| BackgroundWith the rapid development of global productivity,population aging has become a serious problem for most countries,including China.The growing number of older adults are facing severe health challenges,especially hearing loss.Hearing loss has been shown to negatively affect physical,cognitive,behavioral,and social functions,as well as general quality of life,and is related to depression.Within the older adults with hearing loss,prevalence estimates of depression remain varied,but suggested that up to 1 in 5 older adults with hearing loss reported a clinically relevant level of depression symptoms necessitate treatment,and a further 22%experienced the onset of incident depression symptoms over time.To date,there is a minimal examination of best practices for the treatment of comorbid depression and hearing loss,especially within the older adult population.While there remain some variations to date,taken together,the extant literature clearly points to an association of hearing loss in older adults with the presence of depression.However,ongoing research to guide clinical intervention in this area is needed.Firstly,domestic researches on the prevalence of hearing loss in older adults with hearing loss mainly focused on hospital patients.Secondly,a range of possible mechanism for depression in hearing loss have been proposed,although ongoing reseaches remain needed to paint a clearer picture and resolve equivocal findings.Thirdly,to date,limited evidence regarding intervention for depression of older adults with hearing loss exists.There is an important area requiring future examination and trials in order to guide practice.In conclusion,the aim of this study is to describe the prevalence of depression symptoms in older adults with hearing loss in China,and to promote interventions in this area.Given that hearing loss poses a substantial risk to psychosocial health and well-being of older adults,assessment and focused intervention is needed in this population to improve quality of life and reduce mental health burden.ObjectivesThe general objective of this study is to analyse the prevalence and risk factors of depression symptoms in older adults with hearing loss,and to promote interventions in this area.(1)To warrant the association between hearing loss and depression symptoms in older adults;(2)To investigate depression symptoms status of older adults with hearing loss;(3)To investigate the mechanism for hearing loss in depression;(4)To examine the effects of intervention means on depression symptoms of older adults with hearing loss;(5)To put forward suggestions for health aging of older adults.Data Sources and samplesThe research data of this study mainly include:First,the data of older adults with hearing loss in Guan County,Shandong Province;Second,the data of hearing intervention study for the older adults with hearing loss and depression symptoms in Guan County,Shandong Province.Research Contents(1)The literature method was used to study and analyze the literature related to depression of older adults with hearing loss at home and abroad,and problems of the literature were collated and analyzed.(2)Systematic review and meta-analysis were used to synthesize the available evidence to provide a summary effect estimate of the association between hearing loss and depression symptoms in older adults.(3)Using the data of older adults with hearing loss in Guan County,Shandong Province to explore the prevalence of depression symptoms in older adults with hearing loss.Functional hearing was measured with audiometric tests and depression symptoms was measured by Geriatric Depression Scale-15,The regression model was used to analyze the risk factors of depression symptoms in the older adults with hearing loss.(4)Based on previous researches and literature review,the hypotheses about relationship between hearing loss and depression symptoms in older adults was built.Linear regression model and Structural equation model were used to examine mechanism between hearing loss and depression symptoms in this study.(5)Older adults with hearing loss and depression symptoms were recruited and randomly divided into control group and intervention group.Intervention group received hearing aids and the intervention group didn't receive any treatment.GDS-15 was used to estimate the depression sympotms of two groups before intervention,one month,three months and 6 months after the start of intervention.Mann Whitney U test,Wilcoxon Signed-rank Test and Generalized Linear Mixed Models are used to evaluate the effects of intervention experiment.Main Results(1)The relationship between hearing loss and depression symptoms in older adults14 studies reported depression symptoms was associated with hearing loss in older adults and 8 studies denied this association.The results of Meta-analysis showed that hearing loss was associated with statistically significantly great odds of depression symptoms in older adults(OR=1.26,95%CI:1.18,1.33).When studies were stratified by design,hearing loss was associated with greater odds of depression symptoms in cross-sectional studies(OR=1.28,95%CI:1.18,1.39)and cohort studies(OR=1.23,95%CI:1.11,1.34).(2)Status of depression symptoms in older adults with hearing lossA total of 4111 older adults from Guan County,Shandong Province were sampled and 3769 data were collected,of which 1648 older adults with hearing loss(43.73%).The prevalence of depression symptoms in older adults in Guan County was 10.93%.According to different levels of hearing loss,the prevalence of depression symptoms increased from 16.90%in older adults with mild hearing loss to 34.78%in those with profound hearing loss.According to Mantel-Haenszel ?2 test,an increase in prevalence of depression symptoms was seen in different levels of hearing loss(P<0.001).Multiple linear regression analyses revealed that hearing loss was positively associated with depressive symptoms among older adults.Compared with older adults without hearing loss,a significant association between mild hearing loss(?=0.16,P=0.04),moderate hearing loss(?=0.33,P=0.02),heavy hearing loss(?=1.23,P<0.001),profound hearing loss(?=1.74,P<0.001)and depression symptoms.The result suggests that there was a significant association between the levels of hearing loss and depression symptoms.Furthermore,depression symptoms of older adults were associated with unemployment(?=0.09,P<0.001),chronic disease(?=0.06,P=0.001),basic activity handicap(?=0.11,P<0.001),social participation(?=-0.01,P<0.001),social isolation(?=-0.08,P<0.001)and loneliness(?=0.11,P<0.001).(3)Mechanism for hearing loss on depression symptomsThe results of multiple linear regression and logistic regression showed that ?compared with older adults without hearing loss,those with mild(OR=0.17,P<0.001),moderate(OR=0.14,P<0.001),heavy(OR=0.10,P<0.001)and profound(OR=0.08,P<0.001)hearing loss were significantly associated with lower odds of social participation.?compared with older adults without hearing loss,those with mild(?=-4.60,P<0.001),moderate(?=-6.29,P<0.001),heavy(?=-6.59,P<0.001)and profound(?=-8.53,P<0.001)hearing loss were signigicantly associated with greater social isolation.?compared with older adults without hearing loss,those with mild(?=14.32,P<0.001),moderate(?=16.56,P<0.001),heavy(?=16.86,P<0.001)and profound(?=17.97,P<0.001)hearing loss were signigicantly associated with greater loneliness.?depression symptoms has significantly association with social participation(?=-0.33,P<0.001),social isolation(?=-0.03,P<0.001)and loneliness(?=0.04,P<0.001).A significant direct association between hearing loss and depression symptoms(0.25,95%CI:0.19,0.33)was seen in structural equation model.Significantly,but weak,partial indirect ssociations(0.16,95%CI:0.15,0.24)were evident in all models,including mediating influence of social participation(0.02),social isolation(0.03)and loneliness(0.11).(4)The effects of intervention experimentOlder adults with hearing loss and depression symptoms were recruited and randomly divided into control group and intervention group.Intervention group received hearing aids and the intervention group didn't receive any treatment.A total of 215 older adults finished the experment which included 107 older adults in intervention group and 108 older adults in control group.?After 1 months of hearing aids intervention,for the intervention group,the pure tone average in the better ear was shown to be 36.91dBHL.After 6 months of follow up,the pure tone average was 34.53dBHL.For the control group,there were no significantly changes in hearing loss.?The median GDS-15 scores after 1 month,3 months and 6 months were 6(5,8),5(4,7)and 4(4,6)which were significantly better than the control group.?For the intervention group,significant improvement were found between each of these two points in GDS-15 scores(from baseline to month 1,from month 1 to month 3,from month 3 to month 6)(P<0.001).For the control group,there were no significantly changes between each of these two points in GDS-15 scores.?The changes of GDS-15 scores in the two groups were different at each time point.The GDS-15 score of the intervention group gradually decreases with time(Fgroup=27.49,Ftime=270.54,Finteraction=214.66,P<0.001).At the same time,the GDS-15 scores of the control group didn't change with time.?The changes of social participation in the two groups were different at each time point.For the intervention group,the odds of social participation gradually increased with time(Fgroup=13.56,Ftime=11.50,Finteraction=7.41,P<0.001).At the same time,the control group didn't change with time.?The changes of social isolation in the two groups were different at each time point.The LSNS-6 scores of the intervention group gradually decreases with time(Fgrup=11.34,P<0.001;Ftime=13.92,P=0.001;Finteraction=27.85,P<0.001).At the same time,the LSNS-6 scores of the control group didn't change with time.?The changes of loneliness in the two groups were different at each time point.The UCLA scores of the intervention group gradually decreases with time(Fgroup=6.30,P<0.001;Ftime=15.93,P=0.001;Finteraction=16.44,P<0.001).At the same time,the UCLA scores of the control group didn't change with time.Conclusions and SuggestionsMain conclusion:(1)The prevalence of depression symptoms in older adults with hearing loss is 18.26%.Hearing loss was positively associated with depressive symptoms among older adults.In old adults with hearing loss,depression symptoms were associated with unemployment,chronic disease,basic activity handicap,social participation,social isolation,and loneliness.(2)Hearing loss had an independent association with depression symptoms,that was partly mediated by social participation,social isolation,and loneliness.(3)Among older adults with hearing loss,lower depression symptoms,social isolation,loneliness,and greater social participation were associated with better hearing which was improved by using hearing aids.Suggestion:(1)Strengthen the early screening of depression in older adults with hearing loss.Implement depression screening with tracking,and initiate appropriate interventions to identify and treat older adults with depression.(2)Strengthen social participation and social network of older adults with hearing loss.In order to promote mental health of older adults with hearing loss,social support is required to help them maintaining social resources,establishing satisfactory social network,and getting support from family members.(3)Action is required to reduce hearing loss and improve outcomes of older adults with haring loss.Government,public health agencies,social services orgnazations,educational institutions and civil society groups all need to collaborate in this endeavour.Innovations and LimitationsInnovations:(1)This study used field survey data to analyze the mechanism of hearing loss on depression symptoms,filled the gap in domestic research in this area,and provided evidence for the intervention of depression symptoms.(2)This study firstly tired population-based intervention for depression symptoms in older adults with hearing loss and made a new attempt for the management of mental health.Limitations and Prospects:(1)Due to time and funding constraints,the research only conducted a cross-sectional survey in Guan County,Shandong Province.Future research suggests to carry out a large sample cohort survey;(2)Due to the time limit,this intervention study has only been carried out for 6 months,and the long-term intervention effect needs to be further observed. |
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