Hearing loss, mood and memory in later life

Hearing loss creeps up slowly. At first you turn up the TV, or think people are mumbling. Over time, family dinners, phone calls and church services take more effort. Many people start to skip them without quite noticing why.

That slow pulling back is why hearing matters for mental health. This guide explains how hearing loss is tied to loneliness, mood and memory in later life, what the best trial so far found, and how to get help, including over-the-counter hearing aids. For more on the brain science, see Hearing loss, loneliness and the brain and Hearing, vision and brain health.

Signs of hearing loss

See a doctor or hearing professional if you:²

• Have trouble understanding phone calls
• Struggle to follow a conversation with two or more people
• Often ask people to repeat themselves
• Turn the TV up so loud that others complain
• Have trouble hearing speech when there is background noise
• Think people are mumbling
• Find children's or higher-pitched voices hard to understand

Family members often notice before the person does. Listening may also feel tiring by the end of the day.⁵

How hearing loss affects mood

When conversation takes hard work, people often stop trying. They skip gatherings, nod along without understanding, and feel left out at their own family table. Frustration and embarrassment can lead to withdrawal, loneliness and depression.² People with hearing loss may also be wrongly seen as confused or uncooperative, which hurts.²

Hearing loss also affects safety. Even small amounts of hearing loss are linked to a higher risk of falls.^2,6 See Falls and fear of falling.

If you feel low, take our Loneliness test or the Check-in for older adults.

Hearing loss and memory

Researchers have found that older adults with untreated hearing loss have a higher risk of dementia, and the risk rises with how severe the loss is. In early studies, mild hearing loss was linked to about twice the risk, moderate loss to about three times, and severe loss to about five times.¹ Memory and concentration also declined faster in people with hearing loss.¹

Why might this happen? Scientists think a few things may play a part. The brain may work so hard to make sense of sound that less is left for memory. Less sound reaching the brain may change how it works. And hearing loss can lead to isolation, which is itself bad for the brain. These ideas are still being studied.

What the ACHIEVE trial found

ACHIEVE was the first large trial to test whether treating hearing loss slows thinking decline. It enrolled nearly 1,000 adults aged 70 to 84 with untreated hearing loss at four U.S. sites. Half got hearing aids plus instruction and coaching on how to use them. Half got a healthy-aging education program instead. Both groups were followed for three years.⁴

• Overall: There was no difference in the rate of thinking decline between the two groups.⁴
• Higher-risk group: About 250 people came from a long-running heart study. They had more risk factors for dementia. In this group, the hearing intervention cut the rate of thinking decline by almost half.⁴
• Communication: People who got hearing aids reported much better communication.⁴
• Social life: A later analysis found that over three years, people in the hearing group kept about one more person in their social circle. They also had a small drop in loneliness compared with the education group. The researchers said the loneliness change was too small to matter much in daily life, but called hearing care a low-risk way to help people stay connected.⁷

In daily life, this means hearing aids are not a proven way to prevent dementia for everyone. But they clearly help communication, they carry little risk, and they may help most for people who already have other risk factors. Take our Brain health quiz.

What helps

Practical steps

1. Get a hearing check. Start with your primary care doctor. They can look for earwax, infection or other medical causes.²
2. Watch for red flags. See a doctor, ideally an ear, nose and throat (ENT) doctor, before buying OTC aids if you have ear pain, fluid or blood from the ear, sudden hearing change, sudden worse hearing in one ear, ringing in only one ear, or severe dizziness.⁵
3. Decide on OTC or prescription. If your loss seems mild to moderate, OTC aids may work. If you cannot hear speech in a quiet room, you likely need a professional fitting.⁵
4. Check the return policy. FDA rules require OTC packages to list the return policy. Choose one that gives you time to try the aids in different places.⁵
5. Wear them every day. Your brain needs weeks to get used to new sounds. Start in quiet places, then try busier ones.
6. Ask about costs. Original Medicare does not cover hearing aids or the exams to fit them. Some Medicare Advantage plans do.⁹ Medicare Part B covers some diagnostic hearing exams when your doctor orders them.¹⁰
7. Get back to the things you skipped. Pick one activity you have avoided, such as a group dinner or worship service, and go with your hearing aids.

For family caregivers

• Name it kindly. Say what you see ("You seem to miss parts of our talks") rather than blame ("You never listen").
• Offer to go along to the hearing test or the store.
• Make the home easier. Turn off the TV during talks, face the person, and do not cover your mouth.²
• Rephrase rather than repeat the same words louder.²
• Help with the devices. Batteries, charging, cleaning and settings can be hard with stiff fingers or poor eyesight.
• Watch for withdrawal and low mood, and help them get care if it lasts.

Special situations

Living with dementia. Untreated hearing loss can make confusion worse and can be mistaken for memory loss. Ask for a hearing check as part of any memory workup. See Communicating with someone with dementia.

Living alone. Make sure you can hear the doorbell, phone and smoke alarm. Devices with flashing lights or vibration can help. Captioned phones and video calls with captions make staying in touch easier. See Technology and staying connected.

Language barriers. Many people find it harder to follow a second language than their first, especially with background noise. Ask for a medical interpreter and written notes at appointments.

Rural areas. OTC hearing aids can help when hearing clinics are far away, as long as your loss is mild to moderate and you have no red-flag symptoms.⁵

Frequently asked questions

Will hearing aids prevent dementia?

Not for certain. In ACHIEVE, hearing aids did not slow thinking decline for the whole group, but they did for people at higher risk.⁴ They clearly help communication, which matters for mood and connection.

Are OTC hearing aids as good as prescription ones?

They can work well for perceived mild to moderate loss. They are not meant for severe loss or for people with warning signs such as ear pain or sudden hearing change.⁵ A hearing test can tell you which kind fits your needs.

Does Medicare pay for hearing aids?

Original Medicare does not pay for hearing aids or fitting exams.⁹ Some Medicare Advantage plans offer hearing benefits.⁹ Part B covers some diagnostic hearing and balance exams.¹⁰

My father refuses hearing aids. What can I do?

Listen to his reasons, such as cost, looks, or feeling old. Suggest a trial with a good return policy, and point out the things he is missing. Small, sleek devices are common now.

When to get help

See a doctor promptly if you have sudden hearing loss, hearing loss in one ear, ear pain, fluid from the ear, or severe dizziness.⁵ Sudden hearing loss is urgent.

Talk with your doctor about mood if hearing loss has made you avoid people, or if you feel low, hopeless or uninterested in life for more than two weeks.⁸

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.