Here is something that surprises families: a good share of what looks like “the dementia getting worse” in the homes I visit turns out to be, at least partly, not hearing properly. The person who stopped joining in at dinner. The one who answers a different question from the one you asked. The one who gets agitated in a noisy room and calm in a quiet one. Sometimes that is the illness. Sometimes it is their ears, and ears are fixable.
What the research says
Hearing loss is one of the largest modifiable risk factors for dementia that researchers have identified. The Lancet Commission on dementia, in its 2024 report, estimated that it accounts for about 7% of dementia worldwide — tied for the largest share of the fourteen risk factors it counted. That is a population-level finding about risk. It does not mean hearing loss causes any one person’s dementia, and it does not mean hearing aids treat dementia once it is there.
What the evidence does say is encouraging, if more modest. In the ACHIEVE trial, published in 2023, adults aged 70 to 84 with hearing loss but without dementia who received hearing care did not show slower cognitive decline overall across three years. But in the group at higher risk of decline to begin with, hearing care was associated with substantially slower decline. Researchers are still working out who benefits most.
So here is how I would frame it to a family. Treating hearing loss is not a cure for anything. It is a way to keep your person connected — to conversation, to you, to the world — and connection is a large part of what keeps people well.
Why it matters even more once dementia is here
A brain with dementia has less spare capacity. Straining to decode muffled speech uses up effort it doesn’t have, and what’s left for understanding and remembering shrinks. Missed words become missed meaning, and missed meaning looks exactly like confusion. People who can’t follow a conversation also withdraw, and withdrawal feeds everything else. Not hearing can also be frightening: someone who can’t hear you coming may startle, and startle can look like aggression.
Start with the simplest check: earwax
Before anything else, ask their doctor or nurse to look in their ears. Earwax buildup is common in older adults, especially in anyone who wears hearing aids, and it can make hearing noticeably worse. Clearing it is usually simple, though it sometimes takes softening drops for a few days first. Please don’t try to dig it out with cotton swabs. Ask about safe options.
Then ask for a hearing test. Most people with mild dementia, and some with moderate dementia, can do a hearing test with an audiologist, especially if you come along and mention the dementia when you book. A formal test tells you what kind of help will work.
Hearing aids: what to choose, and for whom
In the United States, since 2022, over-the-counter hearing aids can be bought without a prescription, exam, or fitting by adults 18 and older with perceived mild to moderate hearing loss. They are usually much cheaper than prescription aids.
Honesty note: some links below are affiliate links. If you buy through one, this site earns a small commission at no extra cost to you. These are categories I recommend on house calls; the specific products are examples, not the only good ones.
For someone in the early stage who can still learn a new routine, or for you, the caregiver, if the hearing test shows mild to moderate loss, an over-the-counter pair is a reasonable place to start. Vivtone’s SyncTune is a rechargeable over-the-counter set (listed at US$349 on Vivtone’s site in September 2026) with a charging case, which spares you the tiny batteries. It uses simple buttons rather than an app. Caregivers lose hearing too, and a caregiver who can’t hear is working twice as hard.
For someone further along, a professional fitting through an audiologist is usually the better route. Fitting and follow-up matter, and someone has to put the aids in, take them out, clean and charge them. If that someone is you, choose rechargeable over batteries, and simple over clever.
Helping hearing aids stay in (and not get lost)
- Build it into the routine that already exists: in with the glasses in the morning, out with the teeth at night, into the charger in the same spot every time.
- Start with short, pleasant stretches — a favorite program, a phone call with a grandchild — rather than a full day in a noisy room.
- Use a hearing aid retainer clip (paid link) that attaches to clothing, so a pulled-out aid dangles instead of disappearing into a napkin.
- If they won’t tolerate hearing aids at all, a simple personal amplifier can still rescue conversation. The Williams Sound PockeTalker (paid link) is a pocket-sized box with a microphone and ordinary headphones. You put the headphones on them, start with the volume low, and speak close to the microphone. With the headphones nothing goes in the ear, nothing needs fitting, and it is very useful at medical appointments.
How to talk so they can hear you
- Face them, at their level, in good light, so they can see your mouth and your expression.
- Get their attention first. Say their name, touch an arm, then speak.
- Lower your pitch rather than raising your volume. Shouting distorts speech and sounds angry.
- Turn off the television before you talk. Background noise is the enemy of an older ear.
- Rephrase, don’t repeat. If a sentence didn’t land, say it differently and more simply.
When it isn’t their hearing
Gradual hearing loss creeps up over years. Sudden hearing loss in one or both ears is urgent. Call their doctor the same day, or go to urgent care, and use the words “sudden hearing loss” — treatment works best when it starts early. If it comes with a drooping face, weakness, slurred speech, or severe dizziness, call 911. And if your person is suddenly more confused than their usual, don’t put it down to their ears. A sudden change is medical until proven otherwise — that needs a phone call. See when to call the doctor and when to go.
And for you
If you have been repeating yourself all day and wondering whether it’s the illness or you, it may be neither. It may be their ears. Getting that checked is one of the few things in this illness that can make daily life easier within weeks. If you’re early in this, the dementia or normal aging letter is a good next read.