Sensory cells for balance are close cousins to the hearing auditory cells. If they become degenerated or lack connections, patients become unsteady and can fall, which can happen with age. —Rick A. Friedman, MD, PhD
Explore This IssueSeptember 2019
Risk Factors for Cognitive Decline and Falls
A range of potential risk factors for cognitive decline and dementia exist, including advancing age, genetic factors (including one or more apolipoprotein ε4 alleles), and several health conditions and lifestyle factors, Dr. Curhan said. The Lancet International Commission on Dementia Prevention, Intervention, and Care identified nine potentially modifiable risk factors that contribute to the risk of cognitive decline and dementia: level of education, hypertension, obesity, smoking, depression, physical inactivity, social isolation, diabetes, and hearing loss.
Risk factors for falls in older adults include older age, muscle weakness, history of falls, gait or balance deficit, visual deficit, arthritis, depression, cognitive impairment, and fear of falling, Dr. Deal said. Some studies have found that hearing loss might be a potential risk factor for falls, but hearing loss isn’t a traditional risk factor for falls and is not typically addressed in fall intervention programs (Laryngoscope. 2016;126:2587–2596).
Rick A. Friedman, MD, PhD, professor of otolaryngology and neurotology and director of the UCSD Acoustic Neuroma Center at the University of California in San Diego, said there is good evidence that genetic variation exists within the population for genes that are critical to balance function, because not every elderly person is unsteady and not every elderly person falls. Falls are a major health risk in the elderly and have a fairly high mortality rate when they result in hip fractures. “Sensory cells for balance are close cousins to the hearing auditory cells,” he said. “If they become degenerated or lack connections, patients become unsteady and can fall, which can happen with age.”
Identifying Patients at Risk
Risk factors for age-related hearing loss include older age, male sex, white race, and history of noise exposure, Dr. Deal said. Some medications can cause hearing loss as well, and it’s probable that some vascular factors, such as hypertension, diabetes, and smoking, may slightly increase risk for hearing loss in seniors.
A hearing test is probably the single best way to identify hearing loss. However, many patients do not seek out a hearing evaluation until significant hearing loss has occurred, Dr. Hansen said. Therefore, clinicians should be proactive in exploring the possibility of hearing loss, just as they are for high blood pressure, diabetes, and other common problems.
It’s difficult for clinicians to perceive a significant hearing impairment in one-on-one conversations because patients develop adaptive strategies and often manage quite well in quiet, private settings, even if they have fairly significant hearing loss. “Oftentimes, spouses or other family members begin to notice the increased hearing difficulties as they interact with patients in more real-world settings,” Dr. Hansen said. “This commonly manifests as misunderstanding of conversations, especially in noisy environments.”
If possible, it’s helpful for physicians to ask the patients’ family members or close friends if they have noticed any hearing difficulties. Furthermore, certain occupations or prior activities such as farming, construction work, manufacturing work, military service, night clubbing, or riding motorcycles carry a higher risk of noise damage and hearing loss, Dr. Hansen added.