The issue
Age‑related hearing loss is nearly universal and now affects more than two‑thirds of adults ≥ 60; beyond communication problems, it is the single largest potentially modifiable risk factor for dementia later in life.
What do I need to know?
Hearing declines gradually because the inner‑ear hair cells that encode sound cannot regenerate; age, noise, vascular risks (diabetes, smoking, hypertension) and even low cochlear pigmentation all accelerate damage. Untreated loss raises social isolation, medical costs and cognitive load. Although modern hearing aids improve quality of life and may slow cognitive decline, fewer than one in five U.S. seniors who could benefit actually use them, in part because of stigma and price. Since October 2022, U.S. regulations allow adults with mild‑to‑moderate loss to buy over‑the‑counter (OTC) hearing aids for roughly $100–$300, while prescription devices and cochlear implants remain options for more severe loss.
Potential risk of disabling hearing loss
An older adult reports occasional difficulty in noisy rooms or says others “mumble,” but no formal testing has been done.
Recommended Actions
Ask the primary doctor for a whispered‑voice or finger‑rub screen and discuss risk factors.
Try easy communication tweaks: face‑to‑face conversation, reduced background noise, internet calls with better audio.
Consider a smartphone self‑test (hearingnumber.org) to track changes.
Imminent risk of disabling hearing loss
Persistent trouble following speech, family concern, or self‑test suggesting mild‑to‑moderate loss.
Recommended Actions
Schedule a full audiologic evaluation; thresholds guide treatment choices.
Discuss starting an OTC hearing aid if pure‑tone average < 60 dB.
Begin home noise‑protection habits (earplugs for loud events) and strengthen cardiovascular risk control.
Confirmed disabling hearing loss
Audiogram shows ≥ 60 dB loss or speech understanding remains poor despite aids.
Recommended Actions
Trial prescription hearing aids fitted by an audiologist; fine‑tune directional microphones for noisy settings.
If benefit remains limited, ask about cochlear‑implant candidacy; many adults describe postoperative improvement as “life‑changing”.
Enroll in rehabilitative listening therapy and ensure fall‑prevention and cognitive‑health plans are in place.
What can I do?
Tell the clinician, “Am I at potential, imminent, or confirmed risk, and what’s my next step?” Keep a diary of situations where hearing fails and any safety concerns (e.g., missed alarms). If you start an aid, wear it at least six hours daily for brain adaptation and note any feedback or discomfort for follow‑up tuning. Family or caregivers can help set up captioning on TV, accompany the patient to audiology visits, and encourage social activities so hearing challenges do not lead to isolation.
