Background Hearing impairment is common in later life and associated with morbidity. However few population-based studies have investigated the impact of hearing impairment on frailty in older adults. We examined the association between hearing impairment and the risk of incident frailty over 4 years.

Methods 2836 community-dwelling adults aged ≥60 years from the English Longitudinal Study of Ageing were followed up from 2004 (baseline) to 2008. Hearing impairment was defined as reporting poor self-experienced hearing. Frailty was defined using the Fried Phenotype based on self-reported questionnaires and nurse assessments. A score of 0 out of 5 frailty components (slow walking gait speed, grip strength, self-reported exhaustion, weight loss and low physical activity) was defined as having no prevalent frailty, 1–2 pre-frailty and ≥3 was defined as being frail. Participants without prevalent frailty at baseline were followed up for pre-frailty and frailty, and participants who were pre-frail at baseline were followed up for subsequent frailty.

Results At follow-up, there were 367 new cases of pre-frailty and frailty among those without prevalent frailty at baseline (n = 1396), and 133 new cases of frailty among those who were pre-frail at baseline (n = 1178). Compared to participants with no prevalent frailty at baseline who reported good hearing, participants with no prevalent frailty who reported poor hearing had an increased risk of becoming pre-frail at follow-up (age- and sex-adjusted OR 1.43, 95% CI 1.05–1.95). However the association was attenuated after further adjustment for wealth and education. Compared to pre-frail participants with good hearing, pre-frail participants with poor hearing were associated with an increased risk of becoming frail at follow-up (age- and sex-adjusted OR 1.64, 95% CI 1.07–2.51) and the association remained after further adjustment for wealth, education, CVD, cognitive function and depression.

Conclusion Older adults with pre-frailty who experience poor hearing have an increased risk of becoming frail over 4 years. In contrast, those with no prevalent frailty who experienced poor hearing did not have an increased risk of becoming pre-frail or frail. This suggests that hearing impairment in older adults may be a particular problem in those who are starting to experience other health and functional concerns. Identifying and actively managing hearing impairment in pre-frail older adults may have potential to delay the development of frailty. Further research is warranted on the possible mechanisms of frailty in hearing impaired older adults.