Social Isolation, Loneliness, and Hearing Loss in Older Adults

Elizabeth, categorized as an older Baby Boomer since her birth year is 1953, took seriously the  social distancing recommendations issued by coronavirus medical researchers. She ended her previously-extensive social life. Instead of going to her part-time employment site, she was told  to start working from home. Instead of volunteering to make phone calls in a local non-profit office, Elizabeth was given a cell phone to make her calls from home. Elizabeth’s church stopped in-person worship, so she began attending virtual services. Her Sunday School class no longer met in the church building; instead, members interacted on Zoom. The number of social  activities Elizabeth enjoyed were dramatically reduced by pandemic lockdowns. No going with  friends to concerts and plays; live theatre and performances had shut down. No dropping in to see new museum exhibits; early in the pandemic, museums were closed. Elizabeth had danced at  a dance hall and exercised at a local recreation center weekly, but both facilities were shuttered. Elizabeth told her family she wouldn’t get together with them for holiday meals and told her friends she wouldn’t socialize with them in their homes or hers. She no longer felt safe flying on  a plane to visit her grandchildren. Elizabeth’s life changed in significant ways to avoid COVID infection. She followed social distancing guidelines and became socially isolated.

Prior to the pandemic, social isolation was defined by researchers as having little day-to-day contact with others, and the opposite was termed social engagement or social interactivity. In the first three months of the pandemic, a survey of 1,100 adults 50 years of age and older (AARP, 2020), found that 89% of respondents reported staying away from people other than immediate family members and 74% said they stayed home instead of going to work, running errands, or engaging in other regular activities. Like Elizabeth’s, these older adults’ pandemic lives were curtailed until they became socially isolated.

Do you think social isolation causes loneliness? That question was studied by researchers long before the 2020 pandemic. Because humans are social creatures and most people have a strong need for social relationships, researchers often worked from the premise that having minimal day-to-day contact with others puts individuals at risk of loneliness, anxiety, and depression. Loneliness can be labeled social pain, the feeling that accompanies unsatisfying relationships. People can live rather solitary lives and not feel lonely, or they can have many social relation ships and nevertheless feel lonely (Hawkley et al., 2008). Studies expanded during the pandemic to determine whether this social pain of loneliness is directly linked to social isolation. At this unique historical time, researchers were able to study large groups of older adults who chose to be socially isolated, even though it was not their nature to withdraw from day-to-day contact with others. They hoped their isolation was temporary as they kept themselves safe during the coronavirus threat.

Researchers who had, in previous studies, observed a direct link between social isolation and loneliness learned that during the pandemic, older adults are more resilient than expected. It became clear that not all socially-isolated adults are lonely. In fact, after experiencing months of social isolation during the pandemic, fewer than half—43% —of older adults reported feeling lonely (National Academies of Sciences, Engineering, and Medicine, 2020). The observation that loneliness did not result from social isolation in a majority of U.S. older adults was also found in adults over 65 years of age in the Netherlands (Tilburg, Steinmetz, Stolte, van der Roest, & de Vries, 2020). The older Dutch adults did state, “I miss having people around me,” but the pandemic did not correlate with increased mental health struggles. Mental health levels in the respondents remained unchanged before and after the start of the pandemic.

Loneliness as a function of age

Interestingly, a number of studies have seen an age link between social isolation and loneliness. When the 1,100 adults responding to an AARP (2020) survey were divided by age cohorts, younger than 65 years versus older, loneliness was reported by a greater percentage of younger adults than older adults. A vast majority of the older cohort—90%—reported on a survey question that they hardly ever or only sometimes felt a lack of companionship or felt left out. Similarly, on a question where respondents were to rank their loneliness on a scale, 68% of the older cohort (over 65 years) chose the lowest or next to lowest score, but only 52% of the younger cohort did the same. When the AARP survey asked respondents if they had felt down, depressed, or hopeless in the last two weeks, twice as many in the younger cohort reported these feelings as did the older cohort.

The Centers for Disease Control and Prevention also found an age link between social isolation and loneliness. Of the 5,412 adults surveyed, it was younger adults (those between the ages of 45-64) who reported a significantly higher percentage of pandemic-induced anxiety, depression, and stress compared to older adults (Czeisler et al., 2020). Comparable age-linked findings have been noted by researchers in other countries including Spain (González-Sanguino et al., 2020) and Canada (Klaiber, Wen, DeLongis, & Sin, 2020). In each country, younger adults consis tently suffered negative effects of social isolation more often than did older adults.

What can explain the widespread finding that older adults fare better following social isolation than younger adults? A 2016 study of 15,000 people between the ages of 18 and 79 years suggests that, even before the pandemic, people under age 50 may be lonelier than older adults. Middle age is when dissatisfaction with the quality of one’s personal relationships often runs highest—and when loneliness can become persistent (Wolff, 2021). A professor of psychiatry, medicine, and behavioral science at UCLA describes early middle age as the age of switching from work that may be nurturing and satisfying to work that is more profitable; middle age is also the time that people have moved away from their childhood friends and family to advance their careers. Longtime friendships may fade and be replaced by colleagues with whom the adults are in competition or by parents of their children with whom they have little in common. Spending time with people whose purpose is more functional than emotional may not stave off loneliness (Cole as cited in Wolff, 2021). Adults approaching 50 years of age may also be moving into the “sandwich generation,” a time when they have caregiving responsibilities for both their elderly parents and their children. As parents die and children move away, adults in the sandwich generation may be too busy to properly address the resulting emotional fallout leading to a peak in loneliness by age 50 (Wolff, 2021).

Older adults have the advantage of wisdom

Several recent studies involving groups of adults across the lifespan have shown an inverse correlation between loneliness and a complex personality trait labeled wisdom (Jeste et al., 2020; Lee et al., 2020). Older adults exhibiting more wisdom components—prosocial behaviors like empathy, compassion, emotional regulation, the ability to self-reflect, and spirituality—have proven to be more resilient to stresses of the current pandemic. In other words, older adults who score higher on wisdom traits experience greater well-being in a time of crisis. Researchers (Lee et al., 2020) are investigating how empathy and compassion can be taught as part of cognitive behavior therapy to enhance coping in adults and to offer them protective factors against chronic stress and anxiety.

Older adults, compared to younger adults, may feel satisfied with fewer relationships that are high-quality and have less interest in engaging with a greater number of people with whom they have shallow relationships. While older adults are saddened when loved ones die, those with more wisdom traits are developmentally better equipped to cope with their losses. The more wisdom demonstrated by older adults, the greater the likelihood they will be resilient when confronted by mental health challenges during COVID times (Hamm et al, 2020; Laird, Krause, Funes, & Lavretsky, 2019; Pearman, Hughes, Smith, & Neupert, 2020). As the typical person moves into his or her later years, studies by Blanchflower (as cited in Harrar, 2020) show that happiness and joy increase. This link between age and happiness is seen not only in Americans, but in adults living in 132 countries. “They’re actually happier than you may think,” says the director of University of California’s Center for Healthy Aging (Jeste as cited in Wolff, 2021), adding that older people’s decades of life experiences allow them to focus on the positive, to not get as upset as younger people when things go wrong, and to feel a sense of purpose.

Research by a psychology professor at the University of Texas shows that people who are more socially integrated engage in conversations with people holding diverse opinions and perspec tives, challenging interactions that help older adults’ brains. “People do better when they have a more diverse group of people in their lives and more stimulating conversations” (Fingerman as cited in Brody, 2020). A fellow researcher in the field found that numerous activities with community members—such as dog walkers, barbers or hair stylists, and café servers—allow ties to form to people other than family and close friends, ties which often foster greater life satis faction and better emotional and physical health (Blau as cited in Brody, 2020).

A focus on others facilitates better emotional well-being. How? By switching from focusing on one’s personal difficulties during dark times—such as the pandemic—to considering the plight of others who have it worse. This focus on others explains why so many volunteers feel deep joy by taking actions to help people. The volunteers believe they can use their own strengths to benefit the world. After a crisis, such as the coronavirus pandemic, it is estimated that up to two thirds of adults may experience an actual increase in well-being, or what psychologists call “post-traumatic growth” (Tedeschi & Calhoun, 1996). During this growth period, people begin to examine their spiritual and emotional values and pay attention to how they can shape their lives in line with those values. Relationships with other people take center stage leading them to feel less victimized by what’s going on in the world and more aware that happiness doesn’t come from external events. They become more emotionally-resilient people (Harrarr, 2020).

Elizabeth decided to retire from her part-time employment site since she found she did not  experience much satisfaction working from home. This enabled her to increase the number of  hours she could devote to her volunteer position which, in turn, made her feel she was making a  difference. Elizabeth became a passionate political activist and spent hours researching issues,  donating to causes she believed in, and writing legislators urging them to take positions she felt  were important. Elizabeth also reached out to arrange walking dates with friends several times  per week. She and nine friends, all of whom shared her political views and wore face masks to  keep themselves safe, exercised while energetically discussing news of the day. Elizabeth  maintained weekly e-mail, phone, and text contact with four friends who were unable to walk with her, either because they were still employed making daytime hours unavailable or because  they didn’t live nearby. She learned to use technology to see her grandchildren on camera and  took delight in her ability to interact long distance while waiting for vaccines that would allow  her to travel again. Elizabeth joined a book group where she discussed, via Zoom, several  interesting books she may not have read on her own. She attended museum exhibits after the  facilities opened, restricting entrance to the number of patrons that would allow a safe distance  to be maintained. Though she could not attend dances or live performances, Elizabeth discovered she could have a satisfying life without engaging in some social activities she had  previously enjoyed. Elizabeth claims that she never felt lonely during the year-long pandemic.

What about older adults with hearing loss? Does hearing loss increase social isolation and loneliness? If so, can use of hearing aids reduce one’s social isolation and risk of loneliness? A 2016 study found that greater hearing loss correlates with higher levels of loneliness in adults over age 50 (Sung, Li, Blake, Betz, & Lin, 2016). A more recent study (Sarant et al., 2020) found 44% of 99 participants with just mild to moderate hearing loss reported feeling lonely.

Hearing loss intervention, or use of hearing aids to reduce loneliness, was not demonstrated by Contrera, Sung, Betz, Li, and Lin (2017) and, interestingly, Mener, Betz, Genther, Chen, and Lin (2013) noted that many studies do not determine the direction of any observed association between hearing aids and loneliness reduction. It could be amplification improves older adults’ social engagement which then reduces their loneliness, or it could be that socially-active individuals are more motivated to obtain and wear hearing aids than are individuals with fewer social ties.

At least three studies assessed study participants’ loneliness before and after being fit with hearing aids and found improved hearing had a positive impact on levels of loneliness. Boi and colleagues (2012) evaluated 15 participants older than 70 years of age with hearing loss and depression. After being fit with two digital programmable hearing aids, participants were tested at 1-, 3-, and 6-month intervals. Hearing aids significantly reduced their loneliness and depression and improved participants’ social functioning, emotional stability, and mental health early on and throughout the duration of the study. Similarly, Weinstein, Sirow, and Moser (2016) found a significant decline in perceptions of loneliness following 4 to 6 weeks of hearing aid use in their 40 participants. Those with moderate to severe hearing losses experienced the greatest reduction in loneliness with hearing aid use.

Encouraging findings were recently reported from Australia (Sarant et al., 2020) where 99 older adults (ages 62-82 years) with mild to moderate hearing loss were assessed for loneliness and cognitive abilities. Study participants wore their hearing aids more than 90% of waking hours as measured by the devices’ data logging capabilities as well as by questionnaires completed by the participants. After 18 months of consistent hearing aid use, 36 of the 37 participants no longer reported loneliness. ‍

Loneliness, hearing aids, and the brain ‍

The above studies suggest that hearing aids may protect against loneliness. But there may be an even bigger issue than loneliness to consider: older adults’ brain health. Dementia risk factors include hearing loss and loneliness (Harrington & Sliwinski, 2020). Although the underlying neural mechanisms are not fully understood, loneliness has been linked with key brain changes. Because loneliness is a social stressor, it can activate the body’s stress responses, which, when prolonged, can lead to increased inflammation and reduced immunity, particularly in older adults. Inflammation is the body’s response to fight off infection, but when it continues unchecked, it can have a harmful impact on health including increased risk of reduced brain function (Harrington & Sliwinski, 2020).

Studies on brain function over time show high-quality relationships facilitate brain health. Older adults who feel more satisfied in their relationships have a 23% lower risk of dementia, and those who judge their relationships as supportive have a 55% lower risk of dementia, compared to older adults who feel dissatisfied or unsupported in their relationships (Harrington & Sliwinski, 2020). It makes sense that wearing hearing aids can enhance interpersonal relation ships as family dynamics may become troubled in the presence of a hearing loss that an older adult denies or refuses to do anything about. Older adults being fit with hearing aids was linked to their relationship with relatives becoming less stressful (Knussen et al., 2004).

Newer research shows that hearing aids that enhance older adults’ family relationships may also facilitate the hearing aid wearer’s brain function. A study of 34 Turkish participants with hearing loss whose cognitive scores were within normal limits were fit with hearing aids. After three months of hearing aid use, participants’ cognitive skills were retested. Their scores in orientation, memory, and attention as assessed by the measure, Mini Mental State Examination, increased in 100% of participants (Acar, Yurekli, Babademez, Karabulut, & Karasen, 2011). In other words, brain function improved following use of hearing aids by participants whose mental capabilities were already within normal limits.

While the respected medical journal, Lancet (Livingston et al., 2017) acknowledges hearing loss as a risk factor for dementia, it states that any link “between cognitive decline and hearing loss is not yet clear; nor is it established whether intervention, such as hearing aids, can prevent or delay the onset of dementia…Experimental evidence on whether hearing aid use might alleviate some of these negative effects is not available” (Livingston et al., 2017).

However, subsequent to the Lancet cautionary statement, studies reveal encouraging findings relative to hearing aids’ ability to impact brain function. For example, evidence from a two-year study of hearing aid use in 2,040 older Americans, Maharani, Dawes, Nazroo, Tampubolon, and Pendleton (2018) showed that being fit with a hearing aid was associated with a slowing of cognitive decline. In the Maharani et al. (2018) study, trajectories of memory test scores were plotted based on before and after using hearing aids; the rate of cognitive decline on the memory test was slower following participants’ adoption of hearing aids.

University of Colorado researchers (Glick & Sharma, 2020) used cortical evoked potentials (CVEPs) to measure brain function in 28 adults with hearing loss who listened to challenging auditory stimuli. The participants were fit with bilateral hearing aids and retested on CVEP measures after six months of consistent hearing aid use (average of 10 hours wearing time per day). When the pre- and post-hearing aid CVEP results were compared, the hearing aid group showed “gains in auditory speech perception abilities and improvements in global cognitive function, executive function, processing speed, and visual working memory performance.”

Elizabeth has a moderate sensorineural hearing loss in both ears. She is aware that the majority  of adults delay seeking a diagnosis and purchasing hearing aids, even after admitting that they  do have hearing problems. Because she sees herself as someone who seeks solutions to  problems, Elizabeth made an appointment to have her hearing tested by her friend, Mandi Solat. Elizabeth’s loss was monitored for a few years until eventually her mild hearing loss dropped to  a moderate degree. At this point, Elizabeth chose to wear amplification. She did not want to  strain to hear others in her job, her volunteer position, or her Zoom meetings. She did not want  to struggle to understand her friends as they walked and talked outside. She did not want her  young grandchildren’s speech to be made any more difficult to understand. So, Elizabeth tried  listening with behind-the-ear (BTE) aids and completely-in-canal (CIC) aids. She preferred the  secure fit of CIC custom hearing aids, and for the last three years has worn them in both ears during all waking hours. Fortunately, she never experienced loneliness, but Elizabeth refuses to  risk her brain health with untreated hearing loss. As a Baby Boomer with hearing loss, Elizabeth takes care of herself and appreciates the positive impact that amplification devices have on her life. She remains interested in exploring how emerging hearing technology can improve her  auditory experiences and brain function.

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