Hearing Loss in Older Adults: A Home Care Guide

Signs of hearing loss

• Asking people to repeat themselves, or answering wrongly.
• Turning the television or radio loud; family finding it uncomfortable.
• Difficulty following conversation in groups, markets, restaurants or at weddings, or on the phone.
• Hearing but not understanding, especially with background noise.
• Not hearing the doorbell, phone, alarm, pressure cooker whistle, kettle or traffic.
• Complaining that people mumble, or withdrawing from social events.
• Feeling tired after conversations from the effort of listening.
• Ringing, buzzing or hissing in the ears (tinnitus).
• Speaking too loudly, or unusually quietly.

Because hearing loss is gradual, the person may not notice. See does hearing loss affect seniors and learn the reasons seniors around the globe are troubled with hearing loss.

Causes

• Age-related changes in the inner ear, the commonest cause.
• Noise damage from years in mills, traffic, drilling, loud music or firecrackers.
• Ear wax blocking the canal; see ear wax and hearing.
• Ear infections, fluid behind the eardrum or a perforated eardrum.
• Medicines that can harm hearing; some antibiotics, diuretics, painkillers and cancer drugs. Never stop a medicine yourself; report any new hearing change to the doctor.
• Illnesses: diabetes, high blood pressure, heart disease, kidney disease and smoking all raise risk.
• Head injury, tumours (rare) and inherited conditions.
• Sudden hearing loss, which is an emergency (see below).

See hearing loss: types, treatment, causes and symptoms.

Getting tested

Ask the family doctor or visit an ENT specialist or audiologist. A hearing test, painless and short, shows the type and degree of loss in each ear. The doctor will examine the ears for wax and infection first. Expect to be asked about medicines, noise exposure, dizziness and tinnitus. A person with hearing loss should have regular checks, usually yearly, and should be tested if there is any change; see hearing test: what to expect and hearing and vision checkup schedule. Treat people with dementia or confusion with extra care, since hearing loss may be mistaken for memory loss or worsen it; see hearing aids and dementia risk.

Options for treatment

• Wax removal by a doctor or trained nurse. Do not poke the ear with pins, matchsticks, hairpins or cotton buds, and avoid ear candles; see ear wax and hearing.
• Treating infection or fluid as the doctor advises.
• Hearing aids: the main treatment for age-related loss. Modern aids come in several styles, behind the ear, in the canal and others. An audiologist fits and tunes them. See hearing aid buying guide, ideal types of hearing aids for our ears and hearing aid or personal sound amplifier. A simple amplifier is not a substitute for a tested hearing aid in moderate or severe loss.
• Cochlear implants may be considered for severe or profound loss that aids cannot help.
• Assistive devices: amplified phones, TV headphones or streamers, flashing doorbells, vibrating alarms and captioning; see amplified phone guide and tv headphones for hearing loss.

Helping your parent accept and use hearing aids

Many people resist hearing aids because of stigma, cost, a previous poor experience or the belief that they are "not that deaf". Be patient.

• Start with the benefits: hearing grandchildren, joining conversations, feeling safe.
• Go together to the appointment, and offer to wear a trial aid yourself to understand the experience.
• Expect an adjustment period. Sounds seem loud and strange at first as the brain relearns; begin with a few hours a day in quiet rooms, then increase; see first weeks with a hearing aid.
• Follow-up visits for fine-tuning are essential; many complaints are fixed by adjustment.
• Daily care: clean as shown, keep dry (avoid wearing during bathing, rain and heavy sweating), store at night in a dry case, check and change batteries or recharge, keep away from children and pets; see hearing aid care and batteries.
• Whistling or discomfort needs an audiologist, not abandonment of the aid.
• Labelling: write the person's name inside the case; keep spare batteries.
• Where the person has dementia or poor dexterity, a carer should check that the aids are in, switched on and working each morning.

Communicating well

Small habits help a great deal:

• Face the person, at eye level, in good light so that they can see your lips and expressions. Do not cover your mouth.
• Get attention first by a gentle touch or by saying their name before you speak.
• Speak clearly and a little slower, at a normal or slightly raised volume; do not shout, which distorts sounds and can sound angry.
• Rephrase rather than repeating the same words if not understood; use shorter sentences and key words.
• Reduce background noise: turn off the television or fan, move to a quieter room, avoid speaking while running water or in a busy kitchen.
• One speaker at a time in group conversation; ask others to wait their turn.
• Check understanding gently by asking them to say what they heard, particularly for medicines, appointments and safety instructions.
• Write down important information.
• At gatherings: seat the person near the speaker, away from loudspeakers and music, and give them a quiet break.
• On the phone: speak slowly, use video calls where possible for lip-reading and use captions or text messages.
• Be patient and respectful: never talk about the person as though they were absent, and avoid the phrase "never mind".

See caring for a parent with hearing loss and dementia communication tips.

Safety at home

• Alarm and doorbell: use a loud or flashing doorbell, vibrating alarm clock and a smoke alarm with a strobe or bed shaker if loss is severe; see home safety for seniors living alone.
• Emergency help: a person who cannot hear on the phone should have a way to call for help that does not depend on hearing, such as a pendant or an SMS plan; see medical alert pendant guide.
• Traffic: road crossing and walking near vehicles is risky; accompany or choose quiet routes.
• Medicine instructions: give them in writing; use a pill organiser; see pill organiser guide.
• Falls: hearing loss affects balance awareness and attention; review fall risk; see falls risk assessment at home.
• Hospital visits: tell staff at the outset and ask them to face the person and write key points down.
• Scams: people who struggle to hear on the phone may be more vulnerable; agree a "call back" rule.

Tinnitus and dizziness

Tinnitus (ringing, buzzing or hissing) is common and often linked with hearing loss. It is usually not dangerous but can disturb sleep and mood. See a doctor if it is in one ear only, pulsing with the heartbeat, sudden, associated with hearing loss or dizziness, or causing distress. Background sound at night, relaxation and treatment of hearing loss can ease it. Avoid unproven remedies and supplements. For spinning dizziness, see vertigo, BPPV and balance.

Emotional and social effects

Hearing loss can cause embarrassment, frustration and isolation, and families may feel irritated by repeating themselves. Remember that exclusion hurts. Include your parent in conversation, explain jokes and decisions, and encourage activities that fit, such as small gatherings, hobbies and clubs. Watch for withdrawal and low mood; see hearing loss and social isolation, loneliness and isolation in older adults and depression in older adults.

Urgent signs

See a doctor or ENT specialist the same day for: sudden hearing loss in one or both ears over hours or days (it is a medical emergency, as early treatment may help recovery); sudden loss with ringing and dizziness; ear pain with discharge or fever; blood or fluid from the ear after injury; facial weakness; or severe dizziness with vomiting. Call 112 if sudden hearing loss comes with a face drooping, arm weakness, speech difficulty or severe headache, since these may be signs of a stroke; see stroke warning signs and the first hour. Protect ears from loud noise; see five precautions seniors can take to prevent hearing loss.

When to ask a professional

A family doctor examines the ears and refers. An ENT specialist diagnoses and treats ear disease. An audiologist tests hearing and fits devices. A speech and language therapist helps with communication strategies. For senior services, call Elderline 14567. In an emergency, call 112.