Intended for healthcare professionals


Tackling hearing loss to improve the care of older adults

BMJ 2018; 360 doi: (Published 18 January 2018) Cite this as: BMJ 2018;360:k21
  1. Jan Blustein, professor of health policy and medicine1,
  2. Barbara E Weinstein, professor of audiology2,
  3. Joshua Chodosh, Michael L Freeman professor of geriatric medicine3
  1. 1Department of Health Policy, Robert F Wagner Graduate School of Public Service, New York University. 295 Lafayette Street, New York, NY, USA
  2. 2Department of Audiology. Graduate Center, City College of New York, USA
  3. 3Division of Geriatrics and Palliative Care, Department of Medicine, New York University Medical School, USA
  1. Correspondence to: J Blustein jan.blustein{at}

Many older adults have difficulty understanding speech in acute healthcare settings owing to hearing loss, but the effect on patient care is often overlooked, argue Jan Blustein and colleagues

Key messages

  • Many healthcare settings are difficult listening situations, with beeping alarms, competing conversations, and poor sound insulation

  • Communication is key for healthcare quality and safety, so people with hearing loss are at risk of receiving poor care

  • Clinicians should be aware that older patients might have trouble understanding speech and should use established strategies to improve communication

  • Hospitals might be able to provide hearing assistive devices and could routinely screen older patients for hearing loss

The World Health Organization estimates that disabling hearing loss affects nearly a third (32.8%) of people aged 65 years and over around the world.1 The prevalence of hearing loss is growing; it is now the fourth leading cause of years lived with disability globally.2

But the implications tend to be overlooked. Clinical care is often delivered in settings where people with hearing loss struggle to understand speech. Communication is key for healthcare quality and safety, so people with hearing loss are at risk of receiving poor care. Simple steps can improve communication in clinical encounters. Changes in practice environments, processes, and policies could substantially improve the quality of medical care. But first, we need greater awareness.

Difficult listening situations

Typically hearing loss isn’t a problem of hearing sounds, but rather of understanding speech. People with mild to moderate presbycusis (age related hearing loss) can often detect sound well and have good speech understanding in ideal circumstances; for example, in rooms with little competing ambient noise, in conversation with one speaker who is facing them. Understanding can decrease when the setting is less than ideal—when the speaker turns away, when there are multiple simultaneous speakers, or when ambient sound …

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