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As we get older, everything doesn’t necessarily age like fine wine. Reading glasses, back pain, and a slower metabolism are some of the first and most common things you might notice. Hearing loss may be another.

A recent study reported that 4.6 million Canadians, 20-79 years old have measurable hearing loss. Reported hearing loss significantly rises to two-thirds in those aged 70-79.

Common symptoms of age-related hearing loss often happen gradually and include:

• Complaining of muffled sound and speech
• Trouble hearing words in settings where there is background noise, like a restaurant or crowd.
• Repeatedly asking people to speak louder, slower, or clearer
• Turning up the volume on the TV
• Avoiding group conversations and social settings
• Many might ignore these symptoms believing they are manageable. Others afraid of appearing older by using hearing aids will continue to just live with hearing loss, believing that the decision will not have any long-term consequences. Recent research connecting hearing loss to dementia may change that.

A study published in July 2021, out of the University of Oxford, looked at over 82,000 participants aged 60 years and older. Findings showed people who struggle to hear speech in noise were more likely to develop dementia than those with normal hearing, as measured over an 11-year period. Before we look further into the research let’s define what dementia is and the impact it has on people’s lives.

What is Dementia?

The Mayo Clinic defines “Dementia[s] as a term used to describe a group of symptoms affecting memory, thinking, and social abilities severely enough to interfere with your daily life. It isn't a specific disease, but several diseases [that] can cause dementia.”

Worldwide, around 50 million people suffer from dementia. The most common of these is Alzheimer’s, Vascular Dementia, and Parkinson’s. The symptoms of dementia can be devasting to those affected and their loved ones. Memory loss, difficulty communicating, inability to handle complex tasks, confusion, and agnosia – the inability to remember objects or people. Dementia can also have severe psychological impacts including changes in behaviour, depression, hallucinations, mood swings, and anger.

How is Dementia Linked to Hearing Loss?

The causes of Alzheimer’s, Vascular Dementia, and Parkinson’s vary and are not well understood. A report produced by the Lancet Commission called Dementia Prevention, Intervention and Care was released in 2020, sharing the risks of dementia. It found that 60% were unknown, and 40% could be broken down into “12 modifiable risk factors.” Some of these included less education, brain injury, social isolation, and depression. But the highest percentage went to hearing loss, representing 8% of the modifiable risk factors. Specifically midlife untreated hearing loss.

This study is not alone in its findings. John Hopkins University tracked 639 adults for almost 12 years. Dr. Frank Lin and his research team found that the degree of hearing loss increased the risk factor for dementia:

• Mild hearing loss doubled the risk.
• Moderate hearing loss tripled the risk.
• While severe hearing impairment increased the risk up to five times compared to those who had no hearing impairment

“Brain scans show us that hearing loss may contribute to a faster rate of atrophy in the brain. Hearing loss also contributes to social isolation. You may not want to be with people as much, and when you are you may not engage in conversation as much. These factors may contribute to dementia,” Lin says.

Another study led by Jonathan Peelle conducted brain scans of older adults. Participants listened to different sentences, that changed in complexity while being scanned. Tests were also done to measure “grey matter” or regions of the brain involved in muscle control. Further tests looked at the senses, seeing and hearing, memory, and decision-making. Findings showed the brain cells of people with hearing loss were less active when they listened to complex sentences. They also had less gray matter in the auditory areas of the brain.

Can Hearing Aids Help Against Cognitive Decline?

Although much work remains to be done, preliminary research is showing positive results that wearing hearing aids can lower the risks of cognitive decline. A meta-analysis of 31 studies published in 2022 demonstrates a convincing link, most likely attributed to how hearing aids and cochlear implants make it easier to prevent isolation and stay socially engaged. Two other modifiable risk factors in developing dementia.

A large 2018 study looked at the results from more than 2,000 Americans aged 50 and up who took word recall assessments every two years for almost 20 years. Among participants who started wearing hearing aids during the period, the results suggested that the aids slowed the rate they lost memory of words.

Circling back to Dr. Lin’s work at Johns Hopkins it is hopeful we will have more evidence in 2023.  A large National Institute on Aging study is looking to understand if hearing aids can protect the mental processes of those aged 70-84. The study is pulling nearly 1,000 people with hearing loss from multiple locations. One set are provided hearing aids while the other set only receives education. It is hoped the study will provide definitive results on whether wearing hearing aids can reduce the risk of brain aging and dementia.

What’s Holding People Back from Hearing Aids?

Aside from the connection to dementia hearing loss can cause other problems in perfectly healthy Canadians. Social isolation, depression, mobility issues, and fatigue to name a few. In fact, a whopping 80% of those estimated 4.6 million Canadians don’t wear hearing aids. So why aren’t people getting the help they need?

Common answers include:

My hearing isn’t that bad. It seems to take time for people to process and get a handle on hearing loss. StatsCan reports, even once hearing loss is suspected, there is still on average a delay of seven years or more before an individual seeks help.

Hearing aids are for old people. Aging is hard to accept, and traditionally most people that wear hearing aids are over 70. If you are one of the unfortunate and start to lose your hearing long before that, hearing aids may come with a “senior” stigma attached to them.

Hearing aids are big and ugly. Today’s technology has improved the look and capabilities of hearing aids and cochlear implants (a device implanted into the inner ear and stimulates the hearing nerve. It’s for children and adults with profound hearing loss.) There are even products on the market that are advertised as the “invisible hearing aid” that fit so deeply in your ear canal that you can hardly see them from the outside.

Hearing aids are difficult to use. Many people do not like to learn new things. As with any technology there is an adjustment period while you learn how to use it. Most doctors and hearing clinics allow for a trial period until you can find the best product for you.

Knowing the Risks, What Should You Do?

Well for starters get your hearing checked. Regular hearing tests in your 30s, 40s and 50s should be part of your health regiment, like eye exams and yearly check-ups with the family doctor. You can even check your hearing with a free online hearing test. If the results aren’t perfect, booking an appointment at a local hearing clinic is covered by your health benefits.

What If I Need Hearing Aids? Are they Covered in Ontario?

OHIP provides some coverage of hearing aids for every resident despite age, through the Assistive Devices Program (ADP). ADP provides a grant of $500 per ear, once every 3 years if required. You just need to fill out the forms given to you by your audiologist. Once you have your hearing aids, the audiologist will bill OHIP directly.

Most private insurance companies provide coverage ranging from $500 to $1500 per hearing aid. Workplace benefits packages also offer some coverage ranging from $300-$500 over 2 years but are often shared with hearing aid repairs.

The cost of hearing aids in Ontario is not insignificant and varies widely depending on the technology, brand, and features. On average, a hearing aid can cost between $2500 to $3500, but be as low as $1000 or as high as $8,000. Premium tech will come with a higher price tag, while basic hearing aids with fewer bells and whistles tend to be less expensive.

Keep the Big Picture in Mind

Knowing all the hang-ups, inconveniences, and expenses that can come with hearing aids, we need to remember the quality of life today and in the future. More and more research is showing us that hearing loss represents 8% of the modifiable risks for dementia AND not treating hearing loss can contribute to another 4% from social isolation.

As a society, we need to start normalizing hearing tests, offer more support for those with hearing loss and encourage governments and insurance plans to provide more coverage. HearingLife Canada reports if we treated all hearing loss cases nearly 1 in 10 dementia cases could be eliminated. The impact of dementia on people, families, society, and the healthcare system far outweighs the stigma and costs of hearing aids.