# Impact of Amplification and Noise on Subjective Cognitive Effort and Fatigue in Older Adults with Hearing Loss

## TL;DR

Older adults with hearing loss feel more effort and fatigue when listening in noisy environments, and hearing aids don't significantly reduce this.

## Contribution

This study reveals the impact of background noise and hearing aid use on subjective effort and fatigue in older adults with hearing loss.

## Key findings

- Participants reported significantly lower effort and fatigue in quiet environments compared to background noise.
- Auditory working memory performance was significantly associated with subjective fatigue across listening conditions.
- Hearing aid use did not significantly reduce effort or fatigue across conditions.

## Abstract

Background/Objectives: Older adults with hearing loss frequently report increased listening effort and fatigue, particularly in complex auditory environments. These subjective experiences may reflect increased cognitive resource allocation during both auditory and visual tasks, yet the impact of hearing aids on task-related effort and fatigue remains unclear. This study examined subjective effort and fatigue in experienced older adult hearing aid users while completing cognitively demanding auditory and visual tasks in quiet and background noise, with and without hearing aids. Methods: Thirty-one adults aged 60–87 years completed a cognitive battery assessing inhibition, attention, executive function, and auditory and visual working memory across four listening conditions: aided-quiet, unaided-quiet, aided-noise, and unaided-noise. Subjective effort was measured using the NASA Task Load Index, and task-related fatigue was assessed using a situational fatigue scale. Linear mixed-effects models controlled for age and pure-tone average hearing thresholds. Results: Participants reported significantly lower effort and fatigue in quiet compared to background noise, regardless of hearing aid use. The aided-quiet condition was rated as the least effortful and fatiguing, whereas the unaided-noise condition was rated as the most demanding. Subjective effort and fatigue were moderately to strongly correlated across conditions, particularly in noise. Auditory working memory performance was significantly associated with subjective fatigue across listening conditions, while visual working memory was not associated with effort or fatigue. Hearing aid use did not produce significant reductions in effort or fatigue across conditions. Conclusions: Background noise substantially increases perceived task-related effort and fatigue during cognitively demanding auditory and visual tasks in older adults with hearing loss. While hearing aids did not significantly reduce effort or fatigue across conditions, optimal listening environments were associated with the lowest subjective reports. Auditory working memory emerged as a key factor related to fatigue, highlighting the interplay between hearing, cognition, and subjective listening experiences in older adulthood.