Hearing loss tends to arrive slowly. Conversations in restaurants get harder, the television gets louder, and family members start repeating themselves. Because it creeps up, many people wait years before doing anything about it. There are good reasons not to wait, and one of them is the brain.

According to the National Institute on Deafness and Other Communication Disorders, about 22 percent of people aged 65 to 74, and 55 percent of those 75 and older, have disabling hearing loss.

The National Institute on Aging lists signs that are worth a doctor’s visit, including trouble understanding speech on the telephone, difficulty following conversations when two or more people are talking, often asking people to repeat themselves, turning up the TV so loud that others complain, and struggling to understand speech over background noise.

NIA notes that older adults with hearing loss have a greater risk of developing dementia than those with normal hearing, and that memory and concentration decline faster in older adults with hearing loss. One explanation is that the brain works harder to make sense of muffled sound, leaving less capacity for memory. Another is that hearing loss leads to social isolation, itself a risk factor.

The 2024 Lancet Commission on dementia prevention included hearing loss among 14 modifiable risk factors for dementia, alongside high blood pressure, high LDL cholesterol, physical inactivity and others. Our article on midlife blood pressure and brain health covers another item on that list.

What the ACHIEVE trial found

The ACHIEVE trial, published in The Lancet in 2023, was the first large randomized trial to test whether treating hearing loss slows cognitive decline. Nearly 1,000 adults aged 70 to 84 with untreated hearing loss received either hearing aids with support from an audiologist or a health education program.

  • Across everyone in the study, three-year cognitive decline was not significantly different between the two groups.
  • In a prespecified analysis, the effect differed between the two groups of volunteers the study drew from. Among participants who were older and had more risk factors for cognitive decline, the hearing intervention appeared to slow decline.
  • No significant adverse events were linked to either approach.

The honest summary is that treating hearing loss may help protect thinking in people at higher risk, and it clearly helps with communication and quality of life. NIA also notes that an analysis of several studies found people who used hearing aids or cochlear implants had a lower risk of long-term cognitive decline.

Small changes that help right away

  • Ask people to face you and speak clearly rather than more loudly.
  • Choose a quiet table in restaurants, away from the kitchen and the speakers.
  • Turn on captions for television and video calls.
  • Tell friends and family that you are having trouble hearing. Most people are glad to adjust.

Over-the-counter hearing aids

Since October 2022, the FDA has allowed over-the-counter hearing aids for adults 18 and older with perceived mild to moderate hearing loss. They can be bought without a prescription or a fitting by an audiologist, which has made hearing aids more accessible and more affordable for many people.

OTC devices are not for everyone. The FDA lists warning signs that call for a professional first, including ear pain or discomfort, a lot of ear wax, dizziness or vertigo, hearing that changed suddenly in the past six months, hearing that is worse in one ear, and ringing or buzzing in only one ear.

What Medicare covers

Original Medicare does not cover hearing aids or exams for fitting them. Some Medicare Advantage plans offer hearing benefits, so check your plan. Part B does cover diagnostic hearing and balance exams when your doctor orders them to find out whether you need medical treatment.

Screening and next steps

The US Preventive Services Task Force found the evidence insufficient to recommend routine hearing screening for adults 50 and older who have not noticed a problem. If you or your family have noticed one, that recommendation does not apply: it is time for a hearing test.

Your internist can look in the ears for wax or infection, review medicines that can affect hearing or cause ringing, and refer you to an audiologist or ear, nose and throat specialist. Hearing also matters for safety, since it is part of how we keep our balance and notice what is around us. See balance and fall prevention.

At Legacy Medical, Dr. Shtern coordinates referrals and keeps track of what specialists find, and family members are welcome at visits with the patient’s permission. If memory is part of the concern, read memory changes: what is normal, or book a complimentary meet and greet.

This article is general information, not advice for your situation. Members can call the office with questions about their own care.