If you’ve ever communicated with someone who’s hard of hearing, you know it can be frustrating and tiring. Nonetheless, it’s a highly practical skill to develop, because hearing loss in the U.S. is increasing—and not just among seniors.
In fact, the number of adults 20 years or older who are hard of hearing is expected to nearly double in the next 30 years. And according to Johns Hopkins Medicine, one in three adults over the age of 65 has hearing loss.
Because the condition develops gradually—and because hearing loss often comes with a stigma attached—people who are hard of hearing may not want to admit it, even to themselves.
In your role as caregiver, family member, or friend of a person with hearing loss, you can enable communication and understanding in many ways. Below is a summary of recommendations by experts at UCSF San Francisco, the Cleveland Clinic and The Hearing Loss Association of America, offering a range of environmental, nonverbal, verbal and technological strategies. Many of them boil down to one idea: People comprehend speech best when using more than one sense modality.
Environmental strategies
- Use lighting to the person’s advantage. Position yourself so the light doesn’t cause shadows on your face, and avoid bright light behind you. Remember that a person with hearing loss will be speech-reading—watching your lips, eyes, facial expressions, gestures, body language and anything else that gives clues to what you’re saying.
- Reduce background noise like TV, radio and music. Move to a quiet space away from the noise. At a restaurant, ask for a table in a quiet area. Hearing aids, while helpful in many settings, don’t eliminate background noise, and most people with hearing loss have trouble understanding speech when there’s ambient noise.
- Make your home hearing-friendly. High ceilings, bare walls and floors make hearing more difficult because they echo. Adapt your environment as much as possible, adding curtains, carpeting and rugs to improve hearing.
Non-verbal strategies
- Gain the person’s attention before speaking. Face your listener directly, on the same level, sitting if they’re seated or standing if they are. Don’t talk or shout from another room. The ideal distance for a conversation with a person with hearing loss is less than 6 feet away so the listener can pick up nonverbal clues. Even when the person wears a hearing aid, you need to be within 6 feet because the further away you are, the less effective the hearing aids will work. You can also gain their attention by touching their hand, arm or shoulder.
- Look at the person. Eye contact allows the listener to read your message.
- Determine if the person hears better from one ear and move to that side. They may cock that ear toward you when listening, but just ask if you’re not sure.
- Pay attention to body language. If they look confused, they might not understand, and you can ask, “Would you like me to say that again?”
- Minimize distracting activities. Be still, and keep your hands away from your face while talking. If you’re eating, chewing gum, or smoking while speaking, your message will be more difficult to understand.
- Remove your mustache or beard. If you’re in a close, ongoing relationship with someone who has hearing loss, you may decide this is worth it because hair around the mouth is a barrier to understanding.
Verbal strategies
- Say the person’s name before beginning the conversation. This gives the listener a chance to focus and reduces the chance of missing words at the start of the conversation.
- Don’t assume the person needs you to adjust your speech. Making assumptions and decisions for someone else is patronizing. Instead, wait to see if they really need help.
- Speak clearly, distinctly but naturally, without shouting or exaggerating mouth movements. Shouting or raising your pitch distorts your voice and makes it harder to understand.
- Don’t speak extra slowly, but do use pauses at meaningful points, to provide time for them to absorb the message and to ask for clarification.
- Use simple sentences. For example, instead of saying, “I’d thought I’d go to the dance, but in the end I was just too nervous, so instead I stayed home and watched TV,” say, “I wanted to go to the dance. I was nervous. I stayed home and watched TV.”
- Repeat once, then rephrase. If the listener doesn’t understand what you said, repeat it. If they still don’t understand, find another way to express the same idea. For example, after repeating, “I’m going shopping,” you could try, “I’m going to the store.”
- Avoid changing the subject abruptly. If you need to switch topics, provide a context to prepare for the change. For example, “About your medication (pause), how long have you been on it?”
- If you’re giving data, such as a date or a location, ask them to repeat what they heard, or provide it in writing. Many numbers and words sound alike, like “13” and “30,” and some consonants, such as “s,” “h” and “f,” are hard to hear.
- Give them time. Don’t interrupt or finish their sentences.
- Don’t talk down to them or use elderspeak, such as talking in a sing-song voice or calling the person “Honey” or “Dear.” Elderspeak is not only disrespectful and disempowering, it can also diminish an older person’s confidence in their abilities and lower their self-esteem.
Technology strategies
- Ask the person if they use a captioning app, which transcribes audio into captions. There are a number of free or low-cost ones on the market, including Otter, Innocaption and Google Live Transcribe.
Practicing these strategies with people who are hard of hearing will take time and effort, but it will enable you to have much more meaningful, higher-quality communications. And it will offer them a huge benefit, because many people with hearing loss feel deeply isolated. When you show respect and patience, you not only help them participate actively in a conversation, you help to improve their quality of life and to feel connected to the world.
