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Why Older Americans Don't Get Hearing Aids

Many older adults think it’s normal to lose some hearing ability. If a majority of older people have hearing loss – and 55 percent of those over age 70 do — then it can’t be that harmful, right?

Wrong. Because the ear plays a role in balance, hearing loss can lead to falls. “Even mild hearing loss can triple the risk of falling,” said Dr. Frank Lin, professor of otolaryngology and epidemiology at Johns Hopkins University, citing his own research.

And then there is the mysterious link to dementia. Some studies have suggested that mild hearing loss is linked to a doubling of dementia risk, and that moderate hearing loss can triple it. With severe hearing loss, the risk can be five times as high, according to Dr. Lin’s 2011 study in Archives of Neurology and a report last month in The Journal of the American Medical Association.

It is possible that hearing loss leads to social isolation, itself a risk factor for dementia, said Dr. Lin.

In addition, few people realize that delayed treatment may make hearing loss worse. “If you don’t use it, you’ll lose it,” said Dr. Linda S. Remensnyder, audiologist. “I have a retired nurse, age 90, who has lived alone with no auditory stimulation for years. She doesn’t understand 50 percent of the words, and I can’t reverse that now.”

Even among the enlightened, hearing aids still carry a stigma. “Men think, ‘It’s a sign of weakness,’ and women think, ‘It’s showing my age,’ ” said Dr. Hagberg. Anyone over 60 remembers when the words “deaf and dumb” were always uttered together – and “dumb” was not used to mean “mute.”

Vanity, too, is still a deterrent. But that may be receding now that new hearing aids are smaller and less visible than ever. Besides, it’s increasingly commonplace to see young and old alike walking around with devices plugged into their ears. (A good thing, too, because the bigger, more noticeable devices tend to produce better sound.)

Money can also be a serious obstacle. Hearing aids can run from $1,800 to $6,800 or more per pair, according to Consumer Reports. They are not covered by Medicare or most insurance. (Caregivers should ask if the audiologist will set up a payment plan – many do.)

Bottom line: Caregivers have a lot of obstacles to overcome, but they also have a lot of ammunition to explain that the health pros in getting hearing help outweigh the cons.

Start with something simple. “Stop being a living hearing aid,” Dr. Hagberg advised. “Everybody has one — a seemingly helpful caregiver, husband or wife who feeds back the information so the other person doesn’t need to seek help.”

Second, “I tell patients who deny they have a problem, even after testing, to go home and pay attention to every time they say, ‘What?’ or they miss the punchline on TV or ask people to repeat something,” said Dr. Hagberg. “They usually come back in a week” – ready for a hearing aid.

Primary care doctors often fail to test for hearing loss. It helps to line up a certified audiologist who is patient and passionate about working with the elderly.

Don’t be fooled by the misconception that hearing aids are plug-and-play. “There’s still an art to programming hearing aids,” said Dr. Remensnyder. “I spend 80 percent of my time making adjustments and showing patients how to use them properly.”

Caregivers and patients alike should be realistic about their expectations. Hearing aids won’t solve everything. As my own mother has pointed out on several occasions, the sound quality can be especially disappointing in noisy restaurants, where the devices cannot filter out much of the background clatter.

Still, a majority of those who finally get hearing aids — and do the necessary follow-up visits with an audiologist — experience positive results, unfortunately mother is not among this group.