Simulated hearing loss in healthy young and older adults results in poor reaction time in older adults.

Emerging evidence links hearing loss to increased fall risk in older adults, yet mechanisms remain unclear. This study examined the impact of simulated hearing loss on reactive balance control in healthy young and older adults. Participants performed dual-task scenario involving auditory sentence repetition and unexpected surface translations. Hearing loss was simulated using Adobe Audition, applying frequency-specific attenuation based on moderate sensorineural hearing loss levels from the literature. Speech-in-noise performance significantly declined under simulated hearing loss for both age groups (p < .001), confirming effective simulation, but not significant differences were found between age groups. Maximum COP-COM displacement (the scalar distance between Center of Pressure and Center of Mass) increased with perturbation intensity (Level 1 vs. Level 2: p < .001), but no significant differences were found between hearing conditions or age groups (p > .05), suggesting compensatory step execution was preserved. Reaction time analysis revealed a significant interaction between hearing condition and perturbation level (p < .01). Older adults showed a smaller reduction in reaction time between Level 1 and Level 2 perturbations under simulated hearing loss (Level 1: 283±37 ms; Level 2: 224±20 ms) compared to normal hearing (Level 1: 298±42 ms; Level 2: 230±20 ms), indicating impaired ability to modulate initiation of reactive balance strategies during loss of balance with auditory challenge. These findings suggest that while older adults maintain compensatory stepping ability, simulated hearing loss may hinder their ability to adapt reaction timing during challenging dual-task scenarios. This impairment may contribute to increased fall risk in older adults with hearing loss. Further research is needed to explore underlying cognitive mechanisms and develop targeted interventions.