Facilitators and Barriers to Over-the-Counter Hearing Aid Use in People With Dementia: Semistructured Interview Study

Over-the-counter (OTC) hearing aids were introduced to improve the affordability and accessibility of hearing health care for adults with perceived mild-to-moderate hearing loss. While these devices have demonstrated effectiveness in cognitively healthy older adults-particularly in the domains of audibility, self-reported hearing ability, and speech recognition in quiet-their use and outcomes in people with dementia remain underexplored. This issue warrants further attention, as people with dementia often experience co-occurring hearing loss and may rely on OTC hearing aids to overcome cost and access barriers to prescription amplification. However, given the cognitive and functional challenges of dementia, it is unclear whether and how OTC hearing aids can support the hearing care needs of these individuals.

To explore interest-holder perspectives on the feasibility and acceptability of OTC hearing aids for community-dwelling older adults with dementia, identifying key facilitators and barriers that influence their use in this population.

Semistructured interviews were conducted with 45 participants across three interest-holder groups (15 per group): (1) community-dwelling older adults with dementia and hearing loss, (2) family caregivers of community-dwelling older adults with dementia and hearing loss, and (3) geriatric direct care professionals. Interviews were conducted and recorded via secure Zoom (Zoom Communications) videoconferencing, then transcribed and analyzed using thematic analysis.

Participants endorsed several facilitators and barriers to OTC hearing aid use in people with dementia. Facilitators included increased accessibility, perceived affordability and value, and enhanced autonomy and control. Barriers included mistrust of OTC hearing aids, difficulty assessing candidacy due to unreliable self- and proxy reports of hearing status, caregiver uncertainty regarding device programming and adjustment, challenges evaluating device effectiveness, and concerns about caregiver burden and burnout from long-term device management.

OTC hearing aids offer meaningful advantages for people with dementia and their family caregivers. However, significant barriers must be addressed to ensure their feasibility and acceptability for this population. Future research should further examine and quantify these barriers to inform the development of tailored devices, services, and delivery models that promote successful OTC hearing aid use in people with dementia and their family caregivers.