Dementia is a broad term that encompasses many diseases that lead to cognitive impairment – affecting executive function, memory loss, word-finding, and difficulty with depth perception and fine motor skills. It’s not a specific disease but rather a general term for the impaired ability to remember, think or make decisions – leading to difficulty in performing everyday activities.  

The exact cause of dementia is unknown, although there are genetic predispositions for certain subtypes of the disease. When it comes to dementia, there are reversible factors that can make cognitive impairment appear to be worse – including low thyroid levels, low vitamin b12, depression and side effects from other medications. Another major reversible factor that often goes unaddressed is hearing loss. 

If you can’t hear something, you can’t form a memory of it. If a wife tells her husband that he has an appointment on Friday and he doesn’t hear, he never formed the memory. When she asks him or reminds him about it later, he may either pretend he heard or cover up the hearing loss to go about their normal business. Over time the wife may be concerned he’s not remembering things, when in fact he never heard her in the first place. This is one scenario where it’s important to understand a person’s true baseline for memory. 

Generational Approaches to Hearing Loss 
Why is hearing loss not always acknowledged by older populations? From my perspective, a lot of it comes down to generational issues – the World War II generation and baby boomers are very different. Older adults often don’t want to be a burden and don’t want to bring up their problems unless they feel like it’s life or death – they will often choose to “live with” something like hearing loss rather than address it directly. Baby boomers are much more likely to bring up these issues and seek answers. 

Barriers to Hearing 
Cost is another important point to consider when it comes to addressing hearing loss. Hearing aids are not covered by Medicare and can easily cost $3,000 - $5,000, which is simply out of the budget for many individuals on a fixed income. Many people who are in these financial situations don’t get tested. Today there are over-the-counter hearing aid options, with a few under $200, making it much more affordable than ever before. The Veterans Administration is one resource for top-of-the-line hearing aids for those who qualify. The local non-profit Speech and Hearing Center also has grant funding to cover hearing aid costs for those in need. 

The Takeaway 
While hearing loss doesn’t directly make dementia worse, it often makes it appear worse – which can lead family and friends to believe you have less cognitive function than you actually do. It’s critical to have an audiology assessment at the first signs of hearing loss and make a plan to address it. Not everyone needs all the bells and whistles of the latest hearing aids – but hearing well is one of the keys of good health for a number of reasons. 

First, it’s especially difficult to participate in your own healthcare if you can’t understand what’s being said. You might miss what you should do with your diet, exercise or medications. When you can’t hear, your provider may be less likely to interact with you and instead look to a spouse or caregiver for information, which may lead to an incomplete health history and contribute to poorer health outcomes. 

If you have concerns about dementia for yourself or your loved one, it’s important to see a dementia specialist early – to understand the different types, how they progress, life expectancy and ways to prepare for the future. Because treatment options for dementia are limited at this time, arming yourself with education is the very best approach. 

Alycia Cleinman, MD

A game of cards with your girlfriends. A round of golf with your buddies. A leisurely breakfast with an old friend. It’s easy to see the importance and value that strong relationships and social interaction bring to our lives. But more than just the enjoyment we gain from spending time with people we love and respect, regular social engagement is key for older adults because it helps to improve mood and maintain memory and language skills. What’s more, it helps maintain cognitive function by delaying the progression of memory loss and dementia – and it can also improve depression.  

Isolation as You Age

As a young or middle-aged adult, you’ll likely never run short of people to talk to or places to go. Work responsibilities and kids’ activities keep us hopping. But older adults can easily become isolated when their spouse, children, siblings or close friends pass away. Diseases like COPD, stroke and arthritis can make traveling more difficult. Hearing loss often limits a person’s ability to communicate with others effectively. Worst of all, anxieties relating to memory loss cause many seniors to withdraw from others.

Are you or a loved one socializing enough?

Even though some of these situations brought on by aging are unavoidable, there are signs you can be on the lookout for that might indicate you or a family member is struggling with isolation. Self-neglect that shows up in poor hygiene, an untidy home or weight loss, or an apathy or lack of interest toward hobbies and activities that were previously enjoyed (such as knitting, attending church or family events) should not be ignored and are signs of isolation and potential cognitive decline.  

If you’re a child of an aging parent who you suspect is suffering from the effects of isolation, there are some things you can do. First, encourage them to attend activities with you that they previously enjoyed; work with them to think of socialization opportunities they may like (such as a Bible study, senior center group, exercise class, or art lessons); re-examine if their current living environment is adequate to  meet all of their needs including transportation to and from activities. Access to activities and proximity to friends or other older adults is vital.

If you’re struggling yourself, reach out to loved ones, share what you’re feeling, and schedule an appointment with your physician to come up with a plan on how to improve your socialization. It’s important to remember that the goal of socializing is to increase opportunities to meet and interact with individuals who are of similar age, educational or social background, helping you easily engage in a conversation about shared experiences. 

Alycia Cleinman, MD