Summary: A new randomized trial analysis finds that providing hearing aids and individualized audiology care can help older adults preserve social ties and modestly reduce feelings of loneliness over three years. Participants who received hearing interventions kept more varied and deeper social connections than those who received general healthy-aging education.
The study observed a small improvement in loneliness scores for the hearing-aid group, while loneliness slightly increased among those who did not receive hearing treatment. These results suggest that treating hearing loss may be an effective component of strategies to combat social isolation in aging populations.
Key Facts:
- Social retention: Participants who received hearing intervention kept, on average, one additional close social contact over three years.
- Loneliness link: Hearing loss treatment produced a small decrease in loneliness scores compared with a slight increase in the control group.
- Policy implication: Findings add weight to arguments for Medicare coverage of hearing aids to support older adults’ social and mental well-being.
Source: NYU Langone
Providing hearing aids and tailored audiology guidance can help preserve social connections as people age, according to a new analysis of the ACHIEVE clinical trial.
Researchers say this approach could play a meaningful role in addressing the rising problem of loneliness and social isolation among older Americans.
According to U.S. public health data cited by the authors, more than a quarter of older adults report little or no social contact, and about one in three report feeling lonely. Hearing loss can make conversation and relationship maintenance harder, contributing to isolation.
The 2023 U.S. Surgeon General’s advisory emphasized that enhancing social connection is a public-health priority on par with efforts targeting tobacco use, obesity, and addiction.
Led by investigators at NYU Langone Health, this secondary analysis of the ACHIEVE randomized clinical trial compared a best-practice hearing intervention with a health-education control over a three-year follow-up period. The hearing intervention group retained, on average, one more person in their social network than the control group and demonstrated greater network diversity—meaning a broader mix of family, friends, and other contacts—and higher-quality, more embedded relationships.
“Nearing and maintaining social connections is central to older adults’ mental and physical health. Our findings add to evidence that improving hearing can enrich social life and overall well-being,” said Nicholas Reed, AuD, PhD, lead author and member of NYU Grossman School of Medicine’s Optimal Aging Institute.
Both loneliness and hearing loss have been associated with higher risks of depression, cardiovascular disease, and premature mortality. Earlier ACHIEVE findings also suggested that hearing interventions may slow cognitive decline among people at elevated risk for dementia.
Co-principal investigator Josef Coresh, MD, PhD, noted that the results support efforts to include hearing-aid coverage in Medicare as one tool to address social isolation among older adults. “Helping people stay engaged with family and friends as they age is essential to preserving quality of life,” he said.
The trial enrolled 977 adults aged 70–84 with untreated hearing loss across four U.S. field sites—Maryland, North Carolina, Minnesota, and Mississippi. About half of participants received hearing aids along with four sessions with a certified audiologist, counseling, and personalized instruction, plus assistive devices when needed (for example, television adapters). The control group attended four sessions focused on health education topics like chronic disease and disability prevention.
Researchers measured social isolation using the Cohen Social Network Index—assessing frequency of contact, network size, diversity, and the roles participants played—and loneliness using the 20-question UCLA Loneliness Scale. Baseline data were collected, then follow-up assessments occurred at six months and annually for three years.
Across three years, mean social network size fell less in the hearing-intervention arm than in the control arm. In adjusted models, hearing intervention improved network size (difference, 1.05 people), diversity (difference, 0.19), and embeddedness (difference, 0.27) and modestly reduced loneliness (difference, −0.94 on the UCLA scale). Sensitivity analyses that varied model specifications or examined compliance produced similar results.
The investigators caution that while the changes reached statistical significance, the clinical importance of the modest differences—particularly for loneliness scores—remains uncertain. Study participants received a high level of audiology support, including rapid replacement of malfunctioning devices, which may not reflect typical care settings.
Hearing aids and associated audiology services in the study averaged about $4,700 per participant, typically paid out of pocket. The research team plans to continue following participants for another three years and to replicate the study in a more demographically diverse sample, since most participants in this analysis were White.
Funding: Supported by National Institutes of Health grants R01AG055426, R01AG060502, U01HL096812, U01HL096814, U01HL096899, U01HL096902, and U01HL096917.
Key investigators included Nicholas Reed and Josef Coresh at NYU Langone, James Pike, and senior author Frank Lin, MD, PhD, at Johns Hopkins University. Additional co-investigators represented institutions including Johns Hopkins University, University of South Florida, University of North Carolina, Edinburgh Napier University, University of Pittsburgh, Wake Forest University, University of Mississippi, and University of Minnesota.
About this loneliness and auditory neuroscience research news
Author: Shira Polan
Source: NYU Langone
Contact: Shira Polan – NYU Langone
Image credit: Neuroscience News
Original Research (open access): “Hearing Intervention, Social Isolation, and Loneliness: A Secondary Analysis of the ACHIEVE Randomized Clinical Trial” by Nicholas Reed et al., published in JAMA Internal Medicine. DOI: 10.1001/jamainternmed.2025.1140
Abstract
Hearing Intervention, Social Isolation, and Loneliness: A Secondary Analysis of the ACHIEVE Randomized Clinical Trial
Importance
Promoting social connection among older adults is a public-health priority. Addressing hearing loss may reduce social isolation and loneliness.
Objective
To compare the effects of a best-practice hearing intervention versus a health-education control on social isolation and loneliness over three years in the ACHIEVE study.
Design, Setting, and Participants
This secondary analysis of a multicenter randomized controlled trial included 977 adults aged 70–84 with untreated hearing loss, recruited from four U.S. sites. Participants were randomized 1:1 to hearing intervention or health education and followed every six months for three years. Data were analyzed in 2024.
Interventions
Hearing intervention: four audiologist-led sessions, hearing aids, counseling, and education. Health-education control: four sessions with a certified health educator on chronic disease and disability prevention.
Main Outcomes and Measures
Social isolation (Cohen Social Network Index) and loneliness (UCLA Loneliness Scale) were measured at baseline and at 6 months and 1, 2, and 3 years. Intervention effects were estimated with two-level linear mixed-effects models under the intention-to-treat principle.
Results
Mean age was 76.3 years; 53.5% female; 11.5% Black; 87.8% White. Over three years, social network size declined less in the hearing-intervention arm than in the control arm. Fully adjusted models showed hearing intervention improved network size (difference, 1.05 people), diversity (difference, 0.19), embeddedness (difference, 0.27), and modestly reduced loneliness (difference, −0.94). Sensitivity analyses supported these findings.
Conclusions and Relevance
This secondary analysis indicates older adults who received hearing intervention retained one additional person in their social networks over three years versus a health-education control. While statistically significant, the clinical meaningfulness of these changes—especially in loneliness—remains unclear. Hearing intervention is a low-risk strategy that may help promote social connection among older adults.
Trial Registration
ClinicalTrials.gov Identifier: NCT03243422