Age-Related Hearing Loss: A Growing Public Health Issue Transcript
Male narrator: In the age of commercial space flight and instant global communication, it’s staggering just how common age-related hearing loss really is.
Russell Henderson: I got to the place where I would say, "Well, what did you say?"
Laura Waterman Wittstock: I began to feel self-conscious. And I would be in meetings, and I could not hear.
Russell: You’re not able to socialize and be a part of the group.
Christine Morgan: People with hearing loss frequently isolate themselves, and they live in this frustration.
Rick Polski: You know, I never noticed it till I was told I should go in and get it checked.
Audiologist: How are you doing today?
Patient: I’m fine.
Laura: For people who have hearing loss, insurance rarely covers it, and the cost is very high.
Monique Hammond: There has been a general unawareness among the general public, but also among health-care professionals of all kinds about how destructive hearing loss can be. And that’s why early detection and early intervention is tremendously important.
Audiologist: Just generally, what brings you in today?
Patient: I have trouble hearing...
Katherine Bouton: I think we now understand that hearing loss-- it’s not a cosmetic condition. Treating it isn’t like coloring your hair or getting a face-lift. It’s a medical condition. Treating it is actually good for your physical and your mental health.
Male narrator: It’s not just a personal health issue. It’s a public health issue. And here’s why... Katherine: Baby boomers are turning 65 at the rate of 8,000 a day, which is really an astonishing thought.
Monique: The older we become, actually, hearing loss becomes more frequent. Oftentimes it’s said that there is a lot of wear and tear on our, you know, hearing structures.
Dr. Frank R. Lin: It’s incredibly impactful for things like cognitive decline, our risk of dementia, falls, even preventing hospitalizations that we’re seeing that hearing loss is linked with all of these outcomes very, very strongly.
Male narrator: After arthritis and heart disease, it’s the third most common chronic condition affecting older adults. Two out of every three of us will experience it personally once we’re in our 70s. And of those, 2/3 have noticeable hearing loss before the age of 60.
Dr. Lin: Even though it is a usual part of aging that it’s not without consequence. We think it’s a series of dominoes. And, I mean, the three big dominoes which we sort of hypothesize or guess at right now-- it’s a few of them. So one is that, when you have a hearing loss, right, it’s a little bit of a misnomer. It’s not so much you can’t hear. It’s that you can’t understand. And the reason for that is your ear is sending a much more garbled signal to your brain. So understand right now that one of the dominoes is that when you can’t hear well, that you’re constantly putting a load on the brain. The brain is constantly having to dedicate more brain power, per se, or more resources to constantly dealing with that degraded sound, right?
Katherine: And my own work became, you know, so distracted by the effort to hear what was going on in a meeting that I really didn’t have-- I didn’t have time to think about ideas and make contributions in a way that I had been able to earlier when I heard better.
Dr. Lin: At the same time, in many studies right now, we’re seeing that, for people who even have a mild hearing loss, that it leads to faster changes in terms of the brain structure, that you’re losing parts of the brain which handle sound, but then it has cascading effects on other parts of the brain, too, that handle things like memory and learning.
Male narrator: In one study, adults with mild hearing loss were two times more likely to develop dementia than those without hearing loss. Adults with severe hearing loss were five times more likely. It’s true. If you can’t hear what’s going on, your brain gets smaller, leading to depression, isolation, and even a measurable drop in your IQ.
Dr. Lin: And I find the third domino, like I mentioned before, is the idea of social isolation, that, if you can’t hear well, that for many people just subtly, you’re less likely to want to go out and socialize with your friends.
Katherine: One of the things that happens when you have hearing loss as it gets worse and worse is that it gets very effortful to go out and, you know, be part of life. People tend to withdraw.
Dr. Lin: And those subtle effects of social disengagement we know now are incredibly meaningful for maintaining our cognitive, even our physical functional health as we age. So we think that those are actually the three mechanistic pathways to which hearing loss can directly lead to adverse health outcomes as we age.
Katherine: As hearing loss progresses, you do get more uneasy in social and professional situations. But many, many people with hearing loss are under the age of 60. They’re still in the work force. Many people over the age of 60 are still in the work force.
Christine: I left my position as a medical group administrator after 30 years because of my hearing loss. It was difficult to deal with. I think, like everyone with hearing loss, we try to hide it. And the hard thing about that is you're trying to function in a hearing world. And I started feeling like my employers were thinking I was less intelligent or losing it. So it made my job very difficult.
Katherine: This is what happened to me. I stopped contributing at meetings because I was never quite sure what I had heard, and I didn't want to answer inappropriately.
Male narrator: Hearing loss really is just the first domino in a much larger chain reaction. And all these dominoes together-- they lead to increased health-care costs and more medical interventions, all of which have a real impact on families, retirement plans, and state and federal budgets.
Dr. Lin: If you address the hearing loss early enough with good rehabilitative strategies, using hearing aids, things like that, can you prevent that decline from happening? And that’s the key question then.
Katherine: We could delay the onset of dementia by even one year down the line, we would cut the incidents of dementia by 15%, which in the year 2025, 2050, is gonna make an enormous financial difference.
Dr. Lin: The 1965 Medicare Act statutorily precludes coverage of hearing aids. And that was written at a time 50 years ago when it probably made sense. They weren’t very effective back then. They weren’t even necessarily very expensive back then.
Katherine: Hearing aids these days can easily cost up to $4,000 for a single hearing aid, and since most hearing loss tends to be bilateral, in both ears, so that means you need two hearing aids at $4,000 apiece.
Dr. Lin: In 50 years, though, a lot of things have changed in terms of the cost, in terms of how we know how effective they are for things even just for maintaining our daily functioning and improving our quality of life, not to mention hopefully things like dementia. So I think that will cause reevaluation. A bigger issue, I would say, is the current model of hearing health care. I mean, the average cost of pairing hearing aids is usually around anywhere from $3,000 to $5,000 nowadays, and there’s so much sticker shock with that. If you go see an audiologist, an audiologist cannot be reimbursed for providing any type of rehabilitative services. They can only be reimbursed for providing diagnostics. So no one is incentivized to help the individual patient, the individual 65-year-old person. And that’s the bitter irony there, is that the structure, the model right now is just not designed to provide what it should be doing.
Katherine: For me as an advocate for people with hearing loss, I say we need to give them whatever is gonna work for them at a price that they can afford.
Dr. Lin: You have to take personal ownership of knowing the issues, of knowing what to do about it, knowing and wanting to do something about it. But at the same time, that has to be supported by societal governmental infrastructure that allows those resources to be available.