The effect of cochlear implantation in older adults: an umbrella review of systematic reviews and meta-analyses

Abstract

INTRODUCTION: Age-related hearing loss is increasingly prevalent and impacts psychosocial wellbeing, cognitive health, and quality of life in older adults. While cochlear implants (CIs) are effective for severe-to-profound loss, their use in the elderly was historically cautious. This umbrella review synthesizes evidence on CI effects on auditory, cognitive, postural, and quality-of-life outcomes in this population. METHOD: Following PRISMA guidelines and a protocol registered in PROSPERO, we searched PubMed, Cochrane, Web of Science, and Embase up to September 30, 2025 for systematic reviews and meta-analyses on adults ≥60 years undergoing CI. Two reviewers independently extracted data and assessed quality using AMSTAR 2 and PRISMA. RESULT: Analysis of 21 reviews across five domains showed CI generally improves auditory and speech functions. Cognitive improvements were partial, especially in executive function and verbal memory. Postural stability evidence was inconsistent. Quality of life improved overall, particularly in sound perception and social functioning, with social outcomes affirming enhanced communication and independence. However, methodological quality revealed that most reviews had critically low confidence ratings, highlighting the need for higher-quality evidence. CONCLUSION: CI offers meaningful benefits in auditory restoration, certain cognitive functions, and social engagement for older adults. Despite this, evidence is limited by methodological heterogeneity and low study quality. Future research requires standardized protocols and robust designs. Clinically, CI remains a valuable option for eligible older adults with severe hearing loss.