Is Dad ignoring me, or can he not hear me?

He says everyone mumbles. The TV is so loud you can hear it from the driveway. He’s stopped calling, stopped going to the card game, and smiles and nods at things you know he didn’t catch. It’s easy to get frustrated, and easy to think it’s something worse.

It may well be his hearing. 22% of people 65 to 74, and 55% of those 75 and older, have disabling hearing loss. Because it comes on gradually, people may not realize they’ve lost anything.

The signs

These are the signs the National Institute on Aging lists. Your parent may:

• Have trouble understanding people on the phone
• Find it hard to follow a conversation when two or more people are talking
• Often ask people to repeat themselves
• Turn up the TV so loud that others complain
• Struggle to understand speech when there’s background noise
• Think other people are mumbling
• Can’t understand children or people with higher voices

The National Institute on Deafness and Other Communication Disorders has a 10-question self-check. You can do it together in a few minutes.

If it happened suddenly, go now

Hearing that goes all at once or over a few days should be treated as a medical emergency. It often affects one ear, and some people notice it on waking up. People sometimes put it off, thinking it’s allergies or earwax. Don’t wait. Getting treated quickly gives the best chance of recovering some hearing.

The FDA’s warnings for hearing aid buyers also say to see a doctor, preferably an ear, nose and throat doctor, for ear pain, fluid or blood from the ear, severe dizziness, or hearing or ringing that’s worse in one ear.

Why it’s worth doing something

Hearing affects more than conversation.

• Staying connected. People who can’t hear well may become depressed or withdrawn. They may be mistaken for confused or uncooperative.
• Safety. It can be hard to hear phones, doorbells and smoke alarms, or to follow a doctor’s advice. Even a small hearing loss is linked to a higher risk of falls.
• The brain. Studies show older adults with hearing loss have a greater risk of dementia than those with normal hearing. People who used hearing aids or implants had a lower risk of long-term cognitive decline in one analysis. That’s a link, and it doesn’t promise that a hearing aid will protect anyone’s memory.

Plenty of people leave this alone. Fewer than 1 in 3 adults 70 and older who could benefit from hearing aids has ever used them.

How to bring it up

Some people don’t want to admit it. Being told “you can’t hear” in front of the family can sting. These may help:

• Pick a quiet moment, alone. Don’t do it at the dinner table.
• Name one thing you’ve noticed, and why it matters to you. “I miss our phone calls. You sound like you’re straining to follow me.”
• Make it about a check, not a verdict. “It might only be earwax. Let’s ask the doctor.”
• Try it together. Do the 10 questions as a family, or get your own hearing checked at the same time.
• Ask what’s hardest for them. Restaurants? The phone? Start there.

What you can do today, free

These work before anyone buys anything. The National Institute on Aging suggests:

• Face them, in good light, and keep your mouth uncovered. Don’t eat or chew gum while you talk.
• Speak a little louder than normal, but don’t shout. Keep to a natural speed.
• If they miss something, say it another way instead of repeating it.
• Turn off the TV, or find a quieter spot. Pick a booth away from the kitchen.
• In a group, one person at a time, and include them on purpose.

Turn on captions on the TV as well. It costs nothing, and it may be enough to end the volume fight.

Who to see

Who	What they do
Their regular doctor	Checks for other causes and refers them on. Start here if you can
Ear, nose and throat doctor (otolaryngologist)	Diagnoses and treats ear conditions
Audiologist	Measures hearing loss and fits hearing aids

Earwax can cause hearing loss, and the doctor may suggest mild treatments. Don’t let them dig in the ear with cotton swabs, which can damage the eardrum. Some medicines can also affect hearing, so ask about those too.

Hearing aids: over the counter or prescription

	Over the counter	Prescription
Who it’s for	Adults who perceive mild to moderate loss	Significant or complicated hearing loss
Where to get it	Stores and online, no exam needed	From an audiologist or hearing aid specialist
Who sets it up	The user	The professional fits and adjusts it

Over the counter may fit if they have trouble in noise or in groups, on the phone, or need the TV louder. See a professional if they struggle with speech in a quiet room, or have trouble hearing loud sounds like engines or music.

Think honestly about who will do the setup, too. Over-the-counter aids leave it to the user. If your parent would struggle with an app, you may be the one doing it, or a professional may be worth it.

The FDA has also authorized software that lets compatible AirPods Pro work as an over-the-counter hearing aid for adults with perceived mild to moderate loss. We don’t recommend a brand here. If we ever link to one, we’ll say so next to the link and tell you if we’re paid.

Before you buy anything

• Get the return terms first. The FDA doesn’t require a warranty. The box must state the return policy, or say there isn’t one. Leave enough time to try them in real places.
• Ask about the trial. For aids from an audiologist, most manufacturers allow a 30- to 60-day trial. Ask which fees aren’t refunded if you send them back.
• Ask what the price covers. Adjustments, repairs, loaners and how long the warranty lasts.
• Don’t confuse amplifiers with hearing aids. Both make sound louder, but only hearing aids are intended to make up for impaired hearing. The FTC also says to be wary of unusually low prices.
• Watch the claims. Phrases like “FDA Registered” or “FDA Certified” may be misleading.

Getting used to them

Hearing aids take time and patience. Their own voice may sound too loud at first, and background noise doesn’t go away. Most people get used to the plugged-up feeling. Whistling can mean a poor fit or wax, which an audiologist can usually sort out. Encourage them to wear the aids regularly so they don’t end up in a drawer.

Who pays

• Original Medicare doesn’t cover hearing aids or exams to fit them. Part B covers diagnostic hearing exams when a provider orders them. They can see an audiologist once every 12 months without an order for hearing loss that has developed over years. After the deductible, you pay 20% of the approved amount.
• Medicare Advantage. Some plans offer hearing coverage. Call the plan and ask.
• Veterans. If your parent is enrolled in VA health care, an audiologist can decide whether they need aids. If they’re fitted, the aids, repairs and batteries are provided at no charge. This one is easy to miss, so ask.
• Medicaid. Rules for adults depend on the state, so ask your state office.
• Other help. Hearing aids are generally not covered by health insurance, though some plans do. Some nonprofits help with costs or offer used aids. The National Institute on Deafness and Other Communication Disorders can point you to them at 800-241-1044.

Beyond hearing aids

• Captioned phone calls. IP captioned telephone service shows what the other person is saying as text during a call. It’s for people who can speak but have trouble hearing on the phone, and the cost of the calls is paid by a federal relay fund. Users must confirm they have a hearing disability that requires it, and the provider will ask for details, including the last four digits of their Social Security number. Only do this with a provider you sought out, never one that called them, and ask what any phone or equipment costs.
• Relay calls. Dial 711 to reach a relay service in any state.
• Alerts. Alerting devices connect to a doorbell, phone or alarm and use a loud sound or a blinking light.
• Hearing loops. Some places of worship, theaters and auditoriums have them, and some hearing aids can connect to them. Ask at their church or theater.

What to do this week

1. Do the 10-question self-check together.
2. Turn on TV captions, and change how you talk at home.
3. Book a doctor’s visit and ask them to look for earwax.
4. Check whether your parent is a veteran or has hearing benefits in a Medicare Advantage plan.
5. Call more often for a shorter time, or try a video call so they can see your face.