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Hearing loss affects nearly two-thirds of adults 70 years and older in the United States and is strongly and independently associated with an increased risk of social isolation, depression, accelerated cognitive decline, falls, decline in physical functioning, and hospitalization. Of older adults who have hearing loss, 20% of white older adults use hearing aids regularly with even lower numbers among minority and lower income adults.

The primary model of hearing health care available is clinic-based audiological evaluation, provision of a hearing aid, and follow-up care which is highly time intensive (4-6 visits over several months), expensive ($2000-4000 in out-of-pocket costs), and dependent on the individual’s mobility, access to transportation, financial resources, and healthy literacy. The current established model of clinic-based, fee-for-service hearing health care does not accommodate many characteristics of low-income, minority, and vulnerable older adults.

We estimate that 6 million Americans ≥ 60 years with a total household income <$20,000 and 4.6 million Americans ≥ 60 years with a FIPR ≤ 1.3 (corresponding to the poverty level at which government agencies provide services such as supplemental nutrition assistance and Medicaid) have untreated hearing loss.