Clinical and psychosocial risk factors of hearing outcome in older adults with cochlear implants

Objectives/Hypothesis: To identify psychosocial determinants of speech perception (SP) outcome in older adults after cochlear implant (CI) surgery. Study Design: Retrospective study. Methods: Subjects received their CI at age 45 years or older and had at least 12 months of device experience. Independent variables consisted of the Charlson Comorbidity Index, history of depression, length of hearing loss and amplification use, residential status, education and gaps in SP data. Regression models were evaluated for associations with open-set SP gains at 3 months and 12 months, and in the 6- to 12-month time interval. Results: Every 10% increase in the proportion of life spent using a hearing aid was associated with a 2% to 3% decrement in SP gain within the first 3 months of CI use. Later and overall 1y SP gains were negatively impacted by poorer general health, lower education level, and residence in an assisted-living facility. Patients with gaps in SP data at later time points were also more likely to have poorer health and to live in assisted-living facilities. The absence of two or more evaluations was associated on average with 6.3% lower SP outcome compared to subjects with one or fewer missing data points. Age at CI had no influence on the size of post-operative SP gains. Conclusions: Auditory deprivation and the influence of psychosocial and health factors on engagement in postsurgical rehabilitation services may impact CI outcomes more than has been previously reported. These findings have policy implications and highlight the need for more effective delivery of hearing rehabilitation services to an aging population.