RP304 - Association Between Food Insecurity and Hearing Loss in Older Adults

Abstract:
Hearing loss is prevalent; hence, it is important to understand its influence on the food security of older adults. Equally, a fuller understanding of food insecurity as a potential risk factor for poorer hearing could support efforts to eliminate food insecurity and identify an opportunity to prevent hearing loss. In this study we explore the interrelationship between hearing-related measures and food insecurity in older adults. We found that a significant hearing handicap was associated with 91% greater odds of experiencing food insecurity. Alternatively, food insecurity was associated with greater odds of experiencing objectively assessed hearing loss and self-perceived hearing disability.

Summary:
Rationale/Purpose
Food insecurity, the lack of access and ability to acquire safe and nutritious foods, has been shown to negatively impact on the health and well-being of individuals. The literature suggests that there is a vicious cycle between hearing loss and socioeconomic inequalities and lifestyle factors exists. However, there is limited research evidence on whether hearing loss in adults is linked to food insecurity, or vice versa. To our knowledge, ours is the first population-based study to explore the interrelationship between hearing related measures and food insecurity among older adults.

Methods
The cross-sectional analysis included 2,500 participants aged 50+ years with both complete pure-tone audiometry data and information on food insecurity. The pure-tone average of frequencies 0.5, 1.0, 2.0 and 4.0 kHz (PTA_0.5-4KHz) >25 dB HL in the better ear, established the presence of bilateral hearing loss. Self-perceived hearing disability was assessed by administering the Hearing Handicap Inventory for Elderly Screening (HHIE-S total scores of ≥8 indicates hearing disability). A 12-item food security survey was administered, comprising statements related to individual and household food situations. The association between food insecurity with hearing loss and hearing handicap and vice versa, was examined in logistic regression models.

Results
Food insecurity was reported by 12.8% of study participants. After adjusting for age, sex, smoking, home ownership and receipt of government pension; any self-perceived hearing handicap significantly increased the likelihood of older adults reporting food insecurity by 91% (p < 0.0001). Participants reporting severe hearing handicap (HHIE-S scores of 26+) had significantly greater odds of experiencing food insecurity: multivariate-adjusted odds ratios, OR, 2.29 (95% confidence intervals, CI, 1.30-4.03). Objectively measured hearing loss did not significantly influence the food security status of study participants. After adjusting for age, sex, smoking, workplace noise exposure and having family history of hearing loss, food insecurity was significantly associated with both objectively measured hearing loss and self-perceived hearing disability: OR 1.39 (95% CI 1.03-1.87) and OR 1.85 (95% CI 1.43-2.38), respectively.

Conclusions 
Our study suggests that food insecurity was an important social determinant of hearing health among community-dwelling older adults. Conversely, older adults with a significant hearing disability were more likely to experience food insecurity. Overall, our findings suggest that food insecurity acts as a cyclic stressor among older adults with hearing loss, independent of other socioeconomic factors. This is particularly pertinent now because of the unprecedented economic and societal effects of COVID-19, which has led to increased social isolation, unemployment and amplified food insecurity nationwide, with greater repercussions for older adults with hearing loss. These findings add to our understanding of the substantial public health impact of both food insecurity and hearing loss; and may highlight areas for future intervention that could be beneficial and will help ensure the ongoing health and wellbeing of older adults.

Learning Objectives:

• Upon completion, participants will be able to define food security and describe its importance for older adults with hearing loss.
• Upon completion, participants will be able to list the potential pathways which could underlie the association between hearing loss and hearing disability with food insecurity in older adults.
• Upon completion, participants will be able to list potential public health strategies that could address food insecurity in older adults with disabling hearing loss.