When was the last time you got your hearing checked?
Not your vision. Not your teeth. Not your cholesterol. Your hearing.
If you’re like most adults, you might have to think back to elementary school. We screen kids’ hearing every year. It’s routine, it’s automatic. And then we basically stop. Nobody checks again until someone in their sixties or seventies is complaining that they can’t hear the TV.
Meanwhile, the research on hearing loss and dementia is telling us something we can’t keep ignoring. Untreated hearing loss is one of the leading modifiable risk factors for Alzheimer’s and cognitive decline. A sensory issue. Not a brain disease. A sensory issue.
And we already have the intervention. It’s a hearing aid. It’s not experimental. It’s not expensive relative to dementia care. And it’s not new.
But Medicare still won’t cover it. Most people don’t get tested until the damage is done. And we’re spending billions of dollars on Alzheimer’s research while overlooking one of the most accessible prevention tools we already have.
Hot take this week:
Hearing should be screened annually. Just like vision.
This Saturday, september 12th, on Aging Together // Unfiltered
Hearing Loss & Dementia: A Silent Link & A Whole Lot of Money with Dr. Robert (Bob) Keefer, an Alzheimer’s prevention advocate on a mission to change how America treats hearing loss.
Dr. Keefer founded a hearing clinic in Raleigh, North Carolina, built around best practices in hearing care, ran it for ten years, and has since written two books connecting two stories most people keep separate: the link between untreated hearing loss and Alzheimer’s, and the hearing care industry’s failure to consistently follow its own best practices.
How Strong Is the Link Between Hearing Loss and Dementia?
This isn’t a new idea, and it isn’t fringe. Much of the conversation traces back to a study led by Dr. Frank Lin at Johns Hopkins, which followed hundreds of older adults for more than a decade. Compared to people with normal hearing, those with mild, moderate, and severe hearing loss had roughly two, three, and five times the risk of developing dementia.
The worse the hearing, the higher the risk.
That finding changed the direction of Dr. Keefer’s career. He calls it life-changing.
But here’s where it gets interesting. When I asked him how untreated hearing loss actually leads to cognitive decline, his answer was more honest than most people would expect from an advocate. The science on the exact mechanism isn’t settled. So what do we know? What’s the working theory? And what does it mean for families who can’t afford to wait for researchers to finish the argument?
That’s a conversation worth hearing in full.
Why Does Hearing Screening Stop After Childhood?
Think about what a typical annual physical covers. Vision gets its own insurance. Dental gets its own insurance. Labs, blood pressure, physical function – all of it gets tracked year after year.
Hearing? Rarely. Unless you bring it up yourself.
Part of that is individual. Dr. Keefer’s hot take is that fear drives most of the avoidance: fear of the cost, fear of what the provider will say, fear of the word Alzheimer’s itself. And our own brains make it easy to avoid, because hearing loss creeps in so gradually that most people don’t notice what’s slipping away.
"We just do not know what we're missing."
But fear doesn’t explain why the system doesn’t prompt the test. Why isn’t hearing part of the routine checklist the way vision is? Why does it fall entirely on the patient to raise it? And what message does it send when Medicare, since its creation in 1965, has never covered hearing aids?
We get into what that gap signals to patients, and why it’s persisted for so long.
It Looks Like Cognitive Decline. Sometimes It Isn't.
This is the part of the conversation that hit closest to home for me as an occupational therapist.
In my work with older adults, especially in hospitals and institutional settings, I’ve walked into rooms where a patient appears to have cognitive decline. They’re not attending. They’re not responding. They don’t remember what you just told them.
And sometimes, they just didn’t hear you.
Providers don’t always know which one they’re looking at. Is it hearing? Is it cognition? Is it both? Without that distinction, a person can be labeled, treated, and planned for based on the wrong problem.
Dr. Keefer took that one step further:
It's not only a hearing issue, it's an understanding issue.
Hearing is one thing. Making sense of what you heard is another, and that part lives in the brain. So what happens to those pathways when sound stops reaching them clearly? And what does that mean for balance, falls, and safety at home, not just memory?
If you want more on how communication changes with age, our earlier conversation, Expert Perspectives on Communication: Speech, Language, & Aging, is a good companion read.
Not All Hearing Aids Are Fitted the Same Way
Here’s something most families don’t know: getting a hearing aid and getting a hearing aid that’s properly fitted to your ear are two different things.
Everyone’s ear canal is shaped differently. Some are longer, some shorter, some curve like an S. And just like the layout of a room changes how sound travels through it, the shape of your ear canal changes the sound that reaches your eardrum.
There’s a well-established method audiologists can use to account for that, called real ear measurement. I compared it to precision medicine for hearing, and Dr. Keefer ran with it.
So why isn’t every provider doing it? How would you even know whether yours is? And where do over-the-counter hearing aids, the ones filling up TV ads and drugstore shelves, fit into this picture?
Dr. Keefer doesn’t hold back on that last one:
Over the counter hearing aids can't even come close to medical grade hearing aids.
That’s a strong position, and he explains why he holds it. He also shares the specific questions he’d want every family to ask before committing to a provider. You’ll want to take notes for that part.
What Would It Take for Medicare to Cover Hearing Aids?
Traditional Medicare still doesn’t cover hearing aids. Some Medicare Advantage plans offer hearing benefits, but coverage varies widely, and plenty of people never have access to it.
Dr. Keefer has been working on this problem from the policy side, reaching out to legislative aides, writing a Medicare policy brief, and making the case that hearing aid coverage is both a health issue and a financial one.
His argument isn’t just to cover the device. It’s about what Medicare should require from the providers dispensing them, too.
So why hasn’t this happened yet? Who in Congress actually has the power to move it? And what can everyday caregivers do to add pressure without waiting for a legislator to experience it with their own parent first?
We talk about all of it.
The caregiver takeaway: What you Can Do Right Now
You don’t need to wait for Medicare policy to change to start paying attention.
Ask the question. When was your loved one’s last hearing test? When was yours? If nobody can remember, that’s your answer.
Watch for withdrawal, not just repetition. Asking people to repeat themselves is an obvious sign. Quieter ones matter too: stepping back from conversations, sitting silently at family gatherings, responding in ways that don’t quite fit what was said.
Don’t assume it’s cognition first. If someone seems confused or disengaged, consider whether they’re actually hearing what’s being said before drawing conclusions.
Bring it up at the next appointment. If a provider isn’t asking about hearing, raise it yourself and ask about a full hearing evaluation.
Skip the nagging. Dr. Keefer is blunt on this one. Pressure rarely works. On Saturday, he shares a story from his own clinic about what refusal can look like, and why understanding the reason behind it matters more than winning the argument.
Hearing loss can be a normal part of aging. That doesn’t mean it shouldn’t be addressed.
The full conversation with Dr. Robert (Bob) Keefer drops tomorrow morning. Follow aging together // unfiltered wherever you listen or watch so it lands straight in your feed.
Want more conversations like this one? Tune in to the Aging Together Unfiltered podcast, and follow along on Instagram and LinkedIn. If this resonated, share it with another caregiver who needs to read it.
At Aging Together, we’re dedicated to helping you navigate aging together — whether you’re an older adult planning ahead, a caregiver seeking support, or simply someone who wants to understand the aging process. I hope you’ll join us on this journey.