Hearing Loss More Prevalent Among Older Medicare Beneficiaries than Previously Thought

A study published today in JAMA Network Open concludes that hearing loss among the oldest Medicare beneficiaries is more pervasive than previously thought, surpassing previous estimates. The findings also suggest that hearing loss may be more severe than what has been assumed for people aged 80 and older.

In the nationally representative sample of adults age 71 or older, almost two-thirds (65.3%)—corresponding to an estimated 21.5 million individuals—had some degree of hearing loss. By age 90, nearly all (96.2%) had hearing loss. However, only 29.2% of those with hearing loss used hearing aids.

The researchers, led by Nicholas Reed, AuD, PhD, of Johns Hopkins Bloomberg School of Public Health, believe these are the largest and most robust estimates of audiometrically measured hearing among older US individuals to date.

The study included participants aged 71 years and older taken from a nationally representative sample of 2803 participants in the 2021 National Health Aging and Trends Study (NHATS). Overall prevalence and severity of hearing loss increased with age, and severity levels for the entire population were found to be:

• No hearing loss: 34.7%
• Mild: 37.0%
• Moderate: 24.1%
• Severe or worse: 4.2%

Hearing loss prevalence was highest among male, White, and lower-income individuals with less education, but the differences among demographic subgroups narrowed as age increased. The negative impacts of hearing loss were similar across all demographic groups, underscoring the need for comprehensive public health approaches to address hearing loss among older adults.

Regarding hearing aid use, the study revealed relatively low adoption rates (29.2% overall), but there was an increasing trend in overall uptake. Consistent with previous research, race, ethnicity, education, and income levels were associated with a lower prevalence of hearing aid use. The authors believe this suggests a need to consider additional factors and technologies like cochlear implants and over-the-counter (OTC) hearing aids when examining hearing care use in the United States.

Compared to previous studies, the findings show significantly higher prevalence estimates among the oldest age groups: 76.7% for those ages 80-84 years, 91.0% for those 85-89 years, and 96.2% for those 90 years or older. Hearing loss severity for individuals age 80+ was also higher than some previous estimates from NHANES data: 35.8% had mild, 38.8% had moderate, and 9.6% had severe or greater hearing loss. The authors believe the difference might be due to the study's inclusion of underrepresented populations, including the oldest and lower-income individuals. They also discussed the use of different categorical definitions for hearing loss; applying World Health Organization (WHO) updated hearing thresholds results in even higher prevalence estimates.

“The most striking finding is that we knew the prevalence of hearing loss increased with age, but until now, we knew very little about the prevalence in those over 80 years of age,” Dr. Reed told HearingGifts. “This is mostly because we've never had a study like NHATS include hearing measures. NHATS is unique because it focuses on the oldest old Americans and performs in-home visits across the country so it doesn't miss out on participants with travel restrictions. Now we see that, by the time we reach 90 years and older, hearing loss is nearly ubiquitous—over 95% have hearing loss.

“But the deeper numbers are striking,” says Reed. “Among those 90+ years of age, about 75% have moderate or greater hearing loss. This flips the traditional script where we've often assumed the prevalence of hearing loss is high but primarily mild in nature. This is the kind of data we need to appropriately plan public health and policy actions to address hearing loss in the United States.”

The study also points to the need for more granular classifications of hearing loss severity—particularly for the oldest age groups. The authors believe shifting away from a binary description (i.e., “hearing loss” or “no hearing loss”) with more detailed accounting for hearing loss severity should lead to a better understanding of this important, growing patient population and assist in targeted public health planning and resource allocation.

These findings suggest that hearing loss among the oldest old adults (ie, aged 80 years) is more pervasive than previously thought and warrants deeper consideration of discrete severity measures of hearing loss in this population, rather than binary hearing loss terminology."

Another point of emphasis in the study is that about two-thirds of adults older than 71 and nearly all older than 85 have hearing loss, but relatively few use hearing aids. This has important implications for hearing-focused policies and initiatives, such as the Over-the-Counter Hearing Aid Act and Medicare coverage for hearing aids, say the authors. Accurate prevalence estimates are crucial for such initiatives to effectively target and address the needs of individuals with hearing loss.

While future studies with larger samples may increase the precision of estimates among the oldest age groups, the authors note this study provides a significant step forward in better understanding the true extent of hearing loss among older U.S. adults.