Because the prevalence of both Alzheimer's disease and related dementias (ADRD) and age-related hearing loss increases with age, many older adults with ADRD have hearing loss. Since (1) hearing loss may contribute to cognitive decline and (2) neuropsychiatric symptoms commonly associated with dementia (e.g., depression, agitation, anxiety, apathy, and irritability) could be exacerbated by poor communication resulting from hearing loss, it has been suggested that hearing aids (HA) are an important non-pharmacological intervention for older adults with ADRD. However, in the literature there is no strong evidence to support the benefits of HA intervention for older adults with ADRD. Further, it is unclear which HA service-delivery models would be the most cost-effective for older adults with ADRD. The goal of the proposed project is to conduct a pilot study for a future placebo-controlled, double-blinded, randomized-controlled clinical trial that will determine the benefits of HA intervention for older adults with ADRD relative to a placebo and in comparison to adults without ADRD (Aim 1) and compare the outcomes, value, and candidacy of two HA service-delivery models for older adults with ADRD (Aim 2), focusing on communication functions, dementia-related symptoms, quality of life, and caregiver burdens. The two service- delivery models that will be examined include a model in which audiologists use the best practices to fit customized HAs, and a model in which audiologists provide streamlined services to fit pre-programmed, non- customized amplification devices. Finally, the future clinical trial will identify device- or patient-centered variables that could explain how HA intervention impacts outcomes for older adults with ADRD (Aim 3). In the proposed pilot study, the infrastructure, protocols, and materials of the awarded parent project (R01 DC015997), which is designed to determine the outcome, value, and candidacy of various HA technologies and service-delivery models for older adults with normal cognition, will be modified and tailored to patients with ADRD. Older adults with ADRD and age-related hearing loss, as well as their caregivers, will be recruited and randomly assigned to one of the three parallel intervention groups: two HA service-delivery models and a placebo group. Outcomes in daily communication functions, dementia-related symptoms, quality of life, and caregiver burdens will be assessed. The collected data will provide valuable information to formulate the hypothesis, conduct power analysis, and finalize the research protocol for the future clinical trial.
The proposed project is relevant to public health because the knowledge gained from the project will pave the way for a larger scale multi-site parallel-branch placebo-controlled randomized controlled trial that will optimize audiological rehabilitation for older adults with dementias. This, depending on the ultimate outcome, could lead to substantial improvements in quality of life of older adults with dementias.
