Age-related hearing loss is rarely dramatic, happening slowly over time, robbing older people of snippets of conversation and leaving them unable to filter out background noise as well as they once could. Early signs can include routinely cranking up the TV volume and having trouble with phone dialogue. Left untreated, hearing loss can lead to social isolation and mental and physical decline.
But it doesn’t have to be that way. A new study suggests intervening with hearing aids at the time of a hearing-loss diagnosis among people 66 and over can lower the risk of new onset Alzheimer’s disease or dementia, depression or anxiety, and fall-related injuries over the next three years, compared with patients who didn't start wearing hearing aids right away. That's according to a study from the University of Michigan published Sept. 4 in the Journal of the American Geriatrics Society.
The difference was in the double digits. The risk of being diagnosed with dementia or Alzheimer's after three years was 18% lower for hearing-aid users compared with non-users. The risk of a depression or anxiety diagnosis was 11% lower and the risk of being treated for fall-related injuries was 13% lower among hearing-aid users.
The downstream effects of such early intervention could include improved quality of life for patients and lower healthcare costs due to the prevention or delay of chronic conditions and injurious falls, the authors wrote.
“Hearing loss is a potentially modifiable risk factor” for dementia, depression and fall-related injuries, Elham Mahmoudi, a University of Michigan Department of Family Medicine health economist who led the study, wrote in an email. “A simpler system of hearing care, insurance coverage, and more educational outreach on potential benefits of using hearing aids is needed.”
Only 12% of older people with confirmed hearing loss get hearing aids even when they have insurance to offset part of the costs, the study found.
Hearing care in the U.S. is complicated and expensive, requiring an evaluation from an audiologist, purchase of hearing aids, and follow-up visits for tunings, with out-of-pocket expenses that balloon into thousands of dollars -- an estimated $2,000 to $7,000, the study found. Traditional Medicare doesn’t cover hearing aids, but some Medicare HMO plans cover part of the cost.
Age-related hearing loss is not uncommon, often occurring after accumulated noise exposure, a genetic predisposition, exposure to ear-harming medication, head trauma and other factors, according to the American Academy of Audiology ,About one third of people over age 65 develop hearing loss, according to the World Health Organization, and 27 million U.S. seniors live with it. Incidence is expected to rise as the population ages.
Barriers to Care
Once a person learns he has hearing loss, studies have shown it typically takes another seven to 10 years before that person seeks help, said Barbara Kelley, executive director of the Hearing Loss Association of America (HLAA), a consumer advocacy group in Bethesda, Md. Cost is a major barrier to hearing-aid use, she said, but there are others, such as stigma and fear of looking “old,” problems with fit and convenience.
Cultural taboos and lower socioeconomic status among women and some minority groups may deter would-be hearing aid users from improving their hearing. More men than women acquired hearing aids at the time of a hearing-loss diagnosis -- 13.3% of males vs. 11.3% of females, according to the study, which tracked anonymized insurance claims of nearly 115,000 people from 2008 to 2016.
There were racial/ethnic and geographic differences, too. Latinos with hearing loss had the lowest hearing-aid use, at 6.5%, followed by 9.8% of blacks and 13.5% of whites. At nearly 37%, the North Central region, including Minnesota and Iowa. had the highest hearing-aid use, compared with just under 6% for mountain states like Arizona and Colorado.
The study’s large sample size and long follow-up period gave it weight, but it couldn’t account for hearing-loss severity or how often and to what extent people used their hearing aids. It also couldn’t tease out whether hearing aids caused a delay in three important age-related conditions or merely were associated with them. A multiyear, randomized trial funded by the National Institute on Aging called ACHIEVE is recruiting participants to help answer some of those questions.
Older people need to advocate for themselves if a primary-care doctor takes a dismissive approach to hearing loss, Kelley said. “You go in and they say ‘Oh, it’s just aging. Learn to live with it.’ No, you should get an evaluation.”
Doctors and otolaryngologists can evaluate hearing when a medical cause of hearing loss is suspected. But audiologists are often the first stop for age-related hearing loss. Audiologists can determine the severity of the problem, do a needs assessment and recommend a treatment plan,.
The hearing-aid market is expected to expand as a new federal law allowing over-the-counter versions goes into effect next year. The release of more products may lower prices, making hearing aids more affordable for people with mild to moderate hearing loss. But people with more severe hearing loss still will need to go the traditional route of visiting an audiologist or doctor for screening and monitoring.
Kelley is hopeful that as new assistive technology models such as those that use Bluetooth and phone apps become more mainstream, people with mild to moderate hearing loss will flock to them a “first step” toward hearing aids that could help them sooner rather than later.
“Why wait?” she said. “Why take yourself out of life for seven to 10 years?”
The most successful hearing-aid users are those who seek support, Kelley said. HLAA has 140 chapters across the country where anyone can drop in to meetings to find out about new technologies, mingle with peers and learn about their hearing choices, discover coping strategies, workplace laws and get referrals to good audiologists, she said.