Have you noticed that an older relative seems to be having trouble hearing you at times?
Or perhaps you’ve realized that sometimes YOU are the one saying “What?”
These situations are extremely common. Sometimes the issue is that one is trying to communicate in a noisy place and there is no need for concern.
But in many cases, these kinds of issues can indicate that an older person (or even a middle-aged person) is being affected by progressively worsening hearing loss.
You probably already know this: chronic hearing impairment becomes very common as one gets older. The National Institute on Aging reports that one in three adults aged 65-74 has hearing loss, and nearly half of those aged 75+ have difficulty with hearing.
Hearing loss also affects a significant number of people earlier in life. A 2011 study on the epidemiology of hearing loss documented hearing loss in 11% of participants aged 45-54, and 25% of those aged 55-64.
In short, research confirms that quite a lot of people experience hearing loss. But sadly, research also confirms that hearing loss is often under-recognized and inadequately addressed.
This is a major public health issue, for older adults and also for the many middle-aged adults experiencing hearing loss. At this point, we know quite a lot about:
- The many ways hearing loss negatively impacts the person affected by it (and their family),
- The many ways we can help correct hearing loss, through hearing aids, other amplification options, and better communication techniques.
Since this is such an important issue, I recently invited one of my UCSF colleagues, Professor Meg Wallhagen, PhD, to join me on the podcast to talk about hearing loss and what can and should be done about it. She is a nationally recognized expert on hearing loss and has been on the board of the Hearing Loss Association of America since 2010.
Since she is so knowledgeable and there was so much to cover, we actually did two episodes addressing age-related hearing loss. If you or someone in your family is experiencing hearing loss, I highly recommend checking out these podcast episodes!
094 – Interview: Hearing Loss in Aging: Why It Matters & Getting Evaluated
095 – Interview: Hearing Aids & Other Hearing Loss Treatment Options
We have transcriptions available for those who are unable to listen, plus each show notes page includes links to some key resources.
(And did you know: most smartphone podcast players will allow you to slow down the playback speed! This is a great option for those who prefer to listen to people speaking a little more slowly.)
Best of all, as part of the interview, Professor Wallhagen is sharing with us a wonderful informative brochure that she helped design a few years ago. She has also clinically studied the brochure through her research, which confirmed that it helps older adults address hearing loss.
Click here for the brochure: Hearing Helps Us Stay Connected to Others.
4 Key Things to Know about Hearing Loss in Aging
Here are my four top takeaways from the interviews with Professor Meg Wallhagen:
1. It’s not good to put off addressing hearing loss.
Why this is important:
- Your brain’s auditory cortex needs the hearing input to remain in good shape!
- Hearing involves getting the input through your ears and the related nerves, AND then your brain must process this sensory input in what’s known as the “auditory cortex.”
- “Use it or lose it” applies here. Your brain’s auditory cortex will get worse at processing sound, if you don’t give it enough good quality input to work with.
- Hearing loss is associated with negative impacts on cognitive function.
- Cognitive abilities (e.g. memory and thinking) may decline faster in people with hearing loss.
- Studies have linked hearing loss to a higher risk of dementia. For more on this, see: What’s the connection between hearing and cognitive health?
- It is easier and better for the brain if you try to correct hearing loss sooner rather than later.
- The sooner you improve the hearing input coming into the brain, the better it is for the brain. This is also much better for social relationships, work relationships, safety, and more.
- Hearing aids also require a period of adaptation and learning. This becomes harder as brains get older. It also becomes harder as hearing loss becomes more severe with time.
- Hearing loss has a significant impact on social relationships.
- Friends and families become tired of all the extra effort required to communicate when there is hearing loss, and may engage less with a person. Spouses, in particular, can become very frustrated.
- Workplace performance and relationships can be affected, and this can negatively impact an older person’s job and ability to maintain their job.
- People with un-addressed hearing loss are more likely to become socially isolated.
2. Don’t assume that your primary care doctor will notice hearing loss or initiate a suitable evaluation.
Why this is important:
- Research shows that hearing loss is commonly overlooked in primary care.
- Patients and families should be proactive in bringing up hearing loss and in asking their health providers to address it.
- If your older parents or another relative is experiencing hearing loss, encourage them to talk to their health provider about it.
- Try printing out and reviewing Professor Wallhagen’s brochure, as it explains why addressing hearing loss is important and what can be done.
- Traditional Medicare, unfortunately, does not cover routine audiology testing.
- It may cover this type of testing when it is ordered by a medical professional “for the purpose of informing the physician’s diagnostic medical evaluation or determining appropriate medical or surgical treatment of a hearing deficit or related medical problem.”
- Some Medicare Advantage plans may cover audiology.
- The best is to ask your health provider and see if you can get this testing covered.
Provided there are no medical red flags noted, evaluation of most age-related hearing loss requires removing earwax and then a referral to audiology, for in-depth testing of hearing. For more on what is covered in the audiology evaluation, see here and here.
3. Consider options other than hearing aids, especially for people who aren’t good candidates for hearing aids.
Why this is important:
- Hearing aids can be very effective, but they aren’t right for everyone. That’s because:
- For them to help with hearing, a person must put in some time and effort in getting them properly adjusted, and in letting the brain learn to work with them. They require much more work than glasses!
- People who are cognitively impaired, or have very severe hearing loss, may not be able to handle the work of adapting to hearing aids.
- Hearing aids also require maintenance. Some older adults will not able to manage changing batteries, keep track of these devices, or making necessary adjustments.
- Not everyone is a good candidate for hearing aids.
- People with dementia often have difficulty cooperating with the fitting and adjustment period. Plus, the dementia process affecting their brain may also make it harder for their auditory cortex to learn to adapt to the hearing aid.
- People with very severe or long-standing hearing loss may be less likely to benefit from hearing aids. This is in part because more amplification and correction is needed, and also because the brain needs to do more work to compensate for all that time during which it wasn’t getting the right input.
- Other approaches to amplification and communication can be effective to help with hearing loss. These include:
- Assistive devices for phones
- Assistive devices for TVs and other devices
- Better communication strategies, such as seeking quieter places to talk when possible and directly facing the person with hearing loss, so they can see the face and lips of a speaker.
- “Pocketalkers“*, which are a simple and inexpensive hearing amplification device used by geriatricians and others. They can also usually be used with people who have dementia.
4. Age-related hearing loss affects higher frequency sounds in particular, and causes distortion (not muffling) of sounds.
Why this is important:
- This is why older people with hearing loss will say they can hear.
- They are right, they CAN hear! But their hearing loss makes it harder for them to hear certain speech frequencies, which leads to distortion of sound.
- It’s important to realize that age-related hearing loss causes distortion, not muffling.
- This is why it’s usually not helpful to shout at someone with age-related hearing loss.
- You will just be making a distorted sound louder.
- Instead, use the communication strategies recommended in Professor Wallhagen’s brochure.
- This is why deciphering speech becomes difficult for someone with age-related hearing loss.
- Many consonants are spoken at a relatively high frequency.
- When age-related hearing loss affects the ability to hear different consonants, human speech becomes harder to decipher.
- This is why older adults with hearing loss may have difficulty understanding children, and other high-pitched voices.
- Young children often have higher-pitched voices. These can be hard for older adults with hearing loss to decipher, unless the hearing loss is addressed.
What to do if you’ve been concerned about hearing loss
Talking to Professor Wallhagen really brought this home for me: hearing loss is important and it’s much better to address it sooner rather than later!
In particular, addressing hearing loss earlier is better for the brain, better for relationships, and may even help a person perform better at work.
There are, of course, common obstacles that come up to addressing hearing loss.
A major one is that affected person often either doesn’t notice their hearing loss or avoids addressing it. They don’t want to feel old. They may have heard “hearing aids don’t work,” or that they’re expensive. Or they may just be waiting for their doctor to bring it up.
To get around this type of obstacle, I’m going to again recommend Professor Wallhagen’s brochure. You can print it out, discuss it with family, and then use it to spark a conversation with your health providers. Here it is again: Hearing Helps Us Stay Connected to Others.
And for a short-term solution to hearing loss, consider a Pocketalker * type of device. These are especially helpful when it comes to people with dementia, who often are not good candidates for hearing aids. (In fact, I’ve had a Pocketalker in my doctor’s bag since geriatrics fellowship; it’s great for connecting with those “hard-of-hearing” patients.)
I am linking to a Williams Sound Pocketalker on Amazon, but you may be able to find something similar at lower cost by shopping at Best Buy, Radio Shack, or another local electronics store.
Again, if you are interested in this topic, I highly recommend learning from Professor Meg Wallhagen, by listening to our two-part podcast interview, and/or by reading the related transcripts:
094 – Interview: Hearing Loss in Aging: Why It Matters & Getting Evaluated
095 – Interview: Hearing Aids & Other Hearing Loss Treatment Options
And now…if you’ve been concerned about hearing loss, what will you do next? Please let us know in the comments! You can also post your questions and we’ll do our best to answer them.
*Note: our Pocketalker link is an Amazon affiliate link. We are now participating in the Amazon Associates affiliate program, so if you buy through the link on our site, Better Health While Aging will earn a small commission, at no additional cost to you. Thank you for your support!
I am 73. Years ago I was diagnosed with sensoruneural hearing loss in one ear. Will a hearing aid help that? I was given no feedback in terms of treatment follow up.
Thank you.
Most age-related hearing loss is sensorineural, and usually affects both ears progressively. Sensorineural hearing loss in just one ear is considered atypical and may warrant additional workup. If it’s been a few years since you’ve been evaluated, it would probably make sense to start by getting re-evaluated. Your healthcare provider should be able to assist you with the initial workup.
If an evaluation reveals that you still have sensorineural hearing loss mainly in one ear, be sure to ask them why they think this is, and ask whether further testing for less common causes of hearing loss is indicated.
I don’t know how often hearing aids are beneficial to people with hearing loss in just one ear. I suspect it would depend on how the person’s overall speech comprehension is doing. A specialist should be able to advise you on this issue. Good luck!
Someone might be accused of losing one’s hearing, but the problem is none of the ones mentioned in the article. The tone or pitch are not too high, and the person has perfect hearing with most people. The problem could involve another family member speaking in another room, turning away at the same time, talking too fast or about something where there is no apparent context, or significant background noise such as a television blaring loudly. If the person has a spouse with the onset of dementia and an adult daughter with the television on too loud, then the person might be accused but has no hearing loss requiring modification.
One problem regarding hearing is significant and pervasive. Alarms for smoke detectors are often at such a high pitch that they cannot be heard by anyone over age 30. All smoke alarms should have auditory and flashing lights. Smoke alarms should be designed to alert someone of all causes of fire/smoke, not only that which has fine particles that enter the screen. Grease fires caused with a fry pan on the kitchen stove begin with large particles that do not go through the screen in any of the smoke detectors until something else in the kitchen starts to catch on fire. The entire house can fill with smoke with a flash grease fire, but no alarm goes off until the cupboards and walls catch on fire. We found out recently all about this! Only the ONE alarm on the wall near the furnace in the basement went off, and my young daughter was the only one who heard it and ran downstairs in time to put out her father’s cooking fire. We had multiple other smoke alarms, and ADT monitoring service, and none went off. ADT was never notified. I called the fire department myself when my daughter yelled upstairs that Dad was setting the kitchen on fire. The next day, ADT came out at my request and exchanged five smoke alarms for different ones.
Thanks for these comments. I agree, it’s potentially an important safety issue when alarms are at a high frequency that many older adults may not be able to hear. Professor Wallhagen mentioned this in the interview and I think she said there are some devices that sound at a lower frequency or offer other adaptations.
I’ve come to think of hearing aids as another con game aimed at older people based on all the ads I see in every newspaper. And yes, they are expensive! I’ve become very distrustful of the tests and doctors. Unfortunately, this lack of trust will prevent me from pursuing any intervention for some time. Carol
Hearing aids can be very expensive and of course, some hearing aid providers are aggressively marketing options that may or may not be a good fit for certain older adults. That said, for people who have documented hearing loss on audiology testing, and otherwise seem like good candidates for hearing aids, the right type of hearing aid can make a big difference in quality of life, in relationships, and potentially in brain health.
As I note in the article, Professor Wallhagen does explain the interview that not every one is a good candidate for a hearing aid.
But for people who can handle the work of fitting and adjusting, and otherwise seem to be good candidates for a hearing aid, I would recommend doing some careful research to find a hearing aid provider who seems reliable, reasonably priced, and ideally has good recommendations from other customers.
I have lost 62% and 54% on both my ears I am using hearing aids but it’s I still have some difficulties in hearing at times , my concern is can I go on medical board because of hearing loss in this amount of loss
I’m almost 53 yrs of age
Sorry to hear of your hearing loss. I’m not sure what you mean by “can I go on medical board”. You would have to address that question to the board or committee in question. You may also want to see if it’s possible to have your hearing aids adjusted, to help you hear better.
Your article with links is very valuable. I would appreciate a future article or links to research about PSAPs (Personal Sound Amplification Products) as alternatives to expensive hearing aids for low to moderate hearing loss. Wirecutter had an excellent review 1-8-18 but updates are needed as the technology is changing quickly. In 2018 quality, tested, PSAPs were $200-300 depending on bluetooth, batthery life, etc. Updates are needed.
Thank you I’m glad you found the article useful.
I, too, would like to read a good review of PSAPs. I will have to ask Dr. Wallhagen to let us know if she comes across any. As you point out, the technology is changing quickly, which is makes it challenging to find a high-quality, up-to-date review.
You could try writing to the Wirecutter and encouraging them to revise their review. They have more funding and resources than I do.
I am a 71 yr old woman,recently started noticing some loss of hearing.Are there any home tests of hearing?Very early stage so don’t see the urgency to get it tested.Thank you for your opinion.
I’m not aware of any good quality home tests of hearing.
If it seems early stage to you, there may not be any urgency. That said, I would still recommend you bring it up to your health provider and consider having an audiology assessment, to find out just how significant it is. good luck!
I was able to undergo an audio testing for free though Medicare does not cover it because I responded to an AD sent to me. The test shows that I was a bit below the level of the so called acceptable range. I intend to have a follow-up test in the near future. I find this article a kind reminder to act when we experience the symptoms of hearing loss. Thanks!
I’m not sure what is the “AD” you are referring to. But that is great that you were able to get free testing!
I’m glad this article was helpful. Good luck!
I’ve now been wearing hearing aids for some three years. Next month I will be 83. I live in Israel and our medical plans do cover both audiology testing and partial payment for hearing aids. I bought the best of hearing aids and am so disappointed. I’ve had the audiologist set it up at least three or four times in the past year and it doesn’t help. I hear sounds and noise better but certainly cannot hear words and speech any clearer. I’ve spoken to dozen of my friends and acquaintences and all seem to have the same complaint. I have yet to meet someone wearing a hearing aid who said they can hear better and are pleased with their hearing device, no matter the manufacturer or price category. What a disappointment. I began playing the ukulele five years ago and now can’t even enjoy playing for myself.
Oh, that’s too bad if your hearing aids have not been working for you. It’s true that many people are dissatisfied, and I’m not sure why that is. When I interviewed her, Dr. Wallhagen did seem to think that the right device, correctly adjusted, should be helpful to many people. I’ll have to see if she has anything more to add regarding your comment.
My hearing loss isn’t the result of aging, it’s from measles at age 6. Severe to profound loss in both ears, and I’ve worn powerful hearing aids since then. (Yes, I can attest that hearing aids don’t miraculously enable you to hear everything. Rather, they enable you to hear more, and the brain attempts to “fill in the blanks!”)
Here’s my question: Of course I remove my hearing aids at night. I live alone. On a few occasions I’ve thus slept through building-wide fire alarms and neighbors banging on my door. (I think that they finally realize I’m truly deaf. That’s less obvious in daytime because I compensate well with hearing aids and other tactics like lip-reading.) Would a relatively inexpensive Personal Amplification Device or whatever the right name is, worn overnight, be a good safety measure?
Sorry for delayed reply, we had a glitch in our system that we have just resolved.
Hm, that’s an interesting situation you are bringing up. I think wearing a personal amplification device at night might not be very comfortable.
I would recommend connecting with organizations or communities for people with severe hearing loss, to see what solutions they have found. You could also contact the Hearing Loss Association of America to ask. Presumably, this is a serious safety issue for the deaf community, too, so you may want to inquire with organizations that assist people who are deaf. Good luck!
My Dad is 83 years old. He has worn hearing aides for about 15 years. We got him new hearing aides last year due to his increasing lack of ability to understand voice. But even with the new aides and adjusted to his hearing loss, he still has a lot of trouble hearing. In a recent word recognition test by his audiologist, he scored 40% in one ear and 20% in the other. He is really struggling and it is causing withdrawal and depression. Is there anything we can do?
I’m sorry to hear about your dad’s struggle with hearing loss. In addition to hearing aids, there can be other devices to adapt the phone, television, computer and other devices, and those can be very helpful in communication. Groups like the Hearing Loss Association of America might have some resources. Good luck!
I was informed by a friend that Costco members can receive a free hearing test at the audiology vendor in each store so I had one done. This might be useful for other Costco members with limited fund. There was no hidden agenda nor an attempt to sell me anything either.
Unfortunately, it confirmed what my wife has been suggesting – I do have significant hearing loss at high frequencies. Now I know and can do something about it.
My husband and I both got high end hearing aids at 63 and 69 (three years ago). They are wonderful. We joke that we are “bionic.” They’re especially nice to use with BlueTooth with my cell phone. My husband does better with speakerphone when he talks on the phone.
It IS really important not to call to each other from another room. Also, husband has some ADHD issues and so when he is in “hyper focus” mode (concentrating intently) he can’t hear, even with hearing aids in because his attention is already engaged.
I’m happy to hear that you both have had positive experiences with hearing aids! And you rightly point out that hearing someone is more than just using your ears but involves attention and processing. Thanks for sharing your point of view!
Thank you! Thank you! Your articles are excellent, filled with great useful information. I very much appreciate your information and I always pass on your articles to family and friends who would benefit by reading your materials. Could you please add one thing to your articles? Please add a date when it was written. So much of the resource materials and articles I read (not just your materials) are not dated, and I like to have some date reference for these great materials. Thank you!!!!!!!!!!!
Thanks so much for your enthusiastic support. I will let Dr. Kernisan know about your request to have the date that the article was written on the site. I know that Dr. K is diligent about updating and reviewing her articles so I can assure you that the info is relevant and accurate! Thanks again for your interest, and for sharing the articles.
My 91 year old mother has hearing loss and increasingly memory loss. She refuses to get hearing aids. Instead every TV in her house is blaring at excruciatingly loud levels for my ears. She doesn’t care about my hearing. This kind of self-centered behavior seems too common in the elderly. A few years ago her hearing was tested. One ear had poor word comprehension and the other ear had poor volume input. ENT doctor said only loss of volume can be compensated for with hearing aides; not word comprehension which is “a brain problem not an ear problem”. Mother refused to consider hearing aides. Says she hears better than all her friends. The doctor laughed and said “that’s probably true”. What is available to save my hearing when I’m around my mother and her overly loud contraptions. It’s truly painful to my ears. I love her, but there is no reason for me to lose my hearing because she refuses to adapt.
That sounds like a difficult situation. If you’re wondering how to protect your ears from hearing loss, it might be helpful to look at what the government recommends for occupational noise exposure. They recommend hearing protectors if a person is exposed to more than 8 hours a day of noise above 85 decibels (about the same as a vacuum cleaner or heavy city traffic noises). Usually sound becomes painful at about 130 decibels (think jet engine or monster truck rally). So if a person finds loud TV noises painful or irritating, they could use ear protectors when exposed to that noise, and may wish to get their own hearing checked.
It’s interesting that your mom’s doctor mentioned the brain issue. It’s not unusual, when there’s cognitive impairment, for an older adult to have diminished awareness of the effect their behaviour has on others. It may seem uncaring, but could be relate to a legitimate gap in insight. In my experience, when a person stops trying to use logic and reason with an older adult living with dementia it can allow for more practical problem-solving and some progress. Good luck!
All conversations regarding hearing loss lead to suggestions of hearing amplification devices. Louder is at best uncomfortable for me and it’s been suggested I have something called “recruitment.” Audiologist suggested mild to moderate hearing loss, and probably that’s correct, but if I can’t turn the volume up and hear better, I’m not sure spending $6,000 will help. Really loud is painful. I was a block away from a train whistle which was excruciating. Want to hear better, but I’ve no answers. Right now, I’m listening to a baseball game with no problem, but later on, won’t be able to understand the newscaster on the same tv device.
“Recruitment” is common in age-related hearing loss, and involves a distortion of sound processing at the level of the inner ear. You described it perfectly: louder sounds can be painful and harder to hear, and at the same time, quieter sounds are harder to hear as well. As a result there’s a pretty narrow volume range within which a person can hear well, and hearing aids can be harder to fit and may not be as helpful as in other causes of hearing loss.
I would advise individuals with recruitment that if you have a Hearing Society in your area, they might be able to assist you with things like devices that provide closed captioning for the radio or phone, provided your vision is not too impaired. These hearing societies don’t usually sell products directly, but they can point you in the right direction. In Canada, it’s Canadian Hearing Services, and in the US, the American Speech-Language-Hearing Association has many local links that could help.
Has anyone commented on how the wearing of face masks for COVID 19 has impacted those affected by hearing loss who do get quite a bit of information from facial expression and lip reading? Being aware that this could be part of the difficulty, making sure to speak clearly and face to face (but 6 ft. apart) could help. I find myself asking for sales clerks to repeat their question and speak more clearly if they are wearing a mask.
You’re absolutely right, and there have been some face masks with clear plastic inserts that help to alleviate this problem. IF a person relies heavily on lip reading for communication, it’s my belief that they can ask a person to remove their mask in order to facilitate communication. You can watch my YouTube video on face masks, here.
As a speech therapist who works with the elderly, I keep a hearing amplifier with me at all times. I had been using the Williams pocket talker you recommend, but found after a year of intermittent use, only the left channel is working.
I am considering replacing it with a Combination bone conduction headset attached to a wireless microphone or with another pocket talker (air conduction amplifier).
Do you think the bone conduction headset would be more likely to improve hearing in the elderly than the standard amplifier?
Do you think one might be better tolerated than the other for patients with dementia?
Do you think headphones, ear buds, or bone conduction placement headset would be better tolerated by patients with dementia?
Thank you so very much!!
I’m sorry to hear that your pocket talker didn’t go the distance! I’ve been using the same one for years.
In terms of adding in a bone conduction device, I haven’t considered that. The implantable bone anchored hearing aids are considered superior to other hearing aids in terms of sound quality but I had a hard time finding evidence about non-implantable devices. It might be confusing for a person with dementia to understand the device doesn’t go over their ears, since most of us have used earphones at some stage but the bone conduction placement might be odd. Headphones are probably the most familiar and easiest to keep in place.
Let me know what you decide and how it goes! Thanks for doing the important work that you do to improve the lives of older adults!