Untreated Hearing Loss and Dementia: What Families Need to Know Before It’s Too Late with Robert C. Keefer - Episode 254

In this eye-opening episode of the Caregiver Relief Podcast, host Diane Carbo, RN sits down with Dr. Robert C. Keefer, PhD, author of Hear Better, Live Longer, to discuss the crucial link between untreated hearing loss and dementia, why standard hearing aid fittings often fail, and how families can take action.

🎙️ Episode Highlights

• The Dementia Connection: Research from Johns Hopkins shows that mild hearing loss doubles dementia risk, moderate hearing loss triples it, and severe hearing loss increases risk five-fold.
• Use It or Lose It: How hearing loss deprives the brain's 1 billion neurons of vital stimulation, leading to cognitive decline.
• The "In The Drawer" (ITD) Problem: Why so many people spend thousands on hearing aids only to leave them in a drawer.
• The Best Practices Gap: Over 80% of American hearing care providers fail to follow audiological best practices like Real Ear Measurement.
• OTC & Online Quick-Fixes: Why over-the-counter and online hearing tests often fall short of protecting long-term cognitive and physical health.
• Falls, Isolation & Health Risks: How untreated hearing loss dramatically increases the risk of serious falls, isolation, depression, and long-term care placement.

📋 Episode Outline

1. Introduction
   • Host Diane Carbo introduces common family scenarios (cranking up the TV, missing conversation details).
   • The alarming NIH and Johns Hopkins stats on hearing loss and cognitive decline.
2. Dr. Robert Keefer’s Journey
   • Medical background and experience launching medical devices.
   • Discovering why 80% of US hearing healthcare providers skip best practices.
3. How Hearing Loss Alters the Brain
   • Neural stimulation and why unaddressed sound deprivation weakens brain function.
4. Best Practices in Hearing Care: What You Must Ask
   • Why online & phone tests can't replace a proper sound booth test.
   • The critical importance of Real Ear Measurement (inserting a tiny probe microphone into the ear canal).
   • Red flags: Why you must demand a computer printout of your hearing aid adjustments.
5. The Advocacy & Financial Struggle
   • Why Medicare currently fails to cover hearing aids and the push for legislative reform.
   • The broader economic cost of Alzheimer's and long-term care.
6. Actionable Steps for Caregivers & Families
   • How to nudge reluctant parents to get tested using a "baseline-only" approach.
   • Master communication strategies (eye-to-eye contact, acoustic adjustments).

💡 Key Takeaways for Caregivers

🗣️ Pro-Tip: If a loved one refuses a hearing test, frame it as setting a baseline: "Let's just get a baseline check so we know where things stand—no risk, no obligation to buy anything."

• Ask your audiologist: "Do you perform Real Ear Measurement when fitting hearing aids, and will you provide me with a printed graph of the adjustment?"
• Schedule follow-ups: Medical-grade hearing aids should be re-evaluated 3 months after fitting and once a year after that to adjust for hearing changes.
• Practice direct communication: Face the person directly, maintain eye contact, and minimize background noise rather than shouting from another room.

🔗 Mentioned Resources & Links

• Book: Hear Better, Live Longer by Robert C. Keefer, PhD (Available on Amazon)

Dr. Robert Keefer — Hearing Health & Medicare Reform

Working to prevent Alzheimer’s and improve lives through better hearing care and Medicare reform. Author of The Alzheimer’s/Hearing Aid Paradox.

Dr. Robert Keefer

Podcast Episode Transcript

Diane: Welcome to Caregiver Relief. I'm your host, Diane Carbo, RN, and today we are gonna talk about something many families notice but too often minimize: hearing loss.

Maybe your parents turn up the television way too loud. Maybe they miss parts of conversations. Maybe they seem withdrawn at family gatherings. Maybe they say, "I hear you," but their answers tell you they did not fully understand what was said. For many families, hearing loss becomes the subject of jokes, frustration, and repeated reminders.

But untreated hearing loss is not funny. It can affect memory, communication, safety, emotional health, relationships, and independence. Research has connected hearing loss with increased dementia risk. John Hopkins reports that mild hearing loss was associated with double the risk of dementia, moderate hearing loss with triple the risk, and severe hearing loss with a five-fold increased risk.

The NIH also reported that hearing aids reduced the rate of cognitive decline by almost 50% over three years in older adults at higher risk for dementia. Today, my guest is Robert C. Keefer, PhD, author of Hear Better, Live Longer. I love the title, and, We are going to talk about why hearing loss is really a brain health issue, why families delay getting help, why hearing aids sometimes fail, and what caregivers can do to protect the people they love. This conversation is not about fear. It is about awareness, action, and prevention, because the earlier families take hearing seriously, the better chance they have to protect connection, independence, and quality of life.

Diane: Dr. Rob, thank you so much for joining me today. I love the, the, the title, Hearing Better, Live Longer, but I also think you should add, "For a better quality of life." That's just my opinion.

Robert: That's true. It is,

Diane: Yeah

Robert: a much better quality of life, and I might add that, I've got hearing loss myself, and have hearing aids, and, it does improve your quality of life. It means that you don't have to holler at people, and you don't have to put them in that position of ask having to ask you to repeat yourself, ad infinitum. It is a quality of life issue.

Diane: Now, before we talk about dementia and hearing loss, I wanna talk to you about what led you to write this book, Hear Better, Live Longer?

Robert: I've worked in the healthcare industry ever since medical school, and not as an MD, but as a person who, learned so much about all kinds of health issues in medical school, and then did a postdoc at cancer research, and another postdoc in, clinical laboratory medicine. I was, always drawn to, what can we do about this? I like to make a positive benefit. Well, I did that through consulting relationships with, a number of German medical device companies and US medical device companies, and pharmaceutical companies, helping them get FDA approval, and then launching their products in the United States. So to shorten the story considerably, one of my clients was in the, hearing business, had invented a device that German audiologists use to, fine-tune the performance of hearing aids.

And it turns out that this was device was based upon the application of what you call best practices of audiological care. And they thought, and I thought initially, that there'd be a great market in the United States, so I embarked on this, all of the activities that you have to go through to, launch a product in the US, and I took about a year, but we found out that there wasn't a market for it in the United States.

Interesting. Very interesting.

Diane: Yes.

Robert: And the reason is that American audiologists and hearing aid dealers don't follow the best practices of audiological care, and these best practices are established by all three of the professional associations for hearing healthcare providers. I said earlier that none of them, use best practices. Actually, 80% don't.

Diane: Yeah.

Robert: There, there's an actual nam- number about that. So I was so fascinated with this that I decided to start up a, a hearing healthcare clinic in Raleigh, North Carolina. And we use exclusively use best practices, and we were enormously successful. And I sold the company a couple of years ago, but And while I was operating the company, it came to light that, Medicare doesn't cover hearing aids.

Diane: Yep.

Robert: And which is astonishing to me because it's one of the... It covers what, all five of the other, health issues related to aging, and yet it doesn't cover hearing aids. And I looked at, being a business guy, I also looked at the fact that Alzheimer's care, in the United States is currently $250 billion a year.

Diane: Yeah.

Robert: That's a burden on our economy and on, on American families.

Diane: Yes.

Robert: And I could not let go of the fact that this needs to be written about, and need, and, these issues need to be surfaced. And it took me two years, you can say that I'm a slow writer, but, it took me two years to put this put to book together, and it's been a real pleasure.

Diane: Well, it's an important topic, and I can tell you one of the things that makes me crazy, because I've been working with the elderly since I'm 20, and now I'm 73, and it, there's a consistent thing we humans do. Many of, many seniors become very vain, and they say, "Hearing aids make me look old." You know, and that, and... But because I've been a nurse for so long, I've seen children with hearing aids. I've seen teenagers with hearing aids. to have good hearing is so important. But, I wanna ask you, many people think hearing loss is just a normal inconvenience of aging. Why is that belief dangerous?

Robert: It's dangerous because in their mind they're classifying it as normal, and so they don't want to, be the outlier or be the odd person out and do something about their hearing loss.

Diane: Yes.

Robert: That's my speculation here.

Diane: Yes.

Robert: You raise a good point. I haven't done research on that exactly, but, it's the truth.

Diane: Yeah, I can't tell you. I see people that have spent, like, thousands of dollars on these incredible hearing aids, and then they put them in the drawer and forget about them. They went through the process of going through the testing and getting fitted, and then all of a sudden it's over and they don't wear them anymore because it makes it uncomfortable or whatever. But, Dr. Rob, can you explain in plain language how untreated hearing loss affects the brain?

Robert: By the way, I will. But by the way, when you said that audiologists often call those kind of hearing aids ITDs. ITDs, in the drawer.

Diane: In the, ITDs in the drawer. Yep, well, I'm very familiar with that practice.

Robert: Yes, yeah. So, I'm sorry. again, your question was?

Diane: I wanted you to be able to explain in plain language how untreated hearing loss affects the brain.

Robert: Well, there needs to be... I mean, I'm gonna go back to my background and always say that we need more research. And I was on the board of the National Institutes of Health at one time, and, we always, always, in meetings, we'd always say, more research needs to be done." So I'll give you my theory, and it's, now it's being published and talked about in other circles too, so it's a little more than a theory. You know, our brain is, what is it? It's one billion neurons in the average adult brain, and each neuron has up to a hundred connections to, to other neurons, which makes it what? Something like one million, one trillion, synapses or

Diane: Yes

Robert: neurological connections.

Diane: Yes.

Robert: Well, those things need to be activated, this, to be stimulated with sound, in this case with sound, in order to stay active too.

Diane: Yeah.

Robert: So when you're depriving the brain of hearing, or those sounds, it's like other parts of the body. It goes into decline. That's my little theory of dementia right there.

Diane: And you're absolutely right. It actually does cause the brain not only to go in decline, but it gets, weaker. Like it's a muscle, and if you don't work it, you know, use it, you or lose it. And you lose that part of the activity in the brain which is so important. now, research has connected hearing loss with cognitive decline and dementia risk. What do families need to understand about that connection without being, becoming overwhelmed or frightened?

Robert: What they need to do, in my opinion, is to be seeking out a audiologist or hearing aid dispenser, and using the criteria in my book, use audiologists and hearing aid users are using the best practices of audiological care. Ask your family member, take your family member, go with them to the hearing to the healthcare provider, and have a, in a sound booth, have a hearing exam. I hesitated to about that because I'm trying to think of the real name, but it's a hearing exam.

Diane: Uh-huh.

Robert: And that will disclose to the audiologist as well as the patient exactly what parts of the, of speech they can be missing.

Diane: Yeah.

Robert: And we do not know which, parts of speech are most important to keepin' our brain active. So the safe thing to do is to address all of those hearing issues, and get well-performing hearing aids, and go off on your merry way knowing that you're doing everything you can to preserve your cognitive health.

Diane: And that's really important. You know, one of the things I'm seeing, Rob, because Medicare does not cover hearing aids, there is a big growth industry online where you can do your hearing test online, and, they'll send you hearing aids. And I have an issue with that. You know, the soundproof booths that they use are so important. Do you have an opinion on this online testing that they do and the hearing aids they're sending out?

Robert: Well, that's two different issues. I've got an opinion about both. Well- I'm with you it was too late.

Diane: Yeah.

Robert: I'm with you. There's no way that you can do a qualified hearing exam on the phone. It requires a sound booth. And, administering, I assume you've had a hearing test yourself. They administer, all those different frequencies of sound, ranging from very high frequency to very low frequency.

Diane: Yeah.

Robert: And then there's something called a speech banana that I won't get into, but audiologists are very familiar with that, and they draw a map to make sure that what you're not hearing or what you are hearing is appropriately, described in the speech banana. And if you're way out of bounds, the best thing to do is to get hearing aids that are, been, have been fitted with best practices, for sure.

Diane: And the types of hearing aids that these people are selling, can you address that? Because I really... You know, they're saying, "Oh, save thousands of dollars. Get these for such a cheap price." But are they quality hearing aids? Do they, are they, suitable for everybody? And, I just would like your opinion about that, please.

Robert: Okay. Ugh. Huh. I hope I'm not, I don't get too deep in the weeds here, but I'm angry about it.

Diane: Yeah, me too. I'm angry. Me too.

Robert: A few years ago, remember they finally put through with the White House, support of the White House and every Most members of Congress voted for what they called the Hearing Aid Act, and that established the legality of selling over-the-counter hearing aids. Well, guess what? Money talks.

Diane: Yes.

Robert: And the people that were lobbying for this bill were all the electronics, electronics industry.

Diane: Yep.

Robert: Because it opened the door for, over-the-counter hearing aids. There's just no way that over-the-counter hearing aids, can safely, you, that you can safely assume are gonna save you from, dementia or falls with broken bones, for that matter.

Diane: Yeah. Yeah. I just, over-the-counter everything is, and everything online is deceptive, I believe.

Robert: Yeah.

Diane: And I feel sorry that seniors feel like this is their best way when, again, you're talking about best practices, and this is far beyond what best practices are, so.

Robert: Yes. Yeah.

Diane: Yes. Now, what are some of the early signs of hearing loss that families often miss or excuse away?

Robert: You know, I think that they, you ask what do they miss, I think that a lot of families actually know what's going on, but hesitate to, bring the issue up and talk to their spouse or their mom or their dad and say, "Hey, Pa or Ma, I think you've got some hearing loss because when I speak, you don't understand. And sometimes you don't even hear what I'm saying."

And it becomes a very frustrating circumstance inside of families because he or she thinks that, he or she is hearing just fine, but most families don't realize that, that those people are not hearing all of the sounds of life that they need in order to maintain their brain health

Diane: Yeah and it really does affect, family relationships, especially between aging parents and adult children, and even grandchildren. You know, kids, I know because I've been, because I've been around seniors for so long. You know, seniors will deny that they have hearing loss, and, then when the kids, when the grandkids are, come or whatever, they'll, everybody's talking and they miss things, and, uh, they'll say, "Could you repeat that?" and then when the child or the adult child says, repeats it loudly, they're saying, "Why are you yelling at me?" It's just a, it's just a vicious circle, and denial is a coping mechanism people use. But it really does impact relationships, because you don't even want to talk to somebody if they can't hear. and it does, I see the commercials for the phones that, "Oh, you can't hear anymore? here, we'll give you a phone that where it writes the, conversation, closed caption." And I'm thinking, "Well, you know, you're still not addressing the hearing issue."

Robert: As you're speaking, it made me think it's too bad my lady in my life is not, in on this phone conversation, because I've got hearing aids myself. And I know that, they help me, but it, even well-tuned, finely tuned hearing aids don't work in all circumstances.

Diane: Yeah.

Robert: If your partner or your spouse or your child or whomever is talking away from you

Diane: Yeah

Robert: talking to a wall or walking away while while saying something to you, well, gee, that impairs everyone's ability to understand

Diane: Yeah

Robert: and to hear.

Diane: Yes. Yes

Robert: Yeah.

Diane: I heard her in the background.

Robert: Yeah, yeah. she's in the background, that's right.

Diane: Yeah.

Robert: She's frustrated with when those things happen.

Diane: Well, I get a, a giggle when the husbands turn the hearing aid off because they don't wanna hear their spouse. I have so many, females, wives complain, "They just turn it off so they don't have to listen to me." I'm like, "Oh, no." It's just so bad, you know? It just is. But, now you talk about hearing aids not always working well. Why do some people spend money on hearing aids and still struggle to hear?

Robert: Well, in my opinion, I'm sure there's other factors too, but, in my opinion, hearing aids don't...Now, we're talking about medical grade hearing aids.

Diane: Yeah.

Robert: We're not talking about over-the-counter hearing aids. Over-the-counter,

Diane: correct.

Robert: But medical grade hearing aids, if they're not fine-tuned with best practices, then they're never going to work to your total satisfaction. They just aren't, and it's a sad state of affairs. Thank you for mentioning, I'm trying to, I'm doing, with my book, I'm trying to change, hearing healthcare practices in America and get Medicare to start covering hearing aids. But I, a second part of that is that hearing aid dealers would be required to follow best practices when fine-tuning those hearing aids too. So that's my mission right here, Diane, is promoting the use of best practices and getting Medicare coverage too.

Diane: Now, what are best practices in hearing care, and why should families ask whether a provider follows them?

Robert: Well, I'll try to remember every point in my book. It's comprehensive, not comprehensively, but it's fully covered in... I'm not an audiologist, so I use my own way of, describing it. But one of the best practices is called real ear measurement. I dislike the term but it's been around for so long that I'm not trying to change that. Right. But real ear measurement is based on the following: Think about your ear canal as being Anywhere from half of an inch long up to a couple of inches long.

But when sound comes into the ear and it traverses that one to two inches getting to your eardrum, but every frequency of sound does not accurately or fully reach the eardrum just because of acoustics, of the ear.

Well, a real ear measurement, again, sounding, it's a misnomer, should be real hearing, measurement. They insert, they use a tiny little microphone that's attached to the com- to the computer. And they insert it in the ear canal and then administer a test, and the computer registers how mu- what sounds completely reach the eardrum or don't reach the eardrum, and which sounds are distorted because of going through the ear canal. That's called a real ear measurement or real hearing measurement, and they use that information to go back and fine-tune the hearing aids a little bit more on a frequency by frequency basis too.

Diane: I'd never heard that before, so I find that fascinating. Now, usually people get their hearing aids and then they never go back. So I'd like to address, you know, what is a best practice for follow-up care and how often?

Robert: Well, of course it's variable for every person because,

Diane: Yeah ... it's it's age dependent. And it depends upon, what kind of, how, what's wrong with the hearing system in our brain and in our ears. I would say that most audiologists advise their patients after they get hearing aids, medical grade hearing aids, finely tuned, they advise those patients to come back in about three months- Okay for a follow up, checkup.

Robert: And then once a year from then on as well.

Diane: Now, I know damn well that doesn't happen. No, people don't go back for that yearly checkup, and what I'm learning from you is they can readjust it so that if you are changing, and you're not hearing as well, that is something that will improve it so you can continue to have that, a better quality of life, and even delay or, avoid, dementia.

Robert: You're exactly right. And by the way, I love talking to a nurse because you get, you, you get all of these things, really.

Diane: Yeah. Well, I've been around the block a... Been in nursing a long time. You know, I'm the old, older, bossy, know it all sister, my siblings tell me. And but when you're in nursing for so long, and you meet people for decades, you just see some things common in humans throughout that don't change. It's just, we have bad habits, we do things wrong, and it's everybody's got their thing. So I really, appreciate you sharing, your information today because it's, it really does need to be discussed. Now, I'd like to know what questions should a senior or their caregivers ask before buying hearing aids?

Robert: Number one is ask them, "Are you going to use best practices, specifically real ear measurements, when adjusting my hearing aids?"

Diane: Yeah.

Robert: Number two at the end of our session, when you've used the real ear measurements, that you will give me a printout from the computer showing me how you adjusted the hearing aids after you did the real ear measurement. And then keep that, graph, if you will, or that printout, in your file, in your hearing aid file, keep doing that every time that you go and, to the audiologist as well. It sounds ridiculous, but I already mentioned that we know that 80% of hearing healthcare providers don't even use best practices. And there was a book that I could steer you to. It's written by Brian Taylor, and, I forget the other person's name right now.

But it's considered to be the bible, for, audiology students, because it covers everything associated with fitting hearing aids. And they, some years ago, designed a survey, that they used in interviewing hearing healthcare providers and found out that, Over 50% of them would lie and say that they use hearing, best practices, and specifically real ear measurements. They lied.

Diane: Yeah. Oh, that does not surprise me. It doesn't. It's all about the money, and, I get... I've dealt with that too for decades, where it's all about the money. And unfortunately Medicare, does not pay for, hearing, they don't pay for dental, and those are two really big issues that impact the quality of life as we age. And, I know you're going to be working to change the Medicare policy, but right now, Dr. Rob, I have no faith in anything with, the Medicare system because, they have moved to a cost-sharing plan.

And that means that you are going to be more personally responsible for paying the recommended treatments, services, medications, or whatever. If you want them, you're gonna have to pay out of pocket for them, 'cause Medicare will either delay or deny payment to those, for those things. and we're seeing right now in the industry, we're seeing more, denials of Medicare claims than ever before. So we're in, the, they're tightening the budget. While they wanna provide free care for everybody, but they're not... We've paid into the system, we deserve to have the best quality, care that's available to us, but it's not happening anymore.

In fact, that's why I wish you luck, but I have no hope that Medicare will ever pay for things like hearing, hearing tests or hearing aids. I just don't have any confidence in it anymore. I'm just seeing too many things, important treatments being denied. We now live in the system of the military medical delivery system, where it's delay, deny, and wait to die.

Robert: Yeah. And that's our present system, our medical, Medicare system. It now mirrors the military system, and it's very unfortunate. But now I

Robert: Well, my hope is based on the following. We're currently spending $250 billion a year on Alzheimer's. That may- Right that's a grand total. That's the impact, the economic impact. Yeah. And that's soon gonna be $1 trillion.

Diane: Oh, yeah, very soon, yes.

Robert: Yes. And so if the powers that be pay attention- To this fact, they will see that it involves enormous cost savings.

Diane: Yes.

Robert: simply by forcing, by Medicare covering hearing aids and forcing hearing healthcare providers to use best practices Best practices on each and every patient That's my hope.

Diane: Well, you know what? God bless you, you're an idealist. I've dealt with, the military medical delivery system, I've dealt with, Medicare and managed care. I've worked on both sides and, you know, one of the things we're seeing right now, is the family caregiver provides... There's 63 million, soon to double in the next few years. They provide $1.1 trillion in unpaid care.

And, they are the single largest pillar of the long-term care industry. And, without them, the whole system would collapse, but they're paying a severe price for it. 63% of them become seriously ill or die before the person they're caring for. So I don't think in reality that our government policymakers, understand how they, how a, a simple hearing aid could change, the trajectory of a person's life and delay or even eliminate the, possibility for prevent of dementia.

Robert: Well, I tend to be an optimist about these things. It turns out, Diane, that, I've been able to reach through to legislative assistants, over 100 legislative assistants to members of Congress.

And I created a policy draft that when they ask me for it, I send it to them. So I know that there is at least some members of Congress, at least the legislative assistants, are showing interest in this too. I'm an optimist.

Diane: I used to be, Dr. Rob. dealing with, the military medical delivery system with my son has changed all that.

Robert: Oh.

Diane: And then because of the, Medicare Advantage and what's happening there, we're seeing more unsafe discharges to home than ever before. We are in a public health crisis right now, and that's why I think... I love the thought of your book, I love the thought of educating people on how they can actually change and improve their lives by simple things like hearing aids.

Good quality, medical quality hearing aids, and, have you follow up on a yearly basis to make sure your, if there's changes in your hearing, that it can be addressed, can delay dementia Or even eliminate it is what would be the motivating factor for most seniors, I would think. Well But, you know, so many are on a fixed income and they, that with Medicare not happening, helping with anything, it's gonna be challenging. But

Robert: Well said. Well said. I'm

Diane: Now I wanna talk about the untreated hearing loss. It also increases your risk for falls, hospitalizations. Isolation is very real. Depression. And it often results in long-term care placement. people don't understand, it's not just you're preventing dementia.

Robert: Right.

Diane: But there are other issues.

Robert: Yeah. Right. The most scary fact that I uncovered, in my research leading up to the book was that over the age of 50, If you fall and break an important bone in your body it's something like 35 to 50% of people are dead within six months.

Diane: Yes.

Robert: Because of the infections.

Diane: Yes.

Robert: Yeah, yeah. Diane: One fall can prevent a senior from ever returning back to their home.

Robert: There you go.

Diane: Yeah, so, you know, I'm all about fall prevention, and that's so important. and they don't and they say, you know, untreated hearing loss increases the risk for falls, and it does. But people don't make that correlation.

Robert: I would not have made that correlation until Frank Lin, at Johns Hopkins in his fabulous, paper, that was published in Archives of Neurology. You know, that was a really, really impressive study that he did. It was sponsored by the National Institutes of Health, and that data just jumped out at him, and it's, cited in the paper itself. It's important to keep telling people about it, Diane.

Diane: Yes.

Robert: You're doing a great job.

Diane: Well, that... I'm... All we can do, Rob, is to educate people. They choose to take that information and do something with it, or they choose to say, "Poo poo. Nope, nope. Not gonna do it," and it's all up to them. And that's what I'm... I make it, I'm making it my mission to make seniors and their caregivers aware that you can make choices and you can make changes in your life that can improve your quality of life or at least prolong the quality of life you have. And that's what's more important than anything.

Robert: Yes. Yeah. Spok- spoken like a, nurse that I now know that you are.

Diane: Yes. I'm a seasoned nurse. and, what I say, I'm, I often say, you know, "I'm an old nurse," and now I say, "I'm a seasoned nurse," because everybody says- Seasoned ... "Old? No, no, no. I may be 73, but I'm young at heart." Yeah.

Robert: Yeah.

Diane: Now, what role can adult children and caregivers play, without shaming or pressuring the person with hearing loss? What steps can they take maybe to nudge that senior to get tested?

Robert: My favorite strategy is anticipate what spouses and children can, and families can do is anticipate what the pushback is going to be. Normally, we know what the pushback is gonna be. "I can hear just fine." "I don't need hearing aids. It's really not that bad," et cetera, et cetera, et cetera. So when you hear that pushback, offer to go with them to the audiologist or the hearing aid dealer and say, "This is a no risk scenario. You don't have to follow through on any recommendations at all.

It just will simply establish a baseline of where you are, and you can continue to monitor that on a year by year basis as well." So it's is to kind of, if you will, is to say, "We're just doing this to get a baseline, and I'll go with you. And if you're hearing as well as you think you are" Yeah ... then I stand corrected. I will be there in the room when they talk about what your hearing loss is really like, and I will admit that I'm in error and that you're hearing just fine."

Diane: You know, I love that approach. In fact, I'd like to take it one step closer. I wish that they would do a mini mental status exam, not the audiologist but the doctors, and recommend the hearing. Because everybody needs a a baseline mini-mental status exam, because it doesn't identify. You know, if doctors really knew what they were doing, they would offer the SLUMS test. That's the St. Louis University Mental Status Exam.

It picks up on the early symptoms of dementia and signs, and you can start, right away in being treated. But with the everybody standard is the mini-mental, but the mini-mental is you need a baseline, and our present medical delivery system, is letting us down, because they should start offering that to every senior at 60, as part of a yearly exam. And now you're saying with the hearing, I love that approach, where you, you say, "Let's get your hearing tested so we have a baseline, so we know as you get older if you're having problems, we'll now know how to intervene." So I love that, and I just wish they would do 'em, the doctors would be make it a requirement, "Hey, I'm gonna do a mini-mental status exam on you, and I'm also recommending that you go to an audiologist to be tested." That would be the perfect combination to me.

Robert: Yeah.

And I want to add to it too, I think I failed to mention earlier, it's the spouse and the family of the person with hearing loss that can do something as well, and that is to master your own communication strategies. And I write

Diane: Yeah

Robert: about this in the book a bit as well. you know, realizing what you might be doing to impair or to affect communication and adopting some new behaviors, such as speaking directly to them, eyeball to eyeball.

Diane: Ah, good point.

Robert: work, working on, Where you talk to them, you know, what can, what are the acoustics of the room? You, there are things that you can do, what I call master communication strategies. And, I cover that in the book as well, too.

Diane: Dr. Rob, I want to thank you so much for sharing this valuable information. it's one of the most undiscussed topics, but it's the, one of the more important topics that we should focus on as we get older. And I say anybody over the age of 50 should be reading your book. So how do people find you, and how do they get your book?

Robert: It's on Amazon. Excuse me, Amazon. and it's a short, quick read. It's easy to get in, what, if you're on Amazon at all, I think it's $18 or so, and it'll be to you in a couple of days. So that's how people can get it.

Diane: I, will put a link to ... I have a, the book cover. I'll put a link to it on our site future visitors to the, my Caregiver Relief site that come across this podcast can find your book in the future as well.

Robert: Excellent, and thank you. Thank you so much.

Diane: Well, thank you. I really appreciate our time. you've, enlightened me on things that I didn't know, and, I really appreciate that. To my family caregivers out there, you are the most important part of the caregiving equation. Without you, it all falls apart. So please learn to be gentle with yourself. Practice self-care every day because you are worth it.

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