Editor’s note:  The article title was edited for clarity.

Hearing loss is one of the most common conditions affecting older adults. Approximately one-third of people between the ages of 65 and 74 and half of people over age 75 have some type of hearing impairment or loss.1 Despite its high prevalence, however, hearing loss frequently goes undetected and untreated in this population, possibly because only 9% of clinicians recommend that their older adult patients get hearing tests.2

Depression and hearing loss frequently coexist. A study conducted by the National Institute on Deafness and Other Communication Disorders (NIDCD) found that more than 11% of adults with hearing loss also experience depression, compared with only 5% of the general population.3 Hearing loss is also associated with higher levels of anxiety, interpersonal sensitivity, and hostility,4 as well as higher rates of dementia,5 especially in older adults who are also visually impaired.6 Hearing loss in older adults is also independently associated with poorer cognitive and physical functioning and higher healthcare utilization and costs.7

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“Although the relationship between hearing loss and cognitive impairment has been researched, there has been relatively little work done on the relationship between hearing loss and anxiety and depression,” according to Dan Blazer, MD, PhD, MPH, Professor of Psychiatry Emeritus, Duke University, Durham, North Carolina.

“Hearing loss and depression are common partners but understudied and underrecognized in older adults,” he told Psychiatry Advisor.

Reactive Depression

People with hearing loss showed a higher prevalence of psychological distress (39.7% vs 19.3%, P  <0.001) and memory loss (37.7% vs 5.2%, P  <0.001) than those without, according to study results recently published in Geriatrics & Gerontology International.8

While there are both neural (central) and ear-related (peripheral) mechanisms involved in hearing loss,9 there has been virtually no research on neural pathways that hearing loss might share with mood disorders. “It is not clear if there are common neural mechanisms between hearing loss and dementia, depression, or anxiety and, if so, what those might be,” said Robert Frisina, PhD, Professor, Department of Chemical and Biomedical Engineering, University of South Florida.

Dr Frisina, who is also the Director of the Global Center for Hearing and Speech Research, told Psychiatry Advisor that the subjects studied at the center “have many psychological and psychiatric issues because they are losing something they once had, which is a critical component of human communication.”

He noted that remedying hearing loss with hearing aids has been shown to improve depression in hearing-impaired individuals,10 suggesting that the depression is secondary to the hearing impairment.

The Depressive Trajectory

Hearing loss is a problem that often goes unnoticed, according to Dr Blazer.

Initially, the person may not be aware of early hearing loss because of its “insidious onset and progression, or because it is not apparent in quiet environments.”11 Moreover, only about 20% of persons aged 65 years or older with moderate to profound hearing loss perceive themselves as hearing impaired11 and only about only 25% of those with treatable hearing loss take action to get hearing devices.3

Initially, family, friends, or coworkers may also not notice the person’s hearing impairment. “Most people recognize when someone has a problem with eyesight. But on the other hand, people with hearing impairments can sit there and not say anything when they are in company, hearing little of the conversation and feeling isolated,” Dr Blazer said.

Affected individuals are frequently embarrassed by their hearing loss, so they say nothing to friends or family and literally suffer in silence.

Dr Frisina agreed. “At the beginning, people with encroaching hearing impairments lose the subtleties, hidden meanings, and true meanings of words and sentences.”

Most of the losses are of sounds with high pitches and frequencies, so people start losing the ability to hear consonants, which are higher pitched than vowels.

“When this happens, people begin confusing words that seem to sound similar or they guess, based on what they think the word might be, and are often wrong. Sometimes, family or friends think that the affected person has dementia because their responses are not congruent with the other person’s statement, or because the information isn’t getting through the auditory system to the cognitive processing or memory centers,” he explained.

People who are unable to hear even though they know they are being spoken to or who confuse words become anxious and frustrated, Dr Frisina continued. In addition, many withdraw instead of asking others to repeat what they said or to speak louder, and the withdrawal contributes to depression.

“Some people who do not withdraw become disruptive because they feel others are impatient with them or do not like them because it takes too much effort and trouble to communicate,” he said. “Grandchildren and children and even caregivers sometimes lose patience.”

This article originally appeared on Psychiatry Advisor