Hearing Loss and Aggressive Behavior: Results From a Large, Retrospective Study of Older Adults Receiving Home Care Services in 2 US States

To examine the relationship between hearing difficulty and aggressive behavior among adults aged ≥65 years receiving Medicaid home care services in 2 US states. A cross-sectional analysis was conducted using secondary data collected from the interRAI Home Care and Community Health Assessment. Participants included 134,382 adults aged ≥65 years who received home care services in New York and Michigan in 2017 and had an initial interRAI assessment and independent living status. The association of hearing loss with the odds of exhibiting aggressive behavior was estimated using ordered logistic regression controlling for age, sex, and presence of Alzheimer's disease or dementia. Hearing difficulty had 4 levels, and aggressive behaviors was a 3-level variable. Individuals with hearing difficulties had higher odds of showing signs of aggressive behaviors than those with no difficulty in hearing. The odds of aggressive behaviors increased as hearing worsened. After adjustment, compared with individuals without hearing loss, older adults with severe or total hearing loss had twice the odds of displaying signs of aggressive behavior (odds ratio, 2.02; 95% CI, 1.81-2.26). Additionally, individuals with moderate hearing loss had almost 1.5 times the odds of showing aggressive behaviors (OR, 1.44; 95% CI, 1.34-1.55) CONCLUSIONS AND IMPLICATIONS: This research suggests that hearing loss is an important factor to assess and address among older adults. Results of this study illustrate that age-related sensory declines can impact other health-related behavioral conditions. In home care settings, sensory and behavioral changes should be monitored and assessed at regular intervals as part of multidisciplinary care planning. Performing routine hearing tests may result in earlier intervention and better management of care for home care populations, reducing caregiver burden particularly in individuals with multiple comorbidities. Early interventions may include incorporating routine hearing screenings, behavioral monitoring linked to sensory decline, and greater use of assistive devices or other enhanced communication strategies.