When Anne Madison could no longer hear her microwave beep, she assumed that her appliance needed repair. In fact, the machine worked well, but her confusion foreshadowed a frustrating struggle: a long and lonely battle with hearing loss.
Madison didn't bother going to a doctor after the microwave incident. She knew that hearing aids were so expensive that she could never afford them. So she decided to deal with the hassles of hearing impairment on her own and "just kind of pulled up my socks."
Before long, her world began to shrivel. She stopped going to church, since she could no longer hear the sermons. She abandoned the lectures that she used to frequent, as well as the political rallies that she had always loved. Communicating with her adult sons became an ordeal, filled with endless requests that they repeat themselves, or speak louder.
And when she moved to a Baltimore housing development in 2013, she got a reputation for being standoffish, with neighbors incorrectly assuming that she was ignoring them when she had no idea they even had spoken to her.
"You sit in your apartment and turn up your TV louder and louder," says Madison, 68, describing hearing loss as having someone suddenly drop a bell over you. "You're cut off. It's a horrible way to be."
There may be no easy fix for the loneliness epidemic plaguing the nation, but helping people cope with hearing loss could be one key to tackling this complex problem. Hearing loss affects 1 of every 5 people and is strongly linked to loneliness: Every decibel drop in perception in people under 70 increases the odds of becoming severely lonely by 7%, one Dutch study showed. As hearing declines, loneliness can intensify — and set off a cascade of detrimental health effects. Now considered as hazardous as smoking 15 cigarettes a day, loneliness vastly raises the risks of depression, dementia and early death.
Yet the vast majority of people who suffer from hearing loss don't know they have a problem — or don't want to know. The changes happen gradually, and often earlier than expected.
Even when they discover their problems, most don't use hearing devices, likely because of costs, stigma and potential technical difficulties.
For decades, age-related hearing loss was considered medically harmless. Medicare still treats hearing loss as a normal part of aging, not a medical problem, and doesn't pay for hearing aids or even routine hearing tests.
But about a decade ago, scientists began focusing more on the potential harms of hearing loss as well as loneliness. Before long, it became clear that both conditions had enormous medical consequences.
Loneliness is associated with high blood pressure, elevated stress hormones and weakened immune systems, research shows. These feelings of isolation also raise the risk of dementia by 40% and the odds of early death by 26%, according to recent studies.
Untreated hearing loss, meanwhile, increases the risk of dementia by 50%, depression by 40% and falls by 30% over a 10-year period, a study published last year in JAMA Otolaryngology — Head and Neck Surgery concluded.
Researchers are especially interested in untangling the links between loneliness, hearing loss and dementia. Last year, Johns Hopkins University scientists launched the first major randomized controlled trial to determine whether hearing treatment could actually prevent – or slow — cognitive decline, a finding that could revolutionize dementia care. If these scientists show that hearing loss helps cause dementia, they say that hearing treatment could prevent up to 9% of the more than 47 million dementia cases in the world.
The trial, expected to be completed in 2022, will also examine the impact of hearing treatment on loneliness.
"Hearing loss is really linked with loneliness," says Frank Lin, director of Johns Hopkins' Cochlear Center for Hearing and Public Health.
It's unclear why hearing loss contributes to dementia, but loneliness could be an important mediating factor. Loneliness can raise stress hormones and inflammation, which can contribute to dementia. Those with hearing loss, meanwhile, can be so socially isolated that their brains get stimulated less, which could hasten cognitive decline, Lin says.
There's also speculation that those with hearing loss may recruit a different part of their brains to try to perceive sound, which could tax their working memory and lead to dementia.
But for Lin, the exact mechanism doesn't matter as much as potential solutions.
"Hearing treatment can make a difference," he says.
In a small pilot study, Lin and his colleagues reported that hearing aids helped reduce patients' dementia symptoms and "lifted a veil that allowed them to be connected with life in a renewed way." Only a few other studies have explored this link, including a French observational study that followed nearly 4,000 people over 25 years and found that seniors who used hearing aids appeared to reduce their risk of cognitive decline.
Yet only about 20% of older Americans with hearing loss wear hearing aids, Lin says, leaving more than 23 million older adults with untreated problems. Medicare's refusal to pay for these high-cost devices is not the only obstacle. Hearing aids are free in England, yet only 25% of those with hearing loss use them there, he adds. Access to hearing aids and problems with the devices' technical capabilities are issues, too.
For many seniors, getting hearing aids adjusted properly can be an exercise in frustration.
"I was living in this place of banging and clanging and echoes," says Jean Mason, 94, recalling her struggle with hearing aids.
She moved from $1,700 Costco hearing aids to a $6,000 pair and then to a $7,000 set. Trying to muffle unwanted sounds amplified by her devices, she attached 2-inch-thick panels of insulation to her ceiling and tacked carpeting to her kitchen backsplash. She even persuaded her Cambridge, Mass., co-housing community to soundproof its dining room ceiling, hoping that would help her hear conversations. But when the room gets noisy, she says, "it's hopeless."
A promising solution to overcoming barriers like these is in the works. Congress voted in 2017 to establish a new category of over-the-counter hearing devices. These devices, expected to be on the market next year, are likely to disrupt the arcane hearing aid industry, now dominated by six manufacturers.
Companies like Bose seem poised to enter the market — possibly driving innovation and technical improvements to make hearing aids more accessible to consumers — and before long, the distinction between medical devices and consumer electronics will start to blur, Lin predicts. For now, people can buy low-cost unregulated devices, called personal sound amplification products, at some drugstores.
Madison decided to try such a low-cost listening device five years ago, when Johns Hopkins researchers came to her housing development to test a new hearing program. She felt an immediate impact. With just one hour of training, her world was transformed. She could have actual conversations with her neighbors. Family gatherings became enjoyable once again.
She became such an enthusiastic convert that she began volunteering with the hearing program, persuading others to give its personal amplification products a try. She watched one woman's marriage improve and saw another woman startled by what seemed like a foreign noise — birds chirping, a sound she hadn't heard in 30 years.
"This got me back out into the community," said Madison, referring to the amplifiers. "They got me out of my little shell that I'd built up."
Rochelle Sharpe is a freelance reporter based in Brookline, Mass. This article was written with the support of a journalism fellowship from the Gerontological Society of America, Journalists Network on Generations and the Silver Century Foundation.
Copyright 2019 NPR. To see more, visit https://www.npr.org.
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