Imagine a scene in a hospice or care home. A woman lies in bed, connected to softly beeping machines. Her breathing is laboured. Her family sit close, holding her hand, speaking gently to her as they prepare to say goodbye. In one ear, her hearing aid is not seated properly and begins to squeal. A nurse, trying to help, removes it and places it in a drawer. The children continue talking to their dying mother. Sadly, she can no longer hear them.
Hearing at the end of life: why it matters more than we realise
Hearing is widely recognised as one of the last senses to fade at the end of life. For this reason, it is crucial that hearing is supported for as long as possible, particularly for individuals who already live with hearing loss. Maintaining access to sound allows people to remain connected to the world around them, to their loved ones and to moments of comfort during an already frightening and uncertain time.
Facing the end of life is distressing in itself. But to be unable to hear the voices of family, to miss final words of love or reassurance, adds an unnecessary layer of isolation. Being able to hear familiar voices can offer profound solace, dignity and emotional comfort in a person’s final moments.
Hearing loss and end-of-life care
Although hearing is often the last sense to fade, age-related hearing loss (presbycusis) is extremely common in older adults and frequently complicates communication at the end of life. While some individuals appear unresponsive, research suggests that even those who cannot speak or move may still hear. This makes consistent verbal communication and reassurance vitally important.
Hearing loss significantly affects both quality of life and quality of communication – two factors considered central to good end-of-life care. The ability to hear allows individuals to understand information about pain management, treatment plans, goals of care, and prognosis, and to access emotional, social, and spiritual support. When hearing loss interferes with this communication, people are at greater risk of isolation, anxiety, depression and misunderstanding.
Failing to communicate effectively at the end of life because of hearing loss is particularly tragic when relatively simple and effective communication strategies exist.
Despite this, age-related hearing loss remains widely overlooked in healthcare settings. Hearing screening rates in primary care are estimated to be around 20%, and very little attention has been given to the impact of hearing loss on people who are seriously ill or nearing the end of life.
Practical steps to support hearing
There are clear, practical steps families and care teams can take to reduce the burden of hearing loss and improve communication for someone receiving hospice or palliative care.
If your loved one wears hearing aids or other hearing devices, ensure these are available, clean, working and fully charged. As a person becomes weaker, they may need help inserting their hearing aids or keeping them safe when not in use. Removing hearing aids permanently because of occasional feedback may unintentionally cut off their main connection to the world.
If your loved one has hearing loss but does not use hearing aids, it is essential to inform hospice or care staff. This allows professionals to adapt their communication approach. Assistive listening technologies, such as personal amplifiers or captioning apps that convert speech into text, may be helpful alternatives.
Communication tips in hospice settings
Good communication is central to comfort-focused care. Simple adjustments can make a significant difference:
· Get the person’s attention before speaking
· Position yourself at eye level where possible
· Speak clearly and calmly; do not shout
· Make sure the person is wearing their glasses so they can lip-read
· Reduce background noise such as televisions or radios
· Check understanding by gently asking if they heard or understood
· Keep a pen and paper or whiteboard at the bedside
· Be mindful that loud or constant noise may be distressing near the end of life
· Remember that hearing loss can be mistaken for dementia, and in those living with dementia, untreated hearing loss can further impair communication.
Dignity, connection and final conversations
The primary goal of hospice care is comfort, and communication is an essential part of this. Patients need to understand their care, particularly pain management options – not only for safety, but to retain a sense of control and dignity in their final stages of life.
Clear communication fosters connection, eases loneliness and supports emotional well-being. It empowers individuals and allows them to remain active participants in decisions about their own care.
People with hearing loss at the end of life do not need to feel isolated. Hearing aids, assistive listening devices and thoughtful communication strategies allow them to take part in conversations, express wishes and connect meaningfully with loved ones.
In many cases, personal amplifiers can greatly improve communication when hearing aids are unavailable or no longer tolerated. These devices amplify speech while reducing background noise, easing cognitive strain and dignifying the care experience for patients and families alike.
Too often, people say, “I don’t want to invest in hearing aids now,” while their families respond, “But this is when we want to talk to you the most.” At the end of life, perhaps more than at any other time, those connections matter.
Supporting hearing ensures that nothing important is left unsaid.