Blaise M. Delfino, M.S. - HIS:
You are tuned into the Hearing Matters podcast, the show that discusses hearing technology, best practices, and a global epidemic: hearing loss. Before we kick this episode off, a special thank you to our partners. Redux, faster, dryer, smarter, verified. Cycle, built for the entire hearing care practice. OtoSet, the modern ear cleaning device. Fader Plugs, the world's first custom adjustable earplug. Welcome back to another episode of The Hearing Matters podcast. I'm your founder and host, Blaise Delfino. And as a friendly reminder, this podcast is separate from my work at Starkey.
In this episode, Dr. Beck, our co-host interviews Dr. Hannah Glick, dually trained audiologist and cognitive neuroscientist and professor at the University of Northern Colorado. Her research examines the impact of hearing loss and hearing treatment on overall health and well-being. Her research has been supported by the National Institutes of Health and the American Speech Language Hearing Association and featured in publications and presentations globally, A clinician at heart. She enjoys supporting patients and families along all stages along their hearing journey, a skilled teacher and mentor. She loves helping students unlock their purpose and passion. Enjoy the conversation between our co-host, Dr. Douglas Beck, and our guest, Dr. Hannah Glick.
Dr. Douglas L. Beck:
Good morning. This is Dr. Douglas Beck with the Hearing Matters podcast, and today I'm going to be interviewing Dr. Hannah Glick from the University of Northern Colorado where she is a professor. And Dr. Glick got her AuD in 2017 and her PhD in 2019. She's an expert in hearing loss and brain function, cognitive function, and the social emotional well-being aspects of hearing healthcare and related matters. So today we're going to talk about a number of topics, a number of subjects. The first thing I want to do is welcome you Dr. Glick. It's a joy to see you.
Dr. Hannah Glick:
Thank you so much. I'm so excited to be here today.
Dr. Douglas L. Beck:
What I want to start with, we're going to get into cognition and audition and matters related to that. But I always think it's super important to be clear as to what we're talking about. And hearing and listening are very different things.
Dr. Hannah Glick:
This is really important because we tend to use the term hearing and listening interchangeably when in fact they're very, very different. So when we're talking about hearing, really what we're talking about is detection of sound, so telling whether sound is present or not. That's hearing to me is detection. But listening is complex and it involves so many other processes. So for example, discriminating, telling the difference between a male speaker and a female speaker, that's a higher level type of auditory task. Being able to identify words that are spoken, and then finally comprehension of speech, especially in difficult listening environments like the context of background noise, all of those tasks are more complex than just detection of sound. And to me, that's what listening is. Listening is way more complex than hearing.
Dr. Douglas L. Beck:
That's great. I am so glad to hear you say this. The definitions I use are very similar. I say hearing is perceiving or detecting sound. Listening is comprehending sound. Most of the research that's been published last 15, 20 years looks at hearing loss and compares it to cognitive abilities, right? And one of the papers that I published in '23 with Ron Levin and Carol Flexer, I think it was August of '23, something like that. We said, "Well, what would've happened if instead of just measuring pure tones, if these measures of auditory capacity had been instead a speech in noise test?"
And you and I have not discussed this ahead of time, but I'm curious because when I think that we're correlating cognitive function with a peripheral nervous system event, that's one thing. And there is certainly a high correlation there. But I wonder if the correlation would've been even more substantial these last 10 or 15 years had we looked at digits and noise or speech in noise or an SNR-Fifty. What are your thoughts on that?
Dr. Hannah Glick:
I'm in agreement. I think that pure tone screening tells us very, very little about a person's auditory abilities because it's really just a focus on detection or hearing and not on listening. And so I think that by using conventional methods for screening, we are missing a lot of adults who could benefit from different forms of intervention, and we are waiting too long to initiate treatment. I think that the other issue of pure tone screening is, what is the definition of, "normal," hearing? Conventionally, what I've seen in most audiology clinics, 25 db is the cutoff for normal when in fact 25 db is not normal.
Dr. Douglas L. Beck:
Yeah. I happen to agree and underscore, and I've been on a rant about this for about 15 years now. I refer to these scales, zero to 25, normal, 26 to 40, mild, 41 to 70, moderate, etc, I refer to those as categories of convenience. It's an easy way to talk to patients, but it's very misleading as you're saying. And in fact, wasn't it about a hundred years ago when these scales were looked at and we started to measure what is normal hearing? And the outer limit of normal was 15 decibels. And if you go back to Miriam Down's work in your backyard over there, right? Dr. Downs used to say that any child who has 15 dB or worse hearing needs to be diagnosed and treated.
Dr. Hannah Glick:
Well, and still today we screen children at 15 dB. Why should we do any different for adults? Why do we care less about adults, especially given the research that's coming out linking hearing loss to cognitive decline? It's crazy to me, absolutely crazy to me. I think that speech in noise testing, speech in noise screening could allow us to capture more adults who could benefit from intervention sooner and do something sooner.33
Dr. Douglas L. Beck:
And not just that they would benefit a little bit. If you go back to 1999, maybe 2000, the National Council of the Aging study, the people who got amplification, they had better socialization, they earned more money, they had better sex, they had more gratifying personal relationships. They were less anxious, they had less depression. They were able to understand speech in noise more readily. They had less overall frustration. The benefits of amplification, we've known this for decades [inaudible 00:06:54].
Dr. Hannah Glick:
Decades.
Dr. Douglas L. Beck:
And to tell people, "Oh, your hearing is normal for your age," is just insane. It's just absolutely insane. Then when you're talking about screening, and I want to go a little bit into this because there are many people on the planet right now who are doing this. "I can hear my watch so my hearing is normal." That's nonsense. That watch click is most often a square wave sort of a thing, and it's got most of its energy at 2000 hertz probably. We don't know without measuring. And to think that the fact that you could hear that tells you you have normal hearing is insane.
When we talk about hearing screening versus comprehensive audiometric evaluations, we get into a lot of trouble because many people will do a whisper test, which is absolutely meaningless, total waste of everybody's time. "You can hear me whisper," doesn't tell me anything about how you're doing in the real world. If you can hear a whisper in a quiet room, so what? Nobody lives in that quiet room. Same with watch tick test. What are your thoughts on that?
Dr. Hannah Glick:
I'm in complete agreement with that. I think again, it comes back to this difference between hearing and listening. The screening, all it does is tell us about detection of sound. It tells us nothing about how a person is functioning in the real world. And you could have two people with the exact same pure tone audiogram who function very, very differently out in the world.
Dr. Douglas L. Beck:
Absolutely.
Dr. Hannah Glick:
You could have a person who has normal hearing thresholds, pure tone thresholds, who still experiences listening difficulty, and the functional impact of that difficulty is significant in their everyday lives. And we're missing all of that by continuing to do pure tone screening.
Dr. Douglas L. Beck:
And the point isn't to not do screening with pure tones. The point is to do a comprehensive audiometric evaluation. I wrote a paper for ASHA, I think it was November of '22, and I said that screening by technicians and allied health professionals. That's nice. They're trying to help, that's awesome. But if I do a screening because I am an audiology doctor or you do a screening because you're an audiology doctor and you're a neuroscientist, what happens supposing that a 74-year-old guy comes to see me and all I do is a screening and I just do pure tones at 25 or 30 and he passes all that? He's going to go home and tell his wife or loved one or carer or significant other, he's going to go home and say, "Well, I saw Dr. Beck and he said my hearing is normal," which is so misleading. It's so wrong.
Dr. Hannah Glick:
Agreed. I think that how we talk to patients really matters. This might be kind of extreme, but I'm almost of the opinion like a hearing handicap inventory for adults or hearing handicap inventory for the elderly is a better way to screen because we're actually getting information from the patient about their functional difficulty in their everyday life and how their perceived hearing impairment is affecting them. And if that is significant, then let's go on and do a comprehensive audiological evaluation. But just by doing a pure tone screening, it's not providing us enough information.
Dr. Douglas L. Beck:
I don't think anybody has the answer, but there are people who are saying, "Well, you should know your hearing number." I have no problem with that. But that's just a measure of loudness and each one of us does it differently. Some people do a three frequency pure tone average, some do four. Some do four, but if the difference in octaves is more than 20 DB, they use the mid.
Here's the way the numbers work, right? In the USA we have 335 million people. About 38 to 40 million of them will not pass a 25 DB hearing screening. And then we have another 26 million people who have absolutely normal pure tone, but they will complain about hearing difficulty, they will complain about speech in noise. And what most clinicians do is they say, "Oh, that's normal for your age. Oh, that happens to all of us. Oh, you have to get used to it." And again, this is ridiculous. There is no reason that they have to get used to it. And wouldn't their life be enhanced if they could only better perceive speech in noise, which is not very difficult for audiologists or hearing aid dispensers to make happen.
Dr. Hannah Glick:
Yeah. I'm definitely in agreement with that, for sure.
Dr. Douglas L. Beck:
All right. I mean, this is exactly what AAA says. This is what ASHA says, and this is what IHS says is you do your diagnostic work, whether that's ear bone and speech, and then you do temps and reflexes as needed, and you might do auto acoustic emissions. But they all strongly suggest speech in noise. And this is very depressing because only about 15, maybe 20% of hearing care professionals do that.
The number one complaint that we all deal with every day in and out is, "I can't understand speech in noise." Most people don't measure it. And as it turns out, the correlation between your word recognition score in quiet and your speech in noise score is zero. Rich Wilson looked at this in, I think it was 2011, 2012. He looked at 3,500 veterans and he said that about 70% of them had word recognition in quiet that was good to excellent. And then he did speech in noise on them and only 7% had normal speech in noise.
Dr. Hannah Glick:
Yeah. I think that speech in noise should be one of the first tests that we do as part of a diagnostic evaluation. I think it should be incorporated into the screening process. But if not incorporated into the screening process, if that is the patient's chief complaint, that should be the first test that you perform besides looking in the patient's ears.
Dr. Douglas L. Beck:
Absolutely. Okay. I'm with you. And so the one screening that I advocate, and it's the only one, is newborn infant screening. Everybody else, whether it's a child, whether it's middle-aged adult, whether it's an older adult comprehensive audiometric evaluation, if you don't do that, you are quite literally guessing and there's no need to. And people say, "Well, it's so expensive." Well, I'm sorry, but so is healthcare. I just went to get an MRI for my knees, and even though I have insurance, it's 200 bucks out of my pocket and everybody's got a different healthcare plan and everybody pays different amounts.
Healthcare is expensive. I'm sorry. But the worst thing is to know that there's an issue and not address it because, you know what? Addressing it later is going to be much more expensive. Let me ask you, I think one of the most quoted studies in audiology and cognition is Gill Livingston and colleagues in The Lancet in 2020 when they talked about 12 potentially modifiable risk factors.
Now, to put that in context, what they actually said is that your risk, my risk, a person walking around right now, their risk of cognitive decline is 60% due to their age and their deoxyribonucleic acids, their DNA. But there's another 40% that was due potentially to some 12 modifiable risk factors, of which hearing loss untreated was the largest of the potentially modifiable risk factors. Hearing loss was in general 8.2%. So that does mean that 91.8% was not purely about your hearing loss being untreated.
Dr. Hannah Glick:
So this is interesting because I think we've got emerging research coming out that's showing... and the Achieve trial and the Enhance study showing that treatment of hearing loss can improve cognitive function or maintain cognitive function. But these impacts tend to be greatest in those older adults that are at greater risk for cognitive decline. So I think it's important to add in that piece.
Dr. Douglas L. Beck:
I think to a large degree, and I've said this many times, I think that people don't get the Achieve study as well as they might. The larger treatment group, I want to say a thousand people at four sites, and really it's a brilliant study, absolutely very clever. But what happened was there was actually no control group. So in the original study, you had people treated with excellent counseling and nutrition and exercise and health related stuff, and then you had people fitted with hearing aids. And they said, "Well, there was no difference." Well, okay, that's fine. That means that both treatments either worked the same, didn't work at all, or worked poorly. So there's no difference in those two groups. But exactly as you're saying, in the people who were older, the people who had more hearing loss, the people who had multiple other issues going on-
Dr. Hannah Glick:
Comorbidities. Yeah.
Dr. Douglas L. Beck:
... comorbidities, they did see a 49% decline in the rate of cognitive decline over the three-year period. They studied the enhanced study with Dr. Serant's Group in Australia, in about 150 people, normal thresholds or mild thresholds, and about 125 in the other group if I remember that correctly. The people who were fitted with hearing aids versus people who chose not to, that's fine. And they were watched for three years. That was an observational study. And what they found, and Dr. Serant has published this, and she and I did a podcast a month or two ago on it, the people with the hearing aids did not degrade over the three-year period of time. But the people who chose to not have hearing aids, they actually did decline on many functions.
So I think your point is very, very well taken. And I think that we don't want to get crazy and make promises because this is science and medicine, and there are no promises in medicine. None. I don't care if you go for a stapedotomy, stapedectomy, tympanoplasty, acoustic neuroma, no promise on the outcomes. We'll do the very best we can. And you sign about a million pieces of paper saying, "Nobody's made me any promises."
And I think we have to start to really incorporate this information rather than, there was a recent paper that said, "Oh, we shouldn't focus on this." Whereas I'm thinking this is actually part of audiology. Since most of us have degrees in communicative disorders and sciences, many of us have master's degrees, most of us now have doctoral degrees, why would we not relate the long-term outcomes of many studies to the patient sitting in front of us? I'm not saying make that the focus. What you and I just talked about is two studies.
Then there was this other study, let me see if maybe you read this one, it was by Glick and Sharma. Yeah. So you guys, here's my interpretation and you tell me if I've got this right, you had a couple of dozen patients and they had mild to moderate sensorineural loss. And you looked at a lot of stuff. You looked at visual evoked potentials, ABRs, you looked at executive function, you looked at speech understanding, comprehension. You looked at all these things over about six months. And you had patients who were fitted with premium hearing aids according to best practice guidelines. And six months later, the patients who were fit in general improved in executive function, had better word recognition score. And more importantly, I should say, you had anatomic changes. You had the focus shifting back to the superior temporal lobe for hearing, right? Their visual evoked potentials over time went back to a more typical VEP because they were depending less on vision after getting their hearing correction, let's say. And so everything about it was kind of stunning.
Dr. Hannah Glick:
Yeah. So what we saw is behaviorally we saw improvements in cognitive function. And the improvements that we saw in cognitive function wasn't just executive function, but also processing speed, visual working memory, global cognitive, so their performance on the Montreal cognitive assessment, which is a common screener. We saw improvements there. And then we did see functional changes, functional neurophysiological changes. So just like you said, before the adults with hearing loss got hearing aids, the auditory cortex was being recruited for visual processing. We call that cross-modal reorganization. And that reversed after treatment with hearing aids. But I have to say, since publishing that study, I've gone back and looked at the untreated hearing loss group and some very interesting things have emerged.
Dr. Douglas L. Beck:
Can you share some of that or can you-
Dr. Hannah Glick:
Sure. Yeah.
Dr. Douglas L. Beck:
Okay.
Dr. Hannah Glick:
I actually presented some of this last week. It's not published yet, but I just wanted to get it out there. So one of my recent talks, but I took that group of adults with untreated hearing loss. And I actually split them into two subgroups. Adults with untreated hearing loss, mild to moderate hearing loss who at baseline had normal performance on the MOCA and those who were at risk for mild cognitive impairment on the MOCA.
Dr. Douglas L. Beck:
Based on the MOCA. And the MOCA, for those who don't know, that's the Montreal Cognitive Assessment, and it's given verbally and scored by usually the person giving the test.
Dr. Hannah Glick:
And then I looked at those two subgroups. What were the differences that we saw of outcomes? Because I had been looking at things coming out from the Achieve trial and all of that. And I'm like, "Did we see the same thing in our data set?" What I found, and this is a small data set similar to what we see with the Achieve trial, those adults who are at risk for mild cognitive impairment at baseline, so they had poor cognitive function at baseline, they actually receive significantly greater cognitive improvement with hearing aid use. But that is not true in the adults with hearing loss who are not at risk for cognitive impairment.
Dr. Douglas L. Beck:
So what did you find when you went back and looked at it, so if you can share some of those findings?
Dr. Hannah Glick:
So basically we took that group of adults with hearing loss from the 2020 study, and I broke them into two subgroups. So I broke them into a group of adults that at baseline they had hearing loss, but they had poor cognitive abilities. So they scored below the 27 cutoff on the Montreal Cognitive Assessment.
Dr. Douglas L. Beck:
On the MOCA.
Dr. Hannah Glick:
And then a group of adults with hearing loss who had good cognitive abilities. They scored above 27 on the MOCA. And I wanted to look at outcomes between those two groups. So basically differences in hearing aid outcomes for those adults who are at risk for mild cognitive impairment. And here's what I found. So just like the achieved study had shown, what we saw is in that subgroup of adults at risk for mild to cognitive impairment, they showed the greatest cognitive benefit from hearing aids whereas the group of adults that was not at risk didn't see a significant improvement in cognitive function.
Dr. Douglas L. Beck:
And that sounds totally consistent with the overall Achieve study. It sounds consistent with the Enhance study. It sounds consistent with Amieva. If you go back to Helen Amieva, 2015... can't remember where she published it. But from Bordeaux, France, she looked at 3,500 people over 25 years using the Mini Mental State Exam as the measure of cognitive function, and she broke them into three groups. So group one, people who said they had no hearing loss. I think that was like 2,400 out of the 3,500 or 3,600.
Then you had people who said they had hearing loss untreated and hearing loss treated with hearing aids. The group that said they had hearing loss, but they wore hearing aids, after 25 years their cognitive measures look the same as people without hearing loss. What we're starting to really develop is a better candidacy profile. Cognitive decline may be slowed down, maybe attenuated a little bit by fitting with amplification on selected patients. But I've been seeing in the literature in the last 30 days, last 60 days where some of our colleagues are saying, "Oh, we shouldn't talk about this." We should focus on the clear auditory benefits. What are your thoughts on that?
Dr. Hannah Glick:
I think that we should be talking about cognition with our patients. I think we should be screening for cognitive decline screening for dementia in our clinics. And JAMA, some of the recent statistics about mild cognitive impairment and dementia, I think it's 20% of adults in the United States have mild cognitive impairment. By the time an older person reaches their eighties, nineties, one third of them will have Alzheimer's disease or dementia. That is a huge portion of the population.
And the problem is that on average, a physician visit is like 20 minutes long. And there's a shortage of physicians and primary care doctors in general. So the chance of an older adult, an adult receiving a cognitive screening at a routine primary care visit is quite low. And it's not happening as much as it should be happening. Meanwhile, in audiology clinical settings, we have I think one and a half hours of counseling time over the process of hearing aid fitting where we can incorporate cognitive screening and we can talk about the importance of cognition as it relates to communication. I think audiologists are actually uniquely positioned to perform cognitive screening in our practices.
Dr. Douglas L. Beck:
Yeah. And it's not a new idea. I mean, if you go back Earhart and Sousa, right? They published, I think it was 2015, they were saying audiologists should be prepared to understand that about one fifth of their patients over age 65 are going to have mild cognitive impairment and it's not going to be diagnosed. You're going to be the first person to address it. And they're going to talk about, well, they can't understand speech in noise. They forget what people are saying. They're worried about memory issues.
And if we just do ear bone and speech, all of those patients become invisible to us. The easiest way to identify them I think is a speech in noise test because that tells us really what happens when you're combining your peripheral auditory nervous system and your central auditory nervous system and your brain and your hippocampus, your memory, your executive function, you're putting all that together to make sense out of the world, and that gives you much more insight than does a pure tone. My last point on pure tones is to press the button when you hear the beep, that's good. That's repeatable. But it's not a good measure of auditory capacity because you only need 20% of those auditory fibers intact to perceive that sound.
Dr. Hannah Glick:
And I will say the other reason why I think cognitive screening is so important in the context of audiology is because cognition influences outcomes.
Dr. Douglas L. Beck:
Absolutely.
Dr. Hannah Glick:
So for example, people that have mild cognitive impairment, they are less likely to comply with hearing aid use. And in my re-look at the 2020 study, something that I found is that those adults who are at risk for mild cognitive impairment or performed poorly on that MOCA screening at baseline, after getting hearing aids, they were less satisfied with their hearing aids and they perceived less benefit. I think that the other reason we need to think about cognitive screening is that it does influence outcome, cognitive status, poor or lower cognitive status could be a reason why hearing aids are ending up back in the drawer.
Dr. Douglas L. Beck:
Yeah, sure.
Dr. Hannah Glick:
Knowing that might impact our treatment and rehabilitation plan for those patients.
Dr. Douglas L. Beck:
Right. And the patient in front of you is an N of one, right? When you're looking at these large demographic studies, you're looking at epidemiologic studies of tens of thousands of people, that tells us a general trend of what happens. But it doesn't tell you about your patient. And it is so important to apply this appropriately for the individual. If we do this correctly, in some people at some time I believe we can prevent decline. What are your thoughts on that?
Dr. Hannah Glick:
I agree. I look at it more even from my own personal perspective is, what can I do to reduce my risk? To me, hearing aids are a really benign intervention. And I'd be willing at the point that I've developed hearing loss or listening difficulties to try that out and to comply with using that treatment to hopefully reduce my personal risk. But I don't actually know what that number is for me individually.
Dr. Douglas L. Beck:
I don't know anybody in hearing healthcare who says that hearing loss causes dementia. I don't know anybody who does that. And I feel pretty comfortable saying that untreated hearing loss in certain individuals tends to exacerbate cognitive decline and amplification in appropriate candidates tends to slow it down. That's not a shock. That's what Enhance said. That's what Glick and Sharma said. That's what Achieve said. And for us to not acknowledge this and start managing it appropriately is really folly.
We are doctors, we are professionals, we are licensed. If we're not taking care of this, I don't know who is. And that observation that you just shared is brilliant because when you think about people with hearing loss in the USA, 70% of them have a mild loss, maybe mild to moderate. But that's the clear majority. And of course, for those people with just the least amount of hearing loss, it's very hard for them to know they have hearing loss. You can't tell what you can't hear. So it's very important to start reporting to your audiologist or your hearing aid dispenser that you're having these difficulties because everybody else is going to dismiss them. Before I let you go, any new exciting research that you're involved with that you can share?
Dr. Hannah Glick:
Yeah. So I've become really fascinated by this group of adults with hearing loss and who are at greater risk for mild cognitive impairment. So we know there's a high comorbidity between hearing loss and mild cognitive impairment. About 80% of patients who have mild cognitive impairment will also have hearing loss. Compared to the general population, we've got 60% of adults that have hearing loss without mild cognitive impairment.
So it's a huge number. 60 to 90% of adults living with MCI are completely unaware that they have this. And so what I'm interested in looking at is, how can we better support that group of adults that have hearing loss who are also at greater risk for cognitive decline, maybe in that MCI stage to enhance outcomes? And the way that I'm interested in looking at better ways that we can support that population is through things like things like reminiscence therapy, right? Reminiscence therapy is a very common intervention, non-pharmacological intervention for adults living with MCI and dementia. Reminiscence therapy involves things like getting an individual to recall past experiences and memories from their life. And they've shown that things like reminiscence therapy can enhance holistic health outcomes.
Dr. Douglas L. Beck:
Yes, the more access you have to information within your brain, and when you bring it from your hippocampus from long-term memory and you become conscious of that right away, you're reinforcing that memory. And okay, I got you.
Dr. Hannah Glick:
You. There's some pretty interesting apps out there. One of them is called LifeBio Memory App. It was created by a woman whose mom had dementia. And she saw huge benefits of reminiscence therapy in her mom's life. And so she got a grant from the National Institute of Aging to create this app that basically uses artificial intelligence to... It gives voice prompts. It asks you, "Tell me about your first relationship. Tell me-"
Dr. Douglas L. Beck:
Oh, that's great.
Dr. Hannah Glick:
The older person can record that memory and re-listen to those memories. So in a way, it's a form of auditory training. But it's relevant and it's meaningful, and it's tapping into those memory networks. And so I'm interested in looking at different types of rehabilitation used alongside conventional treatment with hearing aids to improve outcomes in adults with hearing loss who are kind of in those at-risk groups.
Dr. Douglas L. Beck:
Yeah. Yeah. Well, that's brilliant. It goes back to the earliest study that I recall on this was, it was called the nun study, NUN, the women who wear habits and the very religious women. And what happens in the nun study, this goes back to the late eighties, maybe early nineties, this neuroscientist got permission to study the brains of nuns after they had died. And what he found is that many of the nuns in their seventies, eighties, nineties, even though they had anatomic presentations of Alzheimer's, they had amyloid plaque, they had tau proteins, they had all this stuff going on, they didn't manifest it. They were fine in their day-to-day function. And his presumption was that nuns, because they study all the time, because they teach all the time, they're in groups all the time, they're socializing all the time, they're involved in their community, they're reading, they're writing, they're teaching, they're learning, he said that that ability to be an adult learner more or less, and to participate as an adult learner, not passively, but actively, that that offered protection of their cognitive, psychological, emotional wellbeing.
And that became known pretty much in the late nineties as cognitive reserve, that we were encouraging people to do Sudoku or crossword puzzles or read or do book clubs and things like that because you're building up more and more information within your brain and reinforcing the neuronal information that's already in there. So this idea is not new, although I think it's very, very good, and I think it makes total sense.
Dr. Hannah Glick:
Yeah, not new. But we're living in a loneliness epidemic, a social-
Dr. Douglas L. Beck:
Oh my gosh.
Dr. Hannah Glick:
... [inaudible 00:31:45] epidemic. And looking at older adults, 20, 30, 40, 50 years ago, we had older adults that were more likely to live in multi-generational households with family members at least nearby. More and more, we've got older adults living on their own in their homes with not a lot of socialization happening. So how can we create those opportunities to bolster cognitive reserve, whether they have hearing loss or don't have hearing loss to increase longevity, promote holistic health and wellbeing in creative ways because we are more and more socially isolated?
Dr. Douglas L. Beck:
When you use the term loneliness, that's not a casual usage. Last year, the surgeon general of the United States actually said we had an epidemic of loneliness in the USA. And just recently, three or four weeks ago, I think it was the World Health Organization, they said we have a global pandemic on indifference. And to put that in perspective, the opposite of love is not hate. The opposite of love is indifference. And that was kind of the idea, that people are not engaging in normal health activities. They are not taking care of other people, they are not concerned about necessarily politics and water and air and climate. The indifference that we see all around us, they said, is at pandemic stage. Hannah, it is such a joy to see you, and I love working with you. We definitely have to do this again.
Dr. Hannah Glick:
Sounds good. Thank you so much for having me.
Dr. Douglas L. Beck:
Have a joyful weekend. Be safe, and I look forward to reading the new study when it comes out.