As people age, the onset of hearing loss is very likely. However, age-related hearing loss frequently goes untreated and typically is not covered by insurance, leading to poor overall health. For example, findings show that hearing loss can affect the brain and interfere with memory and cognition as well as shrink the auditory cortex—a part of the brain that plays a key role in our ability to perceive sound—which can trigger a cascade of harmful effects on the rest of the brain.

Given the far-reaching consequences of hearing loss and how common it is, treating the impairment seems like a no-brainer. But only about 20% percent of people 65 and older with moderate to profound hearing loss perceive themselves as hearing impaired, and many believe they don’t need medical intervention for the condition. What’s more, society’s negative perceptions of aging can compound the problem.

“There is something wrong with the way we approach hearing loss today across the life span; there’s obvious ageism,” says Justin S. Golub, MD, MS, an associate professor of otolaryngology, at Columbia University’s Vagelos College of Physicians and Surgeons and stiNew York–Presbyterian/Columbia University’s Irving Medical Center.

“When we see children who have hearing loss, we treat them all the time regardless of the level of hearing loss,” he continues. “If you have a child with even a small amount of hearing loss, that child gets a hearing aid, wears a hearing aid, and it will be paid for by insurance.”

In contrast, in older adults, hearing loss is rarely treated with hearing aids. “I just find this incredibly puzzling,” Golub says.

For the past several years, Golub has been studying the connection between hearing loss and dementia, loneliness and cognitive problems among seniors. “I think the most drastic behavior change from hearing loss is that you’re going to restrict your social life,” Golub explains. “You will tend to no longer do certain social activities when it becomes difficult to hear and those interactions are more frustrating rather than pleasurable. You’re not going to want to go to restaurants as much, so you’re going to have a more restricted social life. Depending on your social network, that could be damaging.”

Nell Jackson, a retired businesswoman who lives in New Jersey, experienced this problem firsthand when her husband, David, 87, who is living with hearing loss, became increasingly uncommunicative when the couple entertained at home or socialized with friends.

“He can’t hear what people are saying, so he just sits there and doesn’t speak,” she says. “Then after I finally convinced him to get a hearing aid, which cost $5,000, he wouldn’t wear it. He told me, ‘What’s there to hear? I hear good enough.’ That makes no sense to me!”

Frustrated with her husband’s attitude, she cut back on hosting get-togethers and turned down invitations to events or would attend them alone. In response, her husband has become even more distant and continues to avoid wearing his hearing aid.

Like Jackson’s husband, some older people harbor negative opinions about the device. Many may feel ashamed and pitiful when wearing a hearing aid.

“In my family too, my mother has hearing loss, and she’s listened to talks about what can happen if the problem isn’t addressed,” Golub says. “Yet she still does not want hearing aids.”

To overcome the stigma people attach to using the devices, Golub suggests that a multipronged approach involving different segments of society is needed. “We have to start saying that being able to hear matters for socialization and the quality of life and that if you want to enjoy life until the last drop, we need to be able to hear, go out and communicate, engage and socialize,” he says. “And we have to stress that we have tools like hearing aids and cochlear implants to help. The world just needs to be more enthusiastic about these solutions.”

People with hearing loss who become less social may wind up developing depression. “Hearing loss and depression are common partners but understudied and underrecognized in older adults,” observes Dan Blazer, MD, PhD, a professor of psychiatry at Duke University, in Durham, North Carolina.

When hearing loss is the trigger for depression, however, findings show that hearing aids can help. In a study involving 113 participants who received either cochlear implants—small electronic devices used to treat more severe cases of hearing loss—or hearing aids, all individuals showed significant improvement in symptoms of depression after six months of treatment with the gadgets.

Today, hearing aids are smaller and offer better sound quality—even in noisy environments—and greater convenience, connectivity, comfort and functionality than their predecessors. But they are costly (about $2,400 for one device on average), and most people who need them require two and often have to dig deep into their pockets. Medicare does not cover the devices; Medicaid coverage depends on the state you live in; and private insurance coverage varies widely.

If passed, the Over-the-Counter Hearing Aid Act of 2017 would allow people to buy hearing aids in drugstores without visiting a health professional. These devices are a new category of hearing aid specifically for adults with mild to moderate hearing loss. The Food and Drug Administration was supposed to issue guidelines for consumer use of the gadgets, but the coronavirus pandemic delayed this action. In July, President Joe Biden asked the agency to generate its recommendations within 120 days. With any luck, the device could be available to the public sometime this year.

Online, consumers can buy hearing aids directly from their manufacturers. But experts advise individuals who buy them to visit an audiologist or hearing center to have the devices customized to meet their particular needs.

Golub believes that the availability of over-the-counter hearing aids will prompt highly innovative, cost-conscious consumer electronic companies, such as Apple, Samsung and Bose, to begin making these kinds of medical wearables.

“Headphones have gotten so amazing over the last 10 years because Apple is competing with Bose, and all this other stuff is going on,” Golub says. “If that kind of innovation happens with hearing aids, that would revolutionize the industry, and I think that is very likely to happen.”