Coping with hearing loss is different from other disabilities in that it is an invisible handicap. The reactions or behaviors associated with hearing loss may not be apparent, and even the sight of a hearing aid doesn’t guarantee recognition of a disability.

A day in the life of a hearing-impaired older adult may include struggles with the following:

• hearing alarms or telephones;

• understanding someone while talking on the phone;

• understanding when several people are talking;

• understanding when a speaker’s face is unseen;

• hearing in a car, wind, or traffic;

• understanding speech on TV;

• understanding whispering;

• understanding people in a large room;

• understanding unclear or accented speech;

• being unaware someone is talking;

• understanding in public places;

• ordering food;

• understanding cashiers or sales clerks.

Individuals with normal hearing often assume that simply saying something louder or turning up the volume will enable a hard-of-hearing elder to hear.

Volume is not necessarily the issue; difficulties with sound and word discrimination may be involved.

The need to repeat or experiencing non sequitur responses adds to negative perceptions of older adults with hearing loss as being slow. Internalizing these stereotypes and the resultant negative self-perception certainly contributes to emotional sequelae of hearing loss.

Adults who have early-onset hearing loss report that while there are negative aspects of hearing loss, they’ve incorporated them into their personalities. They develop ways to cope with and manage hearing loss in their daily lives. It may be somewhat different for older adults who experience hearing loss at a later stage. These individuals have already developed a personality that does not incorporate hearing loss. They are accustomed to life as hearing individuals. Hearing loss may trigger an identity crisis, and reactive depression may occur.

Sometimes hearing loss exerts a direct impact on mental health. Depression and adjustment disorder can occur as a natural response to hearing loss and its subsequent impact on the quality of life. On the other hand, some people have pre-morbid mental health issues and hearing loss simply compounds the problem.

Inability to hear and discern message and meaning can result in feelings of shame, humiliation, and inadequacy. It can be highly embarrassing to be unable to behave according to applicable social rules. The feeling of shame linked to hearing loss stems from older adults inadvertently reacting in inappropriate and socially unacceptable ways, such as responding to a misunderstood question in an inaccurate fashion.

Contemporary psychiatrist William Glasser, MD, proposes that all individuals have five basic needs. How might hearing loss affect these needs?

• Survival: Is the sense of security threatened when an elder is concerned about hearing a fire alarm or a car horn?

• Love and belonging: Where do elders who are hard of hearing belong in the larger society? How does hearing loss affect a relationship or the ability to have a relationship?

• Power and recognition: Does hearing loss affect job performance or others’ perceptions of the abilities of the individual who is hard of hearing?

• Freedom: How is autonomy or self-sufficiency affected?

• Fun: Does the loss impair elders’ abilities to hear jokes, banter, or music or to have fun in any number of ways?

The stress of living with hearing loss can put people at risk for many reactions, including distrust, chronic sadness or depression, nervousness, anger or irritability, isolation, poor self-image, feelings of incompetence or inadequacy, or feeling marginalized.

Depression is a common emotional reaction to any loss, and hearing impairment can involve a number of losses. The primary one is the reduced ability to hear and communicate successfully or on equal terms, resulting in interpersonal difficulties. Second, status and career possibilities may suffer from the perception that elders’ skills are affected by the loss.

Depressed, hard-of-hearing elders may experience fear, anger with themselves, self-reproach, self-loathing, guilt, incompetence, unworthiness, and sadness. They may see the future as negative and hopeless, with decreased initiative or energy to live an active life. At worst, thoughts of suicide can occur. The prejudices that are unfortunately often associated with hearing loss can exacerbate low self-esteem. Older adults with hearing loss carry a social stigma as troublesome, slow witted, and tiresome. If a person who is hard of hearing internalizes such prejudices, self-esteem suffers a severe blow.

The negative emotional strain caused by the hearing loss can provoke a depressive exhaustion, especially if it is difficult to implement a solution to functioning in everyday life and validate an elder’s perception as being an equal member of the community. Personal life is affected because it becomes gradually more difficult to understand conversations, increasing isolation and feelings of being a nuisance.