Hearing Loss
Number 2
CHRONIC AND DISABLING CONDITIONS
CHALLENGES FOR THE 21
December 1999
Hearing Loss
A growing problem that
NATIONAL
affects quality of life
ACADEMY ON AN
AGING SOCIETY
Twenty-two million Americans—about 8 percent of the population—have impaired
hearing, which may vary from mild loss of sensitivity to total loss of hearing. It is esti-
mated that untreated hearing impairments cost the U.S. economy $56 billion in lost
productivity, special education, and medical care—an annual per capita tax of $216.1
More than 10 million Americans report that they have
WHO HAS
hearing loss, defined as difficulty hearing normal conver-
HEARING
sation. Hearing loss affects more than 4 million Americans
LOSS?
age 65 and older, and almost 6 million Americans under
ST
5% AGE 0–17
age 65. Hearing loss can have a profound impact on an
23%
AGE 18–44
CENTURY
individual’s emotional, physical, and social well-being.
43%
AGE 65+
People with hearing loss are more likely to report symp-
29%
AGE 45–64
toms of depression, dissatisfaction with life, reduced
functional health, and withdrawal from social activities.
AGE
Although most people with hearing loss can be helped
with hearing aids, four out of five Americans with hearing
:
39%
loss do not use a hearing aid.
FEMALE
61%
MALE
Hearing loss is highly associated
GENDER
with aging
6% BLACK
A large proportion of people with hearing loss—43 per-
3% OTHER
cent—are 65 years of age or older. By comparison, only 12
percent of the general population is 65 years of age or older.
People age 65 and older are more likely than any other age
group to have hearing loss. Older people are not the only
91%
ones with hearing loss, however. More than 5 million peo-
WHITE
ple age 18 through 64, and close to half a million children,
have hearing loss.
RACE
SOURCE: National Academy on an
Aging Society analysis of data from
the 1994 National Health Interview
Survey of Disability, Phase I, 1994.
N A T I O N A L A C A D E M Y O N A N A G I N G S O C I E T Y
Men are more likely
than women to have
FIGURE 2
hearing loss
Prevalence of Hearing Loss
by Age Group and Race
Some 60 percent of people with hearing
BLACK
WHITE
loss are men. Only about half of the gener-
al population is male, however. Men of all
20
ages are more likely than women to have
18
hearing loss, but the gap widens after age
16
14
18 (see Figure 1).
14
12
9
10
FIGURE 1
8
PERCENT
6
Prevalence of Hearing Loss
6
3
by Age Group and Gender
4
2
MALE
0.7
2
FEMALE
0.6
1
19
0
0–17
18–44
45–64
65+
20
A G E
18
SOURCE: National Academy on an Aging Society analysis of
16
data from the 1994 National Health Interview Survey of Disability,
Phase I, 1994.
14
12
10
10
8
8
PERCENT
WHAT IS
6
3
3
HEARING LOSS?
4
0.8
A number of conditions can lead to hearing
2
2
0.6
loss. The most common condition causing
0
0–17
18–44
45–64
65+
hearing loss in adults is presbycusis, a gradual,
A G E
age-related reduction in the ability to hear
SOURCE: National Academy on an Aging Society analysis of
high-pitched sounds. The second most com-
data from the 1994 National Health Interview Survey of Disability,
Phase I, 1994.
mon condition, noise-induced hearing loss, is
caused by one-time exposure to extremely
loud sound, or by exposure to sounds at high
Whites are more than
decibels over months or years. Examples of
twice as likely as blacks
potentially hazardous noise include sounds
from powerful stereos and headphones,
to have hearing loss
power tools, city and airport traffic, lawn-
mowers, and even hair dryers and vacuum
Whites are proportionately overrepresented
cleaners. Both presbycusis and noise-induced
among people with hearing loss. They com-
hearing loss result in what is called sen-
prise 91 percent of the population with
sorineural hearing loss, which occurs when the
hearing loss, but only 83 percent of the
delicate hair cells in the inner ear that trans-
general population. Whites of all ages are
late sound waves into nerve impulses are
more likely than blacks to have hearing
damaged either by aging or abuse. High-fre-
loss, but the gap widens in the adult popu-
quency sounds—consonants such as “S” and
lation (see Figure 2).
“F” and children’s and women’s voices—are
usually the first to be lost. The major cause of
hearing loss in children is ear infections.
Hearing loss in children can also be caused by
birth defects, illness, and injury.
N A T I O N A L A C A D E M Y O N A N A G I N G S O C I E T Y
2
The prevalence of
age 70 and older, 26 percent of those with
hearing loss decreases
hearing loss, but less than 15 percent of
those without hearing loss, reported that
as family income and
they experienced four or more symptoms of
education increase
depression during the past week.
People with hearing loss are less satisfied
The prevalence of hearing loss at all ages
with their “life as a whole” than people
decreases as family income increases.
without hearing loss. In particular, people
Overall, people with a family income of
with hearing loss express greater dissatisfac-
less than $20,000 are more than twice as
tion with their friendships, family life,
likely to have hearing loss as those with a
health, and financial situation than people
family income of $50,000 or more. In the
without hearing loss (see Figure 3). Dis-
adult population, the prevalence of hear-
satisfaction with their financial situation is
ing loss is also greater for those who are
likely related to the fact that individuals
not high school graduates than for those
with hearing loss are, in general, less well-
who are. Although education levels are
off than individuals without hearing loss.
lower among older age groups, the rela-
For example, among people age 51 to 61,
tionship between education and hearing
the median net worth for those with hear-
loss is similar for all age groups.
ing loss is $65,575, compared to $102,000
for those without hearing loss.
For some people with hearing loss, loss of
Hearing loss is also
independence may be part of the reason
a social loss
they are dissatisfied with various aspects of
life or unlikely to participate in social activ-
People with hearing loss are less likely to
ities. For example, people of all ages with
participate in social activities than people
hearing loss are more likely to need help
without hearing loss. For example, among
with instrumental activities of daily living,
people age 51 to 61, some 10 percent with
or IADLs, such as preparing meals, shop-
hearing loss report that they did 100 hours
ping, or handling money, than people with-
or more of volunteer work in the past year,
out hearing loss. Among people age 70 and
compared to 18 percent without hearing
older, 22 percent with hearing loss report
loss. Hearing loss can also affect an individ-
they need help with shopping, compared to
ual’s emotional well-being. Among people
14 percent without hearing loss.
FIGURE 3
Proportion of Older Adults Dissatisfied with Various Aspects of Life
40
WITH HEARING LOSS
37
35
WITHOUT HEARING LOSS
30
28
25
22
20
15
12
PERCENT
10
9
9
5
6
7
4
3
3
4
0
LIFE AS A
HEALTH/PHYSICAL
FINANCIAL
FRIENDSHIPS
FAMILY
HANDLING OF
WHOLE
CONDITION
SITUATION
LIFE
PROBLEMS
SOURCE: National Academy on an Aging Society analysis of data from the 1992 Health and Retirement Study.
N A T I O N A L A C A D E M Y O N A N A G I N G S O C I E T Y
3
People with hearing
loss are less healthy
HEARING LOSS AND
than others
OCCUPATION
Among the population with hearing loss,
Compared to workers without hearing loss,
only 39 percent say they are in excellent or
workers with hearing loss are more likely to list
very good physical health, compared to 68
their occupation as
percent of those without hearing loss (see
s Farming
Figure 4). Nearly one-third of the popula-
s Craft and repair
tion with hearing loss report being in fair
s Machine operator
or poor health, compared to only 9 percent
s Transportation
of the population without hearing loss.
and less likely to list their occupation as
FIGURE 4
s Administrative
Percent of Individuals Reporting
s Professional
Excellent or Very Good Health
s Service
s Sales
80
WITH HEARING LOSS
WITHOUT HEARING LOSS
70
68
60
compared to 75 percent of the working-
age population without hearing loss. In
50
addition, close to 13 percent of workers
age 51 to 61 with hearing loss report that
40
hearing loss limits the type or amount of
39
41
30
paid work they can do.
PERCENT
29
20
Retirement decisions
10
may be influenced by
0
hearing loss
ALL AGES
65+
Among people age 51 to 61, about 18 per-
A G E
cent of those with hearing loss are com-
SOURCE: National Academy on an Aging Society analysis
pletely retired, compared to just 12 percent
of data from the 1994 National Health Interview Survey
of those who do not have hearing loss.
of Disability, Phase 1, 1994.
Health status appears to be a strong factor
in retirement decisions for people with
hearing loss. For example, 70 percent of
Labor force participation
retired people with hearing loss, but only
rates are lower for people
44 percent without hearing loss, report that
poor health was a very important factor in
with hearing loss
their decision to retire. In addition, only 23
The majority of the working-age popula-
percent of retired people with hearing loss
tion—age 18 to 64—with hearing loss is
say they wanted to retire, compared to 42
employed, but hearing difficulties can
percent of people without hearing loss.
affect the kind and amount of work they
Satisfaction with retirement is also much
do, and whether they work at all. Labor
lower for people with hearing loss than for
force participation rates are lower for peo-
those without hearing loss. Only 29 percent
ple with hearing loss than for others.
of people with hearing loss are very satisfied
Some 67 percent of the working-age pop-
with their retirement, compared to 42 per-
ulation with hearing loss is employed,
cent of those without hearing loss.
N A T I O N A L A C A D E M Y O N A N A G I N G S O C I E T Y
4
A sonic boom?
Americans age 65 and older with hearing
loss, and nine out of ten younger Americans
Traditionally, statistics on hearing loss
with hearing loss, do not use hearing aids.
have shown seniors to be the most vul-
Among the population that wears hearing
nerable age group. However, over the aids, less than 10 percent are under 45 years
last three decades there has been a sharp
of age, although this age group accounts for
increase in the number of younger
some 27 percent of people with hearing loss.
Americans with hearing difficulties. From
Most hearing-aid users—71 percent—are age
1971 to 1990, hearing difficulties jumped
65 and older, although less than half of all
26 percent among those age 45 to 64, and
people with hearing loss are 65 years of age
17 percent among those age 18 to 44.2 A
or older (see Figure 5).
study of more than 5,000 men and
women found an even sharper increase in
Nonusers cite cost, poor
hearing impairments for those age 50 and
older, with rates of impairment increasing
performance, and stigma
more than 150 percent from 1965 to
of wearing hearing aids
1994.3 The increase in hearing loss has
been attributed to environmental noise,
The National Council on the Aging com-
which is present today at much higher
missioned a survey of 2,300 people age 50
levels than in the past. As baby boomers
and older with hearing impairments to
age, the number of people with hearing
examine barriers to wearing hearing aids.
loss is expected to increase.
When asked to cite the reason or reasons
why they do not wear a hearing aid, about
Four out of five Americans one-half of the respondents cited the cost,
and about one in five checked responses
with hearing loss do not
concerning vanity and the stigma of wear-
use hearing aids
ing hearing aids. However, the most com-
mon reasons cited were “my hearing is not
Although most people with hearing loss can
bad enough” and “I can get along without
benefit from using a hearing aid, more than
one.” In fact, one-third of the respondents
8 million Americans with hearing loss do
believed that “they (hearing aids) will not
not wear a hearing aid. Two out of three
help with my specific problem.”4
FIGURE 5
Hearing Loss and Hearing Aid Use
9% AGE 0–44
27% AGE 0–44
20%
43%
AGE 45–64
AGE 65+
71%
AGE 65+
30%
AGE 45–64
HEARING LOSS
HEARING AID USE
SOURCE: National Academy on an Aging Society analysis of data from the 1994 National Health Interview Survey of
Disability, Phase I, 1994.
N A T I O N A L A C A D E M Y O N A N A G I N G S O C I E T Y
5
Advances in hearing aid
growing segment of the market, although
they accounted for only 9 percent of hear-
technology offer exciting
ing-aid sales in 1999.5
possibilities for the future
New technology developed in the last few
1. Better Hearing Institute. (1999). Facts About Hearing Disorders.
years can help most people with hearing
Available at http://www.betterhearing.org.
loss achieve improved hearing. But the new
2. Ries, Peter W. (1994). Prevalence and Characteristics of Persons with
Hearing Trouble: United States, 1990–91. National Center for Health
digital hearing aids can cost several thou-
Statistics, Vital and Health Statistics, Series 10, No.188.
sand dollars—compared to a few hundred
3. Wallhagen, M.I., W.J. Strawbridge, R.D. Cohen, and G.A. Kaplan.
dollars for the standard analog hearing
(1997). “An Increasing Prevalence of Hearing Impairment and
aid—prohibiting many consumers from
Associated Risk Factors Over Three Decades of the Alameda County
Study.” American Journal of Public Health; 87(3): 440–442.
purchasing them. Most insurance plans do
4. The National Council on the Aging. (1999). The Consequences of
not have hearing-aid coverage, and
Untreated Hearing Loss in Older Persons. Washington, D.C.
Medicare does not cover hearing aids. As a
5. Data from the Hearing Industries Association as explained by Sergi
result, the majority of hearing-aid users are
Kochkin, M.D. (personal communication, June 1999).
still buying hearing aids manufactured
using thirty-year-old technology with poor
sound quality and only amplification
ABOUT THE DATA
adjustments. However, despite all the barri-
ers to hearing-aid use, sales of hearing aids
Unless otherwise noted, the data presented in
are booming. Ear specialists saw a surge in
this Profile are from four national surveys of
business after the announcement in 1997
the community-dwelling population living
that President Clinton was getting a hearing
within the United States. The 1994 National
aid. Nearly 2 million hearing aids were pur-
Health Interview Survey (NHIS) was conducted
chased in 1997, almost 25 percent more
by the National Center for Health Statistics.
than in 1996. According to the Hearing
The NHIS defines hearing impairment as a
Industries Association, high performance
condition that ranges from slight trouble hear-
digital hearing aids that analyze and
ing in one ear to complete deafness in both
respond to specific sounds are the fastest
ears. The 1994 National Health Interview
Survey of Disability, Phase 1 (NHIS-D) defines
hearing loss as difficulty hearing normal con-
ABOUT THE PROFILES
versation. Wave 1 of the Health and
Retirement Study (HRS) provides information
This series, Challenges for the 21st Century: Chronic and Disabling
for a population age 51 to 61 in 1992. Wave 1
Conditions, is supported by a grant from the Robert Wood
of the study of Asset and Health Dynamics
Johnson Foundation. This Profile was written by Greg O’Neill
Among the Oldest Old (AHEAD) provides
with assistance from Laura Summer and Lee Shirey. It is the
information about respondents age 70 and
second in the series. The first Profile was:
older in 1993 and 1994. The HRS and AHEAD
measure hearing ability using a 5-point scale
1. Chronic Conditions: A challenge for the 21st century
ranging from excellent to poor. Hearing loss is
The National Academy on an Aging Society is a Washington-
defined as self-ratings of fair or poor hearing
based nonpartisan policy institute of The Gerontological
ability. The HRS and AHEAD data sets were
Society of America. The Academy studies the impact of demo-
sponsored by the National Institute on Aging
graphic changes on public and private institutions and on the
and conducted by the Institute for Social
economic and health security of families and people of all ages.
Research at the University of Michigan.
NATIONAL ACADEMY ON AN AGING SOCIETY
1030 15th Street NW, Suite 250, Washington, DC 20005
PHONE 202-408-3375 FAX 202-842-1150
E-MAIL info@agingsociety.org WEBSITE www.agingsociety.org
N A T I O N A L A C A D E M Y O N A N A G I N G S O C I E T Y
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