Hearing Loss and Fatigue: Fred Bess, PhD Lab members Assessment and - PDF document

10/21/2013 Acknowledgements and Disclosures • Research collaborators – Erin Picou, PhD – Dan Ashmead, PhD – Aaron Kipp, PhD Hearing Loss and Fatigue: – Fred Bess, PhD • Lab members Assessment and Intervention – Julie Fix – Zoe Doss – Katie Makowiec – Alissa Harbin Benjamin W.Y. Hornsby, Ph.D. – Bridget Stone – Amanda Headly  Funding for the works described here was provided by  Phonak, Inc.,  NIH R21 DC012865-01A1  Starkey Inc., and  IES #R324A110266  the Dan Maddox Foundation  the ASHFoundation What is Fatigue? Consequences of Fatigue • Decreased attention, concentration, • Fatigue is a complex construct that can occur mental processing, and decision ‐ making in both the physical and mental domains. – van der Linden et al. 2003; DeLuca, 2005 – Our focus is on mental fatigue • Less productive and more prone to • Subjectively, defined as a mood or feeling of accidents tiredness, exhaustion or lack of “energy” – Ricci et al. 2007 • Often associated with a lack of, or decline in, • Less active, more isolated, less able to monitor own self ‐ care, and more prone – Focus, concentration, alertness and/or mental to depression energy and efficiency – Amato, et al. 2001; Eddy and Cruz, 2007 • Kennedy, 1988; O’Conner, 2006; Lieberman, 2007; Boksem and Tops, 2008 1

10/21/2013 Who has Fatigue? Hearing Loss and Fatigue • Fatigue is a common accompaniment of hearing loss • Everybody! with severe consequences on quality of life – Complaints of transient fatigue are common even – Listening IS exhausting!!! in healthy populations • Post on hearingaidforums.com • Recurrent fatigue is common in many chronic – “…since I lost most of my hearing…, I've had periodic bouts health conditions of tiredness that are deeper and of a different quality than I ever experienced before.” – Cancer, HIV AIDs, Parkinson’s, Multiple Sclerosis • Copithorne, 2006 – Very little work specifically looking at hearing loss – “I go to bed most nights with nothing left. It takes so much and fatigue energy to participate in conversations all day, that I’m often asleep within minutes.” • Blog post http://hearingelmo.wordpress.com/2008/06/17/fatigue ‐ fear ‐ and ‐ coping/ Quantifying Fatigue Subjectively Subjective Measures of Fatigue • Fatigue can be measured many ways • Profile of Mood States (POMS) – Subjectively using surveys, rating scales and – 65 items used to derive six mood scores questionnaires that ask about mood or feelings including fatigue and vigor (uni ‐ dimensional) • Many options, none specific to hearing loss • Sensitive to effects of multiple variables on fatigue • Fatigue scales may be Below is a list of words that describe feelings that people have. Please read each word carefully. Then circle the number that best describes how you have been feeling during the PAST WEEK, including today. – Uni ‐ dimensional: Assess “general” fatigue Not at all A little Moderately Quite a bit Extremely • a composite fatigue measure Item # Item 0 1 2 3 4 Construct 4 Worn Out Fatigue – Multidimensional: Assess various fatigue constructs 7 Lively Vigor 11 Listless Fatigue 15 Active Vigor • E.g., General, physical, mental, emotional, sleep, etc… 29 Fatigued Fatigue 51 Alert Vigor – Can also assess frequency and severity McNair et al, 1971 2

10/21/2013 Subjective fatigue in adults seeking Subjective Measures of Fatigue hearing help • Multidimensional Fatigue Symptom Inventory (MFSI ‐ short form; Stein et al., 2004) • Participants: Subset of individuals scheduled for a hearing test or hearing aid evaluation. – 30 items; four fatigue scores (General, Physical, – ≥ 55 years old (mean: 72.3 years; s.d. 10.2 years) Emotional, Mental), a vigor and total score • range 55 ‐ 94 years. Below is a list of statements that describe how people sometimes feel. Please read each item carefully, then circle the one number next to each – N= 116 adults (63% males). item which best describes how true each statement has been for you in the past 7 days. • Participants were mailed two self ‐ report measures of fatigue and a measure of hearing handicap Not at all A little Moderately Quite a bit Extremely Item # Item 0 1 2 3 4 Construct 2My muscles ache Physical – POMS (fatigue and vigor subscales) 3 I feel upset Emotional 7 I feel lively Vigor – Multidimensional fatigue scale (MFSI) 12I am worn out General I have trouble 15 paying attention Mental – Hearing handicap inventory (HHIE/HHIA) Severe fatigue and vigor deficits * • 1.5 st. dev above * normative mean is a common “cutpoint” for identifying cases needing additional attention – Expect ~7% of cases • Adults seeking hearing help reported more fatigue based on normative data and significantly less vigor than age ‐ matched adults • Our group was much more likely to report severe recruited from church and community groups fatigue and vigor deficits (Nyenhuis et al., 1999) *p<0.01 3

10/21/2013 Degree of loss and subjective fatigue Hearing handicap and fatigue 30 100 100 PTA = 75 dB HL 95% Confidence Interval Regression Prediction Age: 67 POMS Fatigue Score HHIE/A Total Score 80 • As fatigue increases, Raw Data Gender: Male HHIE/A Total Score 25 60 80 hearing handicap • Surprisingly, no 40 PTA = 25 dB HL 20 increases 20 60 relationship 0 15 • Suggests -20 -10 0 10 20 30 40 50 60 70 80 90 MFSI Total Score between degree consequences of 40 10 PTA: 35 of hearing loss Age: 67 hearing loss and fatigue Gender: Male 5 20 and subjective are associated 95% Confidence Interval Regression Prediction 0 fatigue or vigor 0 0 10 20 30 40 50 60 70 80 -20 -10 0 10 20 30 40 50 60 70 80 90 MFSI Total Score Better Ear PTA • Suggests factors other than “increased effort” • Strong relationship between hearing handicap affect fatigue in adults with HL and subjective fatigue (POMS and MFSI) Hornsby, Werfel, Camarata, and Bess (2013). Subjective Summary Fatigue in Children with Hearing Loss, AJA. Subjective fatigue in children with HL • Fatigue is a complex multidimensional construct that More Fatigue * p< 0.05 100 can be defined subjectively as a mood or feeling and CHL 90 CNH quantified using various subjective measures PedsQL Score 80 70 – E.g., POMS, MFSI, PedsQL ‐ MFS * * * 60 • Results using validated, generic, measures confirm 50 40 – fatigue is increased in adults and children with HL, 30 – risk for more severe fatigue is increased in these groups, 20 – Psychosocial consequences of hearing loss and fatigue are 10 related 0 General Sleep/Rest Cognitive Overall • CHL report significantly more fatigue. Pervasive across domains 4

10/21/2013 Hornsby, B. (2013). The Effects of Hearing Aid Use on Listening Effort and Mental Fatigue Associated With Sustained Speech Processing Demands. Ear and Hearing Objective Measures of Fatigue Objective fatigue measures Visual Reaction times • Fatigue has also been defined behaviorally • Unaided RTs 500 Unaided slow over time – A decline in cognitive performance due to Reaction Time (in ms) Aided Basic 450 sustained mental demands consistent with 400 • Kennedy 1988; DeLuca 2005 onset of fatigue • Measures of attention, concentration, 350 • Aided RTs are processing speed, and decision ‐ making have more stable 300 been used as objective markers of fatigue Error bars = 1 st. error suggesting some 250 ST 1 2 3 4 5 6 Mean – van der Linden et al. 2003; DeLuca, 2005 resistance to Trial Block fatigue • Very limited work in this area in HI persons • Reaction times (RT) during a demanding dual ‐ task requiring sustained (~50 minutes)speech processing References Subjective Ratings Change in POMS Fatigue Scores after sustained listening • DeLuca, J. (2005). Fatigue, Cognition, and Mental Effort. In J. DeLuca (Ed.), Fatigue during a demanding speech task as a window to the brain (pp. 37 ‐ 58). Cambridge, Mass.: MIT Press. • Hetu, R., Riverin, L., Lalande, N., Getty, L. and St ‐ Cyr, C. (1988). "Qualitative 30 More Fatigued More Fatiguing when Aided analysis of the handicap associated with occupational hearing loss." British Journal Change in Aided Fatigue Rating Fatigue Subscale Score Unaided 10 25 Mean Aided of Audiology 22 (4): 251 ‐ 64. 20 • Hornsby, B. W. Y. (2013). The Effects of Hearing Aid Use on Listening Effort and 8 Mental Fatigue Associated With Sustained Speech Processing Demands. Ear and 15 6 Hearing. doi: 10.1097/AUD.0b013e31828003d8 10 4 • Hornsby, B. W., Werfel, K., Camarata, S., & Bess, F. H. (2013). Subjective Fatigue in 5 Children with Hearing Loss: Some Preliminary Findings. Am J Audiol. doi: 2 More Fatiguing when Unaided 10.1044/1059 ‐ 0889(2013/13 ‐ 0017) 0 Less Fatigued 0 0 5 10 15 20 25 30 • Lieberman, H. R. (2007). Cognitive methods for assessing mental energy. Nutr Pre-Test Post-Test Change in Unaided Fatigue Rating Neurosci, 10(5 ‐ 6), 229 ‐ 242. • Demanding listening IS fatiguing especially unaided! • van der Linden, D., Frese, M., & Meijman, T. F. (2003). Mental fatigue and the control of cognitive processes: effects on perseveration and planning. Acta Psychol • I.e., Aids help consistently across participants (Amst), 113(1), 45 ‐ 65. doi: S0001691802001506 [pii] 5