The Surprising Connection Between Hearing Loss and Cognitive Function

Alrighty. Hearing loss. This is one that is kind of near and dear to my heart because my husband's really. Come on. I guess we'll get started in a second. This is Brewster. This is my four legged old man. All right, Boo boo, you gotta go. Mama's teaching. Okay, so anyhow. Or maybe not. My husband's grandfather is all but deaf, and his hearing aids are pegged out to the nth degree. And he hears some. He does really pretty well in environments where there's not a lot of background noise, but if there's background noise, he can't hear. And sometimes because it takes so much energy to listen and pay attention, he just checks out. Why am I telling you this? Well, he went to be evaluated for admission into an assisted living facility. And number one, they didn't really explain to him what they were doing with the mmse, but they administered the MMSE and my senses, but both. He couldn't hear and understand what they were saying very well, and he just didn't care. So he didn't pay that much attention. And he ended up scoring a 7 out of 30 on the MMSE. This same man was home the next day. And my. My grant. My husband's mother was talking to him and was talking to him about how he liked the facility and everything. And he's like. And she's like, oh, I think it's wonderful. And she was just going on about it. He turns around, he's like, why don't you go there? Oh, okay. Very lucid. And then after his wife passed, it wasn't a couple days later he was talking about, well, maybe I should go back to church, because, hey, at least I could meet some ladies there. And we were like, pop, really? But my point being, he's not struggling with cognitive decline. He's on point when he wants to be. He just didn't care. And so paying attention to hearing loss and. And why did he not care? Well, number one, he didn't want to go. But number two, anytime he has to listen to hear, to understand, it takes, you know, just estimating 10 times as much energy for him to hear what's being said and interpret it than it does us, because it's like somebody's speaking to him through. Talking to their. Through their hands. It's really a lot harder. It sounds muffled, it sounds garbled, like somebody's talking to you underwater and he wants to hear. So that takes energy. Our brain uses a ton of energy. So hearing loss can actually contribute to a lot of people's stress. Among other things, and negatively impact the older adult's well being. So let's go ahead and get started. I think Brewster's finished trying to get attention. Welcome back to this presentation on hearing loss, cognition, energy, blood sugar, balance, loneliness and mood. Wow, that was a mouthful. I'm your host, Dr. Donnelly Snipes. In this presentation, we're going to explore the impacts of hearing loss on each piece of the older adult's life. Identify strategies to help the older adult live their highest quality of life, thereby reducing stress, inflammation, and cognitive, emotional and physical illness. High blood sugar. Well, this is one of the most common causes of hearing loss. And what did I say earlier? Nearly 40% of adults are insulin resistant, pre diabetic or diabetic and which means that they frequently may have high blood sugar. Diabetes and insulin resistance can damage small blood vessels and nerves in the ear as well as throughout the rest of the body, including the mouth, like we learned in the presentation on oral hygiene. But anyway, diabetes can damage these small vessels in the ear, causing hearing impairment. Vascular damage related to blood sugar also affects the brain health and cognition, creating a shared pathway. So when we have vascular damage in our ears, we're not hearing as well, which means our brain's not being stimulated. And that pathway, it's kind of like a road with a bridge out that's just, it's not connecting in our brain very well. And that increases stress. Stress related to hearing loss and cognitive load, which is how much energy we need to use to actually hear and understand what's being said. This stress can increase blood sugar, worsen diabetes and increase inflammation. What causes hearing loss? Oh, a lot of things. Loud noise exposure is one of the most common. Papa Snipes worked on the railroads for his entire career. And that was back, way back before they thought hearing protection was anything that was necessary. A head injury can cause hearing loss. Diabetes, we already talked about allergies and sinus infections can cause hearing loss. And for some, the allergies are persistent. They're always stuffy, they're always clogged, and that's going to cause sort of persistent hearing loss, if you will. For others, it may be episodic when they have a sinus infection or something, but when they can't hear very well, then they've got a strain. They've got to use more energy to hear what's being said and it can throw off their balance. But that's a whole side issue. Toxins, There are certain medications and certain toxins that people ingest that actually can cause hearing loss. And hypertension, just like diabetes, can damage the blood vessels and the nerve endings. Hypertension can as well. In diabetes, and I didn't mention this on the last slide, you know how you have peripheral neuropathy, we think about that in diabetes, in their hands and in their feet, especially in their feet. But you can also get peripheral neuropathy in the nerves of the ears, and that can cause an inability of the ears to transmit the sound signals to the brain. Hearing imbalance systems are anatomically and functionally connected, which I'm not exactly sure why, but they are. So hearing loss increases the risk of falls, especially in older adults. You have. And, and this is true even in transient hearing loss, like with a sinus infection. Being aware that the older adult is going to, going to likely have more problem with balance is super important because if they fall and they get hurt, then you've got a whole other set of issues. They've got to go to the hospital, and then in the hospital they're in contact with all kinds of weird germs. They end up getting sicker. It's just, you don't want to go there. So being aware of this and making sure that the older adult is, their environment is free of trip and fall hazards, even more so when they're, when they're sick. Constant effort is required to understand speech and sound, especially noisy environments, and it drains energy. Think about if you were in a very noisy restaurant and you're trying to hear what people are saying, or when you were younger and you used to go to the dance clubs, maybe you still do, I don't know. And you were trying to talk to somebody and you were having to shout at each other and you could barely hear and you were trying to understand what they were saying. It took energy. Now, it may not have felt really stressful, but it took a lot of energy. And we're already dealing with people who don't have a whole lot of excess energy interpersonally. When people cannot hear, it's hard for them to communicate, which causes frustration and irritability in both people thinking again. And, and I'm using my husband's grandparents as examples because I don't have HIPAA problems there. But they had been married for 75 years. I mean, they'd been together forever. And. But as his hearing got worse, it would cause more frustration because he'd have trouble hearing his wife when she would talk to him. And he wasn't ignoring her. He just didn't hear her or he didn't understand what she said correctly. So he wouldn't do what she wanted him to do. And then she would get angry. And then he would get angry with her because he's like, I don't know why you're angry with. You can see how this can spiral out of control. So it is important to recognize that difficulty hearing can cause frustration. If you want to try it Sometimes I have people experiment a day in the life, if you will. And if you want to try seeing what it might be like to have hearing impairment, take cotton and stick it in your ears and go around for a day. Now you haven't lost all your hearing, but you're not hearing things nearly as well. And see whether it's harder to understand, whether it's more frustrating to try to interpret things like you're watching the TV and you're straining to understand what they're saying. Don't cheat. And put the. And and put the subtitles on. You got to try to hear it through your ears. But you can start to understand a day in the life. People who have hearing loss may have reduced self esteem due to perceived rejection because of these misunderstandings. Somebody may say, I can't think of anything, but you know, do you want to go to dinner tonight? And they say, yeah, I'll take the trash out in a minute. What? I didn't say anything about the trash. But what they heard or what they thought they heard they were responding to. Sometimes we can think people are developing dementia because they have nonsensical responses to things we say. However, it could be that they are just not hearing well and their brain is filling in the gaps. It happens. And so they are misunderstanding what is actually being said. Cognitively, they're fine, but their brain is misinterpreting the signals it got. So they're getting a whole different message. And that's important to remember. And it's important to remember that people may be able to hear better at certain pitches. So people who have a really high voice, for example, it may be harder for somebody with hearing loss to hear what they're saying because a lot of times we lose the high pitch first. Or people who have a really low voice, not a quiet one, but a low, like a bass type voice. It may be harder for peop some people to understand. So it may feel like the person with hearing loss is selectively ignoring certain people. Or some people who are frequently misunderstood by the person with hearing loss maybe just convinced that the person has dementia, when in reality the person with hearing loss just can't hear that range of sound very well, so they don't hear Susie speaking or understand what Susie is saying nearly as well as they understand what Bob is saying because it's a different area in the sound register. Additionally, people with hearing loss have volume control issues. And, and I think a lot of us have had that experience when we've had a sinus infection, an ear infection and we're trying to talk to others and we're like, it sounds like I'm screaming so. Or maybe it doesn't let me know about my volume because I can't tell how loud I am with people with hearing loss. And I've seen this in assisted living facilities where other people will get up and leave the room when the person with hearing loss comes in because they are so loud and they just, they don't realize how loud they are. And instead of trying to help the person deal with that, which we're going to get to in at the end of the presentation on strategies for that, they just leave the room. And then the person with hearing loss is like, what gives? That was rude. So they can feel off put. They can. When they go into the dining room, people can get annoyed with them because they're being too loud. Again, they don't realize they're being loud. They can't hear how loud they are. There are devices that can help them learn to monitor and modulate their sound, but it can impact their self esteem when they feel like, oh, I'm so embarrassed that I annoy everybody because I'm too loud. All right, well they need to get over it. Find activities that the person can do. If you're doing group activities, find ways the person can participate without speaking if they are feeling self conscious about their volume or encourage educate other people about the fact that Tom doesn't realize how loud he is and he can't hear himself. And we need to be patient and accepting of the fact that he's doing his very best and you know, we appreciate him and care for him as a human being. We're not going to abandon him because he's loud. Difficulty engaging socially can result in withdrawal, lower oxytocin and loneliness, which further worsens mental health, reduces oxytocin and imp. Impairs cognitive functioning. Recognizing. Remember I said as people get older their estrogen and testosterone go down which help modulate the nervous system and are strong anti inflammatories. Well, when those go down and we don't have them anymore, what do we have that helps modulate the nervous system and acts as an anti inflammatory oxytocin but if the person is completely withdrawn, if they're feeling isolated, if they're not spending time with others, if, especially if they don't have a dog or a cat or something that they can connect with and get that oxytocin release, they're really going to start struggling, um, with blood sugar and, and motivation and, and inflammatory, inflammatory issues. And this may seem silly, but I think it's important to mention that older adults may miss auditory cues from their dogs or their grandkids. And again, I'm thinking of my husband's grandfather right now. He has this dog that he loves to death, but it's one of those little tiny dogs that has a very high pitched squeal voice thing and when it wants attention, it just squeals and wags its butt, but he can't hear that sound. Everybody else is going, oh my gosh, make it stop. But he doesn't hear it. So people with hearing loss, especially with upper register hearing loss, may miss auditory cues from their dogs or from their grandkids that want something because they, both dogs and small children tend to have higher pitched voices. And I mean the dog. If they're trying to go out, they may end up peeing on the carpet. The grandkids may get their feelings hurt thinking that Pop Pop's ignoring them. And it's important to educate the grandchildren that Pop Pop's not ignoring you. He just can't hear. He just can't hear you. And we don't need to get into specifics about why. If you want Pop Pop's attention, you need to go around in front of him so he can see you before you start talking to him. Emotionally, it is frustrating when you can't hear, when you can't understand what's going on. And again, even if you don't want to go around with cotton in your ears for an entire day, I know in our living room the acoustics are horrible. I don't know what's wrong with them, but the acoustics are horrible. And when we had the TV on there, on down there, I have to have the subtitles on because I can't understand what's being said. Even though we have a sound bar and everything else, for some reason it sounds a lot more garbled. Now I have the same TV in my bedroom and I don't have that problem. So it has to be something with the acoustics in the living room. Either way, when I'm sitting in the living room, if I don't have the subtitles on, I get really frustrated because I can't understand what's going on in the show. I'm like, what did he say? What's going on? And then my husband gets irritated with me because he's like, pay attention. I'm like, I am paying attention. I just can't hear. But he even has problems with the living room television. And I bring that up to highlight the fact that we've experienced this. If we think in our own lives about times when we haven't been able to hear things clearly, we can recognize how frustrating it might be. And even though, you know, thinking of our. Our stress bucket, even though it may only be a cup or so, it's not a gallon dump of water in that stress bucket. It's still water. And if our stress bucket's already full, it doesn't matter if it's one cup or one gallon, it's going to overflow. People who are experiencing hearing loss may struggle with grief. I love listening to my birds, and I love listening to music. Those are huge parts of my life. And if I wasn't able to hear them as well or hear them at all, that would be a loss that would be devastating for me, and I'd have to grieve that. And people who enjoy noticing sounds. Not everybody is sound oriented, but a lot of people are. And if hearing loss means they're losing something that's important to them, then it can be really devastating, and they need to grieve that loss. They need to grieve the loss of, I can't hear as well, or I can't hear it all. Most people, it's, I can't hear as well. So then we want to look at what can we do to make it better for Papa Snipes? If you get him out on the porch and talk to him while you're looking at him, he hears you just fine. Thank you very much. But if you're in the house and people are banging dishes and the dog's running around and there's just ambient noise, it's too much, and his brain can't filter it out, so he doesn't hear as well. And a lot of times he just kind of checks out. He's like, if it's. If it's important enough, they'll. They'll let me know. Depression, feeling hopeless and helpless, which goes along with grief. Very common when people have difficulty hearing because they. They may feel left out. They may feel like everybody else is able to, and I can't anymore. Boredom. Some people, a lot of their life, revolved around sound oriented things. Talking, teaching, listening, singing. And if they can't do it, then they may get bored. My grandfather, the one that had Parkinson's, thankfully he never lost his hearing because the last thing he was able to do towards the end of his life was watch, which watch westerns on tv. He first lost his ability to do his miniatures and then his eyes went so he couldn't read anymore. So the only thing left was really sitting there kind of watching slash listening to the tv. And yeah, I mean, he would, he would start to get bored because there's only so many episodes of Gunsmoke you can watch before you know you want something else to do. And helping people figure out what else is there that you can and want to do that would bring happiness. Turning their attention. If they can't hear as well what they can see, Are there things that they like to look at, like pretty flowers, picture books, animals? I don't, I don't know. Sometimes using a different sense to bring enjoyment can be helpful. Now if they've got impairments in both hearing and vision, then you've got to work with other things. Being outside, feeling the sun on your skin can feel soothing for people. Being outside. Some people don't have good in close vision to read anymore, but they can watch what's going on in nature. They can be outside, watch the birds, turning their attention to those things. Finding activities that they can do is really important. Instead of looking at what they can't do, let's figure out what you can do. Maybe you can still paint, maybe you can cook. Smell is another sense. Maybe you plant an herb garden around the facility and you don't have to plant a big one. You can put them in little pots. Lavender, basil, oregano, rosemary, those are all really aromatic and let people just go over and, and smell. Most of those you can grow in a sunny window so you don't have to. You reinvent the wheel and there's reduced motivation to engage in activities. Well, if you can't hear and it feels like people don't want you there because you're too loud or you misunderstand everything, then yeah, you can see where people might have a lack of motivation to get engaged. Or if the activities that you have at your facility involve hearing, then they may not want to partake. If you're doing a trivia game, if you're doing something that involves hearing what's being said, obviously that person may struggle to participate. Are there ways like bingo? Are there ways you can incorporate visual? So if you're calling out a bingo number, you're calling it out verbally, but you're also writing it down or holding up a card that says, you know, B12. That way the person with hearing impairment can participate. And that's important, that's super important. To make the environment as inclusive as possible. Have as much stuff written down as possible. If in your cafeteria they have options of foods they can choose, provide them a written menu. You don't have to provide each person one, but maybe have one up by where they get their tray from so they can see what's available instead of having to communicate verbally with the kitchen staff, because generally there's a lot of noise in the back of the kitchen too. You can also have people, if they've got significant hearing impairment, write down what they want to eat. If they've got choices, you know, basically they check on a piece of paper or on a whiteboard if you want to be eco friendly, they check the different foods that they want and they hand it to the person so everything's easy peasy. Hearing loss increases cognitive load because it takes more effort to process sounds. Now this is also interesting. Our brain is one of the biggest users of blood sugar. All right, let that sink in for a second. So if people's blood sugar is low, if they're not eating well, they're not going to think well. When we are hungry, we don't think well. So when people are using a lot, when they're straining, they're using a lot of cognitive resources, they're using a lot of blood sugar, so they're going to get hungry faster and they're going to need more food to maintain their blood sugar. This constant extra effort increases stress and inflammation and diverts mental resources from other cognitive tasks like memory and attention, causing confusion and brain fog. So instead of taking in information and having some energy devoted to figuring out if it's something that's important and where to store it in our memory, all of the energy in our brain is just being devoted to interpreting what's coming in. So it never really gets processed and filed away. It just in one ear and out the other. A lot of times, hearing impaired individuals have a higher risk of accelerated cognitive decline and dementia because of increased stress, which is increases inflammation, which increases neurodegeneration and reduced cognitive stimulation. When people don't hear well, a lot of times, like I said, it takes too much effort to participate in hearing activities and, and they withdraw. So they are not engaging in social, socialization, which stimulates people cognitively. They're not engaging in games or activities. Some people do. Some people will sit in their, in their room and they'll do crosswords and whatever all day long. And that's. But those are the exception, not the rule. Environmentally, people with hearing impairment need less noisy spaces and good acoustics to hear conversations. So if you look around, you can't really see my office right now. In order to prevent echoes and make better acoustics, I have tapestries on a lot of the walls. And behind the tapestries I actually have those egg crate foam things that you put on beds in order to absorb more of the, More of the sound vibration so it's not bouncing off all the walls. You can talk with. You can have people go in and take a look at what your acoustics are. If you've got carpet, that helps with the acoustics. If you don't have carpet, I'm not suggesting putting them down because that can cause a trip and fall hazard. But making sure that you've got soft things on the wall to absorb sound so you don't have sound echoing all over the place can be super helpful. Use. And when I say tapestries, what I use are the, the woven fl. Woven throw blankets that are recreations of different Thomas Concade pictures. I love Thomas Concade. So they're not expensive. They're like 35 bucks on Amazon or something. I, I'm not spending oodles of money and I know decorating your facility, you probably don't have a never ending budget, but it really has helps a lot to have soft absorbent things on the walls. In terms of managing the acoustics, make sure that people are aware of safety issues if they can't hear alarms, people or cars coming up behind them. Now some of these cars, especially the evs, now normal people can't hear coming up behind them. I was walking into the grocery store the other day and I wasn't paying attention and was walking kind of down the aisle and I realized there was a car right behind me and I'm like, oh crap. So obviously I got out of the way. But for the older adult, they may not hear a car coming up behind them and may kind of merge out into traffic as they're walking. And you know that's, that's problematic. Alarms, they may not be able to hear. And I'm not talking about fire alarms that are obnoxiously loud. Sorry, my throat's getting dry. I am talking about alarms on their mobile device that tell them it's time to get up or it's time to take their medication. Or doorbells or people coming up behind them, that's a big thing. If you can't hear very well, you can't. Not only can you not see our peripheral vision is going, but our hearing is also going. So you may not hear people coming up behind you. And then you can startle easily. So you don't. You start getting to the point where you don't feel safe in the environment. Encourage people who have difficulty hearing and feel stressed in open environments to sit with their back to the wall. A lot of law enforcement officers will do that. They don't want people walking behind them. But that's one way to help people feel safer. Use mirrors. And they're not attractive, but they are what they are. Those big circular mirrors that they have up in the corners of hallways and hospitals, you can use those so people can see. Or even pretty mirrors in a house or something so you can see people coming up behind you. It's actually a fun principle that if we are aware of our surroundings, we are more relaxed. If there's any way we can be snuck up on. It actually maintains some level of stress. According to fun. A need for visual doorbells. If they can't hear the knock or the doorbell, some people will have a doorbell that is attached to a light right inside their. Their door or a light that's in their living room that goes off. So they see it and they know to get up and answer the door. Signs of hearing loss. Straining to hear conversations. Responding with nonsensical answers. And when I mean nonsensical, I. I should say it's a non sequitur. Because what they say makes sense in isolation, but what they're saying is not an appropriate response to what they were asked. Like the example I gave earlier, where somebody says, where do you want to go for dinner? And the other person says, I'll take the trash out in a minute. So one person said something made total sense. The other person said something in isolation. The sentence made sense. It was just didn't make sense as a response to that question. So when that happens, when people start responding to you in ways that you're like, that's not what I asked. It could be their hearing. Don't automatically assume that it's dementia, social withdrawal, or just checking out. Maybe they're sitting in the room, but they're not paying attention to what other people are doing may be a sign of hearing loss. And it's just too much effort, too much energy to try to listen and actually understand what's Being said, agitation and irritability, especially in social situations, because they're using a lot of cognitive energy to hear, to pay attention, and they may feel vulnerable because they can't hear or see everything that's going on around, especially if it's a high energy, high movement, social situation and increased fatigue and inflammation and blood sugar due to stress. If you notice that the older adult is having more difficulty managing, or even a younger adult, especially a younger adult with diabetes, may start having more significant hearing loss before they are considered an older adult. If they're having difficulty managing their blood sugar, definitely looking at what is contributing to their cognitive load is part of it. Hearing. Are they experiencing peripheral neuropathy in their ears? Hearing loss interventions reduce background noise. The the more you can reduce background noise and improve acoustics, the easier it's going to be for that person to hear. Use visual adaptations and activities like holding up the bingo card that says B12. Improve lighting. You don't want a glare and you don't want to glare coming in behind you. If you're talking to a person, but they need to be able to see your mouth move, look the person in the face if you're sitting. You know, a lot of times we sit in a living room and we're talking to one person. But if you're in a live group and there's one person that has hearing impairment, it's better for them if you're looking at them and talking so they can see your mouth move. Now, sometimes that's weird, but because you're actually talking to another person. But if you're including them in the conversation, try to look at them, speak slowly and clearly, and address issues contributing to congestion, allergies, sinusitis, whatever. Instrumental hearing aids. They have some really good hearing aids now that are out there. They're expensive. Medicare may cover hearing aids. Medicare Part Medicare Advantage may cover hearing aids and chronic. It's called something like C Snip or something. For chronic conditions, there's actually a special writer that people who have diabetes or other chronic conditions can get to help with some of those expenses. Encourage them to get headphones that can be paired with the television so they can hear them. One of the things that I never understood in every single facility I went to in the day room, they would have the television playing, but it wouldn't be loud enough for anybody to hear what was being said. Plus, they had music being piped in over top of what was over top of the television. So there was music for the whole facility. And then the television was going and people were just plopped in front of the television and the, the captions weren't on either. So they were just like staring at this television, not hearing anything and, you know, not doing anything. And I'm like, oh, poor person. So making sure that if they're going to watch television, they have headphones that are Bluetooth headphones that are paired with the television that they can put on and adjust the volume as needed, turn on the closed captioning so they can read. Use noise canceling devices. There are some devices that you can get that actually cancel out background noise and to make it easier to hear spoken word. And you can get some of the. Get some of those actually on like Amazon and stuff. They're not super expensive. They have these great phone apps now if you've got hearing aids that actually listen to the conversation and pipe the conversation into the. Into your hearing aids via the Bluetooth. So that's really cool. And I think, I think the name of the movie, it was on Hulu, I think the name of the movie was like Thelma, but it was a great. Is a great movie about this older woman who gets scammed and she is not going to sit down and take it. Thank you very much. And she and her friend go after, go after the scammers. But one of the tools that they used, which is how I actually learned about it first, was an app that helped. He could talk to her. He talked on his phone and it went to her phone and piped into her Bluetooth hearing aids, which was really cool. But there are devices that you can just set down. They hear the, hear the sound and they pipe it into the hearing aid, which is theoretically tuned to your hearing needs. Educate the person about the effects of hearing loss and strategies to manage hearing loss. Empower people. We don't want to do things to people or for people. We want to empower them to live their best life and have hearing loss. Educate family, caregivers and young children about strategies to improve communication with the person with hearing loss. A lot of times people don't understand or don't realize. So it can be helpful if you tell them. If you want Pop Pop to hear you, you need to go around in front so he can see you and he can see your mouth move. We don't need to over articulate what we are saying. That's condescending. But we also need to speak slowly and I speak fast. Y' all know you've been listening to me for a while when I talk to people with hearing impairments. I try to slow down a little bit, you know, not. Not too much because that's not comfortable for either of us. But I try to slow down a little bit. If they have dogs, train the dogs to use visual cues to go out to be fed or if they want love. And I'm thinking about Princess right now, my papa snipes dog. But she'll start squealing and wanting attention, but he doesn't hear her. And so if. If she were trained to put her paw on his leg, if she needed to go out, if she were trained to bring him the leash or if she wanted to be fed, if she were trained to bring him something else, probably not her food dish, but something else that was associated with food that would make it easier for both of them. Now, that hasn't happened, but it's certainly something that is an effective intervention for people with hearing loss that have dogs and want to communicate with them and meet their needs more effectively. Cats. Cats are cats. So I don't think there's any training on that. But. But dogs, definitely. In terms of loudness, you can work with audiologists to help the person become more aware of how hearing loss affects voice volume and communication. Auditory feedback and self monitoring using hearing aids with features like real time auditory feedback to perceive and regulate speaking volume. So the app will actually show on a bar graph how loud they are speaking and. And then they can learn to modulate their volume by watching the app. Because it feels different when you talk. When you talk really loudly, you can feel the vibrations differently in your head and your throat, your chest than when you're talking really softly. More than half of adults will have some hearing loss by the time they're 50. Even transient hearing loss can increase stress and fall risk. Addressing hearing issues can significantly impact and improve a person's quality of life.