilingualism, and healthy sleep. (Read, for example, "Speaking more than one language may delay dementia," by Kim Painter, USA Today, Nov. 7, 2013). 

Whatever the cause, these scientists’ findings may offer a starting point for interventions — even one as relatively simple as hearing aids — that could delay or prevent dementia by improving patients’ hearing. At this point, I’m asking Why, then, does Medicare refuse to fund hearing aids? Why are old people denied this support? And what can we together do about it?! Well, for one thing, the decennial White House Conference on Aging is in the planning stages. Its purpose is to make recommendations to the President and to Congress to help guide national aging policies for the next ten years and beyond. The White House Conference on Aging in 2015 theme is “The Shape of Things to Come.” 

“Researchers have looked at what affects hearing loss, but few have looked at how hearing loss affects cognitive brain function…There hasn’t been much crosstalk between otologists and geriatricians, so it’s been unclear whether hearing loss and dementia are related.” (Study leader Dr. Lin.) To make this connection, Lin and his colleagues used data from the Baltimore Longitudinal Study on Aging (BLSA). The BLSA, initiated by the National Institute on Aging in 1958, has tracked various health factors in thousands of men and women over decades. 

The study, published in the Archives of Neurology, focused on 639 people whose hearing and cognitive abilities were tested as part of the BLSA between 1990 and 1994. While about a quarter of the volunteers had some hearing loss at the start of the study, none had dementia. These volunteers were then closely followed with repeat examinations; by 2008, 58 of them had developed dementia. The researchers found that participants with hearing loss at the beginning of the study were significantly more likely to develop dementia by the end. Compared with volunteers with normal hearing, those with mild, moderate, and severe hearing loss had twofold, threefold, and fivefold, respectively, the risk of developing dementia over time. The more hearing loss they had, the higher their likelihood of developing the memory-robbing disease. Even after the researchers took into account other factors that are associated with risk of dementia, including diabetes, high blood pressure, age, sex and race, hearing loss and dementia were still strongly connected. 

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PC stands for personal computer as well as for pleasant communication! Cognitively stimulating activity is among the lifestyle factors that may help lower the risk of developing Alzheimer's disease and other forms of dementia. And yet technology use among elderly Americans is low, relative to the rest of the population.  

Seniors 74-years-old and older are the fastest-growing age group on social-networking sites. Why are some senior citizens so resistant to technology? Would they be less so if senior centers and retirement communities encouraged their pc learning and acquisition? Instruction and equipment are often lacking. A few tears ago I received an email from England from a second cousin I never knew I had — she had found me via the Internet. She’s a genealogy buff, and we have exchanged photographs via the Internet (by email attachments) from our personal “archives.” 

A senior center planning a program of motion pictures related to dementia and AD might consider these: Floating is Easy (BBC Film Network;) Iris, a 2001 biographical film that tells the story of British novelist Iris Murdoch and her relationship with John Bayley; Away From Her, based on Alice Munro’s short story, “The bear came over the mountain;” A Moment to Remember, a love story about quiet carpenter Chol-su and Su-jin with AD, in Korean with optional subtitles; The Savages with Laura Linney, a 2007 closed captioned motion picture in English with optional subtitles; and She Doesn't Want to Sleep Alone.  

No quiero dormir sola is the original title, with English subtitles, of She Doesn't Want to Sleep Alone, the feature debut (in 2012) of Mexican director Natalia Beristain, who co-wrote the script. Two generations of women dealing with loneliness and addiction are elements of dramah in any language. Mexico City resident Amanda (37-year old Mariana Gajá) is well off and doesn’t need to work. She dabbles in photography during the day and sex with various men in the evening. Bartender Pablo is patient with her because she has a problem— she can’t sleep alone without pills. A neighbor summons Amanda to the neglected, memento-stuffed apartment of grandmother Dolores (79-year old Adriana Roel,) who maintains a state of inebriation that exacerbates her Alzheimer’s-induced short-term memory loss. Amanda must acknowledge her grandmother’s need for full-time care, and checks her into a residential facility for aged. Amanda gradually finds spending time with her abuela gratifying. Even when most confused, grandma has a sharp grasp of Amanda’s character. A tender empathy grows between them…applying makeup, enjoying the swimming pool, reacting to the sight of themselves naked in a changing-room mirror.  

In his 2011 book, My Father at 100; A Memoir, Ron Reagan suggested that his father suffered from the beginning stages of Alzheimer's disease while he was still in the White House. President Ronald Reagan was diagnosed with Alzheimer's in 1994, five years after leaving office. He died in 2004 at age 93. Reagan's son (then 53 years old) wrote that he believed his father would have left office before his second term ended in 1989 had the disease been diagnosed then.  

The Consumer Handbook on Hearing Loss and Hearing Aids; A Bridge to Healing, 3^rd edition, edited by Richard E. Carmen (Auricle, AZ: Auricle Ink Publishers, 2009) can be borrowed in your behalf via The Link service. Twelve chapters by several experts provide information about topics not usually covered in memoir-like collections, including AD and dementia, the audiogram, tinnitus, aging, wireless telephones (hand-held phones with built-in antennas, often called cell, mobile, or PCS phones,) CAPD, boomers, and cost of hearing aids. I recommend chapter 6, ‘Hearing aid technology and rehabilitation’ by UCSF Department of Otolaryngology Director Robert W. Sweetow, Ph.D. The Federal Communications Commission (FCC) has a system of cell phone ratings. When acquiring a cell phone, watch for a M3, M4, T3 or T4 rating. The “M” refers to the microphone and “T” to the T-coil.  

For a state-by-state list of services for adults with hearing loss, as of April 2012, go to www.hearingloss.org/content/medicaid-regulations. (“Covered states” included Florida and Hawaii; “not covered” were mostly in the Deep South.) 

Why is Medicare so anti-hearing aids for senior citizens? What are we together doing about it?