It was my first appointment with a new doctor, and out came the typical getting-to-know-you questions. How often do you exercise? Do you smoke? How well do you sleep?
Then came one I’d imagined was still years away: How’s your hearing?
A few quick finger snaps next to each of my ears, and he was recommending an audiologist. I slunk out of his office, deflated. True, 65 percent of people my age — that is, over 60 — have age-related hearing loss, the kind that often could benefit from a hearing aid. And yet 80 percent of older adults who need hearing aids don’t actually get or use them.
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I get it. To me, an age-related hearing aid has always screamed You are old, even though I know that’s not always true. We live in an ageist society, where advanced age gets conflated with disability and irrelevance. But the more I read and spoke to people, the more I realized the serious costs of not using them when they could help.
For people with hearing loss, it’s exhausting trying to piece together meaning when you can’t hear all the words, explained popular blogger Shari Eberts in a recent post, “My Least Favorite Things About Living With Hearing Loss.” “It’s like playing a game of Wheel of Fortune. Some of the letters are filled in while others are blank.” It’s somehow still OK for friends and family to make fun of you, or people assume you’re rude if you don’t respond to them. They assume a lot of other things are wrong with you, too. (Eberts, whose eyesight is fine, was once offered braille information cards on a plane so she could “follow the announcements.”)
Sometimes, people treat you dismissively or just give up on trying to communicate with you. “The two words I hate the most are: ‘Never mind,’” says Sue Schy of Waltham, who has hearing loss and leads the Boston chapter of the Hearing Loss Association of America.
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What’s more, hearing loss is more than just a sensory disorder. It’s associated with a torrent of health problems including depression, injuries from falls, diabetes, and cardiovascular disease.
And here’s something to keep you up at night: If left untreated, hearing loss can be linked to a higher risk of cognitive decline and dementia in older adults. Put even more starkly, as Dr. Frank Lin of Johns Hopkins Bloomberg School of Public Health has explained, studies suggest “hearing loss may be the largest contributor to dementia out of all known risk factors.”
But some encouraging news arrived this summer out of an ambitious research study co-led by Lin, which found that hearing aids can significantly reduce this risk.
Funded by the National Institutes of Health, Lin’s research team studied nearly 1,000 adults, ages 70 to 84, to see if hearing aids could reduce the risk of cognitive decline, and eventually delay or prevent dementia. It concluded that those at higher risk of dementia who used hearing aids for three years cut cognitive decline — loss of thinking and memory abilities — by an incredible 48 percent, compared with those who didn’t use hearing aids.
The findings were published in The Lancet, which underscored the point in a commentary: “Hearing aids could really make a difference for populations at risk of dementia.”
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I called Frank Lin to learn more, especially: What does hearing loss have to do with dementia anyway?
He suggested three possible explanations. With hearing loss, speech and sounds are garbled by the time they reach the brain, he says, so the brain “has less resources to devote to thinking and memory.”
Second, the parts of the brain that are stimulated by speech and sound are under-stimulated in people with hearing loss, which exacerbates brain atrophy. “You can imagine,” Lin says, “that a shrinking brain is not a good thing.”
And third, hearing loss can make communicating with others more difficult, which can lead to social isolation — and that’s another risk factor of dementia.
“It’s really a landmark study,” says Dr. Maura Cosetti, director of the Ear Institute of New York Eye and Ear Infirmary of Mount Sinai. “Nothing like this has been done before. There has never been a randomized controlled study of that magnitude which allowed understanding of the specific impact of hearing amplification [or] treatment of hearing loss on cognitive decline.”
But has it triggered a stampede to audiologists’ offices (if only to fend off visits to neurologists’ offices)?
Predictably, no, say those in the hearing loss community. Resistance to hearing aid use is high. A national 2022 survey of 1,250 older adults found they were more than twice as likely to take their pet to a veterinarian than have their own hearing checked.
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“I see [hearing loss] as the 800-pound gorilla in the room everyone is so desperately trying to ignore, even though they are all worried about it,” says Geoff Plant, executive director of the Hearing Rehabilitation Foundation in Woburn, a nonprofit organization that promotes speech communication skills for people with hearing loss.
There have been plenty of reasons for this, starting with cost. A pair of prescription hearing aids can cost more than $5,000. High-end hearing aids go for upward of $8,000, Plant says. And Medicare, inexplicably, still doesn’t pick up the tab.
Cosetti adds that hearing loss is an invisible problem and it’s misunderstood, so that people who have it might not even know it. “Most people wait an average of 10 years before getting treatment,” she says. “They wait until it becomes un-ignorable.”
And even then, many people hesitate to use the aids, says Schy, whose 91-year-old father-in-law owns six pairs of hearing aids — all of them tucked away in a drawer, mingling with his socks. I asked her why that is. “Stubbornness, denial, he doesn’t want to be bothered.” Plus, he finds that everything gets uncomfortably amplified. Unlike with glasses, “You don’t just put on a hearing aid and hear,” she says. They take time and patience to adjust, and often the assistance of an expert.
It also takes a medical professional to take the issue of hearing loss seriously. “A kid can have the same test as an 80-year-old, with the same hearing loss,” Lin says. “But with the kid, it’s seen as critically important to manage it. With the 80-year-old it’s, ‘OK, you don’t need to worry about your mild hearing loss.’”
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With the stakes so high — reminder: dementia — Lin thinks a lot about how to get more people to use hearing aids. “How do we rejigger all the market assumptions to actually make hearing-aid use work for the public and drive adoption?” he asks. “Why are these devices so bloody expensive and the technologies not appealing to use?”
But the situation is improving. After years of delay — thanks in part to objections by hearing aid manufacturers and other stakeholders — the Food and Drug Administration recently finalized guidelines that make over-the-counter hearing aids available to those with mild to moderate hearing loss, as an alternative to prescription-only versions.
This move is already promoting competition and lower prices. The National Council on Aging reports the average cost of over-the-counter hearing aids is now at $1,600. One manufacturer on the organization’s September 2023 list of recommended hearing aids is Audien Hearing, which was offering models ranging from $99 to $249. Other models — like those made in a partnership between Sony and a hearing-aid manufacturer — reduce the stigma of wearing hearing aids, since the work they do is seamlessly integrated into wireless earbuds. “Is that an [earbud], or is it a hearing aid? You might not be able to tell the difference,” Lin says.
Eventually, I dragged myself to an audiologist. He told me I do have mild hearing loss, but I don’t have to worry about it just yet. Still, those earbud versions do sound, if not exactly cool, then something I can live with. And as grim as I once found the prospect of hearing aids, I find the prospect of dementia even worse.
Linda Matchan is a frequent contributor to the Globe Magazine. Send comments to magazine@globe.com.
Linda Matchan can be reached at linda.matchan@globe.com