Hearing loss is one of the four leading chronic conditions for older persons (U.S. Department of Health and Human Services, 1991). The rate of occurrence of this condition increases dramatically with age (Wax & Di Pietro, 1984). Census figures for 1989 report the rate of hearing loss among people age 45 to 64 to be approximately 13%, age 65 to 74 to be 24%, and age 75+ to be 36% (National Center for Health Statistics, 1990). Other researchers have found the prevalence of hearing impairment in older adults to be much higher than that suggested by the Census, with estimates ranging from 50% (Wax & Di Pietro) to 74% (Davis, 1983).

Because the percentage of older persons who have hearing losses is large, service providers, family members, and persons in this older age range need to be familiar with the experiential and phenomenological aspects of this condition. The purpose of the current article is to provide information regarding intrapersonal experiences and psychosocial implications associated with late onset hearing loss. It is hoped that such information will result in increased sensitivity to the emotions and challenges faced by older persons who experience hearing loss.

Although a number of terms have been used to describe hearing loss that occurs in adulthood (i.e., adventious deafness, late deafness, acquired hearing loss); the term, presbycusis, is generally used to describe the hearing loss of older persons (Agnew, 1986; Brooks, 1989; Kampfe & Smith, 1997, in press; McFarland & Cox, 1985; Stein & Bienenfeld, 1992; Williams, 1984). Presbycusis refers to a wide range of problems associated with auditory deterioration (Hull, 1977; Stein & Bienenfeld; Williams). Hearing loss in older people is thought to be the result of a combination of a variety of factors. These include an accumulation of many degenerative changes that relate to the aging process itself (Agnew; Brooks; McFarland & Cox; Williams), to zinc deficiency (Shambaugh, 1989), to medication (Agnew; Brooks), to heredity, to environmental conditions, and to other health conditions (McFarland & Cox,). The deterioration of heating associated with degenerative changes is thought to progress at such a slow rate that the individual usually is not aware that the heating loss is occuring or of the extent of its effects (Stein & Bienenfeld).

Because of the variety of physiological changes associated with this degenerative condition, a diagnosis of presbycusis fails to communicate much information about the disorder. Although several hypotheses exist regarding the physiological aspects of presbycusis; the inner ear, specifically the cochlea, and nerve pathways leading to the brain are generally and most often considered to be the primary sites of the degenerative process. Damage in the inner ear creates a sensorineural loss and results in difficulty in hearing high frequency sounds (Brooks, 1989; McFarland & Cox, 1985; Williams, 1984). A high frequency loss affects the ability to hear consonants; and because consonants are important elements of speech, the high frequency loss can cause difficulty in understanding spoken conversation, especially when there is background noise (Hallberg, Erlandsson, & Carlsson, 1992). The psychosocial effects of such loss can easily be contemplated by considering the difference in communication that may result when the person understands the missing word in the sentence, “I’m really–!” to be “bad” or “mad.”

Typically, the loss of hearing associated with presbycusis occurs in both ears (Williams, 1984), but the extent of loss in each ear may vary. For example, one ear may be exposed to environmental conditions such as right ear exposure to mechanical noise while working with a machine that is on the worker’s right hand side. Deterioration associated with this noise-induced hearing loss may occur either separately or in addition to other deterioration related to aging/use.

In addition to difficulty in actual hearing, persons with sensorineural hearing loss will experience distortions in what they do hear. As a result, even when they hear speech, they may not be able to understand it or they may misunderstand it (McFarland & Cox, 1985). Furthermore, external sounds may be misinterpreted resulting in misconceptions of environmental cues (Hull, 1977; Luey, 1980; Ramsdell, 1978). These problems result in differential hearing (i.e., seeming to hear sometimes and not other times). Variance in perceived hearing may result from differing environmental conditions, differing personal conditions, or differing interpersonal conditions. Common environmental conditions that may exacerbate problems with hearing acuity include inappropriate lighting (Kampfe, 1990), distortion of sound waves bouncing off of certain materials (Brinson, 1983), and introduction of extraneous sounds such as group conversations or background noises (i.e., air conditioners, dishwashers, vaccuum cleaners, music) (Hallberg, et al., 1992; Thomsett & Nickerson, 1993). Personal variables that can influence heating acuity include familiarity with the context of the conversation (Kampfe; Thomsett & Nickerson), current energy level (Luey; Orlans, 1987; Thomsett & Nickerson), medication (Thomsett & Nickerson), visual acquity (Brinson; Luey, Belser, & Glass, n.d.), and other psychological and physical factors (Luey; Thomsett & Nickerson). Comprehension can also be greatly affected by interpersonal variables such as the expressiveness, clarity, and rapidity of the speaker (Kampfe) and familiarity and relationship with the speaker (Orlans; Thomsett & Nickerson).