Hearing loss is the third most prevalent chronic health condition facing older adults (Collins, 1997). But the treatment gap is significant: Only 20% of people who might benefit from treatment actually seek help. Most tend to delay treatment until they cannot communicate in even the best of listening situations. On average, hearing aid users wait more than 10 years after their initial diagnosis to be fit with their first set of hearing aids (Davis, 2007).
And the incidence of hearing loss only increases with age—approximately one-third of Americans between ages 65 and 74 and nearly half of those older than 75 have hearing loss (National Institute on Deafness and Other Communication Disorders, 2011). With the population of individuals older than 65 expected to double between 2008 and 2030 to a projected 72.1 million (U.S. Administration on Aging, 2011), audiologists are poised to close the treatment gap. Early and careful evaluation and treatment show great promise in lessening the negative impact of hearing loss on clients' long-term health and quality of life.
A Slow Decline
Audiologists typically aren't surprised to hear that a spouse or significant other has been frustrated by hearing loss long before the affected individual acknowledges it. The insidious nature of age-related hearing loss—or presbycusis—allows many adults to ignore their hearing loss for years or even decades. One of the first signs of hearing loss often is an inability to hear and understand speech in noisy environments, but communication in all situations is hindered as the condition progresses.
Gagné (2011), in explaining why individuals delay seeking hearing health services, eloquently describes the phenomenon of stigma: "In order to live well with hearing loss, one must recognize and accept hearing loss. Specifically, many people must overcome the misplaced shame and poor self-esteem that they may experience."
A number of factors contribute to hearing loss in adults, including age, genetics, noise exposure, and chronic disease (e.g., diabetes, chronic kidney disease, and heart disease). Presbycusis advances gradually over time, affects both ears equally, and begins in the high frequencies before spreading to the lower. Because of this slow progression, many adults with presbycusis don't readily acknowledge their hearing loss, instead considering it a normal sign of aging.
Not Just Decibels
The impact of hearing loss is measured not only in decibels. Hearing loss is an individual experience—how a person copes depends on a great many factors, including early vs. late onset, progressive or sudden loss, the severity of the loss, and communication demands and personality (Kaland & Salvator, 2002). Regardless of the combination of these presenting factors, hearing loss has been linked to feelings of depression, anxiety, frustration, social isolation, and fatigue.
Several studies have documented the impact of untreated hearing loss. An oft-cited survey was commissioned by the National Council on Aging in 1999 (Kochkin & Rogin, 2000). This nationwide survey of nearly 4,000 adults with hearing loss and their significant others showed significantly higher rates of depression, anxiety, and other psychosocial disorders in individuals with hearing loss who did not wear hearing aids. The survey examined the positive benefits of amplification and showed that hearing aid use positively affected quality of life for both the hearing aid wearers and their significant others. These findings were consistent with those of a large, randomized control study that found hearing loss to be associated with increased depression and decreased social/emotional, communicative, and cognitive functions for participants who were unaided as compared to those who received hearing aids. These conditions improved after hearing aids were fit (Mulrow, 1990).
More recently, Frank Lin and colleagues (2011)at Johns Hopkins found a strong link between degree of hearing loss and risk of developing dementia. Individuals with mild hearing loss were twice as likely to develop dementia as those with normal hearing, those with moderate hearing loss were three times more likely, and those with severe hearing loss had five times the risk. This study could not definitively conclude that early treatment with hearing aids would reduce the risk of dementia, but there was a positive correlation between degree of hearing loss and risk of dementia.
Hearing loss is an invisible handicap. Despite its increasing prevalence with age, hearing loss is often ignored during the diagnosis and treatment of cognitive and memory disorders in elderly patients (Chartrand, 2005). The comorbidity of hearing loss and cognitive disorders makes it even more important to determine hearing status prior to any diagnostic protocol. This determination would undoubtedly lead to more appropriate diagnoses and treatment and thus likely to result in better outcomes for individuals with cognitive impairments.
Closing the Treatment Gap
The impact of untreated hearing loss cannot be ignored. Educating consumers about the importance of seeking early treatment for themselves and their loved ones should be part of the equation. But with the U.S. population aging so rapidly, a health care system that recognizes the importance of early identification and treatment is also critical.
Healthy People 2020—a government-sponsored, 10-year agenda for improving the nation's health—outlines several goals related to improving hearing health outcomes for adults. Specifically, Healthy People 2020 calls for an increase in the number of adults older than 70 who use hearing aids and hearing assistive technology, as well as in the number of adults ages 20–70 who have had a hearing evaluation in the past five years (U.S. Department of Health and Human Services, 2010).
The fitting of hearing aids should be part of a larger treatment program that includes the person with hearing loss and his or her significant others. Research has shown improved quality of life and overall satisfaction when significant others receive support and education on hearing loss and communication strategies (Kramer, 2005). Group and individual audiologic rehabilitation programs tailored to the individual's communication needs have been shown to encourage feelings of acceptance and confidence that lead to earlier acceptance and improved benefits from carefully fit technology (Chisolm et al., 2004). Holistic rehabilitation approaches that take into consideration other age-related changes such as vision impairment, cognitive decline, and manual dexterity are needed to meet the needs of our growing elder population (Saunders, 2011).
Ongoing research and advocacy on the efficacy of early identification and management of hearing loss may encourage better funding for hearing aids, as well as for important audiologic rehabilitation services. Before that change takes place, audiologists can help close the treatment gap. To increase the number of individuals who ultimately benefit from early management, we need to change commonly held perceptions of hearing loss. Audiologists who fit hearing aids must implement audiologic rehabilitation as part of their patient's plan of care, and ensure that individuals who ultimately seek hearing services are treated in a holistic, evidence-based manner that takes their psychosocial, physical, and communication needs into consideration.
This article was adapted from "Untreated Hearing Loss in Adults: A Growing National Epidemic," which appeared in the Feb. 2 issue of ASHA Access Audiology. Read the original essay at Access Audiology.