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Hearing well in old age: crucial for quality of life and health

Oct 1, 2021

On the International Day of Older Persons, MED-EL is drawing attention to the important subject of hearing health

October 01, 2021 – (Innsbruck, Austria) – On October 1, the International Day of Older Persons celebrates our older loved ones and recognizes their needs and the challenges that they can face.  Living fulfilling, inclusive and healthier lives is a UN focus for our nation’s older adults.  Good hearing is an important part of this to help maintain relationships and social contact with friends and family.

In a recent survey* by hearing implant manufacturer, MED-EL, “conversations with loved ones” came out at the top of a list of everyday sounds that  people would miss the most if they lost hearing.*  Hearing enriches everyday life and provides moments of joy that older people in particular can really appreciate: hearing the voices of loved ones, having a stimulating conversation, listening to natural and ambient sounds, enjoying music. Last but not least, hearing keeps our cognitive abilities sharp, increases short-term memory, and improves reaction times. A recent study** has shown that untreated hearing loss is now the number one modifiable risk factor for dementia.
According to the World Health Organization (WHO), more than 25 percent of people over the age of 60 are affected by a hearing impairment – this rises to over 46% by the age of 80. As the world is ageing, the proportion of people suffering from hearing loss will also increase over time. In 2050, the WHO anticipates that 700 million people around the world will be living with severely restrictive hearing loss.*** 

Causes of Hearing Loss in Older Adults

Age-related hearing loss is generally caused by progressive hearing difficulties in the inner ear, which are often seen as an unavoidable part of getting older. In addition, typical age-related diseases such as cardiovascular problems, diabetes, high blood pressure, and arteriosclerosis also damage hearing. Loud noise has a detrimental effect on hearing over the course of a lifetime, for example traffic and machine noise or loud music. Those affected can feel increasingly restricted by it in their everyday lives. 
It is often relatives or friends who first notice progressive hearing loss. Progression is so gradual that those affected initially compensate for it without realizing and adapt to their changing hearing. People grow accustomed to life with their worsening hearing; as this becomes “normal” hearing it affects their self-assessment and self-perception of their new situation, says Dr. Stefan Zimmer, Secretary General of the European Hearing Instrument Manufacturers’ Association (EHIMA). 

Typical signs of hearing loss in adults include: 
• Increasing the volume of everyday sources of sound, such as the television, radio, or music system, 
• Asking people to repeat themselves during conversations, 
• Having trouble making phone calls,
• Deliberately avoid socializing and group discussions if they are no longer able to follow conversations because voices and background noise blur together. 
Carola, 74, user of a MED-EL hearing implant: “I could no longer understand speech or make phone calls, I could only watch TV with subtitles, and I had difficulties understanding in the theater. It became dangerous in traffic. My hearing aids, which I had been wearing for about 20 years, were simply no longer sufficient.
For most people, hearing loss starts at the age of 50 or 60. Yet adults with a hearing loss wait for an average of 10 years before seeking help or deciding to use hearing aids or implants. Even those who initiate a diagnosis frequently don’t see it through to the end. 

The Significance of a Hearing Device

Dr. Stefan Zimmer explains: “On average - based on data from 11 countries**** - only three out of four people who experience hearing loss consult a doctor. Of these, about 70% are referred to a hearing care professional or audiologist after medical diagnosis, and of these, 73% are eventually fitted with hearing aids. This is where we see a very important reason for the low uptake of hearing aids and devices across the world: high drop-out rates in the fitting process. These drop-out rates must be minimized.
This applies in particular to older people with progressive hearing loss: many of them prefer to avoid situations where they struggle because of their hearing impairment rather than being provided with hearing technology. They fear social rejection, yet studies show that people who live with untreated hearing loss experience more stigmatization than those who use hearing devices. It is not the implants or hearing aids that are stigmatized, after all, but the hearing impairment itself, explains Professor Heidi Olze, Director of the ENT Clinic at Charité Berlin. It is seen as a sign of age, of not understanding, of communicative limitations, and is often even taken to show a lack of mental capacity. 

Health Risks of Untreated Hearing Loss

People with hearing loss not only experience communication and hearing barriers, and isolation. They may also find it harder to concentrate because the more arduous hearing becomes, the more attention it takes away from other areas. Hearing loss in old age can also have direct health implications. Those affected may struggle to understand medical explanations and instructions and may not receive adequate medical care for this reason. Everyday risks also increase: they don’t hear the sound of smoke or fire alarms and miss the doorbell or telephone ringing. Safety in traffic is also reduced if people don’t hear bicycle bells or oncoming cars. Hearing loss also increases the risk of falling, as Dr. Stefan Zimmer explains: “Even a mild hearing loss of 25 decibels or more increases the risk of falling almost threefold, whereas the risk of falling is considerably reduced for hearing aid users. Untreated hearing loss puts older people in particular at greater risk of disability.
Scientific studies also show that people with hearing loss have a higher risk of dementia: The absence of auditory stimulation in the brain leads to a degeneration of the brain’s structures, first in the auditory center and later on in the cognitive area. Untreated hearing loss in middle life is by far the greatest modifiable risk factor of dementia, says Dr. Stefan Zimmer. 
Jane Opie, MED-EL Senior Research Audiologist, adds “Numerous studies over the past 10 years or so have demonstrated that hearing loss increases the risk of developing cognitive decline. What lies beyond cognitive decline? Dementia.

Treatment and Rehabilitation

Hearing loss can be better treated if technical provisions and rehabilitation are made as early as possible. Among other things, the amount of time a person has lived with hearing loss is a crucial factor in the success of a hearing implant. When clearer memories of speech and sound are present, the easier it is for the brain to learn to hear and understand them again. 
Often, emotional experiences in the immediate vicinity tip the scales when it comes to seeking treatment for the hearing loss: “The fact that hearing care helps people to do much more than ‘just hear well’ is an eye- and ear-opener for many people,” emphasizes Dr. Stefan Zimmer. There is no age restriction for the treatment of hearing loss. The oldest recipient of a MED-EL hearing implant in Europe was 99 years old! 
It can also be useful to get in touch with self-help groups early on - while still in the decision-making stage - or get to know individuals with hearing implants, says Professor Heidi Olze. “What strikes me most is the joy and gratitude that our patients show us, as well as their stories about all the things they can do (again) with the hearing implant. For example, a patient who is working as a choir director once again, patients who go back to concerts and the theater, who hear the birds singing in the morning for the first time in years, who hear their children’s voices again for the first time...” says Heidi Olze.
So, everything speaks in favor of not just accepting hearing loss in old age, but returning to hearing. In this way, an important prerequisite for physical and mental health, high quality of life, and participation in society are provided for. 74-year-old Carola states: “Everything that was difficult before is possible again. I can participate in conversations, I can watch TV without subtitles, listen to music. I can hear the birds singing again, the ringing of bicyclists, I can make phone calls and thus establish contact. There are no more restrictions for me.”


*MED-EL International Survey 2019, 11,016 participants. Data on file
** Livingston, G., Huntley, J., Sommerlad, A., Ames, D., Ballard, C., Banerjee, S., Brayne C., (…), & Mukadam, N. (2020) Dementia prevention, intervention, and care: 2020 report of the Lancet Commission. The Lancet. 396(10248), 413-446. doi:10.1016/S0140-6736(20)30367-6
*** WHO World Report on Hearing 2021
****Belgium, Denmark, Germany, France, Italy, Norway, Poland, Spain, Switzerland, Netherlands, and United Kingdom

About MED-EL

MED-EL Medical Electronics, a leader in implantable hearing solutions, is driven by a mission to overcome hearing loss as a barrier to communication. The Austrian-based, privately owned business was co-founded by industry pioneers Ingeborg and Erwin Hochmair, whose ground-breaking research led to the development of the world’s first micro-electronic multi-channel cochlear implant (CI), which was successfully implanted in 1977 and was the basis for what is known as the modern CI today. This laid the foundation for the successful growth of the company in 1990, when they hired their first employees. To date, MED-EL has grown to more than 2,200 employees from around 75 nations and has 30 locations worldwide.
The company offers the widest range of implantable and non-implantable solutions to treat all types of hearing loss, enabling people in 124 countries enjoy the gift of hearing with the help of a MED-EL device. MED-EL’s hearing solutions include cochlear and middle ear implant systems, a combined Electric Acoustic Stimulation hearing implant system, auditory brainstem implants as well as surgical and non-surgical bone conduction devices. 
More than 95% of the hearing implants are exported and used by more than 4.000 clinics around the world. www.medel.com 


Doz. DI Dr DDr med. h.c. Ingeborg Hochmair

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