Why and How to Start the Conversation About Hearing Tests

The link between hearing loss and cognitive decline

Encouraging a hearing test is not just a practical step; it is a proactive one that can be life changing. Dr Aldridge advises that hearing impairment has been identified by the Lancet Commission  (2024) as the most significant modifiable risk factor in preventing dementia. In other words, hearing loss can be one of the few dementia-related risk factors that can be managed with early intervention.¹

Dr Aldridge also suggests that untreated hearing problems can lead to diagnostic overshadowing, where symptoms of hearing loss are mistaken for symptoms of cognitive decline. If someone cannot clearly hear instructions or questions during an assessment, they may appear confused or disengaged, leading to an inaccurate diagnosis or false assumptions by others. 

Normalising hearing checks helps prevent these situations. A hearing test is not an inconvenience; it is an essential part of healthy ageing. The stigma often attached to hearing aids, such as assumptions that they are a sign of weakness, ageing or decline, needs to be challenged. In reality, hearing aids are now sophisticated, discreet and life-enhancing devices that support long-term independence.

Further health benefits of hearing tests

Hearing loss can affect far more than communication. It can lead to feelings of isolation, withdrawal and embarrassment, especially when conversations become difficult to follow. This social isolation is itself a known risk factor for both cognitive decline and poorer mental health.

Regular hearing checks can also improve safety. At its most practical level, hearing well increases awareness of environmental warnings such as traffic, alarms or someone calling your name. Hearing loss is also linked to poorer balance, increasing the risk of falls. 

Addressing hearing issues early, through hearing aids, wax removal or tailored support, can therefore improve confidence and physical wellbeing.

Why older adults often resist hearing tests

It’s completely normal for older people to feel hesitant about having their hearing checked. Resistance often stems from:

• Fear of being judged or labelled as “getting old”
• Not recognising that their hearing has declined
• Difficulty separating hearing issues from cognitive issues
• Embarrassment, pride or fear of needing help
• Concern about “bulky” or highly visible hearing aids

From an audiologist’s perspective, these concerns are well understood, and they are far more common than many people realise. Every individual’s hearing is different, and modern hearing care focuses on comfort, confidence and personal choice. The stereotypical large, beige hearing aids of the past have been replaced with sleek, discreet designs that offer exceptional performance, including invisible-in-the-canal (IIC) devices and slim behind-the-ear (BTE) models.

No one is ever pressured into solutions they are uncomfortable with. The aim is simply to understand what is happening and to offer support that genuinely makes life easier.

How to start the conversation gently

Starting the conversation can feel daunting, but doing so early can make a significant difference. It helps to choose a calm, private moment rather than mentioning it in front of others, where it might feel embarrassing.

Focus on wellbeing, independence and quality of life rather than framing hearing loss as a “problem.” Using gentle, observational language like, “I’ve noticed you’re straining to hear the TV, have you noticed that too?” opens the conversation in a natural, non-confrontational way.

Reassure them that hearing tests are quick, painless and routine. If they feel anxious about attending an appointment, let them know that you are happy to accompany them. Some services also offer at-home appointments, although these may come with limitations compared to in-clinic testing.

If your loved one still seems hesitant, it can help to reframe the conversation so that it feels empowering rather than intimidating. Emphasise that a hearing test is not a commitment to any particular treatment, it is simply the first step in understanding what is happening, giving them control and allowing them to decide what they would like to do next. Positioning it as a way of staying informed and in charge of their own health can make the idea feel far less daunting.

If they continue to resist, try revisiting the topic gently at different points in the conversation. Keeping the tone positive makes a significant difference. You can also explain that early support is a way of future-proofing their wellbeing, helping them maintain independence and confidence for years to come. For some people, it may be helpful to mention the modern technology behind today’s hearing aids. Features such as Bluetooth connectivity, app controls and discreet rechargeable devices may help shift perceptions and make the idea more appealing.

Above all, reassurance is key. Remind them that hearing loss is extremely common with age, and addressing it early can help protect cognitive function and prevent unnecessary worry. Dr Aldridge stresses that unmanaged hearing issues can cause behaviour to be misunderstood and can even lead to inaccurate cognitive assessments, so early testing is a simple but powerful safeguard.

Why hearing tests are so important

Dr Aldridge shares a scenario that highlights how poor hearing can be misinterpreted and the negative impact this can have. Imagine your family notices changes in your behaviour and mood, and are really concerned that you are responding incorrectly to questions that they think you should know, and you appear to forget conversations you had last week. 

You feel scared and embarrassed, and don't go out unless you have to for fear of making a mistake. You have convinced yourself that you are developing dementia. Over several months, your mood deteriorates, you are not socialising, yet you are reluctant to go and see a doctor. You finally go and see your GP, who notices you appear to have difficulty with your hearing rather than with your cognition. 

You have an assessment which confirms you have hearing loss, and you are fitted with a hearing device. Immediately, you and your family can see this was the problem, but you have spent many months feeling scared. A hearing test in the first instance could have made an enormous difference to your well-being over that time. 

This scenario highlights how easily hearing loss can mimic cognitive decline and how vital it is to check hearing health before making assumptions 

Tips if the person is still reluctant to have a hearing test  

Some people will continue to hesitate, even after a gentle conversation. If so, it may help to:

• Suggest booking a hearing test alongside a routine eye test
• Attending the appointment with them
• Framing the check as simply “getting a baseline” rather than looking for a problem.

It may also be useful to return to the core reassurances shared earlier in the conversation: 

• Hearing tests are quick and painless
• Hearing loss is extremely common in  older age 
• Addressing it early is simply part of looking after long-term health and quality of life.
• Reframe the conversation so that it feels empowering rather than intimidating.
• Try revisiting the topic gently at different points in the conversation.

The role of regular hearing care in healthy ageing

Regular hearing care is a key part of ageing well. It supports communication, emotional wellbeing, and cognitive health. Routine checks ensure that minor issues aren’t mistaken for memory problems and that support, when needed, is provided early.

If you have a loved one who may be experiencing hearing loss, don’t be afraid to start the conversation. Hearing loss becomes more common as we age, and early intervention can make a meaningful difference to long-term wellbeing.

At Dipple & Conway, we pride ourselves on our welcoming atmosphere and patient-centred approach. You are always welcome to accompany a loved one to their appointment, and our expert audiologists will guide you both with care, reassurance and clear advice. Simply book an appointment or call us today at any of our branches across Norfolk. 

Bibliography:

1. Dementia prevention, intervention, and care: 2024 report of the Lancet standing Commission. Livingston, Gill et al. The Lancet, Volume 404, Issue 10452, 572 - 628