GUEST SECTION EDITOR
Barbara E Weinstein,
PhD, Professor and Founding Executive Officer
Health Sciences Doctoral Programs,
Graduate Center, CUNY,
Adjunct Assistant Professor of Medicine,
NYU Langone Medical Center,
New York, USA.
The prevalence of dementia is escalating worldwide, with absolute numbers expected to rise from 50 to 150 million by 2050. While the disease burden and economic costs are great, rates of diagnosis are low. In part, stigma and fear of a definitive diagnosis impact health seeking behaviour . Raising dementia awareness, addressing misconceptions and stigma are worldwide priorities. Presently, there is no effective therapeutic intervention available, so an important priority is identifying modifiable risk factors.
The Lancet Commission on dementia prevention, intervention, and care recently updated their 2017 report, identifying 12 modifiable risk factors which account for 40% of worldwide dementias, which could possibly be prevented or onset delayed . Hearing loss remains the strongest preventable risk factor based on mounting evidence from the epidemiologic literature.
Age-related hearing loss and dementia share many overlapping features. Primary care physicians are unlikely to screen and refer for diagnosis and management, social functioning is impacted by both conditions, caregiver burden is high and both conditions occur insidiously and, accordingly, are frequently unrecognised. Early diagnosis of each condition promotes optimal outcomes. Management goals are well aligned. Providing opportunities for social engagement, maximising ability to communicate, reducing caregiver burden, optimising safety in the home including reducing falls risk, and promoting adherence with interventions are critically important. Optimising audibility and earlier identification of hearing loss is of paramount importance when working with persons with dementia.
For March/April, we heed the words from the 2020 Lancet Commission; it is never too early and never too late in the life course for taking action to prevent or delay the onset of dementia. We begin with an overview of the Lancet Commission report with a call to action for audiologists as gatekeepers to engage with inter-professional teams to identify hearing loss early and to offer interventions which could help to improve the quality of lives of persons with dementia and hearing loss. Next, we offer hypotheses regarding the link between hearing loss and dementia, underscoring that while a causal connection has not yet been established, the potential for audiologic interventions is compelling. In the latter regard, we offer some practice guidelines for audiologists and insights into how the COVID-19 pandemic has underscored the urgency of our engagement with persons with dementia and hearing loss. Next, we offer specific recommendations for healthcare providers regarding detection, assessment, treatment and support of persons with hearing loss and a dementia diagnosis. We conclude with discussion of ageism and how discrimination against older adults in healthcare settings compromises their health and wellbeing.
1. Eccleston C, Doherty K, Bindoff A, et al. Building dementia knowledge globally through the Understanding Dementia Massive Open Online Course (MOOC). npj Sci. Learn. 2019;4(3).
2. Livingston G, Huntley J, Sommerlad A, et al. Dementia prevention, intervention, and care: 2020 report of the Lancet Commission. Lancet 2020;396(10248):413-46.