Hearing Loss and Social Isolation in Community-Dwelling Older Adults over Time: The Role of Neighborhood Disorder and Social Cohesion

Background and Purpose: Hearing loss is one of the most common sensory impairments that people acquire, particularly as they get older. Hearing loss in later life causes difficulties with communication, potentially leading to social isolation, dependence on others, and reduced quality of life. However, less is known about the social aspects of those with age-related hearing loss, and few studies have assessed the influence of environmental factors on hearing loss and social isolation. Based on the ecological model of aging, the specific aims of this study are to examine: (1) the longitudinal association between hearing loss (i.e., use of hearing aid) and social isolation of older adults over time, and (2) the moderating effects of neighborhood disorder and perceived social cohesion on this relationship. 

Methods: We analyzed data from 2,080 community-dwelling older adults from Round 1 (2011) to Round 3 (2013) of the National Health and Aging Trends Study (NHATS), a longitudinal study on late-life functioning with a nationally representative sample of Medicare beneficiaries ages 65 and older. We used NHATS items comparable to the Social Network Index’s indicators of isolation: marriage of partnership, family and friends, church participation, and club participation. We measured four domains with six items, with higher scores indicating greater isolation. We measured hearing loss as a binary variable indicating whether the respondent used a hearing aid or other hearing device in the last month. Neighborhood disorder and social cohesion each consisted of three items. We also included age, gender, educational level, living arrangement, race/ethnicity, annual total income, self-rated health, and the number of chronic diseases as covariates. We conducted random coefficient models for longitudinal analyses, treating hearing loss as a random coefficient.  

Results: Older adults with hearing loss were less socially isolated than those without hearing loss (B = -0.052; 95% CI = [-0.189, -0.022]). The effect of hearing loss on social isolation varied depending on perceived neighborhood social cohesion. Older adults with hearing loss who had high levels of social cohesion had significantly lower social isolation, while older adults with hearing loss who had low levels of social cohesion had significantly higher social isolation (B = -0.047; 95% CI = [-0.087, -0.006]).  

Conclusions and Implications: Our findings suggest neighborhood social cohesion influences the association between hearing loss and social isolation among community-dwelling older adults. Considering that hearing assistive devices are rarely covered by health insurance (with the exception of some state Medicaid plans or rehabilitation services for veterans), modifying neighborhood factors may be an effective intervention to help older adults with sensory impairments be socially engaged.  This study only focused on the general impression of individuals’ surrounding neighborhoods and their perceptions on their community. Future studies should conduct a more in-depth examination of neighborhood social and disorder environments and their effects on those older adults who may be particularly at risk for social isolation.