In this nationally-representative study of 40–69 year-old adults, greater hearing loss was independently associated with self-reported falls over the preceding 12 months. These results were robust to analyses accounting for multiple confounders, excluding participants with moderate or severe hearing loss, and after adjustment for vestibular balance function. The magnitude of the association of hearing loss with falls is clinically-significant with a 25 dB hearing loss (equivalent from going from normal to mild hearing loss) being associated with a nearly three-fold increased odds of reporting falling over the preceding year.
Our results contribute to the literature examining the association between hearing loss and falls. Our findings are consistent with prior research studies that have utilized both self-reported6
and audiometric 1, 7
measures of hearing and have demonstrated associations between hearing loss with balance function 7
and incident falls 1
. In contrast, another longitudinal study has not found similar associations 8
. Potential factors that may limit the consistency of reported results across studies are variability in how hearing loss was measured, variability in cohort characteristics, and how balance and falls were assessed. For example, in studies using a hearing screening instrument rather than pure tone audiometry 8
, any misclassification of hearing loss status by the screening device may bias any observed results toward the null hypothesis
A number of mechanisms could explain the observed association between hearing loss and falls. There may be concomitant dysfunction of both the cochlear and vestibular sense organs given their shared location within the bony labyrinth of the inner ear. Decreased hearing sensitivity may also directly limit access to auditory cues that are needed for environmental awareness. Finally, the association of hearing loss with falls may be mediated through cognitive load and reduced attentional resources. Attentional resources are critical for maintaining postural control 9
, and decrements in attentional and cognitive resources imposed by hearing loss 10
may impair the maintenance of postural balance in real-world situations and increase the risk of falling.
A key limitation of our study is that our results are based on cross-sectional data rather than on longitudinal trajectories of hearing loss and fall history over time. Our measure of fall history was also dependent on retrospective self-report. However, our results were generally consistent with other studies 1, 6, 7
, and our results demonstrated a robust association between hearing loss and falls after adjustment for multiple confounders.
Further prospective research is needed to determine whether hearing loss is a modifiable risk factor for falls that may be amenable to hearing rehabilitative strategies that remain underutilized.