Chronic Disease Self-Management Education (CDSME) programs play an important role in improving health outcomes, self-efficacy, and quality of life for older adults living with one or more chronic conditions. Yet older adults with hearing loss face unique barriers to full participation.

Hearing loss is common, affecting one in three U.S. adults ages of 65 and 74. Nearly half of those older than 75 have difficulty hearing, which can interfere with communication, comprehension, and social engagement.¹ Without intentional accommodations, hearing loss can reduce program accessibility, participant satisfaction, and educational impact. The right accomodations can make all the difference.

Understanding hearing loss in older adults

Hearing loss in older adults is typically gradual, affecting the ability to hear soft sounds and follow speech in noisy environments. Untreated hearing loss is linked to social isolation, depression, cognitive load, and decreased engagement in health management.^2,3

In group CDSME settings, where discussion, peer sharing, and facilitator instruction are essential, unaddressed hearing loss can disrupt learning, social connection, and can result in disengaging from classes that could benefit health. Below are some strategies to make workshops more accessible for participants with hearing loss.

Download the Hearing Loss Accessibility Checklist.

Best practices for engaging older adults in evidence-based programs

1) Create a Hearing-Friendly Environment—The physical environment plays a key role in communication accessibility. Seating arrangements that allow participants to see one another, such as circles or U-shaped layouts, support visual cues and lip-reading. Adequate lighting and reduced background noise further enhance speech comprehension.⁴ For virtual programs, consider adding closed captioning.

2) Use Clear, Accessible Communication Techniques—Facilitators should speak clearly, at a moderate pace, and face participants at all times. While projecting your voice is important, shouting should be avoided, as it can distort speech rather than improve clarity. Repeating or paraphrasing participant comments and checking regularly for understanding ensures that all participants can follow group discussions.³

Assistive listening devices, such as portable amplification systems or hearing loop technology, can significantly improve speech comprehension by reducing background noise and enhancing sound clarity.⁴ For virtual workshops, consider using closed captioning.

3) Adapt Program Materials—Written and visual supports are essential for reinforcing auditory information. Large-print handouts, written summaries of key concepts, and visual aids help reduce cognitive load and support learning for participants with hearing loss.³

Programs can improve accessibility for participants with hearing loss by thoughtfully integrating American Sign Language (ASL) interpreters into workshop delivery. Shasta Health, a 2024 ACL grantee, shared several strategies that have helped support participants who rely on interpreters in CDSME classes:

• Schedule interpreters early. Arrange for ASL interpreters several weeks before the class begins. Early scheduling helps ensure interpreter availability and allows time for coordination and preparation.
• Share the curriculum in advance. Providing interpreters with copies of the CDSME curriculum before the workshop helps them become familiar with key terminology and health concepts, improving interpretation accuracy during sessions.
• Adapt lesson navigation to reduce missed information. When participants are asked to turn to a specific page in their workbook, they must look away from the interpreter to find the page. This can cause them to miss important information. Provide handouts listing relevant page numbers and resources so participants can stay focused on the interpreter during discussion and review the materials later.

4) Train Facilitators in Hearing-Inclusive Practices—Facilitator training is critical to effective accommodation. Training should include awareness of age-related hearing loss, communication strategies, and techniques for managing group discussion to reduce cross-talk. Establishing clear communication norms—such as one speaker at a time—supports comprehension and preserves the integrity of evidence-based CDSME models (ACL, 2023; NCOA, 2022).

Review and share these resources on hearing loss with your facilitators:

• Hearing Loss Association of America
• Age-Related Hearing Loss (Presbycusis)
• ADA Requirements: Effective Communication | ADA.gov

5) Promote Peer Support and Inclusive Group Norms—Group norms that emphasize clear communication benefit all participants, not only those with hearing loss. Encouraging turn-taking, summarizing group discussions, and pairing participants for peer support can enhance understanding and foster social connection.

Sources

1. National Institute on Deafness and Other Communication Disorders. Age-Related Hearing Loss. Found on the internet at https://www.nidcd.nih.gov/health/age-related-hearing-loss

2. Frank R. Lin and Marilyn Albert. Dementia and Hearing Loss—Who is Listening? Aging & Mental Health. 2014. Found on the internet at https://pubmed.ncbi.nlm.nih.gov/24875093/

3. Pichora-Fuller, et al. Hearing, Cognition, and Healthy Aging: Social and Public Health Implications of the Links between Age-Related Declines in Hearing and Cognition. Seminars in Hearing. August 2015. Found on the internet at https://pubmed.ncbi.nlm.nih.gov/27516713/

4. World Health Organization. World Report on Hearing. March 3, 2021. Found on the internet at https://www.who.int/publications/i/item/9789240020481

5. Administration for Community Living. Chronic Disease Self-Management Toolkit. 2023.

6. NCOA. Delivering Evidence-Based Programs with Fidelity and Flexibility. 2023.

This project was supported by the Administration for Community Living (ACL), U.S. Department of Health and Human Services (HHS) as part of a financial assistance award totaling $10,000,000 with 100 percent funding by ACL/HHS.  The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by ACL/HHS or the U.S. Government.