A precision medicine tool to understand who responds best to hearing aids in late‐life depression

Objectives Accumulating evidence suggests that hearing loss (HL) treatment may benefit depressive symptoms among older adults with Major Depressive Disorder (MDD), but the specific individual characteristics of those who stand to improve most are unknown. Methods N = 37 patients ≥60 years with HL and MDD received either active or sham hearing aids in this 12‐week double‐blind randomized controlled trial. A combined moderator approach was utilized in the analysis in order to examine multiple different pretreatment individual characteristics to determine the specific qualities that predicted the best depressive symptom response to hearing aids. Pretreatment characteristics included: Hearing Handicap Inventory for the Elderly (HHIE‐S), pure tone average (PTA), speech reception threshold (SRT), Short Physical Performance Battery (SPPB), cognition (Repeatable Battery for the Assessment of Neuropsychological Status). Results The analysis revealed a combined moderator, predicting greater improvement with active versus sham hearing aids, that had a larger effect size than any individual moderator (combined effect size [ES] = 0.49 [95% CI: 0.36, 0.76]). Individuals with worse hearing‐related disability (HHIE‐S: individual ES = −0.16), speech recognition (SRT: individual ES = −0.14), physical performance (SPPB: individual ES = 0.41), and language functioning (individual ES = 0.19) but with relatively less severe audiometric thresholds (PTA: individual ES = 0.17) experienced greater depressive symptom improvement with active hearing aids. Conclusions Older adults with relatively worse HL‐related, physical, and cognitive functioning may stand to benefit most from hearing aids. Given the large number of older adults experiencing HL and MDD, a non‐invasive and scalable means of targeting those most likely to respond to interventions would be valuable. Key points Using a combined moderator approach, we identified pre‐treatment characteristics of older adults with hearing loss whose depression was more likely to improve with active versus sham hearing aids. Older adults with relatively worse hearing loss‐related, physical, and cognitive functioning were observed to benefit most from hearing aids in depression. Given the large number of older adults with hearing loss and depression and the underutilization of hearing aids, these results may represent a non‐invasive and scalable means of targeting those most likely to respond to treatment.