ACHIEVE - The Aging and Cognitive Health Evaluation in Elders Study
A landmark study of the effect of hearing intervention on brain health in older adults
Overview
The ACHIEVE study is a multicenter randomized trial involving 977 older adults ages 70-84 years with untreated hearing loss, that was designed to determine if treating hearing loss in older adults reduces cognitive decline over a three-year period.
The ACHIEVE study also looks at the effects of hearing intervention on other health outcomes, including cognitive impairment and dementia, brain structure and function, mental health and well-being, physical function, and health care use.
The ACHIEVE study is led by Co-Principal Investigators Frank Lin, MD, PhD and Josef Coresh, MD, PhD from the Johns Hopkins Bloomberg School of Public Health. Participants were enrolled at four research sites across the U.S., and four academic centers contributed to the study’s design and implementation.
The ACHIEVE study (ClinicalTrials.gov identifier: NCT03243422) has been funded by grant # R01AG055426, R01AG060502, and R34AG046548 from the National Institute on Aging, part of the National Institutes of Health. Hearing aids and related technologies provided to participants in the study were donated in-kind by Sonova under a material transfer agreement with Johns Hopkins University.
Why Study Hearing Loss and Cognition?
The number of older adults with dementia is increasing rapidly around the world because of the aging of the population. Identifying prevention strategies that can be implemented globally to reduce dementia is an urgent priority for governments around the world.
Important risk factors for cognitive decline and dementia that could be potentially addressed to help reduce dementia include hearing loss, less education in early life, smoking, diabetes, high blood pressure, social isolation, and physical inactivity.
Hearing loss is treatable in later life, which makes it an important public health target for dementia/cognitive decline prevention efforts.
What ACHIEVE Studied
The main focus of the ACHIEVE study was to learn if treating hearing loss in older adults reduces the loss of thinking and memory abilities (cognitive decline) that can occur with aging. The ACHIEVE study also looks at the effects of hearing intervention on other health outcomes, including cognitive impairment and dementia, brain structure and function, mental health and well-being, physical function, and health care use; that research will be published over time.
Participants in the ACHIEVE study came from two distinct study populations: a group of adults who were already participating in a heart health study and a group of healthy volunteers who were newly recruited from the community. The 238 participants who came from the heart health study were, on average, older and had more risk factors for cognitive decline than the 739 new healthy community volunteers.
At the beginning of the study, participants were randomly assigned to hearing intervention or a health education control intervention then followed for 3 years with tests of thinking and memory. The researchers used testing procedures to ensure hearing loss would not affect the accuracy of cognitive testing.
- The hearing intervention involved sessions with an audiologist and learning how to use hearing aids and other technologies to hear and communicate optimally.
- The health education control intervention involved individual sessions with a health educator covering topics relevant to chronic disease and disability prevention.
Implications for Hearing Care Policy
Hearing loss may be a particularly important target in global efforts to reduce the rate of dementia because hearing loss is very common in older adults but often goes untreated.
Treatment of hearing loss with hearing aids does not carry any health risks.
Policy changes are needed in many parts of the world to increase affordable access and insurance coverage for hearing treatment/intervention. Hearing intervention consists of two components:
- hearing aids and related hearing technologies, and
- the diagnostic and hearing care support services of an audiologist to guide the individual in using these hearing technologies to hear and communicate optimally.
In the U.S., Medicare and nearly all other private insurance plans do not cover either hearing aids or hearing care support services. A Medicare hearing benefit to cover these two components of hearing intervention was included in the 2021 Build Back Better Act but was not passed.
In late 2022, the U.S. FDA issued regulations that allow for hearing aids to be sold over the counter, and this policy will fortunately increase the affordability and accessibility of hearing aids in the U.S. However, U.S. seniors will still need access to hearing care support services that are not covered by Medicare or nearly any other private insurance.