Word Recognition for Temporally and Spectrally Distorted Materials:The Effects of Age and Hearing Loss

Objectives: The purpose of Experiment 1 was to measure word recognition in younger adults with normal hearing when speech or babble was temporally or spectrally distorted. In Experiment 2, older listeners with near-normal hearing and with hearing loss (for pure tones) were tested to evaluate their susceptibility to changes in speech level and distortion types. The results across groups and listening conditions were compared to assess the extent to which the effects of the distortions on word recognition resembled the effects of age-related differences in auditory processing or pure-tone hearing loss. Design: In Experiment 1, word recognition was measured in 16 younger adults with normal hearing using Northwestern University Auditory Test No. 6 words in quiet and the Words-in-Noise test distorted by temporal jittering, spectral smearing, or combined jittering and smearing. Another 16 younger adults were evaluated in four conditions using the Words-in-Noise test in combinations of unaltered or jittered speech and unaltered or jittered babble. In Experiment 2, word recognition in quiet and in babble was measured in 72 older adults with near-normal hearing and 72 older adults with hearing loss in four conditions: unaltered, jittered, smeared, and combined jittering and smearing. Results: For the listeners in Experiment 1, word recognition was poorer in the distorted conditions compared with the unaltered condition. The signal to noise ratio at 50% correct word recognition was 4.6 dB for the unaltered condition, 6.3 dB for the jittered, 6.8 dB for the smeared, 6.9 dB for the double-jitter, and 8.2 dB for the combined jitter-smear conditions. Jittering both the babble and speech signals did not significantly reduce performance compared with jittering only the speech. In Experiment 2, the older listeners with near-normal hearing and hearing loss performed best in the unaltered condition, followed by the jitter and smear conditions, with the poorest performance in the combined jitter-smear condition in both quiet and noise. Overall, listeners with near-normal hearing performed better than listeners with hearing loss by ∼30% in quiet and ∼6 dB in noise. In the quiet distorted conditions, when the level of the speech was increased, performance improved for the hearing loss group, but decreased for the older group with near-normal hearing. Recognition performance of younger listeners in the jitter-smear condition and the performance of older listeners with near-normal hearing in the unaltered conditions were similar. Likewise, the performance of older listeners with near-normal hearing in the jitter-smear condition and the performance of older listeners with hearing loss in the unaltered conditions were similar. Conclusions: The present experiments advance our understanding regarding how spectral or temporal distortions of the fine structure of speech affect word recognition in older listeners with and without clinically significant hearing loss. The Speech Intelligibility Index was able to predict group differences, but not the effects of distortion. Individual differences in performance were similar across all distortion conditions with both age and hearing loss being implicated. The speech materials needed to be both spectrally and temporally distorted to mimic the effects of age-related differences in auditory processing and hearing loss

Observational Outcome Measures to Evaluate Assistive Technology Use by People with Dementia - Report Series # 12

This report describes a digital video-audio behavioural observation methodology for use in a naturalistic setting to evaluate communication rehabilitation interventions for older adults with dementia. Behavioural observation via recorded video-audio offers a number of advantages over other data collection methodologies, which can be subject to a number of biases and limitations, some of which are discussed. In this study, high quality digital audio-video recordings were collected on participants attending a respite care day program. Recording equipment was inconspicuously placed, and measurement occurred either during normal day-to-day activities or during more directed activities (e.g., playing bingo). The recordings can be used to document the occurrence of behaviours and paired behaviours of interest over extended periods of time or selected samples of interest can be downloaded for detailed analysis including lag-sequential analyses. It was found that behavioural observation can complement traditional objective measures of impairment and subjective questionnaire measures, in accordance with the World Health Organization’s (WHO) International Classification of Functioning, Disability, and Health (2001)

Intrinsic and extrinsic motivation is associated with computer-based auditory training uptake, engagement, and adherence for people with hearing loss

Hearing aid intervention typically occurs after significant delay, or not at all, resulting in an unmet need for many people with hearing loss. Computer-based auditory training (CBAT) may provide generalized benefits to real-world listening, particularly in adverse listening conditions, and can be conveniently delivered in the home environment. Yet as with any intervention, adherence to CBAT is critical to its success. The main aim of this investigation was to explore motivations for uptake, engagement and adherence with home-delivered CBAT in a randomized controlled trial of adults with mild sensorineural hearing loss (SNHL), with a view to informing future CBAT development. A secondary aim examined perceived benefits of CBAT. Participants (n = 44, 50–74 years olds with mild SNHL who did not have hearing aids) completed a 4-week program of phoneme discrimination CBAT at home. Participants' experiences of CBAT were captured using a post-training questionnaire (n = 44) and two focus groups (n = 5 per group). A mixed-methods approach examined participants' experiences with the intervention, the usability and desirability of the CBAT software, and participants' motivations for CBAT uptake, engagement and adherence. Self-Determination Theory (SDT) was used as a theoretical framework for the interpretation of results. Participants found the CBAT intervention easy to use, interesting and enjoyable. Initial participation in the study was associated with extrinsic motivation (e.g., hearing difficulties). Engagement and adherence with CBAT was influenced by intrinsic (e.g., a desire to achieve higher scores), and extrinsic (e.g., to help others with hearing loss) motivations. Perceived post-training benefits included better concentration and attention leading to improved listening. CBAT also prompted further help-seeking behaviors for some individuals. We see this as an important first-step for informing future theory-driven development of effective CBAT interventions

Older Adults With Hearing Loss Have Reductions in Visual, Motor and Attentional Functioning

Evidence from epidemiological, laboratory and clinical research suggests a link between age-related auditory declines and domain-general cognitive declines. Nevertheless, few studies have experimentally compared measures of non-auditory cognitive functions in younger normal hearing adults (YN), older adults with typical hearing thresholds for their age (ONHA) and older adults with clinically significant threshold hearing loss (OHL). The current study investigated the differences between these groups on measures of attentional response selection and execution to visual stimuli. A visual reaction time (RT) paradigm involving four tasks with differing and hierarchical attentional demands was administered. RTs on trials with differing foreperiods (FPs; pre-stimulus waiting times) were analyzed to assess context-related slowing, error commission and related cognitive control and strategic and automatic neural preparatory processes. The OHL group demonstrated a general slowing that was most apparent on the simplest tasks. Although the number of errors was similar when comparing all three groups, the OHL group exhibited less control over recovery from an error compared to the younger and ONHA groups. Unlike the YN and ONHA groups, the OHL group also showed difficulties with both strategic and automatic response preparation, although automatic preparation was more affected across all tasks. This pattern of results suggests that in older adults with hearing loss there is an underlying difficulty in automatic temporal processing that can affect higher order cognitive functions, although there may not be a completely generalized decline in cognitive functioning that is associated with hearing loss

Prevalence of sensory impairments in home care and long-term care using interRAI data from across Canada

Background In the general population, sensory impairments increase markedly with age in adults over 60 years of age. We estimated the prevalence of hearing loss only (HL), vision loss only (VL), and a combined impairment (i.e., dual sensory loss or DSL) in Canadians receiving home care (HC) or long-term care (LTC). Methods Annual cross-sectional analyses were conducted using data collected with one of two interRAI assessments, one used for the HC setting (n = 2,667,199), and one for LTC (n = 1,538,691). Items in the assessments were used to measure three mutually exclusive outcomes: prevalence of VL only, HL only, or DSL. Trends over time for each outcome were examined using the Cochran-Armitage trend test. A negative binomial model was used to quantify the trends over time for each outcome while adjusting for age, sex and province. Results In HC, there was a significant trend in the rate for all three outcomes (p \u3c 0.001), with a small increase (roughly 1%) each year. In HC, HL was the most prevalent sensory loss, with a rate of roughly 25% to 29%, while in LTC, DSL was the most prevalent impairment, at roughly 25% across multiple years of data. In both settings, roughly 60% of the sample was female. Males in both HC and LTC had a higher prevalence of HL compared to females, but the differences were very small (no more than 2% in any given year). The prevalence of HL differed by province after adjusting for year, age and sex. Compared to Ontario, Yukon Territory had a 26% higher rate of HL in HC (relative rate [RR] = 1.26; 95% confidence interval [CI]:1.11, 1.43), but LTC residents in Newfoundland and Labrador had a significantly lower rate of HL (RR: 0.57; CI: 0.43, 0.76).When combined, approximately 60% of LTC residents, or HC clients, had at least one sensory impairment. Conclusions Sensory impairments are highly prevalent in both HC and LTC, with small sex-related differences and some variation across Canadian provinces. The interRAI assessments provide clinicians with valuable information to inform care planning and can also be used to estimate the prevalence of these impairments in specific population sub-groups

Hearing and cognitive impairments increase the risk of long-term care admissions

Background and Objectives: The objective of the study was to understand how sensory impairments, alone or in combination with cognitive impairment (CI), relate to long-term care (LTC) admissions. Research Design and Methods: This retrospective cohort study used existing information from two interRAI assessments; the Resident Assessment Instrument for Home Care (RAI-HC) and the Minimum Data Set 2.0 (MDS 2.0), which were linked at the individual level for 371,696 unique individuals aged 65+ years. The exposure variables of interest included hearing impairment (HI), vision impairment (VI) and dual sensory impairment (DSI) ascertained at participants’ most recent RAI-HC assessment. The main outcome was admission to LTC. Survival analysis, using Cox proportional hazards regression models and Kaplan–Meier curves, was used to identify risk factors associated with LTC admissions. Observations were censored if they remained in home care, died or were discharged somewhere other than to LTC. Results: In this sample, 12.7% of clients were admitted to LTC, with a mean time to admission of 49.6 months (SE = 0.20). The main risk factor for LTC admission was a diagnosis of Alzheimer’s dementia (HR = 1.87; CI: 1.83, 1.90). A significant interaction between HI and CI was found, whereby individuals with HI but no CI had a slightly faster time to admission (40.5 months; HR = 1.14) versus clients with both HI and CI (44.9 months; HR = 2.11). Discussion and Implications: Although CI increases the risk of LTC admission, HI is also important, making it is imperative to continue to screen for sensory issues among older home care clients

Hearing impairment and cognitive energy: The Framework for Understanding Effortful Listening (FUEL)

The Fifth Eriksholm Workshop on “Hearing Impairment and Cognitive Energy” was convened to develop a consensus amongst interdisciplinary experts about what is known on the topic, gaps in knowledge, the use of terminology, priorities for future research and implications for practice. The general term cognitive energy was chosen to facilitate the broadest possible discussion of the topic. It goes back to Titchener (1908) who described the effects of attention on perception; he used the term psychic energy for the notion that limited mental resources can be flexibly allocated among perceptual and mental activities. The workshop focused on three main areas: 1) theories, models, concepts, definitions, and frameworks; 2) methods and measures; and 3) knowledge translation. We defined effort as the deliberate allocation of mental resources to overcome obstacles in goal pursuit when carrying out a task, with listening effort applying more specifically when tasks involve listening. We adapted Kahneman’s seminal (1973) Capacity Model of Attention to listening and proposed a heuristically useful Framework for Understanding Effortful Listening (FUEL). Our FUEL incorporates the well-known relationship between cognitive demand and the supply of cognitive capacity that is the foundation of cognitive theories of attention. Our FUEL also incorporates a motivation dimension based on complementary theories of motivational intensity, adaptive gain control and optimal performance, fatigue, and pleasure. Using a 3D illustration, we highlight how listening effort depends not only on hearing difficulties and task demands, but also on the listener’s motivation to expend mental effort in the challenging situations of everyday life

A Newly Identified Impairment in Both Vision and Hearing Increases the Risk of Deterioration in Both Communication and Cognitive Performance

Vision and hearing impairments are highly prevalent in adults 65 years of age and older. There is a need to understand their association with multiple health-related outcomes. We analyzed data from the Resident Assessment Instrument for Home Care (RAI-HC). Home care clients were followed for up to 5 years and categorized into seven unique cohorts based on whether or not they developed new vision and/or hearing impairments. An absolute standardized difference (stdiff) of at least 0.2 was considered statistically meaningful. Most clients (at least 60%) were female and 34.9 per cent developed a new sensory impairment. Those with a new concurrent vison and hearing impairment were more likely than those with no sensory impairments to experience a deterioration in receptive communication (stdiff = 0.68) and in cognitive performance (stdiff = 0.49). After multivariate adjustment, they had a twofold increased odds (adjusted odds ratio [OR] = 2.1; 95% confidence interval [CI]:1,87, 2.35) of deterioration in cognitive performance. Changes in sensory functioning are common and have important effects on multiple health-related outcomes

Current reported outcome domains in studies of adults with a focus on the treatment of tinnitus: protocol for a systematic review

Introduction: In Europe alone, over 70 million people experience tinnitus. Despite its considerable socioeconomic relevance, progress in developing successful treatments has been limited. Clinical effectiveness is judged according to change in primary outcome measures, but because tinnitus is a subjective condition, the definition of outcomes is challenging and it remains unclear which distinct aspects of tinnitus (ie, ‘domains’) are most relevant for assessment. The development of a minimum outcome reporting standard would go a long way towards addressing these problems. In 2006, a consensus meeting recommended using 1 of 4 questionnaires for tinnitus severity as an outcome in clinical trials, in part because of availability in different language translations. Our initiative takes an approach motivated by clinimetrics, first by determining what to measure before seeking to determine how to measure it. Agreeing on the domains that contribute to tinnitus severity (ie, ‘what’) is the first step towards achieving a minimum outcome reporting standard for tinnitus that has been reached via a methodologically rigorous and transparent process. Methods and analysis: Deciding what should be the core set of outcomes requires a great deal of discussion and so lends itself well to international effort. This protocol lays out the first-step methodology in defining a Core Domain Set for clinical trials of tinnitus by establishing existing knowledge and practice with respect to which outcome domains have been measured and which instruments used in recent registered and published clinical trials. Ethics and dissemination: No ethical issues are foreseen. Findings will be reported at national and international ear, nose and throat (ENT) and audiology conferences and in a peer-reviewed journal, using PRISMA (Preferred Reporting Items for Systematic reviews and Meta-analysis) guidelines