Sometimes the changes that affect the well-being of our loved ones come about so slowly that we don’t understand what’s happening. Even being a medical professional didn’t make me immune from misunderstanding what was happening to my father.
For many years it was clear that my father was progressively withdrawing from the world. Normally gregarious and the life of the party, he became increasingly quiet. A couple of years ago, Dad, now in his 80s, began to walk with a shuffling gait, with painfully slow movements.
When we exchanged e-mails, he still had all of his sharp intellectual curiosity, profound insights on the community and warm storytelling skills; but in person, he was fading away. I was especially shocked and saddened to observe him at the wedding reception of a close friend of mine, sitting quietly in a corner, excluding himself from the festivities and happy conversations.
My “diagnosis” was no different from those of his friends and other family members: He was certainly suffering from the inevitable mental and physical effects of the aging process. Maybe even the beginnings of dementia.
And, oh, yes: Like many people his age, Dad was losing his hearing. He frequently asked us to repeat ourselves, and he always turned the television volume up to levels that made others wince. Every now and then he ordered one of those $200 gadgets he saw advertised on TV, only to throw it away when it failed to solve his problems. Mom and I suggested — all right, strongly suggested — several times that he get a real hearing aid, and he would counter that they were very expensive and didn’t really work.
And besides, he would add, his hearing wasn’t really that bad.
I failed to put the puzzle together until I went to work for an organization that specialized in the medical and lifestyle challenges — including hearing — of older people. I am chief medical officer for AARP Services, which manages relationships with providers of the products and services carrying the AARP brand, including a hearing-care program that includes discounts on hearing aids. Some revelatory studies and findings began crossing my desk.
My dad’s situation became an aha moment for me —as a daughter and a doctor. To my astonishment (and some embarrassment), I realized that hearing loss, which often is fairly easily alleviated, is about more than it seems. And it continues to be a largely hidden psychological and societal problem. These days, hearing loss or the prospect of hearing loss doesn’t affect only people age 70 and older. It also affects their baby-boomer children and anybody else who is either a parent or a caregiver or a dependent.
In short, just about everybody.
According to the National Institutes of Health, nearly 25 percent of Americans ages 65 to 74 and 50 percent of those who are 75 and older have a disabling form of hearing loss, and about 15 percent of Americans between 20 and 69 have high-frequency hearing loss due to noise exposure — not surprising, considering decibel levels produced by sports events, ear buds, rock concerts and even hair dryers.
And earlier this year the World Health Organization warned that 1.1 billion young people are now at risk of losing their hearing because of exposure to unsafe volume levels in personal audio devices like smartphones and ear buds.
Hearing loss brings with it cascading medical, emotional and social side effects. Hearing loss affects communication, so it is not surprising that several studies as well as consensus among medical professionals point to a strong association between hearing loss and depression.
One recent medical survey published by NIH showed the likelihood of depression increases as hearing declines. Depression was present in about 5 percent of respondents who reported excellent hearing and in more than 11 percent of those who said they also had hearing loss.
A study at the Johns Hopkins School of Medicine found that older adults with hearing loss experienced higher rates of hospitalizations for other serious illnesses than those without. According to a study that surveyed adults with Medicare Supplement plans, hearing loss has a greater impact on quality of life than diabetes, heart disease, coronary artery disease or hypertension.
Why don’t these warnings about hearing loss get, well, heard? Hearing issues tend to hide in plain view. There are no colored ribbons for hearing loss; the changes can be gradual, without the stunning suddenness that can inspire high-profile public awareness campaigns.
And yet, even with the rapid growth of hearing technology and the growing understanding of how hearing impacts health, social engagement and well-being, the uptake of hearing testing and treatment isn’t growing at the same pace.
For many, hearing difficulties and hearing aids or devices are an embarrassing sign of aging and approaching death. A 2011 poll by AARP and the American Speech-Language-Hearing Association found that more adults 50 and older reported having had a colonoscopy (58 percent) or cholesterol screening (81 percent) than a hearing test (43 percent).
Knowing about flawed hearing’s ties to depression and other health issues means paying close attention to the people in your life, young and old. Other than the obvious but unsubtle “Mom, turn the TV down. You need a hearing aid,” we should take a softer approach and look for other clues. People with hearing loss tend to avoid interactions with others because they can’t hear. They might blame others for mumbling or not speaking clearly.
Family physicians have no problems discussing hearing loss with their patients, especially if asked. Most will refer them to an ear, nose and throat specialist or to an audiologist, an expert in diagnosing and measuring hearing loss. If necessary, the audiologist will suggest what type of hearing aid is most appropriate.
The bad news is that Medicare and many private insurance plans will pay for hearing exams but not for hearing aids. And most real hearing aids are not inexpensive. The better news is that today’s hearing technology, while not perfect, is much, much better than the bulky amplifiers that predominated in our grandparents’ time.
Old-fashioned hearing aids merely turned up the volume of all the sounds entering the ear. Today the technology includes devices that filter out background noise and let the wearer concentrate on what he wants to hear or adjust to different environments.
Hearing devices can initially be frustrating or annoying to wear, but almost always, patience and a breaking-in period will overcome that. Remember that when one has hearing loss, the brain is not receiving sounds as it once did. Therefore, one has to almost relearn how to hear, which takes practice.
Of course, the best approach is to protect your hearing. Hearing loss is more likely as we age, but its onset and severity can be the outcome of some of our actions.
How loud do you turn up the sound when you are wearing ear buds? If others can hear your music, clearly your volume is too loud. When was the last time you wore earplugs at a concert, loud bar or sports stadium to protect your hearing?
But back to Dad.
One evening Mom called me, alarmed, that Dad hadn’t responded when she had rung the doorbell at their home. The implications for a fire or other emergency were frightening.
After much prodding, I persuaded my father to get a pair of hearing aids. After they arrived, he worked with a CD-based training program to help him adjust to this new way of hearing.
At a family reunion a month later, there was my father sitting at the breakfast table regaling everyone with stories of his mischievous childhood; he was the center of attention. And he could hear his children and grandchildren.
Moreover, when he stood up, he stood taller and walked with a surer footing, reminiscent of the father of my youth. To be able to rejoin society and one’s own family has a powerful impact, emotionally, socially and physically.
The father I knew had returned.
Yeh is AARP Services’ chief medical officer.