The Elephant in the Room: Ageism and Hearing Loss Stigma

Some thoughts on World Hearing Day

The WHO’s theme for World Hearing Day 2024 is “Changing Mindsets: Let’s make ear and hearing care a reality for all!” One target of the campaign is to:

Call on countries and civil society to address misperceptions and stigmatizing mindsets related to hearing loss, as a crucial step towards ensuring equitable access to ear and hearing care.

While the nature of “stigmatizing mindsets” can very widely across regions and cultures, there are some common elements. In the developed world the source of stigma seems to have bifurcated. There is the stigma associated with having a disability, and that associated with aging.

Those looking through the lens of one of these causes sometimes decry solutions meant to address the other. With concerted action both sources can be made to diminish over time, but until that day it is best to address stigma by meeting people where they are. This is especially true because they are subject to the larger cultural perceptions of their respective issues, and perceptions about disability have moved in a different direction than that of aging.

Hearing loss as a disability

The Super Bowl (American football championship) is consistently the most-watched television program in the USA. Ads at this year’s event cost about $7m for 30 seconds. Companies’ Super Bowl ads reflect their desired brand perception as well as serving as a sales tool. It says a lot that Google used their time to show off a Pixel 8 phone feature that helps low vision people take photos of themselves and others.

People are exposed to increasing numbers of positive images showing people with different abilities living active, happy, and productive lives, and this is beginning to resonate. Case in point, the Paralympic Games. The Tokyo Games of 2021 were watched by 14.1m Americans in total, nearly double that of the 2016 Rio Games according to NBC Sports, who provided the TV coverage.

The hearing aid industry and other ecosystem companies see this trend and are driving a change in perception of people with hearing aids. Devices in a variety of stylish form factors have been introduced, and companies such as Deafmetal offer jewelry for people to make their hearing devices an expression of themselves.

A strong headwind on positive perceptions of hearing aid wearers come from the mainstream media, who indiscriminately grab the same old photos of hearing aids from the 70’s disturbingly often.

A lack of images showing modern hearing aids on a broader cross-section of the public hasn’t helped. Now a major initiative by GN promises to change that with a new collection of free photos. How long will it be before we see the last of the “beige banana?” It’s hard to predict but the hope is that once these new images begin to appear in popular press articles, others will follow suit.

All of this is laying the groundwork for the normalization of hearing aid wear in the same way that eyeglasses went from stigma to fashion. But the path to getting there is running into a roadblock that the vision care industry didn’t have to face.

Hearing loss as a sign of aging

As the US National Institutes of Health (NIH) put it, “Age is the strongest predictor of hearing loss among adults aged 20-69, with the greatest amount of hearing loss in the 60 to 69 age group.” Contrast this with the common eye condition myopia (nearsightedness) which is typically corrected with eyeglasses. Myopia most often begins when young and, according to the NIH, actually declines with age. The prevalence of myopia in younger people was an open door for fashion eyeglasses. In the case of hearing aids, the “eyeglasses as fashion” analogy breaks down because of the strong association with aging.

Ageism is the barrier

It’s a sad fact of life that ageism in the workplace remains persistent, as recently described by Martin J. Smith in Stanford Business and Richard Eisenberg in Forbes. They were referring to the USA but that country is far from unique. Liz Alderman, writing from Paris in The New York Times, pointed out how a light was shown on age discrimination in France when the retirement age was raised from 62 to 64. The author quotes an Indeed France survey that revealed four out of 10 employers surveyed by Indeed said they didn’t intend to recruit anyone older than 45.

Is it any wonder that older working people, already feeling vulnerable in their employment or actively looking for a job, hesitate to be seen wearing hearing aids? The strong association between hearing loss and aging will not go away because it is backed up by actual circumstances. So long as age discrimination (real or perceived) exists, people of later working age will be shy about anything that accentuates how old they are. “Hearing aids as fashion” will rarely work for this cohort as they begin to come in need of hearing care.

Two causes, two solutions

There are those who criticize manufacturers for making hearing aids invisible in one form or another, saying that only reinforces stigma. This does not do justice to a person who is facing, or is afraid of facing, the very real problem of age discrimination. It's important to get that person hearing care and an appropriate device in a style that enables them to go about their life comfortably and confidently.

I very much appreciate the movement toward making hearing aids visible and attractive because in the end, those who adopt this approach will positively influence broader perceptions about hearing loss. The same is true of people who wear classic styles and don’t hide them. For those who are not yet ready to take these approaches, I applaud the increasing availability of “invisible” form factors ranging from small RIC and CIC devices to the new generation of eyeglass hearing aids. “Ear and hearing care for all” means meeting everyone where they are.