Background: Awareness of hearing disability in the elderly has adverse cognitive and functional consequences over time, in a longitudinal population-based study. Aim: To analyze the hypothesis that over time old people aware of hearing disability make less use of technology and lose more instrumental activities of daily living than peers with other self-reported hearing conditions. Methods: We analyzed 1171 healthy participants in the longitudinal population-based InveCe.Ab study. The consistency between self-reported hearing loss with clinician-evaluated hearing status (Whispered Voice Test; WVT), was categorized by consistency as: unaware of hearing loss (UHL), aware of hearing loss (AHL), only subjective hearing loss (OSHL), without hearing loss (noHL). Results: At baseline (2010), hearing loss was found in 159 [13.6% (95% CI: 11.7 - 15.7)] of the participants [28 = 17.6% (95% CI: 12.0 - 24.4) AHL; 131 = 82.4% (95% CI: 75.6 - 88) UHL], while 23 [2.3% (95% CI: 1.4 - 3.4)] of the subjects with normal WVT had OSHL. Mobile phone usage was significantly associated with different consistency categories (p < 0.001). It was lower in AHL and OSHL than in noHL subjects (p = 0.004 and p = 0.008) and UHL (p = 0.007 and p = 0.011). Doing shopping, using transportation, medication management and handling finances varied depending on consistency categories. Logistic regression models showed that, after 4 years (second follow-up: 2014), among AHL subjects, compared to noHL ones, the odds of having less use of mobile phone had increased over threefold, the odds of acquiring dependence in doing shopping had increased over six fold. Cognitive domains performances ( i.e. executive, memory and visuo-spatial) were independently associated with maintaining mobile phone usage and instrumental activities of daily living. Conclusion: Self-reported hearing disability is linked to subsequent loss of mobile phone usage and functional dependency. As cognitive performances independently influence technology usage and functional impairment, targeted preventive interventions should address functional impact of perceived hearing loss, but also encourage social participation and improve mobile phone usage. Trial registration: ClinicalTrials.gov, NCT01345110; registered on April 29, 2011.
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