Say That Again: Using Hearing Aids Can Be Frustrating for Older Adults, but Necessary

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It was an every-other-day routine, full of frustration.

Every time my husband called his father, who was 94 when he died in 2022, he’d wait for his dad to find his hearing aids and put them in before they started talking.

Even then, my father-in-law could barely hear what my husband was saying. “What?” he’d ask over and over.

Then, there were the problems my father-in-law had replacing the devices’ batteries. And the times he’d end up in the hospital, unable to understand what people were saying because his hearing aids didn’t seem to be functioning. And the times he’d drop one of the devices and be unable to find it.

How many older adults have problems of this kind?

There’s no good data about this topic, according to Nicholas Reed, an assistant professor of epidemiology at Johns Hopkins Bloomberg School of Public Health who studies hearing loss. He did a literature search when I posed the question and came up empty.

Reed co-authored the most definitive study to date of hearing issues in older Americans, published in JAMA Open Network last year. Previous studies excluded people 80 and older. But data became available when a 2021 survey by the National Health and Aging Trends Study included hearing assessments conducted at people’s homes.

The results, based on a nationally representative sample of 2,803 people 71 and older, are eye-opening. Hearing problems become pervasive with advancing age, exceeding 90% in people 85 and older, compared with 53% of 71- to 74-year-olds. Also, hearing worsens over time, with more people experiencing moderate or severe deficits once they reach or exceed age 80, compared with people in their 70s.

However, only 29% of those with hearing loss used hearing aids. Multiple studies have documented barriers that inhibit use. Such devices, which Medicare doesn’t cover, are pricey, from nearly $1,000 for a good over-the-counter set (OTC hearing aids became available in 2022) to more than $6,000 for some prescription models. In some communities, hearing evaluation services are difficult to find. Also, people often associate hearing aids with being old and feel self-conscious about wearing them. And they tend to underestimate hearing problems that develop gradually.

Barbara Weinstein, a professor of audiology at the City University of New York Graduate Center and author of the textbook “Geriatric Audiology,” added another concern to this list when I reached out to her: usability.

“Hearing aids aren’t really designed for the population that most needs to use them,” she told me. “The move to make devices smaller and more sophisticated technologically isn’t right for many people who are older.”

That’s problematic because hearing loss raises the risk of cognitive decline, dementia, falls, depression, and social isolation.

What advice do specialists in hearing health have for older adults who have a hard time using their hearing aids? Here are some thoughts they shared.

Consider larger, customized devices. Many older people, especially those with arthritis, poor fine motor skills, compromised vision, and some degree of cognitive impairment, have a hard time manipulating small hearing aids and using them properly.

Lindsay Creed, associate director of audiology practices at the American Speech-Language-Hearing Association, said about half of her older clients have “some sort of dexterity issue, whether numbness or reduced movement or tremor or a lack of coordination.” Shekinah Mast, owner of Mast Audiology Services in Seaford, Delaware, estimates nearly half of her clients have vision issues.

For clients with dexterity challenges, Creed often recommends “behind-the-ear hearing aids,” with a loop over the ear, and customized molds that fit snugly in the ear. Customized earpieces are larger than standardized models.

“The more dexterity challenges you have, the better you’ll do with a larger device and with lots of practice picking it up, orienting it, and putting it in your ear,” said Marquitta Merkison, associate director of audiology practices at ASHA.

For older people with vision issues, Mast sometimes orders hearing aids in different colors for different ears. Also, she’ll help clients set up stands at home for storing devices, chargers, and accessories so they can readily find them each time they need them.

Opt for ease of use. Instead of buying devices that require replacing tiny batteries, select a device that can be charged overnight and operate for at least a day before being recharged, recommended Thomas Powers, a consultant to the Hearing Industries Association. These are now widely available.

People who are comfortable using a smartphone should consider using a phone app to change volume and other device settings. Dave Fabry, chief hearing health officer at Starkey, a major hearing aid manufacturer, said he has patients in their 80s and 90s “who’ve found that being able to hold a phone and use larger visible controls is easier than manipulating the hearing aid.”

If that’s too difficult, try a remote control. GN ReSound, another major manufacturer, has designed one with two large buttons that activate the volume control and programming for its hearing aids, said Megan Quilter, the company’s lead audiologist for research and development.

Check out accessories. Say you’re having trouble hearing other people in restaurants. You can ask the person across the table to clip a microphone to his shirt or put the mike in the center of the table. (The hearing aids will need to be programmed to allow the sound to be streamed to your ears.)

Another low-tech option: a hearing aid clip that connects to a piece of clothing to prevent a device from falling to the floor if it becomes dislodged from the ear.

Wear your hearing aids all day. “The No. 1 thing I hear from older adults is they think they don’t need to put on their hearing aids when they’re at home in a quiet environment,” said Erika Shakespeare, who owns Audiology and Hearing Aid Associates in La Grande, Oregon.

That’s based on a misunderstanding. Our brains need regular, not occasional, stimulation from our environments to optimize hearing, Shakespeare explained. This includes noises in seemingly quiet environments, such as the whoosh of a fan, the creak of a floor, or the wind’s wail outside a window.

“If the only time you wear hearing aids is when you think you need them, your brain doesn’t know how to process all those sounds,” she told me. Her rule of thumb: “Wear hearing aids all your waking hours.”

Consult a hearing professional. Everyone’s needs are different, so it’s a good idea to seek out an audiologist or hearing specialist who, for a fee, can provide guidance.

“Most older people are not going to know what they need” and what options exist without professional assistance, said Virginia Ramachandran, the head of audiology at Oticon, a major hearing aid manufacturer, and a past president of the American Academy of Audiology.

Her advice to older adults: Be “really open” about your challenges.

If you can’t afford hearing aids, ask a hearing professional for an appointment to go over features you should look for in over-the-counter devices. Make it clear you want the appointment to be about your needs, not a sales pitch, Reed said. Audiology practices don’t routinely offer this kind of service, but there’s good reason to ask since Medicare started covering once-a-year audiologist consultations last year.

We’re eager to hear from readers about questions you’d like answered, problems you’ve been having with your care, and advice you need in dealing with the health care system. Visit http://kffhealthnews.org/columnists to submit your requests or tips.

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

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  • Kale vs Watercress – Which is Healthier?

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    Our Verdict

    When comparing kale to watercress, we picked the kale.

    Why?

    It was very close! If ever we’ve been tempted to call something a tie, this has been the closest so far.

    Their macros are close; watercress has a tiny amount more protein and slightly lower carbs, but these numbers are tiny, so it’s not really a factor. Nevertheless, on macros alone we’d call this a slight nominal win for watercress.

    In terms of vitamins, they’re even. Watercress has higher vitamin E and choline (sometimes considered a vitamin), as well as being higher in some B vitamins. Kale has higher vitamins A and K, as well as being higher in some other B vitamins.

    In the category of minerals, watercress has higher calcium, magnesium, phosphorus, and potassium, while kale has higher copper, iron, manganese, and zinc. The margins are slightly wider for kale’s more plentiful minerals though, so we’ll call this section a marginal win for kale.

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  • What Does “Balance Your Hormones” Even Mean?

    10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.

    Hormonal Health: Is It Really A Balancing Act?

    Have you ever wondered what “balancing your hormones” actually means?

    The popular view is that men’s hormones look like this:

    Testosterone (less) ⟷ Testosterone (more)

    …And that women’s hormones look more like this:

    ♀︎ Estrogen ↭ Progesterone ⤵︎

    ⇣⤷ FSH ⤦ ↴ ☾ ⤹⤷ Luteinizing Hormone ⤦

    DHEA ↪︎ Gonadotrophin ⤾

    ↪︎ Testosterone? ⥅⛢

    Clear as mud, right?

    But, don’t worry, Supplements McHerbal Inc will sell you something guaranteed to balance your hormones!

    How can a supplement (or dietary adjustment) “balance” all that hotly dynamic chaos, and make everything “balanced”?

    The truth is, “balanced” in such a nebulous term, and this is why you will not hear endocrinologists using it. It’s used in advertising to mean “in good order”, and “not causing problems”, and “healthy”.

    In reality, our hormone levels depend on everything from our diet to our age to our anatomy to our mood to the time of the day to the phase of the moon.

    Not that the moon has an influence on our physiology at all—that’s a myth—but you know, 28 day cycle and all. And, yes, half the hormones affect the levels of the others, either directly or indirectly.

    Trying to “balance” them would be quite a game of whack-a-mole, and not something that a “cure-all” single “hormone-balancing” supplement could do.

    So why aren’t we running this piece on Friday, for our “mythbusting” section? Well, we could have, but the more useful information is yet to come and will take up more of today’s newsletter than the myth-busting!

    What, then, can we do to untangle the confusion of these hormones?

    Well first, let’s understand what they do, in the most simple terms possible:

    • Estrogen—the most general feminizing hormone from puberty onwards, busiest in the beginning of the menstrual cycle, and starts getting things ready for ovulation.
    • Progesteronesecondary feminizing hormone, fluffs the pillows for the oncoming fertilized egg to be implanted, increases sex drive, and adjusts metabolism accordingly. Busiest in the second half of the menstrual cycle.
    • Testosterone—is also present, contributes to sex drive, is often higher in individuals with PCOS. If menopause is untreated, testosterone will also rise, because there will be less estrogen
      • (testosterone and estrogen “antagonize” each other, which is the colorfully scientific way of saying they work against each other)
      • DHEA—Dehydroepiandrosterone, supports production of testosterone (and estrogen!). Sounds self-balancing, but in practice, too much DHEA can thus cause elevated testosterone levels, and thus hirsutism.
    • Gonadotrophin—or more specifically human chorionic gonadotrophin, HcG, is “the pregnancy hormone“, present only during pregnancy, and has specific duties relating to such. This is what’s detected in (most) pregnancy test kits.
    • FSH—follicle stimulating hormone, is critical to ovulation, and is thus essential to female fertility. On the other hand, when the ovaries stop working, FSH levels will rise in a vain attempt to encourage the ovulation that isn’t going to happen anymore.
    • Luteinizing hormone—says “go” to the new egg and sends it on its merry way to go get fertilized. This is what’s detected by ovulation prediction kits.

    Sooooooo…

    What, for most women, most often is meant by a “hormonal imbalance” is:

    • Low levels of E and/or P
    • High levels of DHEA and/or T
    • Low or High levels of FSH

    In the case of low levels of E and/or P, the most reliable way to increase these is, drumroll please… To take E and/or P. That’s it, that’s the magic bullet.

    Bonus Tip: take your E in the morning (this is when your body will normally make more and use more) take your P in the evening (it won’t make you sleepy, but it will improve your sleep quality when you do sleep)

    In the case of high levels of DHEA and/or T, then that’s a bit more complex:

    • Taking E will antagonize (counteract) the unwanted T.
    • Taking T-blockers (such as spironolactone or bicalutamide) will do what it says on the tin, and block T from doing the jobs it’s trying to do, but the side-effects are considered sufficient to not prescribe them to most people.
    • Taking spearmint or saw palmetto will lower testosterone’s effects
      • Scientists aren’t sure how or why spearmint works for this
      • Saw palmetto blocks testosterone’s conversion into a more potent form, DHT, and so “detoothes” it a bit. It works similarly to drugs such as finasteride, often prescribed for androgenic alopecia, called “male pattern baldness”, but it affects plenty of women too.

    In the case of low levels of FSH, eating leafy greens will help.

    In the case of high levels of FSH, see a doctor. HRT (Hormone Replacement Therapy) may help. If you’re not of menopausal age, it could be a sign something else is amiss, so it could be worth getting that checked out too.

    What can I eat to boost my estrogen levels naturally?

    A common question. The simple answer is:

    • Flaxseeds and soy contain plant estrogens that the body can’t actually use as such (too incompatible). They’ve lots of high-quality nutrients though, and the polyphenols and isoflavones can help with some of the same jobs when it comes to sexual health.
    • Fruit, especially peaches, apricots, blueberries, and strawberries, contain a lot of lignans and also won’t increase your E levels as such, but will support the same functions and reduce your breast cancer risk.
    • Nuts, especially almonds (yay!), cashews, and pistachios, contain plant estrogens that again can’t be used as bioidentical estrogen (like you’d get from your ovaries or the pharmacy) but do support heart health.
    • Leafy greens and cruciferous vegetables support a lot of bodily functions including good hormonal health generally, in ways that are beyond the scope of this article, but in short: do eat your greens!

    Note: because none of these plant-estrogens or otherwise estrogenic nutrients can actually do the job of estradiol (the main form of estrogen in your body), this is why they’re still perfectly healthy for men to eat too, and—contrary to popular “soy boy” social myths—won’t have any feminizing effects whatsoever.

    On the contrary, most of the same foods support good testosterone-related health in men.

    The bottom line:

    • Our hormones are very special, and cannot be replaced with any amount of herbs or foods.
    • We can support our body’s natural hormonal functions with good diet, though.
    • Our hormones naturally fluctuate, and are broadly self-correcting.
    • If something gets seriously out of whack, you need an endocrinologist, not a homeopath or even a dietician.

    In case you missed it…

    We gave a more general overview of supporting hormonal health (including some hormones that aren’t sex hormones but are really important too), back in February.

    Check it out here: Healthy Hormones And How To Hack Them

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    Anthea Levi, RD, takes much the same view:

    ❝For some ‘hormone-balancing’ products, the greatest risk might simply be lost dollars. Others could come at a higher cost.❞

    Read: Are Hormone-Balancing Products a Scam?

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  • 6 Ways To Look After Your Back

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    Back To Back

    When people think about looking after their back, often thought does not go much further than sitting with good posture, and perhaps even standing with good posture. And those things are important, but:

    1) People’s efforts to have good posture often result in overcorrecting creating an anterior pelvic tilt that causes lower back problems.

    Quick tip: if you’re sticking your butt out, you’re doing it wrong (no matter how great your butt is). Instead, to find the correct posture, go up on your tip-toes for a moment, then imagine a plumb-line down the center of your body, thus perpendicular to the floor, going all the way down to the ground. Now, slowly return your heels to the ground, but as you do so, keep your spine aligned to the plumb-line, so you’re not moving backwards as you drop, just directly down. This will land you in perfect posture.

    Unless you have scoliosis. In which case, it’ll get you as close to good posture as is likely attainable from any quick tip.

    2) There’s a lot more to looking after our back than just good posture!

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    Be strong

    Do strength-training for your back. How to do that is beyond the scope of today’s feature, but there are many good guides and also personal trainers that can be found.

    Start off easy and work up, but do start. The stronger your back is, the less likely a momentary lapse in concentration is to throw out your back because you picked something up with imperfect form.

    See also: Resistance Is Useful! (Especially As We Get Older)

    Stretch intentionally

    Many back injuries occur as a result of stretching and/or twisting awkwardly, so if you ensure your basic mobility and range of motion is good, the less likely it is that unthinkingly twisting around 270° to see where that wasp was going will slip a disk.

    The more you stretch intentionally (carefully, please), the more you will be able to stretch unintentionally without injury.

    See also: Building & Maintaining Mobility

    Stand when you can, walk when you can

    We humans have outrun our evolution in a lot of ways, and/but one thing our bodies are definitely not well-adapted for is sitting. Unless we are sitting in a low squat the way you might often see an orang-utan sitting, sitting is not a good way of being for us. Even sitting seiza-style or cross-legged is passable for a short while, not for too long.

    So, while there sure are times we need to sit (especially if you’re driving!) minimizing those times is ideal. There are a lot of activities that are traditionally done sitting, where there’s no need for it to be so. For example, your writer here sits for the day’s main meal, but takes any smaller meal standing (and when guests visit for a coffee or such, I’ll offer them the couch while I myself prop up the fireplace). Standing desks are also great if you spend a lot of time at the computer for any reason.

    See also: The Doctor Who Wants Us To Exercise Less & Move More

    Rest when you need to

    You can’t stand all the time! But know this: if you want to rest your legs, lying down is a lot better for your back (and internal organs) than sitting.

    Taking a 5 minute break lying on your couch, or bed, or floor, is a perfectly good option and only social convention says otherwise.

    If you want a compromise option, though? A recliner chair, in the reclined position, is a better for your back than being scrunched up in the Economy Class Flight position.

    PS: About that bed situation…

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    Kill pain before it kills you

    Painkillers aren’t great for the health per se, but pain (or rather, our bodily responses to such) can be worse. Half the time, when it comes to musculoskeletal problems, things get a lot worse a lot more quickly because of how we overcompensate due to the pain. So, take your pain seriously, and remember, the right amount of pain is zero.

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    The 7 Approaches To Pain Management

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    The authors outline eleven “lifetraps” that we can get stuck in:

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    The style of the book is very reader-friendly pop-psychology, with illustrative (and perhaps apocryphal, but no less useful for it if so) case studies.

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    Bottom line: if you feel there’s something in your life that’s difficult to escape from (we cannot outrun ourselves, after all, and bring our problems with us), this book could well contain the key that you need to get out of that cycle.

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  • Unfuck Your Brain – by Dr. Faith Harper

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    A word of warning: if something that triggers a trauma-based reactivity response in you is people swearing, then this book will either cure you by exposure therapy or leave you a nervous wreck, because it’s not just the title; Dr. Harper barely gets through a sentence without swearing. It’s a lot, even by this (European) reviewer’s standards (we’re a lot more relaxed about swearing over here, than people tend to be in America).

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    Click here to check out Unfuck Your Brain, and indeed unfuck it!

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  • Pistachios vs Cashews – Which is Healthier?

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    Our Verdict

    When comparing pistachios to cashews, we picked the pistachios.

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    In terms of macros, both are great sources of protein and healthy fats, and considered head-to-head:

    • pistachios have slightly more protein, but it’s close
    • pistachios have slightly more (health) fat, but it’s close
    • cashews have slightly more carbs, but it’s close
    • pistachios have a lot more fiber (more than 3x more!)

    All in all, both have a good macro balance, but pistachios win easily on account of the fiber, as well as the slight edge for protein and fats.

    When it comes to vitamins, pistachios have more of vitamins A, B1, B2, B3, B6, B9, C, & E.

    Cashews do have more vitamin B5, also called pantothenic acid, pantothenic literally meaning “from everywhere”. Guess what’s not a common deficiency to have!

    So pistachios win easily on vitamins, too.

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    Both of these nuts have anti-inflammatory, anti-diabetic, and anti-cancer benefits, often from different phytochemicals, but with similar levels of usefulness.

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