Geriatric Hearing Health: A Multidimensional Challenge Requiring Breakthroughs in Technology, Policy, and Service Systems

Hearing loss among the elderly has become a major public health challenge in China, with impacts far exceeding those of sensory impairment alone. Recently, the "China Hearing Health Report (" jointly released by the China Hearing Medicine Development Foundation and Social Sciences Academic Press2025): The Blue Book on Hearing Health in the Elderly Reveals That China60The prevalence of hearing loss among the elderly population aged 60 and above is as high as11.04, with the estimated number of patients exceeding2000million. Behind this figure lies the grim reality of heightened social isolation among older adults, an increased risk of cognitive decline, and a significant deterioration in quality of life. Hearing loss is not only a prevalent concern among the elderly but also has clear associations with conditions such as Alzheimer’s disease and depression. It has become a critical factor affecting healthy aging, urgently requiring a systematic response from the public health system.

The current rehabilitation service system has significant shortcomings, with dual deficiencies in professional resources and public awareness. The report points out that the proportion of hearing-impaired individuals in China receiving rehabilitation services remains low, and the usage rate of hearing assistive devices among the elderly population is insufficient.10%This situation reflects multi-layered issues: insufficient coverage of professional service institutions, a severe shortage of audiology professionals, misconceptions in society regarding age-related hearing loss, and lagging research, development, and application of rehabilitation technologies. In contrast to the extensive social attention and resource investment already established in the field of pediatric hearing rehabilitation, geriatric hearing rehabilitation remains on the margins, with a comprehensive service system encompassing “prevention–screening–intervention–rehabilitation” yet to be established.

Frontier technologies such as gene therapy demonstrate potential, but clinical translation and widespread application remain a long and arduous journey. The Blue Book specifically highlights that gene therapy holds significant potential in delaying or even reversing age-related hearing loss, with relevant basic research having made progress in animal models. However, the transition from laboratory to clinical practice still faces a series of scientific challenges, including vector selection, safety validation, and the reconstruction of regenerated cells and neural connections. Meanwhile, the widespread adoption of existing technologies such as hearing aids and cochlear implants is constrained by factors like cost, fitting services, and postoperative rehabilitation support. Technological innovation and improved accessibility must be driven in tandem to truly benefit the vast population of elderly patients.

Policy Synergy and Social Co-Governance Are the Keys to Breaking the Deadlock: Building a Supportive Ecosystem with Multi-Stakeholder Participation The report reviews relevant policies introduced by the state in recent years, such as initiatives to promote hearing health among the elderly. However, the effectiveness of policy implementation and regional equity still require strengthening. Prominent issues remain, including limited health insurance coverage, weak service capacity at the primary care level, inefficient cross-sector collaboration mechanisms, and insufficient participation from public welfare forces. Advancing the cause of hearing health for the elderly requires not only coordinated efforts among multiple departments—including health, civil affairs, and disabled persons’ federations—but also mobilizing the enthusiasm of diverse social stakeholders, such as enterprises, communities, families, and professional organizations, to jointly build an inclusive and supportive hearing-friendly environment.

"China Hearing Health Report ("2025): Geriatric Hearing Health systematically portrays the full landscape of hearing health issues among the elderly in China, revealing a level of severity, complexity, and far-reaching impact that far exceeds general public awareness.

First, age-related hearing loss is characterized by a high prevalence and profound cascading impacts. According to the data from the Second National Sample Survey on Persons with Disabilities,60The prevalence of hearing loss is highest among individuals aged [X] years and older, accounting for approximately one-third.65aged over years with hearing disabilities, and by the time80years of age and older, this proportion rises to approximately90%Hearing loss is by no means a simple matter of “not hearing clearly”; it directly leads to difficulties in verbal communication among older adults, triggering social withdrawal and feelings of loneliness. More alarmingly, extensive research has demonstrated that hearing loss is an independent risk factor for cognitive decline and Alzheimer’s disease.

The report indicates that the incidence of Alzheimer's disease among older adults with mild, moderate, and severe hearing loss is, respectively, that of individuals with normal hearing.2times,3VCBeat5fold. Its underlying mechanism may be related to the “cognitive load” hypothesis: the brain needs to expend more resources to process ambiguous auditory signals, thereby crowding out resources allocated to other higher-order cognitive functions such as memory and thinking, which may lead to structural changes in the brain over the long term. In addition, hearing loss impairs older adults’ ability to avoid hazards, increases the risk of accidents, and may exacerbate psychological problems such as depression and anxiety.

Secondly, the application of existing rehabilitation interventions faces the “last mile” dilemma. Hearing aids and cochlear implants are the primary technological interventions for improving age-related hearing loss. Hearing aids effectively amplify sound, helping users re-engage with the auditory world, while cochlear implants provide superior sound perception for patients with severe to profound hearing loss. The report affirms the significant efficacy of these devices in enhancing quality of life, social participation, and mental health. However, the adoption rate of hearing assistance devices among the elderly population in China remains extremely low, with a national average of only approximately10%, far below that of developed countries.

Behind this paradox lies a confluence of multiple barriers: First, there is insufficient social awareness, as many older adults perceive hearing loss as a natural part of aging and are reluctant to acknowledge it or seek intervention, while family members also lack adequate attention to the issue. Second, access to professional services is poor; the network for specialized services—including hearing aid fitting, adjustment, follow-up care, and rehabilitation training—is underdeveloped, particularly in primary care settings and rural areas. Third, the financial burden is heavy; although medical insurance covers hearing aids in some regions, out-of-pocket expenses remain a significant strain on many families, and subsequent maintenance costs are considerable. Fourth, there is a mismatch between products and user needs, as some existing devices are complex to operate and uncomfortable to wear, failing to align with the usage habits of older adults.

Furthermore, there is a structural imbalance in China's hearing health service system. Report data shows,2017Aged2023In 2023, the cumulative number of people with hearing disabilities who received rehabilitation services nationwide in China was463.5With a reach of only tens of thousands, this service clearly fails to adequately cover the vast population with potential needs. The service system exhibits tendencies of “prioritizing children over the elderly,” “favoring urban areas over rural ones,” and “emphasizing intervention over prevention.” Resources are highly concentrated in core hospitals in a few major cities, while primary healthcare institutions and communities lack the capacity for screening and early intervention.

Meanwhile, there is a significant shortage of audiology professionals (such as audiologists, hearing aid dispensers, and auditory rehabilitation teachers), and the training system remains imperfect, which constrains the improvement of service quality and the extension of services to grassroots levels. At the policy level, although the state has issued the “Action Plan for Promoting Hearing Health Among the Elderly (”2024-2027Notice on [Year])” and other guiding documents, there remains a lack of detailed implementation mechanisms and mandatory performance indicators with regard to local execution, inter-departmental coordination, and financial assurance.

In the face of the severe current situation and challenges, the Blue Book puts forward a series of constructive suggestions. To promote the development of elderly hearing health, it is necessary to start from the perspective of system construction and build a systematic solution that covers the whole life cycle, integrates multi-party resources, and focuses on precise services.

The primary task is to establish and strengthen “prevention-Screening-Diagnosis-Intervention-"Rehabilitation" full-chain service network. From a prevention perspective, extensive public health education on hearing should be conducted, particularly targeting middle-aged and older adults, to highlight the importance of noise protection, safe medication use, and healthy lifestyle practices (such as blood pressure and blood glucose control) in preserving hearing.

At the screening level, efforts should be made to incorporate simple hearing screening into65Routine items for annual health examinations of the elderly, and explore the use of grassroots outlets such as community health centers and elderly care institutions to carry out initial screening to achieve early detection of problems. At the diagnosis and intervention level, it is necessary to establish a clear hierarchical diagnosis and treatment and referral mechanism, with grassroots institutions responsible for initial screening and referral, and regional hearing centers responsible for precise diagnosis and device fitting. At the rehabilitation level, there is a need to vigorously develop comprehensive rehabilitation services including auditory training, speech rehabilitation, and psychological support, rather than simply “ending with device provision.” The effective operation of this chain depends on the interconnectivity of information systems and the clear division of responsibilities among institutions at all levels.

The core support lies in the dual-wheel drive of strengthening the construction of professional talent teams and the application of scientific and technological research and development. Talent is the cornerstone of service delivery. It is imperative to accelerate the establishment and expansion of audiology-related programs in higher education institutions, establish standardized professional qualification certification and continuing education systems, and guide the flow of professionals to underdeveloped regions and grassroots levels through incentive measures such as special subsidies for grassroots talent and targeted training programs.

In terms of technology, efforts should be made to encourage the research and development of hearing aid products that better meet the needs of older adults in China, are easier to operate, and offer greater cost-effectiveness (such asOTChearing aids), and drive the iterative upgrading of existing hearing aid and cochlear implant technologies to enhance speech recognition capabilities in complex environments. On the other hand, it is essential to actively explore application scenarios for emerging technologies such as artificial intelligence, big data, and the Internet of Things, for example, by developing smartphone-based self-administered hearing testsAPPremote fitting and debugging systems, intelligent tinnitus management tools, etc., to enhance the accessibility and precision of services. The Blue Paper specifically highlights frontier directions such as gene therapy and hair cell regeneration; although these are still far from large-scale clinical application, they represent potential fundamental breakthroughs for the future, and the state should provide long-term, stable investment in basic research.

The key guarantee lies in improving the multi-tiered payment system and policy coordination mechanism. Economic burden is one of the primary factors hindering the use of assistive devices. The report recommends gradually expanding the scope and reimbursement rates of basic medical insurance for assistive devices such as hearing aids and cochlear implants, and exploring the inclusion of hearing rehabilitation service costs in medical insurance coverage. Meanwhile, a special subsidy or assistance system should be established for elderly individuals facing financial difficulties, and the development of commercial hearing insurance should be encouraged to form a “basic medical insurance payment+Social Assistance+Commercial Insurance+a diversified co-payment model with "individual contribution" to reduce patients' out-of-pocket financial burden.

In terms of policy coordination, it is essential to break down departmental barriers and establish a normalized multi-sector collaboration mechanism led by the health authorities, with participation from civil affairs, disabled persons’ federations, medical insurance, education, science and technology, and other relevant departments. For instance, the health authorities are responsible for the medical service system and preventive care; the civil affairs department integrates community and elderly care resources; the disabled persons’ federation manages the linkage of rehabilitation services and needs assessment for persons with disabilities; the medical insurance department formulates payment policies; and the science and technology department supports research and development innovation. Only in this way can policy resources generate synergistic effects rather than being fragmented or even conflicting.

Building an Age-Friendly Society

Addressing hearing health issues in the elderly cannot rely solely on medical technology and service systems; it is fundamentally a societal issue that requires transformation across broader dimensions, including social awareness, environmental design, and multi-stakeholder governance. The ultimate goal is to build a society that is friendly to individuals with hearing impairments and supports healthy aging.

The fundamental shift lies in comprehensively enhancing societal awareness and eliminating stigma and misconceptions. In contemporary society, there is a widespread misconception that age-related hearing loss is merely a "natural consequence of aging" or an "insignificant minor ailment," often accompanied by stigmatizing labels such as "hard of hearing" or "deaf." This leads patients to avoid seeking medical attention due to fear or shame, while family members lack the motivation to provide support.

Therefore, it is essential to launch large-scale and sustained public awareness campaigns. By leveraging multiple channels—including mainstream media, social media platforms, and community bulletin boards—these initiatives should disseminate hearing health knowledge in an accessible manner, emphasize the importance and benefits of early intervention, and share successful rehabilitation stories. The goal is to foster positive social perceptions, such as viewing “attention to hearing health as a hallmark of active aging” and normalizing the use of hearing aids as being “as commonplace as wearing glasses.” Particular emphasis must be placed on health education for family members of older adults, empowering them to serve as the first line of support in encouraging seniors to undergo screening and pursue rehabilitation.

A key direction is to promote cross-sector collaboration and the deep engagement of public welfare forces. The cause of hearing health for the elderly involves multiple disciplines, including medicine, rehabilitation science, acoustics, psychology, sociology, and engineering, and engages various stakeholders such as governments, enterprises, medical institutions, non-profit organizations, communities, and families. The Blue Book recommends actively building platforms for resource integration to promote cross-sector collaboration among industry, academia, research, and application. For instance, foundations can take the lead in establishing special research funds or innovation challenges; enterprises can fulfill their corporate social responsibility by donating equipment or supporting grassroots screening programs; and non-profit organizations can delve into communities to provide science popularization and companionship services. Particular emphasis should be placed on cultivating and developing professional non-profit organizations focused on hearing health, as they can play a vital “gap-filling” and “advocacy” role in areas not covered by government services.

The ultimate goal is to build an inclusive, hearing-friendly environment. This entails the dual development of both physical and social environments. Regarding the physical environment, acoustic modifications are encouraged in public spaces frequently visited by older adults—such as elderly care facilities, community activity centers, hospitals, banks, and public transportation—to reduce background noise and enhance visual cues (e.g., electronic displays). The adoption of induction loop systems or Bluetooth hearing assistance systems should be promoted to facilitate use by individuals with hearing aids. In terms of the social environment, the public is advocated to adopt habits such as facing the listener, slowing down speech, and articulating clearly when communicating with older adults. Staff at public service counters should receive basic training in communication skills. Through the combined improvement of hardware and soft environments, barriers to social participation for individuals with hearing impairments can be reduced, enabling them to integrate into society with dignity and accessibility.

Addressing the challenges of hearing health in the elderly is a protracted struggle that requires concerted efforts in technological breakthroughs, systemic restructuring, policy coordination, and the updating of social perceptions. It concerns the quality of life and family well-being of tens of millions of older adults, and serves as a measure of “Healthy China”2030”A key measure of strategic quality and the level of social civilization. Only by rallying societal consensus and strength can we truly ensure that every older adult enjoys clear hearing, embracing a later life filled with greater vitality and dignity.