Hearing loss in an aging parent: what to do, in the order to do it

The television volume is the cliché, and it is usually not the first sign. Age-related hearing loss takes the high frequencies first, which is where consonants live, so the early experience is not silence. It is hearing that someone is speaking and not being able to tell which words. That produces behaviour rather than complaints.

• They answer a slightly different question from the one asked, then look for a reaction to check whether they got it right.
• They are fine one-to-one in a quiet room and lost at a restaurant table, which families often read as tiredness or disinterest.
• They stop calling people, because a phone strips out exactly the cues they had been using to fill in the gaps.
• Everyone has started mumbling. This is the most reliable single sign, and it is sincere: consonants really have gone quiet.
• They withdraw from the group conversation at family gatherings while staying in the room. It reads as mood. It is usually effort.

The reason to take this seriously early is that it is routinely mistaken for something worse. A person who cannot reliably hear a question answers the wrong one, loses the thread, and stops joining in. From across a room that looks like confusion or a failing memory, and both families and clinicians make the mistake. A hearing test belongs early in any assessment of a parent who seems to be slipping, not after it. Our self-assessment guide covers the broader picture of when a parent needs more support.

For what each of these signs actually tells you, including the ones that get filed under memory or mood, the federal self-check that comes with a scoring threshold, and the two patterns that mean this is not ordinary age-related loss, the signs guide takes them one at a time.

Two things happen at a diagnostic evaluation that cannot happen in a shop. The first is measurement: how much hearing has gone, at which frequencies, in which ear. The second matters more. It looks for causes a hearing aid does not address, including impacted earwax, fluid, infection, and loss in one ear only, which is a finding that needs investigating rather than amplifying.

Hearing that disappears suddenly is a medical emergency, not a shopping problem. Sudden loss in one or both ears, over hours or a couple of days, needs same-week medical attention, because the treatments that work for it work best early. The same goes for hearing loss arriving with pain, discharge or dizziness. If any of that describes what is happening, stop reading and call a doctor.

Then there is who pays, and the wording changes the answer. Original Medicare covers diagnostic hearing and balance exams when a doctor orders them to work out whether medical treatment is needed, and you pay 20% of the approved amount after the Part B deductible. It does not cover exams for fitting a hearing aid. The same audiologist may perform both, sometimes in one visit, and they are billed differently. So when you ask the primary care physician for a referral, ask for a diagnostic audiologic evaluation rather than a hearing aid evaluation, and say that is what you want.

This became a genuine choice on 17 October 2022, when an FDA rule created a category of hearing aids that adults 18 and older with perceived mild to moderate hearing loss can buy in a shop or online, with no prescription, no medical exam and no fitting appointment. These are regulated hearing aids rather than the older personal sound amplifiers, and the user adjusts them through an app or onboard controls.

The load-bearing word in that rule is “perceived”. Nobody has assessed the hearing loss, so the buyer is judging their own, and a person whose hearing has declined slowly over a decade is the least well-placed person to judge it. That is not an argument against buying over the counter. It is an argument for knowing the number first, which is what the test gives you.

Over-the-counter is a reasonable first move when:

• A test has put the loss in the mild to moderate range.
• Both ears are affected in roughly the same way.
• Your parent, or someone close by, is comfortable enough with a phone app to run the setup and adjust it afterwards.
• The seller has a stated return window. Ask for it in writing before paying, because the first two weeks are when most people decide they hate the thing.

Go the prescription route when:

• The loss is severe or profound. The FDA states that over-the-counter devices are limited in maximum output and are not intended for it.
• One ear is markedly worse than the other, or only one ear is affected. That asymmetry is a medical question first.
• There is pain, drainage, ringing that is new or one-sided, or dizziness alongside the hearing loss.
• Your parent has dementia or significant memory problems. Self-fitting through an app assumes an ongoing relationship with a device, and someone will need to own that whether or not the fitting is professional.
• Dexterity or vision makes small controls impractical. This is worth saying out loud at the fitting rather than discovering at home.

Once you are looking at over-the-counter devices in earnest, the check that matters is not the brand but the packaging, which the rule requires to carry specific warnings and a return policy. What to check before buying an OTC hearing aid goes through it, including how to tell a regulated device from the sound amplifier sold beside it.

The federal hearing institute puts hearing aids at anywhere from hundreds to several thousand dollars, and notes that health insurance generally does not cover them. We are deliberately not printing a tighter figure than the government does: the market moved substantially after the 2022 rule and a precise number typed into a page like this one would be wrong within a year without anything flagging it.

What is worth knowing precisely is the coverage, because it surprises people at the worst moment:

• Original Medicare: no hearing aids, and no exams for fitting them. Diagnostic exams ordered by a doctor are covered.
• Medicare Advantage: many plans add a hearing benefit. It varies by plan and by state, so check the plan documents rather than the brand.
• Medicaid: adult hearing aid coverage is a state-by-state decision. Ask the state Medicaid programme directly.
• VA: hearing aids are provided to eligible veterans through VA audiology, and this is one of the most generous routes available to anyone who qualifies.

Our guide to paying for senior care covers Medicare, Medicaid and VA benefits in full, including the parts of Medicare that surprise families elsewhere.

You will see it stated that hearing aids cut the risk of dementia by 48%. That is not what the research found, and the difference matters if you are making a decision on the strength of it.

The trial being quoted is ACHIEVE, published in The Lancet in 2023. It randomised 977 adults aged 70 to 84 with untreated hearing loss to a hearing intervention or a health education control, and followed them for three years. The primary analysis, across the whole group, found no reduction in cognitive decline. A prespecified analysis then found the effect differed between the two populations that made up the cohort: among participants already at higher risk of cognitive decline, the hearing intervention slowed it by 48%, and among the lower-risk participants it did not.

Separately, the 2024 Lancet Commission on dementia lists hearing loss among fourteen modifiable risk factors, and estimates that 45% of future dementia could potentially be prevented if all fourteen were addressed.

So what should a family take from this? That treating hearing loss is clearly worth doing on its own terms, for conversation, safety and staying part of things. That if your parent is already at higher risk of cognitive decline, the evidence is more encouraging than it is for the general population. And that nobody has shown a hearing aid prevents dementia, so it should not be the argument you use to persuade a reluctant parent. The better argument is the one they can test in a week: they will be able to hear their grandchildren at the table.

Fewer than one in three adults over 70 who could benefit from hearing aids has ever used one. Buying them is the easy half, and the drawer is where a great many of them end up. The reasons are consistent and most of them are fixable.

• Everything sounds harsh at first. A brain that has gone years without high frequencies has adapted to their absence, and getting them back is initially unpleasant. It takes weeks of daily wear, not days, and wearing them only for special occasions guarantees they never stop sounding wrong.
• Their own voice sounds strange. This is the single most common early complaint and it is a programming matter. It is a reason to go back, not a reason to stop.
• The controls are too small. Arthritic hands and tiny batteries are a bad combination. Rechargeable models remove the fiddliest part of the routine, and are worth asking about before choosing.
• Nobody set a schedule. “Wear them when you need them” is not a plan. All waking hours, from the start, is the plan.
• Nobody owns the upkeep. If your parent has memory problems, someone else needs to own charging, cleaning and the follow-up appointment, and it is better to decide who at the outset than to discover the aids stopped being used in March.

When a parent says they do not like them, the useful next question is which specific thing is unpleasant. It almost always resolves into one adjustable complaint, and a follow-up visit to adjust programming is a normal part of the process rather than evidence that the purchase failed.

Does Medicare cover hearing aids?

No. Original Medicare does not cover hearing aids, and it does not cover the exams used to fit them. It does cover diagnostic hearing and balance exams when a doctor orders them to work out whether you need medical treatment, and you pay 20% of the approved amount after the Part B deductible. That distinction is worth carrying into the appointment: a diagnostic evaluation ordered by a physician is covered, and a hearing aid evaluation is not, even when the same audiologist performs both on the same day. Some Medicare Advantage plans add a hearing benefit, and coverage varies by plan and by state, so check the specific plan rather than assuming.

Can my parent just buy over-the-counter hearing aids?

Sometimes, and it is a real option rather than a lesser one. Since 17 October 2022, adults 18 and older with perceived mild to moderate hearing loss can buy FDA-regulated hearing aids in a shop or online with no prescription, no medical exam and no fitting appointment. The word doing the work in that rule is "perceived": nobody has assessed the hearing loss, so the buyer is judging their own. Over-the-counter devices are capped in output and the FDA states plainly that they are not intended for severe or profound hearing loss. If the loss is worse than assumed, is in one ear only, came on suddenly, or comes with pain, drainage or dizziness, a test comes first.

Do hearing aids prevent dementia?

Nobody has shown that. The largest randomised trial to look at it, ACHIEVE, followed 977 adults aged 70 to 84 with untreated hearing loss for three years, and the primary analysis of the whole group found no reduction in cognitive decline. A prespecified analysis then found that the effect differed between the two populations in the trial: among participants already at higher risk of cognitive decline, the hearing intervention slowed it by 48%, and among the lower-risk participants it did not. The honest summary is that treating hearing loss is clearly worth doing for its own sake, that the evidence is more encouraging for people already at higher risk, and that a hearing aid has not been shown to prevent dementia in the general population.

How is untreated hearing loss mistaken for memory loss?

A person who cannot reliably hear a question will answer the wrong one, lose the thread of a group conversation, or stop joining in. Seen from across a room, that reads as confusion, withdrawal or a failing memory, and families and clinicians both make the mistake. It is one of the reasons a hearing test belongs early in any assessment of a parent who seems to be slipping, rather than after it. A test is quick, and it either rules hearing out or turns out to explain more than anyone expected.

My parent has hearing aids and will not wear them. What now?

This is the normal outcome rather than the unusual one. Fewer than one in three adults over 70 who could benefit from hearing aids has ever used them. The common reasons are fixable: everything sounds harsh at first because the brain has spent years without those frequencies and needs weeks of daily wear to readjust, their own voice sounds wrong, the controls are too small for arthritic hands, or nobody set a wear schedule so the aids live in a drawer. Ask what specifically is unpleasant, because "I do not like them" usually resolves into one adjustable complaint. Programming can be changed, and a follow-up visit is normal rather than a sign the purchase failed.

What is the difference between a hearing test and a hearing aid evaluation?

A diagnostic audiologic evaluation measures hearing and looks for a medical cause, including the causes a hearing aid does not fix, such as impacted earwax, fluid, infection or a one-sided loss that needs investigating. A hearing aid evaluation is the fitting process: choosing and programming a device. They are often done by the same audiologist, sometimes in the same visit, but they are different services and Medicare treats them differently. Asking the primary care physician for a referral for a diagnostic evaluation, and saying that is what you want, is the practical version of this distinction.

Every figure on this page comes from one of the following. Where a source gives a range rather than a number, we have kept the range.

• NIDCD, Quick Statistics About Hearing. Prevalence by age group, and hearing aid use among adults over 70.
• NIDCD, Hearing Aids. Price range, insurance coverage, and the difference between over-the-counter and prescription devices.
• FDA, OTC Hearing Aids: What You Should Know. The October 2022 rule, who it covers, and the limits on output.
• Medicare.gov, Hearing & balance exams and Hearing aid coverage. What Part B covers and what it excludes.
• Lin et al., ACHIEVE trial, The Lancet, 2023. The three-year randomised trial of hearing intervention and cognitive decline, including the null primary result.
• Livingston et al., Lancet Commission on dementia prevention, intervention and care, 2024. The fourteen modifiable risk factors and the 45% estimate.