Former president Jimmy Carter, 91, told the New Yorker recently that 90 percent of the arguments he has with Rosalynn, his wife of 70 years, are about hearing. “When I tell her, ‘Please speak more loudly,’ she absolutely refuses to speak more loudly, or to look at me when she talks,” he told the magazine. In response, the former first lady, 88, declared that having to repeat things “drives me up the wall.” Yet after both went to the doctor, much to her surprise, “I found out it was me!” she said. “I was the one who was deaf.”
Age-related hearing loss is like that. It comes on gradually, often without an individual’s realizing it, and it prompts a range of social and health consequences. “You don’t just wake up with a sudden hearing loss,” says Barbara Kelley, executive director of the Hearing Loss Association of America. “It can be insidious. It can creep up on you. You start coping, or your spouse starts doing things for you, like making telephone calls.”
An estimated 25 percent of Americans between ages 60 and 69 have some degree of hearing loss, according to the President’s Council of Advisors on Science and Technology. That percentage grows to more than 50 percent for those age 70 to 79, and to almost 80 percent of individuals older than 80. That’s about 30 million people, a number likely to increase as our population ages.
Behind these statistics are disturbing repercussions such as social isolation and the inability to work, travel or be physically active.
“It’s not just about the inability to communicate,” says James Battey Jr., director of the National Institute on Deafness and Other Communication Disorders. “It has a broader impact on individuals’ lives. It makes them uneasy participating in activities where hearing is important, such as any kind of social interaction — going to parties or going out to dinner in a restaurant where background noise might make it difficult to engage in a conversation. It also can be dangerous — for example, not being able to hear a warning siren.”
Studies have shown that hearing loss is associated with depression and the early onset of dementia and that it can increase by threefold the risk of falling, “because you need your ears as well as your eyes and feet to maintain a sense of balance,” says Charlotte Yeh, chief medical officer for AARP Services. “Hearing is extraordinarily important to health and social well-being.”
Most important, “these effects could potentially be reduced with hearing-loss treatment,” says Frank R. Lin, an associate professor of otolaryngology at Johns Hopkins, who is designing a clinical trial to determine the extent to which treatment could forestall and reduce the risk of cognitive decline and dementia among older adults.
In June, the National Academies of Science, Engineering and Medicine released a report describing hearing loss as “a significant public health concern,” and recommended removing barriers that make it difficult for people to receive care.
These barriers include the price of hearing aids, which can be very expensive and are not covered by Medicare or by many private health plans. The report also called on the Food and Drug Administration to remove the requirement that adults have a medical evaluation before buying a hearing aid, and to establish a new category of over-the-counter wearable hearing devices — separate from hearing aids — that could help people with mild to moderate impairment.
Individuals generally pay a single charge for hearing aids and all associated fitting services, according to Lin, who served as a member of the National Academies panel.
“The average cost of two hearing aids is about $4,700, which is absurd . . . [because] hearing aids, when purchased in bulk, cost about $400 for a pair,’’ Lin says. “One possibility for a model of insurance coverage would be for insurance companies to routinely provide coverage of audiologic services and possibly just a set amount of reimbursement for the actual hearing aid.’’
Original Medicare has always excluded hearing aids and fittings, although the program does cover exams prescribed to determine whether a person needs medical treatment. Some Medicare Advantage plans, which often offer additional benefits and are alternatives to original Medicare, may cover hearing aids. Medicaid sometimes covers hearing aids, depending on state requirements.
“There’s been an overwhelming tendency until just recently to view hearing loss as being an inevitable and hence relatively inconsequential part of aging,’’ Lin says. “This impression, as well as the lack of effective therapies for age-related hearing loss at that time, served as the rationale for excluding coverage from Medicare. . . . Both of these assumptions have now radically changed.’’
Many private insurers also exclude hearing aid coverage, although three states — New Hampshire, Rhode Island and Arkansas — require insurers to cover some related costs, according to AARP, which offers advice on getting financial help and sponsors a discount hearing-aid program for its members. The Hearing Loss Association of America also has a website with guidance on how to obtain financial assistance for hearing aids. The assistance is mostly available for children and low-income adults.
Fewer than a third of Americans older than 70 who could benefit from hearing aids have ever used them, according to Battey. In addition to the expense and the requirements for obtaining the devices, “it is also a stigma, although I have never understood why the same stigma is not associated with putting on a pair of eyeglasses,’’ Battey says. “My own dad had significant hearing loss, and I could not convince him to use a hearing aid. He had plenty of resources to buy any device he needed, and he just wouldn’t do it.’’
Battey and others believe that increased public awareness, including intervention by primary-care doctors, could encourage more people to seek help. “There should be no shame,’’ Battey says. “Just like other things that deteriorate as we age, hearing is no different. It’s a health issue. It’s a safety issue, and it’s a quality-of-life issue.’’