Hearing loss, loneliness and the brain

Hearing loss is one of the most common health changes in later life. It often comes on so slowly that people do not notice it at first. But over time, it can make talking with others tiring and stressful. Many people start to skip gatherings, phone calls and outings. That can lead to loneliness.

Researchers also link hearing loss to faster memory decline and a higher risk of dementia. The good news is that hearing loss can be treated. This page explains the link, what a large trial found, and how to get help, including over-the-counter hearing aids and what Medicare pays for.

How hearing loss leads to loneliness

When you cannot hear well, conversation takes hard work. You may guess at words, miss jokes or answer the wrong question. Listening in a noisy restaurant or a group can leave you worn out.^1,3

After a while, many people pull back. They stop going to church suppers, family dinners or club meetings. They avoid the phone. Others may think they are confused, rude or not paying attention, when they simply did not hear.³

A review of 14 studies found that, in most of them, people with hearing loss had a higher risk of both loneliness and social isolation. Several studies found the link was stronger in women.⁴ Most of these studies took a snapshot at one point in time, so they cannot prove that hearing loss causes loneliness.⁴ But the pattern is consistent.

Loneliness itself can affect your health. You can read more on how loneliness affects health and loneliness in later life.

Hearing loss and the brain

The National Institute on Aging says hearing loss is linked to a higher risk of dementia and to faster loss of memory and thinking skills. It is also linked to depression, falls and safety problems, such as missing warning sounds at home or while driving.³

In 2024, a group of world experts called the Lancet Commission listed 14 health and life factors that may raise the risk of dementia. Hearing loss was one of the largest. The experts estimated that it accounts for about 7 in every 100 dementia cases worldwide. Social isolation accounts for about 5 in 100.⁸ They called for hearing aids to be available to everyone who needs them, and for less harmful noise.⁸

Scientists are still working out why hearing loss and dementia are linked. One reason may be that people who hear poorly often pull away from others, and social isolation is itself on the list of risk factors.⁸ Other possible reasons are still being studied.

What the ACHIEVE trial found

ACHIEVE was the first large, careful trial to test whether treating hearing loss slows memory decline. It was paid for by the National Institute on Aging, part of the NIH.⁶ Results came out in 2023.^5,6

Who was in it: 977 adults aged 70 to 84 at four U.S. sites. All had hearing loss that had never been treated. None had serious memory problems at the start.^5,6

What they did: Half got hearing care for three years. This meant hearing aids, a kit of listening tools, and regular coaching from an audiologist (a hearing specialist). The other half met with a health educator to learn about healthy aging. This second group served as the comparison.^5,6

What happened:

The trial reported no serious side effects from the hearing care.⁵

What this means for you: Hearing aids are not a proven way to prevent dementia for everyone. The benefit showed up in a smaller group, and the researchers say it needs more study.^5,6 Still, the result is hopeful for people who already have extra risk, and the hearing care itself is low-risk.

Effects on loneliness

In 2025, the ACHIEVE team looked at social life in the same trial. Over three years, people in both groups saw their circle of contacts shrink. But the hearing care group kept, on average, about one more person in their social circle. They also had a slightly wider mix of contacts and scored a little lower on loneliness.⁷

The researchers were careful. They said the loneliness change was small and may not be large enough to feel in daily life. They called hearing care a low-risk way that may help older adults stay connected.⁷

Signs you may have hearing loss

Age-related hearing loss usually comes on slowly and affects both ears.³ Common signs include:^1,3

• Trouble following talk in noisy places or in a group
• Asking people to repeat themselves often
• Trouble hearing on the phone
• Others say the TV or radio is too loud
• Children's voices and other high-pitched voices are harder to understand
• Feeling tired after listening

Tinnitus (ringing, buzzing or other sounds in the ear that no one else hears) is common too. It is a symptom, not a disease. Earwax, high blood pressure and some medicines can play a role.³

Over-the-counter hearing aids

In 2022, the FDA created a new group of hearing aids that you can buy in stores or online. The rule took effect on October 17, 2022.¹ You do not need a hearing exam, a prescription or a fitting.¹

OTC hearing aids are for adults 18 and older who think they have mild to moderate hearing loss. They are not strong enough for severe hearing loss. You usually adjust them yourself, often with a phone app.¹ Prescription hearing aids are fitted and programmed by a licensed hearing professional. They can work for every level of hearing loss.¹

When to see a doctor before buying

The FDA says to see a doctor, ideally an ear, nose and throat specialist, instead of buying OTC aids if you have any of these:¹

• Ear pain, or fluid, pus or blood from the ear in the past 6 months
• A lot of earwax, or a feeling that something is stuck in your ear
• Severe dizziness or a spinning feeling
• Hearing that changed suddenly in the past 6 months, or that comes and goes
• Worse hearing, or ringing, in only one ear
• Trouble hearing speech even in a quiet room

Medicare and paying for hearing care

Hearing aids can be costly. Here is what Medicare covers as of October 2026:

Medicare Advantage (Part C): Some plans include hearing benefits that Original Medicare does not, such as hearing aids. Call your plan to ask what it covers.⁹

Help in Virginia: The Virginia Department for the Deaf and Hard of Hearing runs a Technology Assistance Program. It provides amplified phones, captioned phones, personal listening systems and signal devices (like flashing doorbells and bed-shaker alarms) to residents who meet income limits. Virginia veterans with hearing loss qualify at no cost. Call 1-800-552-7917, or dial 711 first if you use relay.¹² The program does not list hearing aids.¹²

If you are a veteran, also ask your VA clinic about hearing care.

Steps to protect your hearing and your connections

1. Get a hearing test. Ask your primary care doctor, or see an audiologist. Knowing your level of loss helps you pick the right help.
2. Choose a device that fits your loss. For mild to moderate loss, OTC aids may be enough.¹ For more severe loss, or if OTC aids are not helping, see a hearing professional.
3. Give yourself time to adjust. New hearing aids can make sounds seem loud or strange at first. Wear them every day so your brain gets used to them. In ACHIEVE, ongoing coaching was part of the care.⁵
4. Make listening easier at home. Turn on TV captions. Use alert devices that flash or vibrate for the doorbell and smoke alarm.³
5. Tell people what helps. Ask friends to face you, speak clearly and not cover their mouths. Pick quiet, well-lit places to meet.³
6. Keep showing up. Plan one social activity each week, even a short one. See ways to feel more connected for ideas like senior centers, classes and phone-friend programs.

Talking with someone who has hearing loss

Family and friends can make a big difference. The National Institute on Aging suggests these habits:³

• Face the person and keep eye contact.
• Speak clearly at a normal pace, a little louder, but do not shout.
• Keep your hands away from your mouth.
• If they miss something, say it a different way instead of repeating the same words.
• Let one person talk at a time in a group.
• Be patient, and ask how you can help.

Many people feel embarrassed about hearing loss or worry that hearing aids make them look old. A gentle, private talk works better than pointing it out in front of others. See helping someone who is isolated for more ideas. If the person also has dementia, talking with someone who has dementia has tips that work well together with these.

Common questions

Will hearing aids prevent dementia?

Not for certain. In the ACHIEVE trial, hearing care did not slow decline for the whole group. It did seem to help people who were at higher risk.^5,6 Treating hearing loss is still worth doing for daily life, safety and connection. Read more on hearing, vision and brain health.

Are OTC hearing aids as good as prescription ones?

They can work well for adults with mild to moderate loss. They are not made for severe loss or for children.¹ If you are not sure how much loss you have, a hearing test first can save money and frustration.

Does Medicare pay for a hearing test?

Part B covers diagnostic hearing tests, usually with a doctor's order. You can see an audiologist once a year without an order for slow, long-term hearing loss. Medicare does not pay for exams to fit hearing aids.¹⁰

My hearing loss makes me feel down. Is that normal?

Many people with hearing loss feel sad, left out or frustrated.³ If low mood lasts more than two weeks, talk with your doctor. See depression in later life.

When to get help

• Right away: sudden hearing loss in one or both ears.³ Call 911 if it comes with signs of a stroke.
• Soon: ear pain, discharge, dizziness, or hearing loss in only one ear.¹
• At your next visit: if you notice any of the signs above, or family members say you miss things.
• For your mood: if you feel hopeless or have thoughts of ending your life, call or text 988 any time, day or night. If someone is in immediate danger, call 911.

For more on staying healthy as you age, see keeping your brain healthy and the loneliness overview.

Education only. This page is general information written from the sources listed. It is not medical, legal or financial advice and does not replace a doctor, therapist or lawyer who knows your situation. How we write and check pages.