Hearing loss is the risk factor that combines two rare things: it is among the heaviest in dementia and among the easiest to correct. In the 2024 update of the Lancet Commission it accounts for around 7% of attributable risk: the highest on the list, level with midlife LDL cholesterol. It was 9% in 2017 and 8% in 2020, and the estimate itself is criticised for not accounting for overlap between factors, which is worth saying whenever such a percentage is quoted. We covered the full list in “The 14 risk factors”.
But this article is not about ten-year dementia risk. It is about Tuesday: hearing decides whether today's session works, and it is the most mundane, and most overlooked, explanation for a session that went badly.
What hearing loss does to a session
Four effects, none of which looks like deafness at first glance:
- The instruction does not arrive. “Look to your right”, said from the side over background noise, is not heard, and what gets recorded is that the person did not follow the instruction.
- Listening effort is tiring. Someone hearing poorly spends attention decoding rather than on what they are seeing. Twenty minutes becomes a lot.
- It is mistaken for cognitive decline. Answering off-topic, asking for repetition, giving up on conversation: the classic picture of someone who cannot hear, and the classic picture of someone declining. Without ruling out hearing, the second hypothesis wins by default, the same problem we describe in undiagnosed decline.
- It isolates. People who hear poorly take part less in groups, and that is where the withdrawal nobody records begins.
Two minutes before the session
The check is not clinical and needs no equipment:
- Does the aid exist? Many residents have one, in a drawer.
- Does it have a battery, and is it on? The commonest single cause, fixed in thirty seconds.
- Is it seated properly? A badly fitted mould whistles, the person removes it, and never puts it back.
- Which side do they hear better on? Everyone on the team should know this by heart for the residents they work with.
- Is there wax? Common, mundane, and reversible in one appointment.
If any of those five fails, fix it before changing the scene. No content compensates for an aid in a drawer.
Seven adaptations that change the outcome
None requires different equipment from what you already have:
- Speak face on, at eye level, before the headset goes on. What is agreed beforehand is what will hold during.
- Agree hand signals for “stop”, “I'm fine” and “louder”. Someone wearing a headset cannot see anyone's face, and this applies to everybody, not only to people who hear poorly.
- Lower the room noise. Television off, door closed. Background noise hurts someone with hearing loss far more than it hurts anyone else.
- Choose content that does not depend on narration. A scene that explains itself beats good narration that is not heard: a criterion to add to choosing a scene.
- Do not shout: articulate and slow down. Shouting distorts and, with an aid, can hurt.
- Watch the headset volume. Someone hearing poorly asks for more, and a hearing aid amplifies on top of it. Start low and raise it with the person telling you.
- Make it shorter. If listening effort tires, fifteen good minutes beat thirty dragged ones: the logic in session length and frequency.
What to record
Two lines, and they change the next session: whether the aid was in and working, and which side you spoke from. Without them, the next session starts from zero and the team again attributes to the person what belongs to the setting.
It is the same principle as the rest of this series: what is not written down does not reach whoever runs it next time.
Our part in this
Our content has audio, and none of the above removes that. When a service asks whether RVer suits someone with severe hearing loss, the honest answer is: it does, if the activity is chosen to be watched rather than listened to, and if the team agrees beforehand how to communicate. That is not a product adaptation: it is a session adaptation, and the team makes it.
The general limits of who can and cannot use it are in accessibility.
The RVer platform's base product is a Class I medical device registered in EUDAMED and with INFARMED (Portugal). Sessions are run by the institution's own professionals, complement existing care and do not replace hearing assessment, diagnosis or clinical follow-up.
Frequently asked questions
How much does hearing loss weigh in dementia risk?
In the 2024 update of the Lancet Commission, hearing loss accounts for around 7% of attributable risk: the highest on the list, level with midlife LDL cholesterol. It was 9% in 2017 and 8% in 2020. The estimate is criticised for not accounting for overlap between factors, which is worth noting whenever it is quoted.
What should be checked before a session with someone who hears poorly?
Five things, in two minutes and with no equipment: whether the hearing aid exists, whether it has a battery and is switched on, whether it is seated properly, which side the person hears better on, and whether there is wax. The battery is the commonest single cause and takes thirty seconds.
Can hearing loss be mistaken for cognitive decline?
Yes, and often. Answering off-topic, asking for repetition and giving up on conversation are the classic picture of someone who cannot hear and also of someone declining. Without ruling out hearing, the cognitive hypothesis wins by default.
How do you adapt a session for hearing loss?
Speak face on before the headset goes on, agree hand signals for stopping and adjusting, lower the room noise, choose content that does not depend on narration, articulate rather than shout, start with low volume and raise it with the person telling you, and shorten the session: because listening effort is tiring.
Does RVer suit someone with severe hearing loss?
It does, if the activity is chosen to be watched rather than listened to, and if the team agrees beforehand how to communicate. It is not a product adaptation but a session adaptation, made by the institution's own team.