It was an every-other-day routine, full of frustration.
Every time my husband called his father, who was 94 when he died in 2022, he鈥檇 wait for his dad to find his hearing aids and put them in before they started talking.
Even then, my father-in-law could barely hear what my husband was saying. 鈥淲hat?鈥 he鈥檇 ask over and over.
Then, there were the problems my father-in-law had replacing the devices鈥 batteries. And the times he鈥檇 end up in the hospital, unable to understand what people were saying because his hearing aids didn鈥檛 seem to be functioning. And the times he鈥檇 drop one of the devices and be unable to find it.
How many older adults have problems of this kind?
There鈥檚 no good data about this topic, according to Nicholas Reed, an assistant professor of epidemiology at Johns Hopkins Bloomberg School of Public Health who studies hearing loss. He did a literature search when I posed the question and came up empty.
Reed co-authored the to date of hearing issues in older Americans, published in JAMA Open Network last year. Previous studies excluded people 80 and older. But data became available when a 2021 survey by the National Health and Aging Trends Study included hearing assessments conducted at people鈥檚 homes.
The results, based on a nationally representative sample of 2,803 people 71 and older, are eye-opening. Hearing problems become pervasive with advancing age, exceeding 90% in people 85 and older, compared with 53% of 71- to 74-year-olds. Also, hearing worsens over time, with more people experiencing moderate or severe deficits once they reach or exceed age 80, compared with people in their 70s.
However, only 29% of those with hearing loss used hearing aids. Multiple studies have documented barriers that inhibit use. Such devices, which Medicare doesn鈥檛 cover, are pricey, from nearly $1,000 for a good over-the-counter set (OTC hearing aids became available in 2022) to more than $6,000 for some prescription models. In some communities, hearing evaluation services are difficult to find. Also, people often associate hearing aids with being old and feel self-conscious about wearing them. And they tend to underestimate hearing problems that develop gradually.
Barbara Weinstein, a professor of audiology at the City University of New York Graduate Center and author of the textbook 鈥淕eriatric Audiology,鈥 added another concern to this list when I reached out to her: usability.
鈥淗earing aids aren鈥檛 really designed for the population that most needs to use them,鈥 she told me. 鈥淭he move to make devices smaller and more sophisticated technologically isn鈥檛 right for many people who are older.鈥
That鈥檚 problematic because hearing loss raises the risk of cognitive decline, dementia, falls, depression, and social isolation.
What advice do specialists in hearing health have for older adults who have a hard time using their hearing aids? Here are some thoughts they shared.
Consider larger, customized devices. Many older people, especially those with arthritis, poor fine motor skills, compromised vision, and some degree of cognitive impairment, have a hard time manipulating small hearing aids and using them properly.
Lindsay Creed, associate director of audiology practices at the American Speech-Language-Hearing Association, said about half of her older clients have 鈥渟ome sort of dexterity issue, whether numbness or reduced movement or tremor or a lack of coordination.鈥 Shekinah Mast, owner of Mast Audiology Services in Seaford, Delaware, estimates nearly half of her clients have vision issues.
For clients with dexterity challenges, Creed often recommends 鈥渂ehind-the-ear hearing aids,鈥 with a loop over the ear, and customized molds that fit snugly in the ear. Customized earpieces are larger than standardized models.
鈥淭he more dexterity challenges you have, the better you鈥檒l do with a larger device and with lots of practice picking it up, orienting it, and putting it in your ear,鈥 said Marquitta Merkison, associate director of audiology practices at ASHA.
For older people with vision issues, Mast sometimes orders hearing aids in different colors for different ears. Also, she鈥檒l help clients set up stands at home for storing devices, chargers, and accessories so they can readily find them each time they need them.
Opt for ease of use. Instead of buying devices that require replacing tiny batteries, select a device that can be charged overnight and operate for at least a day before being recharged, recommended Thomas Powers, a consultant to the Hearing Industries Association. These are now widely available.
People who are comfortable using a smartphone should consider using a phone app to change volume and other device settings. Dave Fabry, chief hearing health officer at Starkey, a major hearing aid manufacturer, said he has patients in their 80s and 90s 鈥渨ho鈥檝e found that being able to hold a phone and use larger visible controls is easier than manipulating the hearing aid.鈥
If that鈥檚 too difficult, try a remote control. GN ReSound, another major manufacturer, has designed one with two large buttons that activate the volume control and programming for its hearing aids, said Megan Quilter, the company鈥檚 lead audiologist for research and development.
Check out accessories. Say you鈥檙e having trouble hearing other people in restaurants. You can ask the person across the table to clip a microphone to his shirt or put the mike in the center of the table. (The hearing aids will need to be programmed to allow the sound to be streamed to your ears.)
Another low-tech option: a hearing aid clip that connects to a piece of clothing to prevent a device from falling to the floor if it becomes dislodged from the ear.
Wear your hearing aids all day. 鈥淭he No. 1 thing I hear from older adults is they think they don鈥檛 need to put on their hearing aids when they鈥檙e at home in a quiet environment,鈥 said Erika Shakespeare, who owns Audiology and Hearing Aid Associates in La Grande, Oregon.
That鈥檚 based on a misunderstanding. Our brains need regular, not occasional, stimulation from our environments to optimize hearing, Shakespeare explained. This includes noises in seemingly quiet environments, such as the whoosh of a fan, the creak of a floor, or the wind鈥檚 wail outside a window.
鈥淚f the only time you wear hearing aids is when you think you need them, your brain doesn鈥檛 know how to process all those sounds,鈥 she told me. Her rule of thumb: 鈥淲ear hearing aids all your waking hours.鈥
Consult a hearing professional. Everyone鈥檚 needs are different, so it鈥檚 a good idea to seek out an audiologist or hearing specialist who, for a fee, can provide guidance.
鈥淢ost older people are not going to know what they need鈥 and what options exist without professional assistance, said Virginia Ramachandran, the head of audiology at Oticon, a major hearing aid manufacturer, and a past president of the American Academy of Audiology.
Her advice to older adults: Be 鈥渞eally open鈥 about your challenges.
If you can鈥檛 afford hearing aids, ask a hearing professional for an appointment to go over features you should look for in over-the-counter devices. Make it clear you want the appointment to be about your needs, not a sales pitch, Reed said. Audiology practices don鈥檛 routinely offer this kind of service, but there鈥檚 good reason to ask since once-a-year audiologist consultations last year.
We鈥檙e eager to hear from readers about questions you鈥檇 like answered, problems you鈥檝e been having with your care, and advice you need in dealing with the health care system. Visit聽聽to submit your requests or tips.
