Communication works better when the environment and method adapt to the person. Do not accuse an older parent of selective hearing or assume that a louder voice solves every difficulty. Ask what helps, reduce competing sound and make important information available in more than one form.
Hearing loss can have several causes and may affect one or both ears differently. A doctor, audiologist or other qualified hearing professional should assess persistent or changing difficulty. Communication strategies support the person while that clinical question is addressed; they do not diagnose the cause.
Ask the person what works
Begin with direct questions:
- Which ear or position is easier?
- Is it easier to understand speech when you can see the speaker?
- Does background noise make conversation difficult?
- Do captions, writing or an assistive device help?
- Is the hearing aid comfortable and working today?
- How should family members get your attention?
- Which language or communication method do you prefer?
Do not speak about the person as though they are absent. A caregiver or relative should not automatically answer every question for them.
Get attention before speaking
Use a respectful agreed signal, such as saying the person’s name, moving into view or a light touch where they have consented to it. Wait until they are ready before giving the message.
Avoid beginning an important sentence from another room or while walking away. The opening words provide context, and missing them can make the rest difficult to interpret.
Face the person in good light
WHO and NIA recommend facing the person, keeping the face visible and using facial expression or gesture. Practical steps include:
- sit or stand at a comfortable distance;
- keep light on the speaker’s face rather than behind it;
- avoid covering the mouth while speaking;
- maintain natural eye contact without forcing it;
- stay on the side the person identifies as easier where appropriate; and
- make sure glasses and other communication aids are available when needed.
Do not assume every person lip-reads. A visible face still provides context and expression even when formal lip-reading is not used.
Speak clearly without shouting
Use a natural voice and reasonable pace. Speak a little louder than usual only if the person finds it helpful, and avoid exaggerating mouth movements or speaking word by word.
When a sentence is not understood:
- repeat it once clearly;
- rephrase it with different words;
- state the topic;
- point to the relevant object or written information; and
- check understanding without testing or embarrassing the person.
For example, replace repeated shouting of an appointment sentence with a shorter version and a written date.
Do not use a childish tone. Hearing difficulty does not mean the person cannot understand the decision itself.
Reduce competing sound
Background noise can make speech much harder to follow. Before an important conversation:
- mute the television or radio;
- move away from a fan, blender, traffic or loud group;
- close a door where appropriate;
- choose a quieter table or time;
- let one person speak at a time; and
- pause before changing speakers or topics.
At a family gathering, ask the person where they would prefer to sit. A quieter seat should improve participation, not isolate them from the group.
Make important information accessible in writing
Dates, names, addresses, medicine instructions and follow-up actions should not depend on one spoken conversation.
Use an accessible format the person can read and control, such as:
- a large-print note;
- a calendar entry;
- an agreed message;
- captions or live transcription;
- the clinic’s written instructions; or
- a concise appointment summary checked against the professional plan.
Do not copy medication doses from memory into an informal message. Use the current pharmacy labels and authorised medication record.
Protect privacy. Transcription, recording and messaging services may store sensitive data. Obtain consent, use the minimum information and avoid recording a clinical or personal conversation merely for convenience.
Prepare for appointments
Before a medical or audiology appointment:
- ask what the person wants to discuss;
- write a short question list;
- bring the hearing aids, charger or batteries in use;
- bring the current medicine list because some medicines or health conditions may be relevant to assessment;
- request an accessible communication method; and
- ask for written follow-up instructions.
During the appointment, the professional should address the person directly. A family member may clarify or take notes with consent but should not automatically take over the conversation.
Seek prompt professional advice after a sudden or marked hearing change, ear pain, discharge, severe dizziness or another acute concern. Use the appropriate urgent route or call 999 for an immediate medical emergency.
Handle hearing-aid problems through the hearing-care service
A hearing aid may be uncomfortable, noisy, difficult to operate or no longer suitable. Ask the audiologist or hearing-care service to check:
- physical fit;
- current settings;
- wax blockage or maintenance;
- battery, charging and connectivity;
- use with the person’s phone or television;
- whether another assistive device would help; and
- whether hearing should be reassessed.
Do not shame the person for not using a device. Ask about pain, sound quality, stigma, dexterity, memory, cost and whether the device produces a benefit they value.
A caregiver may help with agreed routine maintenance and report a problem, but should not diagnose the cause or change clinical settings without instruction.
Use phone and video features deliberately
For distant family calls:
- agree a predictable quiet time;
- keep the speaker’s face well lit and in frame;
- use captions, transcription or a paired hearing device only when the person finds it useful;
- speak one at a time;
- keep important points concise;
- repeat or rephrase rather than filling every silence; and
- send agreed actions in writing afterward.
Check whether the person can operate the device independently and whether automatic captions are accurate enough for the purpose. Do not rely on an imperfect transcript for medication or clinical instructions.
Include the person in group conversations
WHO advises against postponing the explanation and excluding the person from the current conversation. At family meals or meetings:
- identify the topic;
- let one person speak at a time;
- make speakers visible;
- pause so the person can respond;
- clarify jokes, decisions or changes as they happen; and
- ask whether the environment or format should change.
Do not appoint a caregiver to speak for the person by default. The caregiver can help manage noise, seating and accessible notes while preserving the person’s own voice.
Notice withdrawal without diagnosing it
Difficulty following conversation can contribute to avoiding calls, gatherings or activities. New withdrawal may also reflect pain, fatigue, low mood, vision problems, cognitive change, grief or an unsuitable environment.
Ask what changed. Offer a quieter visit, smaller group, hearing review, transport or another accessible form of contact rather than assuming the person has lost interest.
Persistent withdrawal, confusion, low mood or loss of function should be discussed with the treating clinician. The guide to keeping an older parent socially connected helps identify practical barriers without forcing activity.
Brief caregivers and family consistently
The care brief may state:
- preferred language and communication method;
- better hearing side where the person identifies one;
- hearing-aid or assistive-device routine authorised by the person;
- how to get attention;
- accessible format for instructions;
- observable changes to report; and
- who arranges clinical follow-up.
Do not label the person “non-compliant,” “confused” or “difficult” because they did not understand a message delivered in an inaccessible way.
Communication improves when the speaker faces the person, reduces noise, uses clear natural speech, offers an accessible written form and checks what the person prefers. The aim is participation, not merely louder sound.