Seven years ago Irene Schwarz, now 84, noticed for the first time that if she wasn’t near to people who were speaking or close to the source of a sound, she would be unable to hear.

“When you were talking to her, it would be like you’re four steps ahead and all of a sudden she’s bringing up the rear with the conversation,” says Rudy, her husband, a Korean War veteran who is four years older than his wife.

Married for more than 60 years, the two grew old together after settling down in Maywood, a small municipality sandwiched between Hackensack and Paramus in Bergen County, New Jersey. The couple have a son and a daughter, both in their 50s.

Irene and Rudy Schwarz as newlyweds in April 1962

Like 50% of Americans over the age of 75, Schwarz experienced hearing loss severe enough to affect her daily quality of life. But despite being plagued by rising levels of frustration, one year passed before she went for an audio screening. “Sometimes it’s like you’re afraid to hear what the doctor might tell you,” she says.

There are many reasons older people hesitate to get their hearing tested. According to Johns Hopkins Medicine, a large number of individuals wait an average of 10 years before buying hearing aids. Cost is definitely a factor as the expensive devices are not covered by insurance.

Another factor is the perceived stigma some people internalize that is associated with hearing loss and the use of hearing aids. Often this can result in individuals denying they have a hearing problem and delaying a visit to the doctor. What’s more, although low-cost hearing screening is widely available, most older adults are not asked about their hearing during health care visits, notes findings in the medical journal Cost Effectiveness and Resource Allocation.

By the time Irene received an audio screening, her hearing loss had escalated. “It’s like you’re dismissed because you’re older,” she says.

“It’s not all doctors,” Rudy adds. “But the attitude some physicians have with older patients at times is like they just don’t want to be bothered. It’s like if your problem is nothing serious they’re not going to do anything about it.”

The biggest problem with hearing aids for the couple concerned costs. Medicare, the federal health insurance program for older U.S. adults that covers those age 65 and older, does not cover most routine hearing care.

Irene’s first pair of hearing aids cost $5,800. “We financed these,” says Rudy pointing to a small palm-sized charger with his wife’s hearing aids nestled inside their respective spaces.

A second pair they financed later set them back an additional $400. “We’re paying for these through Wells Fargo,” Irene says. “If we pay them off in one year, we don’t have to pay interest.”

Unbothered by stigma, for Irene “just remembering to put them in” posed the biggest issue. Then there were the logistics connected with putting in hearing aids, wearing glasses, and clipping earrings onto her ear lobes. “I’m constantly making sure that they’re securely in my ears; they cost so much money!” she exclaims. “I want to make sure I don’t knock them out."

“Wearing them is almost like putting on your clothes,” Rudy says. “You know, ladies put on their cosmetics and stuff like that that, and make sure that the earrings match the outfit and the shoes and everything else that goes along with it, so why not the hearing aids, one of the most important things?”

Last year, President Joe Biden issued an executive order to make hearing aids and the required doctor’s visit to get a prescription for the devices more affordable for millions of Americans. He also urged the Food and Drug Administration to make hearing aids available over the counter for those with mild to moderate hearing loss.

By mid-October, Americans were able to buy reasonably priced hearing aids over the counter at pharmacies and stores across the country, without needing a prescription and medical exam by a doctor.

Experts advise, however, that the ready availability of hearing aids should not replace a hearing examination conducted by a health professional as this could interfere with the diagnosis of possible auditory problems that might trigger hearing loss.

Interestingly, Rudy has never had a hearing test. "Right now, I can hear everything,” he says.

But what if he encounters a problem? “Well, I might dilly dally around a little bit,” he admits glancing up when a wall clock in his dining room chimes a tune at the top of the hour. “But I’ve learned because I’ve seen what can happen. In the long run I would get my hearing checked. That’s because I believe that with medical conditions you have to handle the problem as soon as possible.”