4 Key Things to Know About Age-Related Hearing Loss

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.
  • 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.
  • 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.
  • 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! 

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  1. Penny Lins says

    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.

    • Leslie Kernisan, MD MPH says

      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.

    • Leslie Kernisan, MD MPH says

      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.

  3. Carol says

    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

    • Leslie Kernisan, MD MPH says

      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.