Mark Hammel’s hearing was damaged in his 20s by machine gun fire when he served in the Israeli Army. But not until decades later, at 57, did he receive his first hearing aids.
“It was very joyful, but also very sad, when I contemplated how much I had missed all those years,” Dr. Hammel, a psychologist in Kingston, N.Y., said in an interview. “I could hear well enough sitting face to face with someone in a quiet room, but in public, with background noise, I knew people were talking, but I had no idea what they were saying. I just stood there nodding my head and smiling.
“Eventually, I stopped going to social gatherings. Even driving, I couldn’t hear what my daughter was saying in the back seat. I live in the country, and I couldn’t hear the birds singing.
“People with hearing loss often don’t realize what they’re missing,” he said. “So much of what makes us human is social contact, interaction with other human beings. When that’s cut off, it comes with a very high cost.”
And the price people pay is much more than social. As Dr. Hammel now realizes, “the capacity to hear is so essential to overall health.”
Hearing loss is one of the most common conditions affecting adults, and the most common among older adults. An estimated 30 million to 48 million Americans have hearing loss that significantly diminishes the quality of their lives — academically, professionally and medically as well as socially.
One person in three older than 60 has life-diminishing hearing loss, but most older adults wait five to 15 years before they seek help, according to a 2012 report in Healthy Hearing magazine. And the longer the delay, the more one misses of life and the harder it can be to adjust to hearing aids.
As Dr. Hammel put it: “I had lost the habit of listening. After I got the aids, it took me a long time to get back into the habit of paying attention to what people were saying.”
The author of the Healthy Hearing report, Debbie Clason, pointed out that “the sooner you get help for your hearing impairment, the easier it will be for your brain to use the auditory pathways it’s developed for processing sound.”
The National Register of Health Service Psychologists states in an online continuing education course, “For the majority of people with hearing loss, the difficulties faced can wreak havoc in a person’s life.” Yet, the register added, “many people who have hearing loss are not aware of it, do not accept the fact of it, or are unwilling to discuss their hearing loss.”
In a large survey by the National Council on the Aging, two-thirds of older adults with untreated hearing loss explained their reluctance to get a hearing aid with statements like “my hearing is not bad enough” or “I can get along without one,” and one person in five said things like “it would make me feel old” or “I don’t like what others will think about me.”
However, those in the survey who had hearing aids were, on average, more socially active and less likely to be depressed, worried, paranoid or insecure, and their family members and friends were even more likely than they were to have noticed these benefits.
The findings of the survey, conducted among 2,096 hearing-impaired people and 1,710 of their family members and friends, and funded by the Hearing Industries Association, a trade group, were published in 1999, but experts say little has changed in people’s attitudes and treatment of hearing loss.
Many who are hard of hearing don’t realize how distressing it is to family members, who typically report feeling frustrated, annoyed and sad as a consequence of communication difficulties and misunderstandings.
For the hearing-impaired person, confusion, difficulty focusing and distracting thoughts are common cognitive impairments, Andrea Ciorba of the University Hospital of Ferrara in Italy and colleaguesreported in Clinical Interventions in Aging. Other frequently reported problems include an inability to think straight and difficulty making decisions.
When people can’t hear what is being said, they may become anxious and even suspect that others are talking about them behind their backs or saying things others don’t want them to hear. Anger, embarrassment and a loss of self-esteem are common emotional fallout.
Links have also been found to an increased risk of dementia, which is not surprising given the diminished cognitive input among those with untreated hearing loss. In a 2013 study of 1,984 older adults living independently and followed for 11 years with repeated cognitive examinations, “rates of cognitive decline and the risk for incident cognitive impairment were linearly associated with the severity of an individual’s baseline hearing loss,” Dr. Frank R. Lin of the Johns Hopkins Center on Aging and Health and his colleagues in the Health ABC Study Group reported.
Untreated hearing loss can have physical consequences as well, including excessive fatigue, stress and headaches, which may result from trying so hard to hear and understand spoken language. One recent study found that moderate to severe hearing loss was associated with a 54 percent increased risk of death, and mild hearing loss with a 27 percent increased risk of death, compared with individuals with normal hearing. Affected individuals also report more problems with eating, sleeping and sex, according to Deborah Touchette, an audiologist in Paradise, Calif.
Working people with poor hearing are more likely to earn less than those with good hearing; they may even risk losing their jobs if the work depends on good communication.
“If the boss says, ‘Don’t go over $15,000 on that contract,’ and the employee hears $50,000, there is a potential for problems,” the national register wrote. A 2011 study by the Better Hearing Institute, the educational arm of the Hearing Industries Association, found that untreated hearing loss adversely affected productivity, performance and career success, and was associated with a loss in annual income that could reach $30,000. Those in the study with severe hearing loss were twice as likely to be unemployed as people with normal hearing and nearly twice as likely to be out of work as their peers who used hearing aids.
There are safety issues, too, for someone who may miss auditory signals important for survival, like alarms, car horns and shouts of warning, as well as the potential impact of missing sounds like the ringing of a telephone, doorbell or alarm clock.