Putting hearing on the agenda

It is vital that older adults including people living with dementia or other complex health requirements are not excluded from hearing healthcare services, writes Dr Caitlin Barr.

Hearing loss is one of the most common long-term health conditions associated with ageing and a major contributor to the disease burden of older Australians. Yet age-related hearing conditions are often under-reported and their impact under-recognised.

There is low uptake of assistive devices by older adults with hearing loss, and little understanding of the need for services to support their use.

Anne, talking about her mother’s hearing aids: “They lived in the drawer. She didn’t feel comfortable going back to the provider for any adjustments, so she just put them away.”

Having trouble understanding conversations in noisy places is often a person’s first indication they have hearing loss.

As hearing loss progresses, communication difficulties are more likely even in quiet settings. There is a common misconception that hearing aids return hearing to normal and that nothing else is needed to support communication.

“I was at a birthday dinner with my family and had my hearing aids in because I wanted to hear everything. My sons had been talking to each other, but because of all the background noise and my tinnitus I hadn’t heard them. When I asked a question, my sons told me I obviously hadn’t been listening. That night I went home and cried. My wife called my sons and explained ‘Dad couldn’t hear you, but he was listening’.” Steve, aged 70.

Hearing loss may have profound implications for an older person’s general health and daily life. It can be a barrier to understanding public health messages and accessing healthcare.

The pandemic has increased these barriers. Masks impede effective communication by both muffling speech and reducing contextual cues, while an increasing reliance on telehealth – either via phone or the internet – has proved difficult for older adults with hearing loss to navigate.

Many of the consequences of untreated hearing loss are recognised risk factors for cognitive decline and dementia. Hearing loss is also linked to balance problems and an increased risk of falls.

Hearing loss quiets the subtle cues that help with balance as well as making it harder for the brain to process sound. This subconscious multitasking may interfere with some of the mental processing needed to walk safely. Thus, older adults with hearing loss may reduce their outside activities or find their mobility at home affected.

Supporting people with hearing loss

“The next time someone doesn’t appear to hear you, be patient, make sure you have their attention and try to communicate again. It can be the little things you do to change your way of communicating that have the greatest impact.” Hannah, hearing aid wearer.

Early detection of hearing loss is crucial to improving health outcomes. App-based screening tools enable initial screening to occur in a wide range of settings. Hearing services are subsidised for eligible adults and most audiology clinics offer low-cost or free initial hearing tests.

Hearing healthcare does not rely solely on provision of hearing aids; many other options are available. It is vital that older adults, and people living with dementia or other complex health requirements, are not excluded from such services simply because of their age, capacity or functional limitations.

Spaces with hard surfaces, loud background noise and low lighting that obscures visual cues are indicative of design decisions that don’t support communication.

In residential care, universal design has an important role to play in supporting people with hearing loss.

“When we are talking about physical accessibility, putting a ramp into a building is something that people get. But where is the consideration in terms of communication access?” Sarah, who lives with significant hearing loss.

Find out more on a public health approach for equitable, person-centred solutions

Dr Caitlin Barr is CEO of Soundfair and a leading researcher in person-centred hearing care. Soundfair exists to eliminate the social and emotional impacts of hearing conditions, and create a world of sound accessibility for everyone – particularly those most vulnerable – through connection and participation.

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