Qian, Z.J. et al. The American Journal of Geriatric Psychiatry. Published online: 12 April 2016
Objectives: Hearing loss is associated with cognitive decline in the elderly. However, it is unknown if the use of hearing aids (HAs) is associated with enhanced cognitive function.
Design: Cross-sectional study.
Setting: Academic medical center.
Measurements: Participants underwent audiometric evaluation, the Mini-Mental State Examination (MMSE), and the Trail Making Test, Part B (TMT-B). The impact of use versus disuse of HAs was assessed. Performance on cognitive tests was then compared to unaided hearing levels.
Results: HA users performed better on the MMSE (1.9 points; rank-sum, p=0.008) despite having worse hearing at both high frequencies (15.3 dB hearing level; t-test, p<0.001) and low frequencies (15.7 dB hearing level; t-test p<0.001). HA use had no effect TMT-B performance. Better performance on the MMSE was correlated with both low frequency (ρ=-0.28, p=0.021) and high frequency (ρ=-0.21, p=0.038) hearing level, but there was no correlation between performance on the TMT-B and hearing at any frequency.
Conclusions: Despite having poorer hearing, hearing aid users performed better on the MMSE. Better performance on cognitive tests with auditory stimuli (MMSE) but not visual stimuli (TMT-B) suggests that hearing loss is associated with sensory-specific cognitive decline rather than global cognitive impairment. As hearing loss is nearly universal in those >80 years, hearing aids should be strongly recommended to minimize the cognitive impairment in the elderly.
70 per cent of people with dementia have one or more other long-term health condition. As GPs and other medical professional try to treat these conditions, people with dementia can end up on a cocktail of drugs that exacerbate their symptoms. Using their specialist skills, pharmacists can play a vital role in improving how medicines are used in care homes and, as a result, the quality of life for the 280,000 people with dementia living there.
Co-morbidities have a complex relationship with dementia: either acting as a precursor to it, a result of it, or being entirely incidental. High blood pressure and diabetes can increase a person’s risk of developing dementia; having stroke can cause dementia; and depression can come as a consequence. It’s no surprise, then, that the Royal Pharmaceutical Society has found that care home residents are taking an average of seven to eight medicines a day – some are taking double or treble this amount.
It’s likely that, in many cases, people with dementia are taking some drugs unnecessarily. As one prescription is added to another and another, the drug burden increases, along with the likelihood of drug interactions or exacerbation of symptoms. This can lead to devastating consequences for the person’s health and quality of life, such as falls, malnutrition, social isolation, unnecessary hospital stays.
The role of the pharmacist in improving the quality of dementia care in care homes cannot be underestimated. Reviewing medications annually, in coordination with GPs, or when medications change or a resident moves, will help ensure that more people with dementia are taking the right drugs at the right time. The fact that this could save the NHS up to £135 million, while improving outcomes for people with dementia, mean that there’s no excuse for commissioners not making this happen.