Social isolation and loneliness have reached crisis levels among older Americans, with more than one in four seniors reporting little or no contact with others and a third feeling persistently lonely. Researchers and public health officials have linked these trends to a host of adverse outcomes—including depression, cognitive decline, heart disease and increased mortality. While factors such as mobility limitations and loss of loved ones play key roles, untreated hearing loss emerges as a significant contributor to diminishing social engagement.
A landmark new study led by NYU Langone Health as part of the ACHIEVE (Aging and Cognitive Health Evaluation in Elders) clinical trial, published May 12 in JAMA Internal Medicine, offers compelling evidence that timely hearing interventions can help older adults maintain larger, more diverse and deeper social networks—potentially easing the loneliness epidemic.
Hearing Intervention Yields Strong Social Benefits
In the three-year study, nearly 1,000 adults aged 70 to 84 with untreated hearing loss were enrolled across four U.S. sites (Maryland, North Carolina, Minnesota and Mississippi). Participants were randomly assigned to one of two groups:
- Hearing Care Group: Received state-of-the-art hearing aids fitted by audiologists, personalized counseling on device use, and tools such as television adapters. Follow-up visits ensured optimal device performance and troubleshooting.
- Control Group: Received general healthy-aging education—covering exercise, nutrition, and communication strategies with healthcare providers—but no hearing devices or audiology support.
At baseline—and again at six months, one year, two years and three years—researchers assessed participants’ social networks, relationship diversity, bond quality and loneliness using validated questionnaires. Social networks were evaluated by the number and types of connections (family, friends, neighbors, acquaintances), frequency of contact and participants’ roles (e.g., confidant, caregiver). Loneliness was measured via a 20-item scale gauging feelings of disconnection, lack of companionship and perceived social support.
One Extra Social Connection—and Stronger Bonds
By the three-year mark, those in the hearing care group had retained, on average, one additional social connection compared to the control group—a significant margin given the natural tendency for networks to shrink with age. Moreover, the treated group demonstrated greater network diversity, maintaining ties not only with close family members but also with friends, neighbors and community acquaintances. Quality of relationships—measured by participants’ ratings of emotional closeness, trust and mutual support—also remained higher among those wearing hearing aids.
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“Improving hearing isn’t just about clarity of sound; it’s about preserving human connection,” said study lead author Dr. Nicholas S. Reed, AuD, PhD, of NYU Langone’s Optimal Aging Institute. “Our findings add to mounting evidence that addressing sensory loss can meaningfully enrich older adults’ social lives and, in turn, bolster their mental and physical health.”
Loneliness Scores Diverge Over Time
At baseline, both groups reported similar levels of loneliness. Over three years, the hearing care group experienced a slight but significant improvement in loneliness scores, while the control group’s scores worsened marginally. Although the absolute changes were modest, they point to a protective effect: treating hearing loss may stem the tide of loneliness that often accompanies aging-related social disengagement.
Study Design: Robust and Representative
The ACHIEVE social-isolation sub-study capitalized on a randomized, controlled trial design to isolate the impact of hearing interventions. Nearly 1,000 participants—balanced for age, gender and geographic region—were enrolled between 2017 and 2020. Inclusion criteria required participants to have mild to moderate sensorineural hearing loss (defined by audiometric thresholds) yet have not previously used hearing aids. Exclusion criteria included severe cognitive impairment, terminal illness or plans to move away from the study area.
Participants in the hearing care arm received high-quality digital hearing aids fitted to individual audiograms. They underwent three to five counseling sessions over six months, covering device operation, communication tactics (e.g., strategic seating in group settings), and maintenance. Damaged devices were replaced within days—faster than typical market turnaround times—ensuring uninterrupted use. Control participants received a series of educational workshops and printed materials on healthy behaviors, with the offer of hearing care at the study’s conclusion.
Measuring Social Networks and Loneliness
Researchers employed the Lubben Social Network Scale Revised (LSNS-R) to quantify network size and diversity, asking participants to list up to 10 people with whom they shared regular contact, then categorize each by relationship type and role. Relationship quality was rated on a five-point scale across dimensions of emotional closeness, reciprocity and perceived support. Loneliness was assessed using the UCLA Loneliness Scale (20-item version), capturing subjective feelings of isolation and lack of companionship.
By tracking these metrics over time, the team could distinguish normal age-related declines from the effects of untreated sensory loss. Statistical models adjusted for confounders—such as health status, mobility and depressive symptoms—reinforced that observed differences were attributable to the hearing intervention itself.
Economic Considerations and Policy Implications
At present, hearing aids and related audiology services cost an average of $4,700 per patient—an expense typically covered out of pocket by older Americans. Given the strong social and mental health benefits documented, study co-principal investigator Dr. Josef Coresh, MD, PhD, argues for Medicare to expand coverage of hearing care as an essential preventive service.
“Social isolation costs the healthcare system billions through increased hospitalizations, nursing home admissions and mental health treatments,” said Dr. Coresh, the Terry and Mel Karmazin Professor of Population Health at NYU. “Investing in hearing healthcare may pay dividends by keeping older adults engaged, active and well-supported in their communities.”
The 2023 U.S. Surgeon General’s Advisory on the Healing Effects of Social Connection named improving social ties as a public health priority on par with tackling tobacco use, obesity and addiction. Incorporating hearing aid coverage into Medicare could address two crises at once: sensory disability and social isolation.
Cognitive and Physical Health Ripple Effects
Previous ACHIEVE results have shown that hearing interventions may also slow cognitive decline among high-risk older adults. Untreated hearing loss has been linked to accelerated brain atrophy, poorer memory performance and increased dementia risk. By preserving social engagement, hearing care may indirectly support cognitive resilience—since active social networks and mentally stimulating interactions are protective factors against cognitive impairment.
Furthermore, social isolation is a known risk factor for cardiovascular disease, immune dysfunction and mortality. The study’s lead authors suggest that hearing aids could form part of a broader, multi-domain approach to healthy aging—combining sensory, physical, cognitive and social interventions.
Limitations and Future Research
Despite its size and rigorous design, the current study has limitations. The participant pool was predominantly White and moderately affluent, potentially limiting generalizability to more diverse or underserved populations. Additionally, the high level of concierge-style audiology support provided—rapid device replacements and frequent counseling—exceeds what many older adults experience in typical clinical settings.
Dr. Coresh and colleagues plan to continue following the original cohort for an additional three years to assess the durability of social benefits. They also intend to launch a follow-up trial targeting more ethnically and socioeconomically diverse groups, and evaluating lower-intensity service models that reflect real-world practice.
Expert Voices Weigh In
Dr. Frank Lin, MD, PhD, of Johns Hopkins University—co-principal investigator of the ACHIEVE trial—praised the study’s contributions to geriatric care. “By demonstrating that hearing interventions can preserve and enhance social networks, we provide a compelling rationale for clinicians and policymakers to treat hearing loss as a critical component of preventive health,” he said.
Loneliness researcher Dr. Julianne Holt-Lunstad of Brigham Young University, not involved in the study, commented: “This trial adds to a growing body of evidence that sensory health underlies social health. It’s an important step toward integrating hearing care into strategies aimed at mitigating social isolation.”
Conclusion: Hearing Care as a Pillar of Healthy Aging
As the population of adults aged 65 and older swells in the decades ahead, strategies to maintain social connection will be essential for sustaining quality of life and reducing the burden on healthcare systems. The ACHIEVE trial’s findings underscore that relatively straightforward interventions—providing hearing aids and targeted counseling—can have outsized effects on social well-being.
“Good hearing opens the door to conversation, laughter and companionship,” Dr. Reed reflected. “Ensuring older adults can stay connected to family, friends and community isn’t a luxury—it’s a cornerstone of healthy aging.”
With policymakers, healthcare providers and insurers taking note, the hope is that coverage of hearing care will expand, bridging the gap between clinical efficacy and real-world access, and helping to turn down the volume on America’s loneliness epidemic.
