Cognitive Wellness in Aging: Hearing and Cognition

Hearing loss affects up to 50 million individuals over the age of 50. By age 65, one in three people has hearing loss. By age 80, hearing loss affects more than 80% of adults. Age-related hearing loss occurs slowly. In fact, for many people, hearing loss occurs so gradually that it goes unnoticed.

Hearing loss can make it difficult to understand and follow a doctor's advice, respond to warnings (like smoke alarms), and hear telephones or doorbells. It can also make it hard to enjoy talking with family and friends, leading to feelings of isolation.²

Beyond social isolation, hearing loss worsens balance and increases the risk of falls. Hearing loss is also associated with cognitive decline and an increased risk of dementia.

To be blunt, untreated hearing loss undermines the health of older adults.  

Yet surprisingly, few people seek treatment to improve their hearing. A study published in 2019 reported that older adults let their hearing decline for an average of 10 years before taking steps to combat their hearing loss.³ Furthermore, only 1 in 7 older adults with hearing loss uses hearing aids.⁴

That’s the bad news.

So, is there good news? Yes! By understanding the relationship between hearing loss and cognitive aging, you can take proactive steps to reduce your risk of impaired hearing and help you maintain a high quality of life in your later years.

Read on to learn about the relationship between hearing loss and cognitive aging.

Key Takeaways

• Hearing conditions like hearing loss, ringing in the ears, and reduced tolerance for sound are common in the population. These conditions can severely impede communication and worsen the quality of life.

• Untreated hearing loss in mid-life is the leading potentially modifiable risk factor for developing dementia in later life and  may account for as much as 8% of dementia cases globally.
  

• Hearing aid use is associated with a 19% reduction in the risk of developing dementia among older adults with hearing loss.

• Hearing aids are effective, and their user-friendliness has increased dramatically in recent decades.

Why does hearing loss occur with aging?

The list of things that cause hearing loss with age is long, including everything from genetics to noise exposure to medications, infections, and even head injuries.

Genetics

• Age-related hearing loss may be as much as 70% heritable.
• Typically, there is no clear inheritance pattern.

Noise Exposure

• Hearing loss can occur with long or repeated exposure to sounds at or above 85 dB.
• Normal conversational tones usually fall between 60 and 70 decibels (dB). Sounds in a movie theater can exceed 100 dB, and sounds from loud motorcycle or dirt bike traffic can approach 110 dB.

• The louder the sound, the quicker the noise exposure can cause hearing loss.

Medications

• Certain classes of medications, some of which are very commonly used, cause hearing loss.

• Over-the-counter pain relievers like acetaminophen and ibuprofen.

• Opioid pain medications.

• “Water pills” like furosemide.

• Antidepressants (eg, Zoloft, Prozac, and Paxil).

• Certain antibiotics (especially those ending in “-mycin,” like streptomycin, erythromycin, and azithromycin).

• Chemotherapy drugs like cisplatin.

• If you experience sudden hearing loss when taking a medication, it is essential to contact your physician immediately.

Infections

• Both viral and bacterial infections can lead to hearing loss.

• Viruses associated with hearing loss are varicella (the virus that causes chickenpox) and West Nile virus, which causes encephalitis (brain inflammation).

• Bacterial infections like Lyme disease and meningitis can cause profound hearing loss.

Head Injury

• Head injuries can cause “cochlear concussion.”

• Symptoms include hearing loss, ringing in the ears, and vertigo.

• This hearing loss tends to resolve in a few months unless the cochlea has been damaged beyond repair.

How do I know if my hearing is declining?

Age-related hearing loss can occur in one or both ears. Initial symptoms might not be evident without a hearing test.

• Difficulty hearing voices on the telephone or understanding companions in loud places, like restaurants.
• Trouble following conversations with multiple people or feeling like others are mumbling or not speaking clearly.
• Frequently asking others to repeat themselves or speak more slowly and clearly.
• Turning up the volume on the television, radio, or other audio devices to levels that others find too loud.
• Trouble understanding children or others with high-pitched voices or hearing high-pitched sounds, like birds singing.
• Lightheadedness or a sensation that the room is spinning around you.

• Ringing, buzzing, or other noises in the ears (tinnitus).
• Avoiding conversations and social occasions due to difficulty hearing.
• Fatigue or stress from straining to hear and understand others.
• Misunderstanding words or responding inappropriately during conversations.

How are hearing loss and dementia related?

Researchers have long known that hearing loss, cognitive decline, and dementia are related. Mounting evidence suggests an important link. Several key studies have contributed to our understanding of this relationship:

• In 2020, the Lancet Commission on Dementia Prevention, Intervention, and Care identified untreated hearing loss at midlife as the most important modifiable risk factor for developing dementia in later life.⁶

• A study published in 2023 found that up to 8% of dementia cases worldwide are due to hearing loss.⁷

• A population study conducted over 25 years with more than 3700 people revealed that dementia occurs more frequently in people who self-report hearing problems, except in people who use hearing aids.⁸
  

• Another study confirmed this finding, reporting that hearing loss and worse cognition were associated only in people who did not use hearing aids.⁹

Do other sorts of problems arise from late-life hearing loss?

According to the National Council on Aging, hearing loss has been linked to increased levels of stress, anxiety, depression, loneliness, and other mental health symptoms. These difficulties worsen over time as long as the hearing loss goes untreated.

Many people who live with hearing loss try to read facial expressions, meet in quiet places for social engagements, and pretend to understand what others are saying. Not surprisingly, these “tricks” often cause embarrassment, awkwardness, frustration, and fears of being found out and misunderstood.

People with mild hearing loss are nearly three times more likely to fall than people with intact hearing. Each 10 decibels of hearing loss carries a 1.4 times higher risk of falling.¹⁰

So, do hearing interventions make a difference?

A study published in 2021 found that hearing aid use was associated with a 19% reduction in the risk of developing dementia in older adults with hearing loss.¹¹

A 2022 study found that cochlear implantation in older adults with severe to profound hearing loss improved cognitive function, including attention and executive function.¹²

A similar study published in 2024 extended this finding, reporting that better hearing after cochlear implants improved quality of life, verbal communication, and ability to function independently.¹³

But I’m worried about how hearing aids look!

Many people hear “hearing aids” and immediately picture old-time devices like ear trumpets or, in more recent years, the big bulky hearing aids that sat atop the ear like an oh-so-very-visible and rather ugly hat. Those older models were clunky, prone to whistling, and relied on environmentally toxic batteries.

Today’s hearing aids are decidedly different. They offer improved performance and are more comfortable than ever.

These are no longer your grandparents’ hearing aids. Modern hearing aids are:

• Smaller and more comfortable than ever before. Most are undetectable to the naked eye. Some hearing aids are now fitted according to laser moldings or other impressions of the ear.
• Sound quality is also better, mainly due to greatly improved computing power in the hearing aid. Modern hearing aids process more sounds faster than ever before in human history.
• Some hearing aids are now rechargeable. Fewer batteries mean less harm to the environment.
• Many hearing aids can connect to smartphones and Bluetooth; some can even be tuned over the internet.
• Modern hearing aids are becoming more “automatic,” meaning they can even sense and adjust to differing levels of ambient noise without “fiddling” by the wearer.

But hearing aids are so expensive!

Medicare and most insurance companies do not cover hearing aids. The resources listed here can be a great place to start when researching affordable hearing aids and audiology care.

Ready to take action to protect your hearing?

You CAN take steps to protect your hearing.

Avoid exposure to loud volumes and other contributing culprits.

• If you must be near loud noise, keep the exposure as short as possible.

• Wear earplugs or earmuffs for protection.

• Keep your ears dry, and avoid using cotton swabs.

• Keep your stress levels manageable.

• And get regular hearing checkups!

Do not ignore the changes if you are already experiencing hearing loss or are concerned that your hearing is worsening.

• An audiologist is a medical professional with expertise in hearing and hearing loss.

• Ask Sunday Health to find an audiologist near you!

Finally, if you prefer to have your hearing checked from the comfort of your couch, you can get your hearing checked over the telephone.

• The National Hearing Test was developed by research sponsored by the National Institutes of Health.

• The test has been validated to measure the loss of speech recognition in noise.

• The test costs only $8. Results are private, and no one will try to sell you anything.

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Do you have another question that the Sunday Health brain health experts can answer? We invite you to send your questions to hello@sundayhealth.com.

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Sources:

World Health Organization. (2021). World report on hearing. World Health Organization.

2. https://www.nidcd.nih.gov/health/age-related-hearing-loss.

3. Reed, N., et al. Trends in Healthcare Costs and Utilization Associated With Untreated Hearing Loss Over 10 Years. JAMA Otolaryngology Head Neck Surgery. January 2019.

4. https://www.hopkinsmedicine.org/health/wellness-and-prevention/the-hidden-risks-of-hearing-loss.

5. Ninoyu Y, Friedman RA. The genetic landscape of age-related hearing loss. Trends Genet. 2024 Mar;40(3):228-237.

6. Livingston G, Huntley J, Sommerlad A, Ames D, Ballard C, Banerjee S, Brayne C, Burns A, Cohen-Mansfield J, Cooper C, Costafreda SG, Dias A, Fox N, Gitlin LN, Howard R, Kales HC, Kivimäki M, Larson EB, Ogunniyi A, Orgeta V, Ritchie K, Rockwood K, Sampson EL, Samus Q, Schneider LS, Selbæk G, Teri L, Mukadam N. Dementia prevention, intervention, and care: 2020 report of the Lancet Commission. Lancet. 2020 Aug 8;396(10248):413-446.

7. Henshaw H, Calvert S, Heffernan E, Broome EE, Burgon C, Dening T, Fackrell K. New horizons in hearing conditions. Age Ageing. 2023 Aug 1;52(8):afad150.

8. Amieva H, Ouvrard C, Meillon C, Rullier L, Dartigues JF. Death, Depression, Disability, and Dementia Associated With Self-reported Hearing Problems: A 25-Year Study. J Gerontol A Biol Sci Med Sci. 2018 Sep 11;73(10):1383-1389.

9. Ray J, Popli G, Fell G. Association of Cognition and Age-Related Hearing Impairment in the English Longitudinal Study of Ageing. JAMA Otolaryngol Head Neck Surg. 2018 Oct 1;144(10):876-882.

10. Lin FR, Ferrucci L. Hearing loss and falls among older adults in the United States. Arch Intern Med. 2012 Feb 27;172(4):369-71.

11. Ye, Q., Zhan, M., Xue, G., Liang, F., Yu, S., Tao, L., & Chen, L. (2021). Association of hearing aids and cochlear implants with cognitive decline and dementia: a systematic review and meta-analysis. BMJ open, 11(10), e053215.

12. Sarant, J., Harris, D., Busby, P., Maruff, P., Schembri, A., Lemke, U., & Launer, S. (2022). The Effect of Cochlear Implants on Cognitive Function in Older Adults: Initial Baseline and 18-Month Follow-Up Results for a Prospective International Longitudinal Study. Frontiers in neuroscience, 16, 973016.

13. Cuda D, Manrique M, Ramos Á, Marx M, Bovo R, Khnifes R, Hilly O, Belmin J, Stripeikyte G, Graham PL, James CJ, Greenham PV, Mosnier I. Improving quality of life in the elderly: hearing loss treatment with cochlear implants. BMC Geriatr. 2024 Jan 4;24(1):16.

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