An older adult doesn’t answer a question correctly. She repeatedly asks what someone just said. He seems confused during a doctor’s appointment. She stops participating in family conversations. He appears to have difficulty following instructions.
It is easy to assume these are signs of dementia.
Sometimes they are. But sometimes hearing loss may be contributing to the problem—or even creating the appearance of cognitive decline when dementia is not present.
For someone who already has Alzheimer’s disease or another dementia, untreated hearing loss can create an additional problem. A brain already struggling to process information must now try to make sense of incomplete or misunderstood sounds.
That is why hearing deserves more attention when families notice changes in an older loved one.
Imagine asking an older adult:
“Did you take your medication after breakfast?”
The person hears only parts of the sentence, misunderstands the question and responds, “No, I don’t want breakfast.”
To someone unaware of the hearing problem, the answer may sound confused or inappropriate.
Now imagine this happening throughout the day.
Someone who cannot hear well may:
These behaviors can sometimes resemble cognitive problems.
The American Speech-Language-Hearing Association (ASHA) specifically recommends that clinicians distinguish between hearing loss and cognitive impairment and identify when one or both are present. Hearing screening is particularly important when cognitive decline is suspected.
This distinction can even matter during cognitive testing. If someone cannot clearly hear a question or instruction, an incorrect response does not necessarily mean the person could not understand or remember it.
You cannot remember information you never heard correctly in the first place.
The situation becomes more complicated when an individual really does have dementia.
Alzheimer’s disease gradually affects a person’s ability to understand and communicate. Add hearing loss, and communication can become considerably more difficult.
The Alzheimer’s Association notes that hearing and vision problems can make communication particularly challenging for people living with dementia and recommends regular hearing and eyesight checks.
Consider an everyday situation.
A caregiver approaches an older man from behind and says that it is time to take a shower. He doesn’t hear the caregiver approaching or understand what was said. Suddenly, someone touches his shoulder.
A person without dementia might simply turn around.
A person with dementia may become frightened because he cannot immediately understand who touched him or why. That fear could result in resistance, shouting or even an aggressive response.
What appears to be a worsening dementia behavior may therefore have several contributing factors.
The person didn’t hear.
The person didn’t understand.
And dementia made it harder to fill in the missing information.
Hearing loss is extremely common among older adults. ASHA reports that approximately one-third of Americans ages 65 to 74 and nearly half of those over 75 have hearing loss.
Research has also found an association between hearing loss and increased risk of cognitive decline and dementia. Scientists are still studying exactly why this relationship exists.
Possible explanations include the additional mental effort required to understand speech, reduced social interaction and other biological or neurological factors.
Importantly, an association does not mean that hearing loss automatically causes dementia.
But treating hearing loss may have benefits beyond simply making conversations easier.
In the NIH-supported ACHIEVE clinical trial, researchers studied nearly 1,000 adults ages 70 to 84 with hearing loss. Across the entire study population, hearing intervention did not produce a significant difference in cognitive decline. However, among participants who were at greater risk of dementia, the hearing intervention was associated with an almost 50% reduction in the rate of cognitive decline over three years.
The research continues, but there is already a very practical reason to address hearing problems: being able to hear improves communication and connection with the world around us.
Families sometimes accept hearing loss as an unavoidable part of getting older. Others may notice it but consider it relatively unimportant compared with other medical conditions.
It shouldn’t be ignored.
If an older loved one begins appearing confused, withdrawn or unusually unresponsive, consider whether hearing could be part of the problem.
Watch for signs such as:
A professional hearing evaluation can help determine whether hearing loss is present and what interventions may be appropriate.
And if a person already wears hearing aids, don’t assume the problem is solved. Make sure the devices are being worn, are functioning properly, have working batteries or are charged, and continue to meet the person’s needs.
For someone with dementia, family members and caregivers may need to help make hearing aids part of the daily routine.
Small changes can make communication much easier.
Approach the person from the front. Make eye contact before speaking. Reduce background noise from televisions and radios. Speak clearly and at a comfortable pace.
Avoid shouting. Instead, move closer when appropriate and make sure the person can see your face.
Use short, straightforward sentences and allow enough time for a response.
Most importantly, don’t immediately interpret an inappropriate answer as confusion. First ask yourself: Did this person actually hear and understand the question?
That simple question can sometimes change an entire interaction.
Hearing loss and dementia are different conditions, but their symptoms and effects can overlap.
An older person with significant hearing loss should not automatically be assumed to have dementia because conversations have become difficult. Likewise, when someone with dementia becomes noticeably more confused, withdrawn or frustrated, families should not automatically assume that the disease has suddenly progressed.
Hearing may be part of the picture.
Regular hearing evaluations, properly functioning hearing aids, thoughtful communication and attention to changes can help families better understand what their loved one is experiencing.
At Divine Home Care Services, we believe effective senior care starts by looking at the whole person—not simply the diagnosis. Sometimes improving someone’s day begins with something as basic as making sure they can clearly hear the people who are trying to connect with them.
Eduardo Berdegué
Divine Home Care Services
www.divinehomecareservices.com
Call today for a free in-home consultation to assess care needs. We provide personalized, confidential, and compassionate support—available 24/7 for your family.
