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 age-related hearing loss. (The medical term is “presbycusis”)
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, in this article, I’ll share the following:
- 4 key things to know about hearing loss in aging
- What to do if you’re concerned about hearing loss
- A brochure you can use to persuade a reluctant older adult to address hearing loss
- The simple device many geriatricians use for hearing loss
4 Key Things to Know about Hearing Loss in Aging
A while back, I interviewed my UCSF colleague, 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 spent years on the board of the Hearing Loss Association of America.
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 unaddressed 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.
Note: as of October 2022, over-the-counter (OTC) hearing aids have finally become available. The National Council on Aging has a list of best OTC hearing aids here. As far as I can tell, the main advantage of OTC devices is that they are less expensive than conventional hearing aids. If a person is not a good candidate for a hearing aid, an OTC hearing aid is not going to fix that problem.
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 (see below).
- 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.
If you’ve had any concerns about hearing loss for yourself or for another older adult, here are the basic next steps:
1.Bring it to the attention of your primary care provider (PCP).
Start by letting your PCP know of any potential hearing loss. The PCP should do a related “history and physical examination”, meaning they will ask questions about related symptoms and medical conditions that can affect hearing. They will also do a physical examination related to auditory issues.
Most hearing loss in older adults is garden-variety age-related hearing loss (which is technically called “presbycusis“). It usually happens due to a combination of age-related changes and noise-related damage to the inner ear, and it slowly gets worse over time.
It’s also extremely common for hearing loss to be caused by — or usually worsened by — ear wax (technically called “cerumen”) plugging up the ear canal.
For this reason, it’s essential that the PCP look in both ear canals, to make sure there aren’t any blockages.
If there is any ear wax accumulation, the ear wax should be removed. This is sometimes done in the doctor’s office, but it’s also common (and probably safer) to do this at home, using some ear wax softening drops and a bulb syringe to gently rinse the ear canal. AARP has a good article on this topic here: The Ins and Outs of Safe Earwax Removal.
There are also many other medical conditions that can cause hearing loss. Among other reasons, hearing loss can be related to a viral infection, to brain changes, or even to certain medications.
A medical exam related to hearing can help check for these less common causes of hearing loss, before you proceed with further audiology evaluation. In some cases, the PCP might refer you to an ears-nose-throat specialist (an otolaryngologist). But in many cases, the initial medical examination can be done in primary care.
2. Get an audiology evaluation.
An audiology evaluation is a special detailed test of a person’s hearing.
During the evaluation, the audiologist will vary the pitch and loudness of sounds, to determine what is the quietest sound each ear can hear at different frequencies. Audiology evaluations also usually include speech recognition tests.
You can learn more about audiology evaluations here: Hearing Tests for Adults.
The audiology evaluation helps pinpoint the specific types of sounds that a person is having difficulty hearing, and also helps classify the hearing loss as mild, moderate, or severe.
These results can then be used to determine what type of hearing aids might be suitable, or whether other types of hearing assistive technology should be considered.
3. Seek out suitable hearing assistive technology.
If the older person is a good candidate for hearing aids (remember, not everyone is!), then you should look into getting suitable hearing aids.
Until recently, this required being fitted for hearing aids by an audiologist. However, as of October 2022, over-the-counter (OTC) hearing aids have become available. A small randomized trial published in April 2023 found that “self-reported and speech-in-noise benefit was equivalent between the self-fitting OTC and audiologist-fitted hearing aid conditions at the end of 6 weeks.”
In other words, preliminary research suggests that OTC hearing aids, which are generally more affordable than audiologist-fitted hearing aids, are a good option for people with mild to moderate hearing loss. (Note: the average age of participants in this trial was 64.)
There are also other hearing assistive technologies to consider. The Hearing Loss Association of America provides a nice overview here: Hearing Assistive Technology.
4. Learn and use hearing loss communication strategies.
Whether or not an older person is using hearing aids or other hearing assistive technology, it’s worth learning and using certain strategies that make communication easier when someone has hearing loss.
These include:
- Face the hearing-impaired person directly, with the speaker’s face in good lighting. Avoid being backlit when you are speaking.
- Avoid shouting, which distorts speech. Instead, speak clearly, distinctly, and not too fast.
- Try to minimize background noise.
- Say the person’s name when you start speaking, or otherwise get their attention before you continue speaking.
- Don’t cover your mouth or chew food while speaking to someone with hearing loss.
There is a good list of communication tips available here: Communicating with People with Hearing Loss.
What to do if an older person won’t address their hearing loss
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.
If this has come up for you, I highly recommend you try using Professor Wallhagen’s specially designed brochure. It’s been clinically tested in research, which has confirmed that it helps older adults address hearing loss.
Click here for the brochure: Hearing Helps Us Stay Connected to Others.
Use the brochure to help an older adult address their hearing loss. 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.
The simple device many geriatricians use for hearing loss
The best approach to hearing loss is the one I described above: get evaluated by the PCP, get an audiology evaluation, and then get suitable hearing assistive technology.
But what if you’re trying to communicate with an older adult who hasn’t yet gotten evaluated for hearing loss? Or maybe isn’t a good candidate for hearing aids?
In this case, a short-term solution to consider is 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.
Many geriatricians carry pocket talkers with them, since they are so handy for communicating with those “hard-of-hearing” patients. (I’ve had a Pocketalker in my doctor’s bag since geriatrics fellowship, and always take it with me on housecalls.)
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.
To learn more about hearing loss in older adults
If you are interested in this topic, I highly recommend learning from my UCSF colleague Professor Meg Wallhagen, PhD, 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
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.)
And don’t forget to check out Professor Wallhagen’s wonderful informative brochure, which has been clinically proven to help older adults address hearing loss:
Click here for the brochure: Hearing Helps Us Stay Connected to Others.
Good luck addressing hearing loss! It’s really worthwhile, even if it can be an effort to get the process started.
*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!
This article was first published in 2019. It was significantly updated by Dr. Kernisan in May 2023.
Vicky says
I have eustachian tube dysfunction in both ears sporadically. When I have it, sounds are distorted similar to high pitched child’s voice. I cannot understand dialogue on TV or over the phone. Professional hearing exam shows minor loss of hearing but insufficient to warrant hearing aids. What do you suggest as remedy for part-time hearing assistance. Even turning up the volume on the TV doesn’t help with understanding what’s being said.
Nicole Didyk, MD says
Here in Canada, I refer clients to the Canadian Hearing Society. They have hearing consultants (whose services are free), who can explain the various devices that can be used intermittently in cases where a hearing aid isn’t needed all the time. In the US, try the Hearing Loss Association of America at https://www.hearingloss.org/
Dave Valentine says
My wife and I are in our eighties and live relatively independently in our granny flat, with our daughter always available for transport, shopping etc.
Our early years were spent on the farm with wood heat, so much of the year I was using a chainsaw without ear protection. Now I’m profoundly deaf, but hearing aids do benefit in most situations. I can listen to the TV directly, and with my most recent pair I also bought a microphone for my wife to wear. She has a very soft voice and without the mike I don’t hear anything she says all day. I ask her to repeat when she looks like she expects a response, but that often takes 3 or 4 tries before I hear and understand. Not very pleasant.
The microphone is a nuisance to wear, quite big and heavy to pin on a blouse or sweater, but when she does it’s heaven. Recently it stopped working full-time and I have to turn it back on every few minutes, but it’s a small price to pay.
I do have the ear-brain disconnection that makes understanding more difficult, but as long as people are willing to speak slowly and articulate I will understand. Thetrelephone, however is pretty well a loss and I don’t bother answering. I’m almost always on the net and folks know email will be responded to promptly so most family and friends do that.
Thanks for up-to-date and informative advice. At 87 I do appreciate it.
Leslie Kernisan, MD MPH says
Thank you for sharing your story! I’m sure this will give other readers ideas as to how they can work around hearing loss.
Meredith Cahn says
I was saddened that you didn’t mention cochlear implants. I got my first one last year and my word recognition went from 25% to 90%. I just got the second one yesterday. I was born with a hearing loss that wasn’t diagnosed until I was 14. And i didn’t get hearing aids until i was 24. It was revelatory to not have to read lips. Then, as i have aged, it’s gotten worse and worse. I can’t imagine preferring not to hear.
The two facebook groups i am in for cochlear implants share stories of people in their 70s and 80s. And a lot of us (including me) are in our mid to late 60s. As long as one has the capacity to spend time doing the exercises (and listening to audible books and podcasts), it is a great solution.
Leslie Kernisan, MD MPH says
Thanks for mentioning cochlear implants. They can be an excellent hearing option for certain individuals, however they are more of an advanced therapeutic option, used after hearing aids have been correctly tried. This article is mostly geared towards helping older adults take the initial steps towards addressing hearing loss, so 2nd line therapies are beyond the scope of what is covered.
Also, Medicare had extremely limited coverage of cochlear implants until Sept 2022. Coverage has been expanded but still requires that the beneficiary fail to get adequate benefit from hearing aids. The Medicare coverage criteria are:
– Diagnosis of bilateral moderate-to-profound sensorineural hearing impairment with limited benefit from appropriate hearing (or vibrotactile) aids;
– Cognitive ability to use auditory clues and a willingness to undergo an extended program of rehabilitation;
– Freedom from middle ear infection, an accessible cochlear lumen that is structurally suited to implantation, and freedom from lesions in the auditory nerve and acoustic areas of the central nervous system;
– No contraindications to surgery; and
– The device must be used in accordance with Food and Drug Administration (FDA)-approved labeling.
I do think we’ll see increased numbers of older adults with cochlear implants, especially if more people start attending to their hearing loss in midlife or in their 60s-70s. I imagine we’ll also see some motivated individuals in their 80s taking advantage of this technology…it does seem like a good option for those who can tolerate the procedure and have the stamina and cognitive ability to go through the extensive rehab that is required.
Eliza says
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!!
Nicole Didyk, MD says
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!
Kim Frohbieter says
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.
Nicole Didyk, MD says
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.
Pat Schmitt says
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.
Nicole Didyk, MD says
“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.
Ann says
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.
Nicole Didyk, MD says
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!
jenifer kelley says
Wow. You hit the nail on the head. Same with my Mom who was diagnosed w severe hearing loss ten years ago. She tried hearing aids for ONE DAY, and said they were not for her and she was fine. Now, I avoid her and so do her former friends. The shouting is so stressful to everyone:
nick says
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!!!!!!!!!!!
Nicole Didyk, MD says
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.
P Webster says
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.
Nicole Didyk, MD says
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!
Norm McElvany says
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.