ESSENTIALS OF DIAGNOSIS
Hearing loss is a common but underrecognized medical problem in older adults.
Screening can and should be done during routine office visits and takes just a few minutes.
Patients with a positive screen should be referred to an audiologist and counseled on the impact hearing loss has on overall health.
Providers can take simple steps to improve communication with individuals with hearing loss, including making their setting hearing friendly through minor modifications.
Hearing loss is highly prevalent in older individuals but is often overlooked as a potential contributor to morbidity in this population. In the United States, an estimated 26.7 million adults 50 years of age or older suffer from bilateral hearing loss of 25 decibels (dB) or greater. The prevalence of hearing loss increases dramatically with age, affecting approximately 45% of adults in their 70s and up to 80% of adults over age 85. Interestingly, the percentage of older adults who self-identify as hearing impaired is much lower; only about one-third of older adults in their last 2 years of life report fair or poor hearing. Although the hearing of many of these individuals could be helped with current technology, evidence suggests that this population is vastly undertreated. For example, approximately 67% to 86% of adults in the United States who might benefit from hearing aids do not use them. The stigma associated with hearing loss and hearing aid use impacts access to care and use of hearing aids and reinforces the importance of the health care provider’s role in helping individuals realize that hearing loss is a health concern.
Hearing loss affects an individual’s ability to communicate effectively but is often erroneously perceived as a normal part of aging, both by patients and health care providers. However, current evidence points out its negative health effects. Studies show that hearing loss can lead to social isolation, depression, and increased cognitive effort. It has also been associated with poorer cognitive function and increased falls. Older individuals in their last 2 years of life who self-report hearing loss also report lower life satisfaction when compared to peers. Such significant negative outcomes warrant routine screening for and treatment of hearing loss in patients.
Age-related hearing loss (ARHL) in older adults represents the sequelae of multiple insults that can progressively damage the cochlea over time superimposed on age-related changes. Although many of these factors cannot be modified (eg, intrinsic aging of the cochlea, sex, genetic predisposition), several factors (eg, noise exposure, ototoxic medication use, cardiovascular health) can be controlled and are discussed in the following sections.
Patients are often unaware of their hearing loss, especially when it progresses gradually over many years. ...