In the United States, age-related hearing loss is experienced by 50% of individuals over the age of 75 (Center for Hearing and Communication, 2009).  It is estimated that only 20% of these individuals, or one out of five, will seek out the assistance of a hearing device such as a hearing aid or rehabilitation (Weinstein, 1994, 2003).  For music therapists these statistics are staggering, and while little has been previously written on the use of music therapy with older adults who experience a mild to moderate hearing loss, it is quite common for a therapist who is working with older adults to receive a referral for individuals with a hearing loss.

Age-related hearing loss is commonly referred to as presbycusis.  This type of hearing loss is typically experienced bilaterally (in both ears) and may be due to many different changes in the ear associated with aging.  The primary intervention for a hearing loss of this type is the use of hearing aids.  Individuals may use one aid or two, and digital hearing aids are common.  These digital hearing aids can be programmed to respond to different listening environments (i.e. conversation, music, quiet conversation).  As hearing aids become more specialized, individuals with hearing loss have found that while these aids are sufficient for spoken conversation, music may not be accurately portrayed. 

There are several things which may be important to consider when working with this population for both caregivers and music therapists:

• While spoken communication and music are both auditory stimuli, there are several characteristics which have different requirements for listening.
• The pattern of each individual’s hearing loss will be specific to that individual,  and so one type of musical stimulus which was enjoyable to one individual  with a hearing loss may not be for another.
• Due to a condition known as "recruitment," auditory stimuli may be physically painful.  In this case, it is important to attend to what the individual is feeling and their preference for how loud a stimulus should be. 
• Trial and error is the best way to know what an individual is actually hearing.  This goes for recordings (analog vs. digital recordings sound different to some hearing-aid users) and instruments (i.e. bass bar vs. triangle vs. guitar).
• For females it is also important to consider the fact that because our voices are higher it may be more difficult for an individual with a hearing loss to hear talking and singing.
• Individuals who have cancer or have been treated for cancer in the past may suffer from ototoxicity, which is hearing loss caused by the chemicals used to treat cancer. 
• Hearing loss has been shown to limit therapeutic effectiveness (Weinstien, 2003).

   

For music therapists and educators who work with older adults, the impact of hearing loss and hearing aids on music perception and enjoyment are important to consider and be aware of.  However, through education about hearing loss and hearing devices, it is quite possible for therapists/educators to help older adults to continue to involve themselves in music and enjoy music as an active or passive participant.

References      
Center for Hearing and Communication (2009). Facts about hearing loss. Retrieved November 6, 2009, from http://www.chchearing.org/

Weinstein, B.E. (2003). A primer on hearing loss in the elderly. Aging and the Senses, (Spring) 2003, 15-19.

Weinstein, B. E. (1994). Age-related hearing loss: How to screen for it, and when to intervene. Geriatrics, 49(8), 40-45.