Closing the Treatment Gap in Age-Related Hearing Loss

Age-related hearing loss is the third most common chronic health condition in older adults, yet 75% of these individuals go untreated. This gap in care is especially concerning because of the important role hearing loss plays in cognitive decline – and the fact that the disorder is “eminently treatable,” says Cleveland Clinic geriatrician Ardeshir Hashmi, MD, AGSF.

“Hearing is incredibly important to cognitive health, longevity and overall well-being,” says Dr. Hashmi, Endowed Chair of Geriatric Innovation and Section Chief for the Center for Geriatric Medicine. “The common idea that you must learn to live with hearing loss and accept it as an unavoidable part of getting older is problematic, especially since the disorder can lead to so many other downstream complications.”

Identified as one of the largest potentially identifiable risk factors for Alzheimer’s disease, midlife hearing loss is also associated with increased social and emotional isolation, depression, and even mortality. Despite its well-known risks, however, hearing loss is profoundly misunderstood by both patients and clinicians, Dr. Hashmi says.

Research shows that only 9% of older adults know what constitutes “normal” hearing. Furthermore, one recent study shows that only 40% of primary care providers believe hearing loss is treatable, and only 17% think it is preventable.

“These responses overlook the advanced hearing devices and assistive technologies now available,” he says. “With the right screening and support, many people can regain not just their hearing, but also their independence. Growing older doesn’t mean growing silent — solutions are available,” he says.

Dr. Hashmi's comments highlight new clinical practice guidelines published by the American Academy of Otolaryngology–Head and Neck Surgery Foundation.

Digging deeper

Dr. Hashmi, who presented this information at the annual meeting of the American Geriatrics Society in 2025, outlines four key actions clinicians should take to address hearing loss in older adults. A simple but critical first step is to screen patients for age-related hearing loss.

“We all agree that screening should be done, but are we actually doing it?” he asks.

If screening suggests the presence of hearing loss, the next step should be an examination of the ear canal and eardrum. In many cases, an otoscopic evaluation will reveal impacted ear wax, infection or another common and easily treated problem that, once resolved, will immediately improve the patient’s hearing, Dr. Hashmi says.

“Appropriate treatment can have a huge effect on a person’s quality of life – often overnight – yet many clinicians will reflexively send patients to an audiologist without ever looking in their ears,” he notes.

Dr. Hashmi also encourages clinicians to consider any socioeconomic factors or personal preferences that may influence patients’ access to hearing care and treatment.

“Financial and social limitations can influence which treatments are in reach, he says. “The solution doesn’t have to be one size fits all. From low-cost amplification devices to advanced hearing aids and implantable devices, there are many options designed to suit each patient’s needs and financial limitations.”

Dr. Hashmi also notes burgeoning research into non-device modes of hearing optimization, including aural rehabilitation. Although this approach is seldom presented as an option, he says it can yield significant improvements in hearing over time.

Finally, Dr. Hashmi encourages clinicians to refer geriatric patients for a full hearing test, including an audiogram, which can also detect subtle symptoms that may signal more concerning health issues. In addition, he says clinicians should be mindful of potential hearing loss when screening patients for cognitive decline.

Restoring quality of life

Dr. Hashmi recalls a 90-year-old patient who performed poorly on cognitive tests despite functioning with a high degree of independence at home. Concerned, the man’s doctors and family had begun to discuss medication and other treatments to address his mental decline. However, when retested using a new screen-based platform that did not require him to hear and respond to verbal instructions, the patient performed quite well.

“This is a good example of why it’s dangerous to make assumptions about older patients without taking the time to investigate more fully,” he says. “Hearing loss should be viewed for what it is: a treatable condition that deserves attention. The longevity and happiness of older adults is largely dependent on their ability to stay connected to the world around them.”