Hearing loss in older adults: a family Q&A
Early signs of hearing loss in older adults, why waiting backfires, and what helps, from a hearing test to OTC hearing aids. Plain answers for families.
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About one in three people aged 65 to 74 has hearing loss, and nearly half of those over 75 have trouble hearing, according to the National Institute on Aging. The signs of hearing loss in older adults arrive so gradually that the person living with it is often the last to notice, and many people wait years before doing anything about it. That wait, more than the hearing loss itself, is the part families can change.
Here are the questions families ask once a parent starts saying "what?" a little too often, answered plainly.
How common is hearing loss with age?
Very. It becomes more common with each decade, from a minority of people in their sixties to about half by the mid-seventies and most people past 85. The medical name is presbycusis. Common doesn't mean it should be shrugged off, because the effects of ignoring it are real and the fixes work.
What are the first signs families notice?
The first clues show up in everyday conversation:
- The TV creeps louder than everyone else wants it.
- Phone calls get shorter, or the phone gets handed to a spouse.
- At a restaurant or family dinner, your parent goes quiet, smiles and nods at the wrong moments, or stops coming.
- They ask for repeats, say people mumble, or turn one ear toward whoever is talking.
- They miss the doorbell or the phone.
One detail explains most of the rest: high-pitched sounds fade first. Consonants like s, f, th and k live up there, and they carry meaning. Vowels are lower and louder, so speech comes through present but smeared, like a radio almost tuned in. That's why a parent can insist they hear you fine but can't make out the words, and why background noise turns a manageable conversation into an exhausting one. The NIA keeps a short list of six signs of hearing loss worth knowing.
Why does hearing fade with age?
The inner ear holds thousands of tiny hair cells that turn sound vibrations into signals the brain reads as speech and music. Over a lifetime they wear out, and they don't grow back. Noise, some medicines, high blood pressure, diabetes and family history all speed the process, which is why two people the same age can hear very differently. The National Institute on Deafness and Other Communication Disorders describes age-related hearing loss as gradual, usually in both ears, and usually starting with high pitches.
Is it hearing loss, or are they just not listening?
Very often it's hearing. When someone catches the easy half of a sentence and loses the consonants, they fill the gap with a guess, and the guess is sometimes wrong. From the outside that looks like inattention, stubbornness or memory trouble.
Watch for the pattern. A parent who follows you easily face to face in a quiet kitchen but loses the thread when you talk from the next room, over the TV or at a busy table is usually struggling to hear, not to pay attention. Only a hearing test can say for sure, and it's the right next step either way.
What happens if we just wait?
Untreated hearing loss rarely stays a hearing problem. When conversation becomes work, people do less of it, and the slow drift toward isolation and low mood is one of its best-documented costs. Our guide to loneliness in older adults covers that side.
There's a thinking cost too. Hearing loss is linked to a higher risk of dementia, and the 2024 Lancet Commission on dementia counts it among the largest risk factors people can change. The encouraging part is that treatment seems to help: the ACHIEVE trial, published in 2023, found that a hearing intervention slowed cognitive decline over three years in older adults at higher risk.
Much of what protects an older adult with hearing loss is ordinary follow-through: making the audiology appointment, getting there, wearing and charging the hearing aids, and keeping the week social. That's the everyday work of our companion care: rides, reminders and conversation on the days a quiet house would otherwise win.
How is hearing loss diagnosed?
More simply than most families expect. A primary care doctor first rules out the easy causes, especially earwax, which can muffle hearing and is quick to clear. Then an audiologist does a hearing test: a painless session in a quiet booth, listening for tones at different pitches and repeating words through headphones. The results go on an audiogram, a chart of the softest sounds your parent can hear at each pitch, which shows where the loss is and how deep.
Medicare Part B covers diagnostic hearing exams in some situations. Original Medicare doesn't cover hearing aids or exams to fit them, though many Medicare Advantage plans include some hearing aid coverage.
What actually helps?
For most age-related hearing loss, the answer is hearing aids, and buying them got easier in 2022. An FDA rule that took effect on October 17, 2022 created over-the-counter hearing aids for adults with perceived mild to moderate hearing loss. They're sold in pharmacies, stores and online without a prescription or a hearing exam. That matters because cost and hassle kept people away: the NIDCD reports that fewer than one in three adults 70 and older who could benefit from hearing aids have ever used them.
Whatever the device, the first weeks are an adjustment, not a verdict. The brain has to relearn sounds it hasn't heard clearly in years. Captioned phones, TV streamers and quieter rooms help too, and so do the people doing the talking.
Is an over-the-counter hearing aid good enough?
It depends on how much hearing is gone. Over-the-counter devices are meant for mild to moderate loss. In plain terms, mild loss means trouble with soft voices and a repeat or two per meal. Moderate means struggling with ordinary conversation in a quiet room and turning the TV up past what the household wants. Beyond that (trouble hearing raised voices close up, leaning on lip reading, no longer using the phone) an audiologist is the faster path.
The FDA lists warning signs that mean seeing a doctor or hearing professional before buying anything:
- Blood, pus or fluid from the ear in the past six months.
- Ear pain or discomfort.
- A lot of earwax, or something that might be stuck in the ear.
- Strong dizziness or a feeling of spinning.
- Hearing that changed suddenly in the past six months.
- Worse hearing in one ear, or ringing in only one ear.
One more signal is where families often give up. If a device is set up well and your parent still says "I can hear it, I just can't make out the words," the next step is a full audiology exam, not another device off the shelf.
How should we talk so they can follow?
Shouting is the wrong tool, because it distorts the consonants that are already hard to catch. Better habits cost nothing:
- Face your parent in good light so they can see your mouth.
- Get their attention before you start.
- Turn off the TV or the running faucet.
- Speak at a natural pace, just a little slower.
- If something is missed, say it a different way instead of louder.
- In a group, one voice at a time.
What should we do first?
- Book a doctor's visit to rule out earwax and get a referral for a hearing test. If your parent resists, call it routine maintenance, like eyes and teeth.
- Change how the household talks tonight: face to face, TV down, one at a time.
- Keep your parent's world from shrinking while you sort out the rest. The isolation is the part you can head off right away.
If your parent needs rides to the audiologist or more company through the week, call us or request care.
This article is general information, not medical advice. Sudden hearing loss, especially in one ear, needs prompt medical attention.
Common questions
Click or tap a question to see the answer.
What are the early signs of hearing loss in older adults?
Early signs of hearing loss in older adults include turning the TV up louder than others like, asking people to repeat themselves, saying that others mumble, struggling to follow conversation in a noisy restaurant or a group, turning one ear toward the speaker, missing the doorbell or phone, and pulling back from gatherings. High-pitched sounds usually fade first, so consonants such as s, f, th and k blur and speech sounds present but unclear. The person with the hearing loss is often the last to notice.
Is hearing loss a normal part of aging?
Hearing loss is common with age, but it's still worth treating. About one in three people aged 65 to 74 has hearing loss, and nearly half of those over 75 have difficulty hearing, according to the National Institute on Aging. Age-related hearing loss can be measured and largely managed with hearing aids and better communication habits, and treating it helps prevent the social withdrawal that often follows.
At what age does age-related hearing loss usually start?
Age-related hearing loss, called presbycusis, develops gradually and is most often noticed from the sixties onward, though changes in the inner ear build for years before that. It becomes more common with each decade, affecting about half of people by their mid-seventies and most people over 85. Noise exposure, some medicines, high blood pressure, diabetes and family history can make it start earlier.
Can untreated hearing loss lead to dementia?
Untreated hearing loss is linked to a higher risk of cognitive decline and dementia, and the 2024 Lancet Commission on dementia counts it among the largest risk factors people can change. Treatment appears to help: the ACHIEVE trial, published in 2023, found that a hearing intervention slowed cognitive decline over three years in older adults at higher risk. Hearing loss doesn't mean dementia is coming, but treating it is one of the most practical things a family can do.
How is hearing loss diagnosed?
Start with a primary care doctor, who can check for simple causes such as earwax and refer to an audiologist. The audiologist does a painless hearing test in a quiet booth, playing tones at different pitches and volumes and checking how well words are understood. The results go on an audiogram, a chart of the softest sounds a person hears at each pitch, which shows what kind of help fits. The test usually takes under an hour.
Does Medicare cover hearing aids?
Original Medicare (Parts A and B) doesn't cover hearing aids or exams for fitting them. Part B does cover diagnostic hearing and balance exams in some situations. Many Medicare Advantage plans include some hearing aid coverage, so check the plan's evidence of coverage. Eligible veterans may get hearing aids through the VA, and some state Medicaid programs cover them for adults.
How do you talk to someone with hearing loss?
Face the person in good light so they can see your mouth, get their attention before you start, and speak at a natural pace, just a little slower. Turn off the TV or move somewhere quieter. If something is missed, say it a different way instead of repeating the same words louder, because shouting distorts speech. In a group, have one person speak at a time.
