Hearing loss in older adults: why it's undertreated, and why that matters

Signs it’s hearing, not attention or memory

• The TV volume has crept up noticeably over the years.
• Frequently asking people to repeat themselves, or answering a different question than what was actually asked.
• Withdrawing from group conversations or gatherings where background noise makes hearing harder.
• Accusing others of mumbling, when the actual issue is their own hearing.

These can look like inattention, confusion, or even early cognitive decline — worth ruling out hearing first, since the fix is often far simpler than families assume.

Why it matters beyond just hearing

Untreated hearing loss is associated with a higher risk of social isolation and depression (see depression and isolation in older adults), a greater fall risk, and research increasingly links it to faster cognitive decline — the brain works harder to process degraded sound, leaving fewer resources for other cognitive tasks. It’s also a genuine safety issue: someone who can’t hear a smoke alarm, a doorbell, or a caregiver calling out is at real risk.

Why it goes untreated so often

• Denial — admitting hearing loss can feel like admitting to getting old.
• Cost — hearing aids are often not covered by Medicare, though some Medicare Advantage and Medi-Cal managed care plans do include a hearing benefit; check your specific plan.
• Stigma around visibly wearing a hearing aid, though modern devices are far less noticeable than older models.
• Simply not knowing lower-cost options exist — FDA-regulated over-the-counter hearing aids, available without a prescription for mild-to-moderate loss, have made this dramatically more affordable in recent years.

How to actually help

• Suggest a hearing test the same way you’d suggest any other checkup — matter-of-fact, not as a confrontation.
• Face the person and speak clearly rather than louder — raising your volume often distorts speech more than it helps.
• Reduce background noise (TV, music) during important conversations.
• If they resist a formal hearing aid, an over-the-counter option can be a lower-pressure first step.