There is sufficient evidence that interventions that improve access to hearing aids are associated with improved health outcomes.
This assessment was made possible through support from Elevance Health. HealthBegins retains full editorial independence, and the content herein reflects its sole views and conclusions.
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The findings below synthesize the results of the studies on hearing aid provision for older adults across three domains of measurement:
By the mid-2030s, the U.S. population is expected to undergo a transformation, with adults aged 65 and older outnumbering children under 18 for the first time in history[1]. Given that an estimated 22% of Americans between 65 and 74 and nearly half of those above 75 experience hearing-related disability[2], this demographic shift will have significant impacts on hearing loss-related disability costs. While over 28 million U.S. adults could benefit from hearing aids, less than one in three adults over the age of 70 has ever used them.
A longitudinal study of claims data that compared older adults with untreated hearing loss to those without hearing loss found that the former incurred 46% more healthcare costs on average over 10 years. This represented an average of $22,434 per person in additional spending. Most of this spending was attributable to an increased risk of hospital stays and of 30-day readmissions. Untreated hearing loss is also associated with an increase in the risk of falls, as well as reduced social connectivity and quality of life[3]. The National Council on Aging notes that older adults who experience hearing loss are more likely to report experiences of social isolation, depression, and anxiety[4]. Social isolation has been characterized by the U.S. Surgeon General as an epidemic, which can increase the risk of illness and death, similar in magnitude to heavy smoking[5].
Studies such as the landmark ACHIEVE clinical trial have demonstrated that comprehensive hearing interventions, including the provision of hearing aids, can help to slow down cognitive decline among older adults at increased risk[6]. Interventions to address hearing loss involve administering a diagnostic hearing assessment to determine the type and severity of hearing loss, which is followed by selecting and fitting patients with hearing aids[7]. Professional organizations further recommend comprehensive rehabilitation services that integrate counseling and education components to help the patient integrate the technology with their daily activities and ensure their full social participation[8].
Despite the demonstrable benefits, access to hearing aids remains constrained by limited healthcare coverage. The Social Security Act does not currently cover hearing aids and related fittings under Medicare Parts A and B, and most beneficiaries have to pay out-of-pocket for their hearing aids or related examinations[9]. While most Medicare Advantage plans provide a supplemental hearing benefit, their coverage levels vary widely and may not always include the full cost of purchasing devices or accessing related professional services[10]. Coverage for adult hearing aids by Medicaid is also optional at the state level, and less than two-thirds of states cover these benefits[11].
The U.S. Food and Drug Administration (FDA) has authorized over-the-counter hearing aids which require no prescription, providing an option for adults with hearing loss to purchase lower-cost hearing aids outside the traditional clinical pathway. This pathway is open to adults 18 and older who have perceived mild to moderate hearing loss[12]. However, over-the-counter hearing aids are not sufficient for more severe hearing loss. Comprehensive coverage remains necessary given the health and healthcare cost impacts of hearing-related disability and its burden on the growing population of older adults.
Adults 60 years and older with co-occurring major depressive disorder and age-related hearing loss.
The intervention group received hearing aids (100% gain targets) while the control group received sham hearing aids (flat 30 dB HL).
Randomized controlled trial. N=25 randomized, of which 23 were available for analysis of their treatment.
Health: Hearing aid treatment over the 12-week study was effective at reducing hearing loss-related disability. There was a suggested signal of effect for hearing aids on immediate memory and response inhibition, both constituent executive functions.
Social: No effect on depression was observed.
Eligible participants were aged 70 to 84 years, had untreated hearing loss, and were without substantial cognitive impairment. The mean age of the sample was 76.8 years; 53.5% were female, 11.5% were Black and 87.8% were White. 53.4% had a Bachelor’s degree or higher.
A hearing intervention including the provision of hearing aids and related technologies, counseling, and education. Controls received health education, including individual sessions covering topics relevant to chronic disease and disability prevention.
Randomized controlled trial. N=490 in the intervention group and 487 in the control group.
Social: In this secondary analysis of the ACHIEVE randomized clinical trial with 977 participants, a hearing intervention (versus health education control) was not associated with RAND-36 Health Survey physical and mental health-related quality of life changes over three years.
These results suggest that additional intervention strategies may be needed to modify health-related quality of life among older adults with hearing loss.
Adults aged 70–84 years with untreated hearing loss and without substantial cognitive impairment in four community study sites across the U.S. They had been 45-64 years old when initially recruited between 1987 and 1989.
The cohort had a mean age of 76.8 years (SD 4.0), 523 (54%) were female, 454 (46%) were male, and most were White (N=858 [88%]). Participants from the Atherosclerosis Risk in Communities (ARIC) study were older, had more risk factors for cognitive decline, and had lower baseline cognitive scores than those in the de novo cohort.
Participants were recruited from two study populations at each site: (1) older adults participating in a long-standing observational study of cardiovascular health (ARIC study), and (2) healthy de novo community volunteers.
Participants were randomly assigned (1:1) to a hearing intervention (audiological counselling and provision of hearing aids) or a control intervention of health education (individual sessions with a health educator covering topics on chronic disease prevention) and followed up every six months.
Randomized controlled trial. N=977 participants: 490 (50%) in the hearing intervention and 487 (50%) in the health education control.
Health: The hearing intervention did not reduce three-year cognitive decline in the primary analysis of the total cohort. In the primary analysis combining the ARIC study and de novo cohorts, three-year cognitive change (in standard deviation [SD] units) was not significantly different between the hearing intervention and health education control groups (–0.200 [95% confidence interval [CI]: –0.256 to –0.144] in the hearing intervention group and –0.202 [95% CI: –0.258 to –0.145] in the control group; difference 0.002 [95% CI: –0.077 to 0.081]; p=0.96).
However, a prespecified sensitivity analysis showed a significant difference in the effect of the hearing intervention on three-year cognitive change between the two study populations that comprised the cohort (ARIC and de novo cohorts) (p interaction=0.010).
These findings suggest that a hearing intervention might reduce cognitive change over three years in populations of older adults at increased risk for cognitive decline, but not in populations at decreased risk for cognitive decline.
Adults aged 60 years or older with hearing loss in senior centers, older adult social clubs, and independent housing complexes in Baltimore, Maryland.
A two-hour intervention consisting of fitting a low-cost amplification device and instruction, which was delivered by community health workers.
Randomized controlled trial. N=151, with 78 in the intervention group and 73 in the wait-list control group.
Social: Among older adults with hearing loss, a community health worker-delivered intervention that included a personal sound amplification device intervention, compared with a wait-list control, significantly improved self-perceived communication function at three months.
Independent-living older adults who were 60 years or older with low incomes who had untreated post-lingual mild hearing loss or worse in New Brunswick, Canada.
56.5% participants self-identified as female and 43.5% as male, with a mean age of 74.5 years.
Provision of hearing aids at no cost. The intervention was delivered by a licensed practical nurse and took between 90 to 120 minutes. It consisted of establishing hearing and communication goals, offering and selecting an amplification device, programming it to the individual’s hearing loss and needs (if appropriate), and providing counselling and education about age-related hearing loss and communication strategies.
Pre-post analysis. N=124 of 175 independent-living older adults screened at the study site and in local community centers in low-income neighborhoods. 109 participants completed the program evaluation survey.
Health: Mean effect sizes measured from baseline to three-months post-intervention were 0.99 (large) for the Hearing Handicap Inventory for the Elderly Screening Version (HHIE-S), 0.58 (medium) for the Duke Social Support Index (DSSI), and 1.02 (large) for listening self-efficacy (LSEQ) indicating significant improvement in self-perceived communication function, social support and listening self-efficacy, respectively.
Older adults with previously untreated hearing loss in Forsyth County, North Carolina; Jackson, Mississippi; Minneapolis, Minnesota; Washington County, Maryland. The mean (SD) age was 76.3 (4.0) years; 523 (53.5%) were female, 112 (11.5%) were Black, 858 (87.8%) were White, and 521 (53.4%) had a bachelor’s degree or higher.
A hearing intervention including four sessions with a certified study audiologist, hearing aid provision, counseling, and education.
Controls received only health education involving four sessions with a certified health educator on chronic disease and disability prevention.
Randomized clinical trial. N=977 older adults with untreated hearing loss.
Social: Hearing intervention participants retained a mean of one additional person in their social network and experienced positive effects in social network diversity and quality and loneliness measures relative to health education control over three years. In fully adjusted models, the group that received the hearing intervention (when compared to the health education control) had significant differences in four aspects of their social networks, namely reduced social isolation (social network size [difference, 1.05; 95% CI: 0.01-2.09], improved social network diversity [difference, 0.19; 95% CI: 0.02-0.36], improved social network embeddedness [difference, 0.27; 95% CI: 0.09-0.44], and reduced loneliness [difference, −0.94; 95% CI: −1.78 to −0.11]) over three years.
People over 60 years of age with hearing loss.
Hearing interventions, including the provision of hearing aids.
Literature review. 176 articles were identified, of which seven met the inclusion criteria. Five studies examined the impact of traditional hearing aids whilst two articles examined outcomes after cochlear implantation.
Social: Loneliness outcomes were reported in three studies and social isolation outcomes in four. All studies reported improved social isolation and loneliness scores following hearing intervention.
However, small sample sizes, a lack of high-quality evidence, heterogeneity between studies, and the presence of confounding factors limit interpretation of the literature.
Adults aged 50 and older with age-related hearing loss.
The use of hearing aids.
Scoping review. Six studies (from Korea, the Netherlands, the U.K., the U.S., and Czech Republic) met the inclusion criteria.
Social: Of the six studies, one study showed that non-hearing aid use mediated the link between hearing loss and cognitive decline with social isolation acting as a mediating factor, while another found that increased usage improved social participation.
People with dementia.
The provision of hearing aids.
Systematic review. Five studies met the inclusion criteria.
Social: Quality of life was found to improve with the use of hearing aids, and hearing rehabilitation was not shown to affect cognitive outcomes.
[1] United States Census Bureau.(2018, March 13). Older People Projected to Outnumber Children for First Time in U.S. History. https://www.census.gov/newsroom/press-releases/2018/cb18-41-population-projections.html
[2] National Institute on Deafness and Other Communication Disorders. (2024, September, 20). Quick Statistics About Hearing, Balance, & Dizziness. NIDCD. https://www.nidcd.nih.gov/health/statistics/quick-statistics-hearing
[3] Johns Hopkins Bloomberg School of Public Health. (2018, November 8). Patients with Untreated Hearing Loss Incur Higher Health Care Costs Over Time. https://publichealth.jhu.edu/2018/patients-with-untreated-hearing-loss-incur-higher-health-care-costs-over-time
[4] National Council on Aging. (2021, December 16). Can Hearing Loss Affect Mental Health in Older Adults? https://www.ncoa.org/article/can-hearing-loss-affect-mental-health-in-older-adults/
[5] Office of the Surgeon General. (2023). Our Epidemic of Loneliness and Isolation: The U.S. Surgeon General’s Advisory on the Healing Effects of Social Connection and Community. https://www.hhs.gov/sites/default/files/surgeon-general-social-connection-advisory.pdf
[6] Lin, F. R., Pike, J. R., Albert, M.S., et al. (2023). Hearing intervention versus health education control to reduce cognitive decline in older adults with hearing loss in the USA (ACHIEVE): a multicentre, randomised controlled trial. The Lancet, 402(10404), 786-97. doi:https://doi.org/10.1016/s0140-6736(23)01406-x
[7] American Speech-Language-Hearing Association. Hearing Loss in Adults. https://www.asha.org/Practice-Portal/Clinical-Topics/Hearing-Loss/
[8] Aural Rehabilitation Clinical Practice Guideline Development Panel, Basura, G., Cienkowski, K., et al. (2023). American Speech-Language-Hearing Association clinical practice guideline on aural rehabilitation for adults with hearing loss. American Journal of Audiology, 32(1):1-51. doi: 10.1044/2022_AJA-21-00252
[9] Social Security. Exclusions from Coverage and Medicare as Secondary Payer. https://www.ssa.gov/OP_Home/ssact/title18/1862.htm
[10] Freed, M., Cubanski, J., Sroczynski, N., Ochieng, N., Neuman, T. (2021). Dental, Hearing, and Vision Costs and Coverage Among Medicare Beneficiaries in Traditional Medicare and Medicare Advantage. https://www.kff.org/health-costs/dental-hearing-and-vision-costs-and-coverage-among-medicare-beneficiaries-in-traditional-medicare-and-medicare-advantage/
[11] KFF. Medicaid Benefits: Hearing Aids and Other Hearing Devices.https://www.kff.org/medicaid/state-indicator/hearing-aids/?currentTimeframe=0&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D
[12] U.S. Food and Drug Administration. (2023). OTC Hearing Aids: What You Should Know. https://www.fda.gov/medical-devices/hearing-aids/otc-hearing-aids-what-you-should-know
