By Marvin Packer, MD—Addressing the high prevalence of age-related hearing loss, the communal and personal failure to remedy it, and the critical consequences for brain health.

Imagine you are sitting in a lecture:

The speaker’s voice is clear at first. You can follow each sentence, each slide.

Then, the words start to blur. It’s as if someone has turned down the volume to a muffled half-presence. The consonants vanish first—“t,” “k,” “s”—leaving only rounded vowels that smear into one another.

At the same time, the other sounds in the room grow sharper: someone clicking a pen, the rustle of pages, chairs shifting on the floor, a cough from behind. Even the hum of the projector feels louder.

You lean forward, straining to piece together fragments. What had been effortless is now work—listening with every muscle tense, guessing from context, hoping you’ve caught the meaning.

The lecture continues smoothly for everyone else, but for you, it feels like you’ve been pushed just outside a glass wall, with faded sound obscured by noise.

I know this experience. I live it. And so do millions of others.

The Invisible Epidemic of Presbycusis

Presbycusis (age-related hearing loss) affects one-third of adults between 65 and 75, and the incidence and severity increase with age. It is invisible, insidious, and profoundly under-recognized. Because it develops slowly, many people don’t notice it in themselves. Because it leaves no outward mark, others rarely notice it. In addition, more than a fifth of adults over 65 live with tinnitus — a ringing or hiss with no external source — another barrier to hearing.

As we age, soft sounds, and especially high frequency consonants, become harder to perceive, and the ability to discriminate similar sounds diminishes. This makes soft or rapid speech significantly harder to understand. A “p” can sound like a “t”, or an “s” like an “f”, which can change the whole meaning of a word or sentence (“cup” perceived as “cut” or “sail” as “fail”). Because consonants transmit much of the meaning of speech, their loss disproportionately affects understanding—even when speech seems loud enough. Speech may be perfectly audible but unintelligible: you hear the voice, but miss the words.

The Public Space Acoustic Barrier

Compounding the natural rapid fall off of sound volume over distance, many lecture halls or houses of worship have hard surfaces and high ceilings that reflect sound, creating prolonged echoes that arrive late, obscure already soft sounds, and blur the separation of syllables.

In addition, speech comprehension in older adults demands a voice volume significantly louder than ambient sound. Background noise, such as ventilation systems and audience movement, instantly erases that critical margin. When you add rapid speech that outpaces an older individual’s processing speed and “clips” high-frequency consonants, comprehension begins to fall apart. Add unfamiliar accents, the loss of facial cues by a speaker who turns away, and the absence of high-quality microphones and assistive listening systems—and comprehension completely collapses.

The Hearing Aid Adoption Crisis

And here is a sad fact: help exists, but most people don’t use it. In Israel, even with substantial government health basket subsidies, research shows that only 40.9% of older adults (65 to 85) follow through with adopting hearing aids. By comparison, in the United States, that number drops even lower, with only about 30% of people over 71 utilizing them.

The reasons for low utilization include cost, physical discomfort, underestimated benefit, difficulty of adaptation, and disappointment in sound quality. In Israel, complex bureaucratic barriers to obtaining hearing aids remain a significant factor.

In addition, because age-related hearing loss has an insidious onset, many individuals remain completely unaware of the extent of their impairment and attribute difficulty to a mumbling speaker, poor acoustics or noise.

Finally, individuals with hearing loss may be reluctant to disclose it. This often stems from a deep-seated stigma, a fear that admitting to hearing difficulties will cause others to perceive them as less capable, unintelligent, or defined by negative stereotypes associated with the elderly. They may adopt a strategy of “passing”:  nodding or smiling to maintain a........

© The Times of Israel (Blogs)