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The scene is played out in homes across the U.S. every year. An aging parent or grandparent at the dinner table, lost amid dueling conversations. A raised voice. A blank look. A plea to get help. A quiet retreat.

If you have a family member with a hearing problem -- and 25% of Americans 65 and older have a disabling hearing loss -- you know how hard it can be on everybody in the family.

Sometimes, the solution can be as easy as seeing your doctor or an audiologist, scheduling a hearing test, and getting your loved one fitted for a hearing aid.

But that’s tricky. Only about 17% of Americans ages 20 to 69 who need hearing aids ever use them. The number goes up for people 70 and older, but only to 30% or so.

It’s a Family Thing

The decision to go with hearing aids can be an intensely personal decision. But the person making that choice isn’t the only one affected. It goes much deeper than that.

“There are tremendous family dynamics that take place around this issue of hearing loss. People don’t want to be told they have a problem,” says Debara Tucci, MD, an ear surgeon with the Duke University School of Medicine. “They would really rather deal with it as best they can and blame the difficulty in communication on the circumstances -- on the spouse who mumbles or something like that.”

But that leads to hard feelings and often a pullback by the person with hearing loss. The condition can be dangerous to them and can take a big toll on a family.

“We get a lot of older family members who basically sit at the dinner table and, because they don’t understand what’s happening, they tend to withdraw,” says Larry Eng, the president of the American Academy of Audiology, “and that leads into a whole spiral of other issues.”

Withdrawal can lead to social isolation and depression. Untreated hearing loss has been linked to cognitive decline and dementia. All of that can be devastating to others in the family.

Sarah Klegman is a writer and baker in her 20s who was fitted for her first pair of hearing aids last year. She went through some family turbulence, then saw it smooth out once she opted for the devices.

“You can’t help but be annoyed with someone if they don’t hear you. You can’t. Even if you’re a saint,” she says. “So there was tension. And some of that tension has been relieved. They don’t have to repeat themselves as often. And you can respond to everything they’re saying more deeply. You can just connect with people more deeply.”

What’s the Hang-up?

“I think there’s a lot of denial,” Tucci says. “Hearing loss is associated with aging, so a lot of people don’t want to admit that they’re losing their hearing.”

In a quiet, well-lit room with someone directly in front of them, where the speaker is clearly visible, those with hearing loss often can get by. Denial works. But throw in a blaring TV, a comment from another room, lots of talking at the dinner table, or a bunch of background noise, and communication becomes much harder.

“They say, ‘I have no problem hearing the TV,’” Eng says, “but they’re not the one sitting in the room with them [with the TV volume blaring].”

Denying the problem is natural, but other reasons for refusing to get help pop up, too:

Cost. The average price of a digital hearing aid is about $1,500. Top-of-the-line devices cost up to $10,000.

Expectations. The newest hearing aids help millions of people, but they can’t help everyone. Some people have an idea that you pop ‘em in and suddenly you can hear everything. When that’s not the case, it can seem disappointing.

“Hearing aids are great. They amplify things. They amplify everything,” says Laura Friedman, the communications and programs manager at the Hearing Health Foundation. She’s worn the devices for years. “They don’t clarify, they don’t distinguish the person standing in front of me from the person standing behind me or the dog barking in the apartment next to me. I have to do that.”

Eng says that “trying to get an 80-year-old [help] who has, say, moderate to severe hearing loss -- something that should have been taken care of a long time ago -- it’s very difficult to try to work with these folks and their expectations.”

Motivation. Eng also says some people “just don’t think that it’s worth it for the time that a lot of them think that they have left on Earth. I think a lot of it is [a lack of] motivation.”

Still, the reasons for using hearing aids can outweigh any perceived negatives.

“I liken my hearing loss to people that probably should wear glasses that, like, don’t wear glasses,” Klegman says. “You don’t realize what you’re missing. And it’s so much. It’s sooo much.”

How to Start the Conversation

If you have a family member who could use hearing aids, opening the discussion is hard enough sometimes. For those in denial, a hearing test with an audiologist might be good place to start.

“I was very unsuccessful at getting my grandpa to wear hearing aids, even though I wear hearing aids,” says the HHF’s Friedman. “When I was in his house, I’d say, ‘If I have to wear mine, you have to wear yours.’

“There is no one solution to get someone to wear hearing aids. I guess a good place to start is making it a game. Take a test. Go into [a store]. Say ‘I’m really curious’ to get them into it. Make it like getting your eyes checked.”

Eng has a simple solution: Hear them. “I think one of the things you have to do is really find out where they’re coming from. And listen to what they say. Listen to what’s important to them.”

Other suggestions include:

See if test-driving some hearing aids will help. Most states offer a 30- or 60-day trial period, and many doctors will work with you to make sure the devices will be of benefit before anyone pays for them.

If your family member worries about appearance, show him the newer hearing aids, which are more discrete than ones that were used only a few years ago.

“Look, people are going to judge you regardless. And they’re going to judge you more if you seem disconnected,” Klegman says.

“It’s truly heartbreaking that the amount of stigma stops so many people from getting hearing aids,” he says. “I think they will never really fully understand how much of a difference it can make in their lives. And how much people, honestly, don’t really care that much that you have things in your ears. They’re much too worried about themselves to be looking in your ears.”

Appeal to your loved one’s sense of family. Make it known that this is a possible solution for everyone, not just the one with hearing loss.

Remind your loved one how much life can change when you hear better. “It’s hard. It’s a tough conversation. You can’t really strong-arm someone into it,” Klegman says. “You say, ‘Just try it.’ You say, ‘What’s the harm?’ You say, ‘This could improve your life, and it doesn’t mean that there’s anything wrong with you.’ How is this different than the glasses I wear or the inserts I put in my shoes? We are imperfect beings, and that’s OK.

“It’s not that big of a deal. It doesn’t mean you’re any less. It’s OK. Your life will be better.”

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