Hearing Loss, Loneliness and Depression

Susan Sealy Arquette, 64, a psychologist and clinic owner in Minneapolis, noticed the first signs of hearing loss in her mid-20s when she couldn’t hear a phone ringing. At the time, Sealy Arquette was told the loss was only for high-frequency sounds and that it wouldn’t cause her problems. A few years later, however, she found it was indeed creating many issues.

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“I was working in a hospital and feeling very stupid because my colleagues seemed to know so much more about our shared patients than I did,” she explains. “It finally occurred to me that although I was hearing people talk in rounds every day, I was missing much of what they were actually saying.”

She got her hearing tested again, and upon learning it had dropped significantly in only a few years, opted to get hearing aids. Doing so was both empowering and difficult, she says, because while the hearing aids helped her better understand what people were saying, her hearing continued to deteriorate, and the aids didn’t always help.

Now, Sealy Arquette is still dealing with feelings of self-consciousness, loneliness and isolation due to hearing loss. When it comes to hearing loss, she is far from unique: About one in three people in the United States between the ages of 65 and 74 experience hearing loss, and nearly half of all adults over 75 experience difficulty hearing, according to the National Institute on Deafness and Other Communication Disorders (NIDCD).

Individuals in these age ranges — along with those who are poor, disabled, single parents, in poor mental health, ethnic minorities or different in some way that makes them feel separate — are already at higher risk for social isolation in general, says Catherine Palmer, president of the American Academy of Audiology. “So, you can imagine [what happens when] an older individual with untreated hearing loss hits two of these categories, and often more,” Palmer says.

What’s more, untreated hearing loss may raise the risk of mental and physical health conditions, including depression, and researchers at Johns Hopkins Medicine have even linked hearing loss to Alzheimer’s disease. One major reason for this is that age-related hearing loss is associated with cognitive decline, in part due to the breakdown of successful communication, Palmer says.

A 2014 study revealed that greater hearing loss was associated with increased odds of social isolation in older adults, particularly among women 60 to 69. This means that by treating hearing loss (such as with hearing aids), you have the ability to impact both depression and social isolation, Palmer says.

Still, many older adults aren’t seeking treatment.

Among adults 70 and older who could benefit from using hearing aids, fewer than one in three has ever used them, according to the NIDCD. This isn’t so much about denial that they need them, but about access and affordability.

With the average cost of hearing aids at about $4,700, according to a report from the National Academies of Sciences, Engineering, and Medicine, “it’s a cost-benefit analysis in their mind,” says Nicholas Reed, an audiologist with Johns Hopkins Medicine. “It’s a slow, insidious process [to get hearing aids], so it’s easier for someone to say, ‘It’s not that bad yet.’”

Individuals who have untreated hearing loss do one of two things in social situations: expend a far greater amount of effort to understand the distorted auditory signals they are receiving or withdraw from the interaction, says Palmer.

If they choose effort, they’re burning through cognitive resources just to keep up with the conversation, which then impacts their success in that social situation as negatively as simply withdrawing. That’s why this creates a vicious cycle that can lead to loneliness and depression, Palmer adds.

It’s important to note that while loneliness and isolation are often included together in these discussions, they are two distinct areas according to scientists who study them.

Social isolation is a state in which the individual lacks a sense of belonging or engagement with others, and lacks a minimal number of contacts.

Loneliness, on the other hand, can occur in the presence or absence of isolation. It’s often described as a subjective feeling of isolation and a lack of social intimacy, regardless of the people you’re surrounded by, Palmer explains.

These definitions are key because it’s possible for a person to be socially connected and still be lonely. As the late comedian Robin Williams once said, “I used to think that the worst thing in life was to end up alone. It’s not. The worst thing in life is to end up with people who make you feel alone.”

No one understands this better than Jerry Russell, 60, of Bayville, N.J. He first began experiencing hearing loss in his early 40s. Although he wears hearing aids (“without them I could not function,” he says) and has dealt with this for the better part of two decades, there are times he feels excluded, even when surrounded by large crowds, because he’s bound to miss things.

Russell says situations that hearing people take for granted can become big issues for people with hearing loss.

“It's the lunch with a group of friends in a loud restaurant where they push a few tables together, and you end up sitting at the end and miss lots of the conversations. It's the friend who talks with a hand in front of their mouth and when you ask them to repeat, they just say, ‘Oh, never mind.’ It's the random joke someone tells at the family party but you miss, and everyone starts laughing and you self-consciously laugh with them even though you have no idea why,” he says.

There have been hundreds of different times when Russell felt isolated and lonely because of his hearing loss. These can easily lead to avoiding social interactions in general, which allows those feelings to grow — even though, Russell acknowledges, they are largely self-induced.

Another part of the problem is that loved ones closest to the individual experiencing hearing loss are often the ones saying, “Oh, never mind.”

Russell talked about this with his late wife, who once explained to him that he was not the only one going through this — that she was mourning the part of their relationship that disappeared with his hearing.

“Just little whispered things when we were lying in bed,” he explains. “She loved that part of us. She missed that part. And so did I.”

If you or someone you know is experiencing impactful hearing loss, hearing aids are certainly a helpful treatment. But there are other methods of coping that can complement hearing aids, including creating a better communication environment.

Here are some ideas:

Be your own advocate. Russell says the single best thing he has learned is that more things are in his control than he thought; that hearing loss is nothing to be embarrassed about. He advises taking actions like: asking the person you’re talking with to face you when they speak (and repeating this as often as necessary); requesting a corner booth or a table on the side of a restaurant when eating out, to minimize noise and taking a seat in the middle of the table when with a larger party, ensuring you won’t be left out of conversations by being on the end.

Advocate for others. If you’re the spouse or family member of a person with hearing loss, take on the role of educating others about how they can help your loved one feel more connected to conversations. This could include things like always facing him or her while speaking, avoiding screaming and reducing distractions, such as the TV. Most people react positively to these suggestions once they know, and are willing to accommodate, Russell says.

Accept your new normal. Age-related hearing loss, in the vast majority of cases, is not reversible; most of the time it’s caused by natural changes to the inner ear that can’t be fixed. People experiencing this can find peace with it by accepting that it’s natural, says Russell.

“If you had diabetes, would you stop checking your blood or keeping away from certain foods because you were embarrassed?” Russell asks. “Your life is different now, so make it as good as you can.”

Find your tribe. Join a Facebook group or another group online of individuals who also are experiencing hearing loss. Having camaraderie with others going through the same thing can help shift your mindset and provide a sense of community.