Here is a number that surprises most people. A 2023 study in JAMA Network Open found that among US adults age 71 and older, about 65 out of every 100 had hearing loss, and by age 90 that figure climbed to roughly 96 out of 100.
For years we treated hearing as a quality-of-life matter, something that made conversation harder at a noisy restaurant. We now understand the stakes run deeper. In 2024, the Lancet Commission on dementia named hearing loss one of the largest modifiable risk factors for dementia beginning in midlife, tied with high LDL cholesterol as the two joint leading contributors at roughly 7 percent each.
The encouraging part is that this is something you can act on. Let me walk you through what the science actually says, where it is still uncertain, and what steps make practical sense for you.
The Link Between Hearing and Thinking
For a long time, doctors viewed hearing and memory as separate systems. One lived in the ears, the other in the brain. Research over the past decade has blurred that line.
Hearing is not something your ears do alone. Sound arrives as vibration, but your brain does the heavy lifting of turning those signals into words, meaning, and memory. When hearing fades, the brain receives a weaker, fuzzier signal and has to work harder to fill in the gaps.
Researchers have watched this relationship closely, and the pattern keeps repeating across studies: people with poorer hearing tend to show faster decline in thinking and memory as the years pass. The key word is tend.
This is a connection, not a guarantee, and many people with hearing loss never develop dementia. Still, the relationship is strong enough that major health bodies now treat hearing as part of brain care, not just ear care.
That shift matters because hearing loss is common, it is often ignored for years, and unlike age or family history, it is something you can address.
What the 2024 Lancet Commission Found
In July 2024, the Lancet Commission on dementia prevention released a major update, presented at the Alzheimer's Association International Conference in Philadelphia and published in The Lancet. The report identified 14 modifiable risk factors that together are associated with an estimated 45 percent of dementia cases worldwide.
In plain terms, that means nearly half of dementia cases might be prevented or delayed if we addressed these factors across a lifetime. Among all 14, hearing loss stood out as one of the largest.
The Commission estimated that hearing impairment is linked to about 7 percent of dementia cases globally, matching high LDL cholesterol, which was also tied to about 7 percent. Together these two sit at the top of the list as the joint leading individual contributors from midlife onward.
The evidence for hearing included a dose-response pattern. All four studies the Commission reviewed that investigated dose-response found a higher dementia risk with each 10-decibel worsening of hearing.
The Commission also noted that the case for treating hearing loss is now stronger than in its earlier reports, and that hearing aids appear especially helpful for people who carry additional risk factors.
The ACHIEVE Trial: Can Hearing Aids Help?
The most important recent study is ACHIEVE, short for Aging and Cognitive Health Evaluation in Elders. Published in The Lancet in July 2023, it was the largest randomized controlled trial ever run on this question.
Researchers enrolled 977 adults ages 70 to 84 with untreated hearing loss and no major cognitive impairment. Half received a hearing program with hearing aids and audiologist counseling, and half received health education.
They were followed for three years. The honest result is a mixed one. Across the whole group, the hearing program did not slow thinking and memory decline compared with the control group.
But in a pre-planned subgroup of participants who were at higher risk of decline, drawn from a long-running heart health study, the hearing program slowed cognitive decline by 48 percent. Co-leader Frank Lin explained that the benefit showed up mainly in people who were declining faster to begin with.
Importantly, in both groups the hearing program improved communication, social function, and loneliness. So hearing treatment may not protect everyone equally, but the people at greatest risk may gain the most.
How Common Hearing Loss Really Is
Hearing loss is one of the most common conditions of later life, yet it stays quietly untreated for years. According to the National Institute on Deafness and Other Communication Disorders, about one-third of people ages 65 to 74 have hearing loss, and nearly half of those older than 75 have trouble hearing.
When measured as disabling hearing loss, the numbers climb steeply with age: roughly 22 percent of adults ages 65 to 74 and about 55 percent of those 75 and older. The institute estimates that nearly 29 million US adults could benefit from hearing aids.
Here is the gap that concerns researchers. Among adults 70 and older who have hearing loss and could benefit from hearing aids, fewer than one in three, about 30 percent, have ever used them.
The 2023 JAMA Network Open study found a similar figure, with only 29.2 percent of older adults with hearing loss using aids. The reasons are familiar: cost, vanity, the slow pace of change that makes loss easy to ignore, and the mistaken belief that struggling to hear is simply part of getting old.
How Hearing Loss May Strain the Brain
Scientists are still working out exactly why poorer hearing travels with faster cognitive decline, and the honest answer is that the picture is not fully settled. Researchers point to several plausible pathways, and they likely work together.
The first is cognitive load. When sound arrives degraded, the brain has to strain to decode incomplete signals, and that extra effort may pull resources away from memory and thinking.
The second is social withdrawal. People who cannot follow conversation often stop going to gatherings, stop calling friends, and spend more time alone. Social connection and mental stimulation help protect the brain, so losing them removes a safeguard.
Hearing loss is also tied to higher rates of depression and isolation in older adults, both of which affect thinking. A third possibility is that less sound reaching the brain means less stimulation over time, which may contribute to shrinkage in regions that process sound and memory.
There may also be shared causes, such as blood vessel health, that harm both hearing and the brain. The uncertainty is real, but the practical message holds: keeping your hearing engaged keeps your brain engaged.
Getting Your Hearing Checked and the New Over-the-Counter Option
The first step costs nothing but a little time: pay attention to the signs. Do you turn the television up louder than others prefer? Do you ask people to repeat themselves, or struggle to follow talk in a crowded room?
Do voices sound mumbled? If so, a hearing test is worth scheduling. Help has become more affordable. On August 16, 2022, the FDA issued its final rule establishing a new over-the-counter regulatory category for hearing aids, with publication in the Federal Register the following day, August 17.
The rule did not broadly approve hearing aids. It created a category that permits over-the-counter sales for adults 18 and older with perceived mild to moderate hearing loss, with no prescription, medical exam, or professional fitting required.
These devices reached store shelves in October of that year. Traditional prescription hearing aids can run from about $4,000 to $6,000 for a pair, and the FDA estimated the over-the-counter rule could save consumers around $1,400 per device.
That said, over-the-counter aids are not for severe hearing loss, which still needs a professional. If your loss is more than mild, or if you have ear pain or drainage, see an audiologist or physician.
And if you lose your hearing suddenly, in one or both ears, treat it as a medical emergency and seek immediate medical care that same day, because fast treatment can make a real difference in whether the hearing comes back. Treating hearing early supports conversation, connection, and quite possibly your brain.
Key Findings on Hearing Loss and Brain Health
| Source | Year | What It Found |
|---|---|---|
| Lancet Commission on dementia | 2024 | Hearing loss is one of the largest modifiable dementia risk factors from midlife, tied with high LDL cholesterol at about 7% of cases each |
| ACHIEVE randomized trial (The Lancet) | 2023 | Hearing program slowed cognitive decline 48% in a higher-risk subgroup; no clear benefit across the whole group |
| JAMA Network Open (Medicare study) | 2023 | 65.3% of adults 71 and older had hearing loss; among those 71 and older with hearing loss, only 29.2% used hearing aids |
| NIDCD statistics | Current | About 55% of adults 75 and older have disabling hearing loss |
| US Food and Drug Administration | 2022 | Final rule created an over-the-counter regulatory category permitting OTC sales for adults with perceived mild to moderate hearing loss, no prescription needed |
If you take one thing from today's column, let it be this: hearing is brain care. You cannot change your age or your family history, but you can get your hearing checked, and you can treat loss when you find it.
The research does not promise that hearing aids will prevent dementia for everyone, and I want to be straight with you about that. What the evidence does show is that treating hearing loss improves conversation, eases loneliness, and may protect thinking in those at higher risk.
Those are real gains at any age. Start by noticing the signs, schedule a hearing test, and ask about both professional and over-the-counter options. Staying connected to the voices around you is one of the kindest things you can do for your brain.
Sources
- Livingston G, et al., Dementia prevention, intervention, and care: 2024 report of the Lancet standing Commission, The Lancet (2024)
- Lin FR, et al., Hearing intervention versus health education control to reduce cognitive decline in older adults with hearing loss in the USA (ACHIEVE), The Lancet (2023)
- Alzheimer's Association International Conference, Hearing Aids Help Slow Cognitive Decline, Study Finds (2023)
- Reed NS, et al., Prevalence of Hearing Loss and Hearing Aid Use Among US Medicare Beneficiaries Aged 71 Years and Older, JAMA Network Open (2023)
- National Institute on Deafness and Other Communication Disorders, Quick Statistics About Hearing (NIDCD)
- US Food and Drug Administration, FDA Finalizes Historic Rule Enabling Access to Over-the-Counter Hearing Aids (2022)