How to Break Stubborn Association Between Hearing Loss and Cognitive Impairment: A Systematic Review and Meta-Analysis of Moderators and Mediators.

BackgroundHearing loss has been related to impaired cognition among older adults. The cost effectiveness of existing hearing support tools is controversial. Other potential modifying strategies that could effectively intervene in this prevalent and far-reaching association between hearing loss and cognitive decline remain unclear. This study aimed to narratively and quantitatively synthesize the mediators and moderators involved in the link between hearing loss and cognitive impairment from a psycho-social and physical point of view.MethodWe searched 6 databases for articles exploring mediating or moderating associations of hearing loss-cognition association from inception to March, 2024. Data were synthesized narratively and quantitatively by meta-analytic approaches.ResultsThe search yielded 63 included studies. Social (social engagement, social support, age, sex, ethnicity, cognitive reserve)-psycho (depression, anxiety, loneliness, resilience)-physical (cardiovascular diseases and risk factors, perceived health, disability, APOE carrier, vision impairment, gait speed) variables mediated or moderated the relationship between hearing loss and cognitive impairment to varying degrees. Subgroup analyses identified susceptible populations at greater risk for cognitive decline, including women, younger elders with hearing loss, and older adults with dual sensory loss.ConclusionCombined interventions targeting these modifiable variables across psycho-social and physical dimensions may be more cost-effective for intervening in the ensemble of hearing loss-cognitive impairment in older adults.