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Worldwide data show that hearing loss prevalence increases dramatically with age, affecting between 25% and 40% of adults over 65, 40% to 66% of adults over 75, and 80% of adults over 85 years (Pascolini and Smith, 2008). Sensory impairments increase with age: Vision and hearing impairments each double, and loss of feeling in the feet increases by 40% in persons aged 80 years and over compared with persons aged 70-79 years. One in five Americans below the poverty threshold has impaired vision: 50% higher than other Americans. Over one-half of those with impaired vision could improve their eyesight by using glasses or by getting a corrected prescription.
Sensory impairments such as problems with vision, hearing, postural balance, or loss of feeling in the feet, are known to increase with age. There is no difference in the prevalence of vision impairment between men and women (Figure 2). Among older Americans, the prevalence of sensory impairments is significantly higher among persons aged 80 years and over compared with persons aged 70-79 years.
The prevalence of vision and hearing impairments more than doubled among persons aged 80 years and over compared with persons aged 70-79 years.
The prevalence of loss of feeling in the feet increases by 40% in the older age group and the prevalence of balance problems increases by almost 30% (Figure 3). Non-Hispanic black and Mexican-American persons have a higher prevalence of vision impairment than non-Hispanic white persons. Non-Hispanic white and Mexican-American persons have a higher prevalence of hearing problems than non-Hispanic black persons. Non-Hispanic black persons have a higher prevalence of loss of feeling in the feet compared with non-Hispanic white persons (Figure 4). Vision and balance impairment is more common among older American adults living below the poverty level compared with those who are at or above the poverty level. One in five older adults living below the poverty threshold has vision impairment, a rate that is 50% higher than among all other older adults. Balance problems were 15% more likely among older adults living below the poverty level (Figure 5). Almost 60% of older persons with vision problems do not use glasses at all or have glasses that do not completely correct their vision. Approximately 70% of older Americans with hearing loss in at least one ear could potentially benefit from using a hearing aid, but do not use one (Figure 6). Hearing impairment (moderate to severe): Defined as an unassisted, pure tone audiometric average (at 500 Hz, 1000 Hz, 2000, and 4000 Hz) of greater than 40 dB in the better ear (6-8).
The percentage of persons who may benefit from using a hearing aid: This is not directly measured, rather, this estimate is the percentage of persons who do not currently use a hearing aid among the group of persons with a pure tone audiometric average at 500 Hz, 1000 Hz, 2000, and 4000 Hz of greater than 40 dB in at least one ear.
Balance (vestibular) impairment: Failure to be able to stand on onea€™s own to complete test condition 4 of the Modified Romberg Test of Standing Balance (3,9). Charles Dillon and Qiuping Gu are with the Centers for Disease Control and Preventiona€™s National Center for Health Statistics, Division of Health and Nutrition Examination Surveys. All material appearing in this report is in the public domain and may be reproduced or copied without permission; citation as to source, however, is appreciated.
We will be provided with an authorization token (please note: passwords are not shared with us) and will sync your accounts for you. The aims of the present multi-center study were to investigate the extent of mental health problems in adolescents with a hearing loss and cochlear implants (CIs) in comparison to normal hearing (NH) peers and to investigate possible relations between the extent of mental health problems of young CI users and hearing variables, such as age at implantation, or functional gain of CI. A cochlear implant (CI) is a prosthesis for the hair cells in the inner ear of persons with severe or profound hearing loss. In the last years further areas gained importance in CI research beyond hearing and speech of children and adolescents growing up with CIs. Furthermore, hearing variables like the age at first and second CI and functional gain of the CI(s) (aided thresholds) may be associated with the mental health outcomes of young CI users.
However, the number of studies addressing mental health problems of adolescents with CIs is still limited (compare Table 1). To the best of our knowledge, only very few studies so far included a NH comparison group when assessing the mental health problems of children or adolescents with CIs.
Huber and Kipman (2011) compared mental health problems between 32 adolescents with CIs and 212 NH peers.
Therefore, the question, whether cochlear implantation can protect children and adolescents with a hearing loss against mental health problems requires further attention. Despite a matching for age, gender and social background, one should also consider that the risk for additional disabling health conditions is increased in the population of persons, who grow up with a hearing loss. It should be noted, that disabling health conditions may also have a negative effect on the mental health of the individuals. To address these questions, we initiated a multi-center study assessing mental health problems in a large sample of 140 adolescents with CIs, who were closely matched to 140 NH adolescents for age, gender and social background. The aim of the study was to investigate, whether more mental health problems were prevalent in adolescents with CIs than in their NH peers.

The study group was comprised of 140 adolescents with CIs (68 boys, 72 girls) and their hearing parents and teachers, 30 from Freiburg, 43 from Hannover, 44 from Mainz and 23 from Munich (see demographic data in Tables 2, 3).
In 21 cases the risk could clearly be attributed to the respective etiology for hearing loss of the young CI users. Clinical files reported about cases of visual impairment, criterion (ii), or inner ear malformations, criterion (iii). 1 in 10 Canadians are living with some degree of hearing loss, and between 20 and 40% of adults over 65 report a significant hearing loss. However, hearing loss does not just affect older people; in the United States, 65% of people with a hearing loss are younger than 65 (Kochkin, 2005). This is the individuala€™s distance visual acuity, measured with the persona€™s distance glasses or contact lenses on, if the person wears them (3-5). This degree of hearing loss means that you are not able to hear and repeat words that a person says if they talk to you in a normal voice from across a quiet room. Howard Hoffman and Chia-Wen Ko are with the National Institutes of Health, National Institute on Deafness and Other Communication Disorders. A conceptual framework for identifying unmet health care needs of community dwelling elderly.
Surveillance for sensory impairment, activity limitation, and health-related quality of life among older adults--United States, 1993-1997. Revision of visual impairment definitions in the International Statistical Classification of Diseases. The prevalence of hearing impairment and reported hearing disability among adults in Great Britain.
Vision, hearing, balance, and sensory impairment in Americans aged 70 years and over: United States, 1999-2006.
This means that you will not need to remember your user name and password in the future and you will be able to login with the account you choose to sync, with the click of a button. This page doesn't support Internet Explorer 6, 7 and 8.Please upgrade your browser or activate Google Chrome Frame to improve your experience. In children with a severe or profound sensorineural hearing loss it usually allows the development of speech understanding and speech production.
Studies on mental health problems of children older than six years and adolescents with cochlear implants (at least 20% of the study group). However, this paper did not explicitly inform about the specific prevalence rates of the CI group.
Particularly, more closely controlled studies comparing young CI users to NH peers are needed to evaluate whether the prevalence rate of mental health problems is still higher in children with CI compared to NH children. These conditions are not only associated with hearing loss, but also with brain pathologies, neurological disorders, physical handicaps, borderline or subnormal IQ, and visual impairment.
We assume that this group is also at risk for mental health problems, since language- and speech outcomes are variable in young CI users with these complications (Aschendorff et al., 2009). We hypothesize that differences in mental health problems between CI users and NH peers are attributable to CI users with additional handicaps (intellectual disabilities or learning disorders, visual impairments or with inner ear malformations) rather than CI users without additional handicaps. The centers Cochlear Implant Center Freiburg, University of Freiburg, Hannover Medical School, Department of Otolaryngology Hannover, University Medical Center, University Mainz, Socialpediatric Center Munich, and Cochlear Implant Center, University Clinic Salzburg participated in the study. 17 cases out of the 21 fulfilled criterion (i): 5 cases with CMV, two cases with Rubella, one case with Dystonia, one case with Toxoplasmosis, and 8 cases with Meningitis. This group was selected from a pool of 212 Salzburgian normal hearing adolescents as described elsewhere [13].
The SDQ evaluates emotional, behavioral and social problems of children and adolescents aged about 3–17 years.
However, not all clinical files provided data about general learning disorders and intellectual disability, criterion (i). In Canada, hearing loss is the 3rd most common chronic condition behind arthritis and high blood pressure (Statistics Canada, 2002). Each of these areas can potentially be impacted by sensory impairment, which is also linked to increased mortality, hip fractures, and depression (2). In formal testing, an examinee should not be able to see the examiners lips when they are talking. NHANES is a cross-sectional survey monitoring the health and nutritional status of the civilian, noninstitutionalized population. World Health Organization Health Statistics and Health Information Systems: the Global Burden of Disease (GBD). Therefore, we expect that in the long term cochlear implantation has a positive effect on the mental health of children and adolescents with a hearing loss.
But no further differences in other domains, including emotional problems, conduct problems, hyperactivity or prosocial behavior were observed between CI group and normally hearing group.
94 CI users had no additional handicaps, and 11 CI users could not be clearly assigned (see Procedures and Table 2 for further information).

One case (out of the 21) with Usher syndrome fulfilled criterion (ii) and 3 cases with Mondini dyplasia fulfilled criterion (iii).
A 1-to-1 matching procedure was employed to match each adolescent with CI to a normally hearing peer of the same sex and comparable age and social background.
It can also be used as screening measure for mental health disorders, which was not the case in the present study.
Important public health goals for older adults include maintaining independent living, health, and quality of life (1). Hearing and vision impairment in older adults may present particular challenges to families and caregivers. Health interviews, health examinations, and laboratory tests are performed in mobile examination centers. The paper did not inform about the specific prevalence rates of the CI group and there was no matching between control and study group. However, the paper did also not inform about the specific prevalence rates of the CI group and there was no matching between control and study group. It is of interest, whether potential mental health problems in children with CIs can be related to these additional risk factors rather than the hearing loss per se. In 14 of 35 cases the risk could not or not clearly be associated with the etiology of the hearing loss. Thereby for all adolescents in the study group, a pediatrician evaluated whether the available anonymized data about physical diagnoses, IQ, neurological status, indication for brain disorders (from the clinical files and an anamnesis questionnaire) indicated an additional disability. Although some degree of sensory loss may be irreversible, these data indicate that significant numbers of persons may be helped by the use of better glasses or by hearing aid use. This report provides updated examination-based estimates for sensory impairments: overall and for specific subgroups of older Americans. In 1999-2006, non-Hispanic black persons, Mexican-American persons, persons with low-income, and persons aged 60 years and over were oversampled for reliable subgroup prevalence estimation. Sample weights accounting for the complex survey design, nonresponse, and noncoverage were used for analysis. However, no further differences between the CI non-risk group and the NH group were observed in any rater. Due to multivariate analysis procedures (see Statistics), TDS was not analyzed further in the present study.
The CI risk-group showed significantly more hyperactivity compared to the NH group and more hyperactivity and conduct problems compared to the CI non-risk group.
Despite these risk factors in the etiology of the hearing loss, risk cases and non-risk cases did not differ in any demographic or hearing variables as summarized in Tables 2, 3. SDQ versions are available for parents, teachers and as self ratings for children from 11 years of age and older. In 16 cases support was needed, whereby the SDQ questions were given additionally in an adapted format, with standard sentences—following a written guideline-shortened and with paraphrases, presented both orally and written.
Cluster analyses confirmed that there were significantly more adolescents with high problems in the CI risk-group compared to the CI non-risk group and the NH group. There are three response categories; 0 = not true, 1 = somewhat true and 2 = certainly true. Adolescents with CI, who were able to understand speech in noise had significantly less difficulties compared to constricted CI users.
For ES, HA, CP, and PP higher values mean more problems, for PBS higher values mean less problems. Parents, teachers, and clinicians should be aware that CI users with additionally special needs may have mental health problems. The SDQ has been translated and validated for the German language (Becker et al., 2004a,b).
The parents filled in the questionnaires (SDQ, demographic data) at the same time, however separately. However, peer problems were also experienced by CI adolescents without additional handicaps.
In the case of their agreement, the teachers received the SDQ from the parents and sent it back to the investigators via mail.
Teacher ratings were available for 55 adolescents of the study group and 42 adolescents of the control group.

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