Treatable, Often Untreated: Sight and Hearing Loss in Later Life

Losing some sight or hearing is one of the most common experiences of later life, and much of it can be treated. Yet worldwide, most people who need a hearing aid do not use one, and one in two people who need cataract surgery do not have access to it^[1][2].

For an older person, unaddressed sight or hearing loss shapes ordinary days: following a conversation at a family meal, reading a medicine label, crossing a road, or hearing a doctor explain a diagnosis. These are not simply the costs of growing older. Glasses, cataract surgery, hearing aids and rehabilitation are among the most established treatments in health care. The gap between what works and what reaches people is the subject of this study, and it is a gap in services, not in the people who live with these losses.

Sight and hearing loss become common with age, and most of it is in older people

The World Health Organization (WHO) estimates that 430 million people worldwide need rehabilitation for disabling hearing loss, defined as hearing loss greater than 35 decibels in the better-hearing ear^[3]. Prevalence rises with age: among people older than 60, more than 25% have disabling hearing loss^[3]. Counting milder loss too, the Global Burden of Disease (GBD) study estimated that 1.57 billion people had some hearing loss in 2019, one in five of the world’s population, and that 62.1% of them were older than 50^[4].

National data show how steep the age gradient is. In the United States, the National Institute on Deafness and Other Communication Disorders (NIDCD) reports that about 5% of adults aged 45 to 54 have disabling hearing loss, rising to 22% at 65 to 74 and 55% at 75 and over^[5]. In the US National Health Interview Survey for 2019, 26.8% of adults aged 65 and over said they had at least some difficulty hearing, against 6.3% of those aged 18 to 44; 4.1% of the older group had a lot of difficulty or could not hear at all^[6].

Sight follows the same pattern. WHO estimates that at least 2.2 billion people have a near or distance vision impairment, that for at least 1 billion of them it could have been prevented or has yet to be addressed, and that most people with vision impairment and blindness are over 50^[2]. Among adults aged 50 and over, the GBD Vision Loss Expert Group found that the leading cause of blindness in 2020 was cataract (15.2 million cases), followed by glaucoma (3.6 million) and undercorrected refractive error (2.3 million), meaning a need for glasses that has not been met^[7]. The leading causes of moderate and severe vision impairment were undercorrected refractive error (86.1 million cases) and cataract (78.8 million)^[7]. Both are treatable.

The numbers are growing as populations age. The GBD study projects 2.45 billion people with hearing loss by 2050, a 56.1% increase on 2019, even though age-standardised prevalence is expected to stay stable^[4]; WHO projects that over 700 million people, one in ten, will have disabling hearing loss by 2050^[3]. For sight, the GBD analysis found that the age-standardised prevalence of avoidable blindness among people aged 50 and over fell by 15.4%, but the number of people affected rose by 10.8%, and the number with avoidable moderate or severe vision impairment rose by 31.5%; the global target for reducing avoidable vision impairment between 2010 and 2019 was not reached^[7]. Better services are reaching more people, but not as fast as need is growing.

Most older people with hearing loss go without a hearing aid

WHO lists hearing technologies such as hearing aids and cochlear implants, and training in their use, among the core rehabilitation interventions for hearing loss^[3]. They reach a minority of the people who could use them. An analysis of GBD data estimated that 401.4 million people worldwide were in need of hearing aids, defined as having moderate, moderately severe or severe hearing loss; 83% of them did not use one, rising to 90% in WHO’s African region^[1]. The authors pointed to low-cost technologies, better service delivery, policy and regulatory change, and tackling stigma and lack of awareness as ways to widen access^[1].

The gap is not confined to poorer countries. In the United States, NIDCD reports that among adults aged 70 and over with hearing loss who could benefit from hearing aids, fewer than one in three (30%) has ever used them^[5]. In the 2019 National Health Interview Survey, 14.4% of adults aged 65 and over used a hearing aid, against the 26.8% who reported at least some difficulty hearing^[6]. Use differed sharply by sex: 19.2% of men aged 65 and over used a hearing aid, against 10.6% of women^[6]. Part of the gap may reflect differences in need, but it is large enough to deserve a closer look by services.

The cost of leaving hearing loss unaddressed is high, and the cost of addressing it is modest. WHO estimates that unaddressed hearing loss costs the world almost US$1 trillion a year, and that an additional annual investment of less than US$1.40 per person in ear and hearing care would, over ten years, return nearly US$16 for every dollar invested^[3]. These are modelled estimates, but the direction is clear: on WHO’s figures, hearing care is among the better-value investments a health system can make for its older population.

Cataract surgery restores sight, but reaches only about half of those who need it

Cataract, the clouding of the eye’s lens, is the leading cause of blindness among people aged 50 and over, and its treatment is very cost-effective^[7][8]. WHO estimates that one in two people worldwide who need cataract surgery do not have access to it, and that two in three people in low-income countries who need glasses do not have them^[2].

The best global measure of progress is effective cataract surgical coverage: the share of people who have had surgery with a good visual outcome, out of everyone who has had surgery or still needs it. A 2026 analysis of population-based surveys of adults aged 50 and over in 68 countries found country estimates ranging from 2.1% in Burundi (2024) to 77.7% in Qatar (2023)^[8]. Modelled globally, effective coverage was 48.2% in 2025, and is projected to rise from 43.9% in 2020 to 52.3% in 2030, an increase of 8.4 percentage points^[8]. The World Health Assembly’s target is an increase of 30 percentage points over that decade; the authors conclude that the world is not on track^[8].

Coverage follows income and sex. In an earlier analysis of 148 surveys in 55 countries, median effective coverage was 60.5% in high-income countries (from only two surveys) and 14.8% in low-income countries (14 surveys)^[9]. Across all 148 studies, it was higher in men than in women, with a pooled risk ratio of 1.20: men with cataract were about a fifth more likely than women to have had successful surgery^[9]. It is a gap that matters for older women. We look at the wider picture in our study of older women.

Quality matters as much as access. In the 2026 analysis, uncorrected refractive error, which can often be corrected with glasses, accounted for a median of 26.4% of poor outcomes per survey^[8]. Near vision tells the same story: WHO reports that rates of unaddressed near vision impairment are estimated to be greater than 80% in western, eastern and central sub-Saharan Africa, against less than 10% in high-income regions of North America, Australasia, western Europe and Asia-Pacific^[2]. Where an older person lives still largely decides whether they can read, see faces and get about safely.

Sensory loss is linked with falls, loneliness and dementia, though cause and effect are still being tested

Much of the concern about sensory loss in later life is about what comes with it. The evidence is strongest for associations; whether treating sight or hearing loss prevents these outcomes is a harder question, and trials are few.

Falls

A 2025 meta-analysis of 27 observational studies with more than 5 million participants, all adjusted for other factors, found that people with hearing loss had 1.51 times the odds of having fallen in cross-sectional studies, and 1.17 times the risk of a later fall in longitudinal studies, compared with people without hearing loss^[10]. The authors concluded that hearing loss may be a risk factor for falls, and that randomised trials are needed to show whether treating it helps^[10]. For sight, a review of exercise programmes for adults aged 50 and over with visual impairment found that pooled data from three trials (539 people) showed no effect on falls, and that there are no proven falls prevention strategies for this group^[11]. That is a gap in research, not a reason for inaction.

Loneliness and isolation

A systematic review of 14 studies of older adults found that most studies adjusting for other factors linked hearing loss with a higher risk of loneliness and social isolation, and several found the link stronger in women than in men; 12 of the 14 studies were cross-sectional, so they cannot show which came first^[12]. A 2026 review of interventions found 11 studies, two of them pilot randomised trials, and reported that hearing interventions consistently showed improvements in loneliness and social participation, most strongly when group auditory rehabilitation was combined with taking up a hearing device^[13]. The evidence is early, but it points in a hopeful direction. Our study of older people living alone looks at loneliness more widely.

Dementia

WHO notes an increased risk of dementia and faster cognitive decline when hearing loss remains unaddressed^[3]. A 2024 meta-analysis of longitudinal studies gave a pooled hazard ratio of 1.21 for incident dementia among people with hearing loss, and found too little evidence to say whether social isolation explains the link^[14]. For sight, a 2021 meta-analysis of 14 prospective cohort studies with more than 6.2 million participants found a pooled relative risk of dementia of 1.47 for people with vision impairment; the authors rated the overall quality of evidence as low, because all the studies were observational^[15].

The largest trial so far, ACHIEVE, randomised 977 adults aged 70 to 84 in the United States with untreated hearing loss to hearing aids with audiological counselling, or to health education. Over three years, the hearing intervention did not reduce cognitive decline in the cohort as a whole, though a prespecified analysis suggested it might help older adults at higher risk of decline^[16]. So hearing and sight care should not be promoted to older people as a guaranteed way to prevent dementia. It is worth providing for its own sake: to hear, to see and to take part. Our dementia library covers modifiable risk factors for dementia in more depth.

The gaps are widest where services are thinnest

Nearly 80% of people with disabling hearing loss live in low- and middle-income countries, WHO estimates^[3], and the GBD study found that moderate-to-complete hearing loss is concentrated in countries with low health-care quality and access^[4]. For sight, WHO puts the annual global productivity loss from vision impairment at about US$411 billion (purchasing power parity), against an estimated US$25 billion cost gap for addressing unmet need^[2]. Productivity is a narrow measure for a mostly older population, many of them past paid work, but even on that measure the case for investment is strong. For older people who also live with a long-standing disability, sensory loss adds to other barriers; see our study of aging with a disability.

What the evidence asks of us

• Count unmet need, not just prevalence. The most useful figures here are coverage measures: how many people who need a hearing aid have one, and how many who need cataract surgery have had it with a good result^[1][8]. Health systems that track effective coverage by age, sex and income can see who is being missed.
• Fund the commitments already made. Countries at the World Health Assembly endorsed a 30 percentage-point increase in effective cataract surgical coverage by 2030; on current trends the world will manage 8.4 points^[8]. WHO estimates that scaling up ear and hearing care globally needs less than US$1.40 extra per person a year^[3].
• Close the gender gap in cataract surgery. Men are more likely than women to have had successful surgery^[9]; the 2022 analysis’s authors call for equity to be built into efforts to widen access, with a focus on underserved groups^[9].
• Make hearing care easy to reach and free of stigma. With fewer than one in three US adults aged 70 and over who could benefit from hearing aids ever having used them^[5], access is not only about price. Low-cost technology, better service models and tackling stigma all matter^[1], and group rehabilitation alongside devices shows promise for loneliness and participation^[13].
• Fund the trials older people need. There are no proven falls prevention strategies for older people with visual impairment^[11], and whether treating hearing loss reduces falls or dementia is still being tested^[10][16].

Hearing a grandchild, reading a letter, seeing a step: these are not luxuries of later life. The tools to protect them exist. The task is to make sure they reach everyone who needs them, wherever they live.

Language: this piece says "older people" rather than "the elderly", and speaks of "people with sight loss" or "vision impairment" and "people with hearing loss", the terms most sight loss and hearing loss organisations use. It is about sight and hearing loss acquired in later life. Many Deaf people who use a sign language see themselves as a cultural and linguistic community rather than as having a loss, and their experience of aging deserves its own study.

Why we're publishing this

We compiled this evidence because older people with sight or hearing loss, and the organisations that work with them, deserve the research in one place, cleanly sourced and ready to put in front of a health minister, a commissioner or a journalist. The case is theirs: the data show that much of the sight and hearing loss of later life is treatable, and that treatment still fails to reach most of the people who need it. Our part is to say that plainly. This study is part of our series on how aging affects different groups of people.

How to read this data

Most global figures here are modelled estimates. The GBD studies and the hearing-aid coverage analysis combine population surveys from many countries with statistical models, and come with wide uncertainty intervals; WHO’s fact sheets draw on the same body of work. Effective cataract surgical coverage comes from population-based eye surveys of adults aged 50 and over, mostly in low- and middle-income countries, with the five European datasets left out of the model; the 2030 figure is a projection. The US figures come from two different sources: NIDCD’s summary of hearing examinations, and the National Health Interview Survey, in which people report their own difficulty hearing. Self-reported difficulty and measured hearing loss are not the same thing, and definitions of “disabling” and “moderate” loss differ between sources, so figures from different sources should not be read as a trend or compared directly.

Links with falls, loneliness and dementia come mainly from observational studies, which show association, not cause; people with sensory loss may differ in other ways that affect these outcomes. Hazard ratios, risk ratios and odds ratios are reported as each study gave them. The evidence for the oldest age groups, for care home residents and for people with both sight and hearing loss is thinner than for older people overall, and data from low-income countries are sparse.

Use this data

Free to cite with attribution to Understanding Aging. Sight loss and hearing loss organisations, campaigners and journalists are welcome to reuse these figures and charts. For the underlying figures as a spreadsheet, get in touch.

Important: This article summarises published research and statistics for general information. It is not medical, care or financial advice and cannot be used to diagnose, treat or predict anything about an individual. If you have concerns about your own or someone else's sight, hearing or health, please speak to a GP or another qualified health professional.

Sources

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2. World Health Organization. Blindness and vision impairment (fact sheet). WHO, 2026. who.int/news-room/fact-sheets/detail/blindness-and-visual-impairment
3. World Health Organization. Deafness and hearing loss (fact sheet). WHO, 2026. who.int/news-room/fact-sheets/detail/deafness-and-hearing-loss
4. GBD 2019 Hearing Loss Collaborators. Hearing loss prevalence and years lived with disability, 1990–2019: findings from the Global Burden of Disease Study 2019. The Lancet, 2021. europepmc.org/article/MED/33714390
5. National Institute on Deafness and Other Communication Disorders. Quick statistics about hearing, balance, and dizziness. NIDCD, US National Institutes of Health, accessed 2026. nidcd.nih.gov/health/statistics/quick-statistics-hearing
6. National Center for Health Statistics. Hearing difficulties among adults: United States, 2019 (NCHS Data Brief No. 414). Centers for Disease Control and Prevention, 2021. cdc.gov/nchs/products/databriefs/db414.htm
7. GBD 2019 Blindness and Vision Impairment Collaborators; Vision Loss Expert Group of the Global Burden of Disease Study. Causes of blindness and vision impairment in 2020 and trends over 30 years, and prevalence of avoidable blindness in relation to VISION 2020: the Right to Sight. The Lancet Global Health, 2021. europepmc.org/article/MED/33275949
8. McCormick I, Ouchtar Y, Macleod D, et al.; eCSC Study Group. Effective cataract surgical coverage in adults aged 50 years and older: empirical estimates from population-based surveys in 68 countries and modelled estimates for 2000–30. The Lancet Global Health, 2026. europepmc.org/article/MED/41687671
9. McCormick I, Butcher R, Evans JR, et al.; RAAB International Co-Author Group. Effective cataract surgical coverage in adults aged 50 years and older: estimates from population-based surveys in 55 countries. The Lancet Global Health, 2022. europepmc.org/article/MED/36240806
10. Yeo BSY, Tan VYJ, Ng JH, et al. Hearing loss and falls: a systematic review and meta-analysis. JAMA Otolaryngology–Head & Neck Surgery, 2025. europepmc.org/article/MED/40111358
11. Dillon L, Clemson L, Ramulu P, Sherrington C, Keay L. A systematic review and meta-analysis of exercise-based falls prevention strategies in adults aged 50+ years with visual impairment. Ophthalmic & Physiological Optics, 2018. europepmc.org/article/MED/29732579
12. Shukla A, Harper M, Pedersen E, et al. Hearing loss, loneliness, and social isolation: a systematic review. Otolaryngology–Head and Neck Surgery, 2020. europepmc.org/article/MED/32151193
13. Beadle J, Yuwono E, Levasseur M, Wister A. Effectiveness of interventions for social isolation, loneliness, and social participation in older adults with hearing loss: results from a systematic review. Systematic Reviews, 2026. europepmc.org/article/MED/41699739
14. Dhanda N, Hall A, Martin J. Does social isolation mediate the association between hearing loss and cognition in adults? A systematic review and meta-analysis of longitudinal studies. Frontiers in Public Health, 2024. europepmc.org/article/MED/38292910
15. Shang X, Zhu Z, Wang W, Ha J, He M. The association between vision impairment and incidence of dementia and cognitive impairment: a systematic review and meta-analysis. Ophthalmology, 2021. europepmc.org/article/MED/33422559
16. Lin FR, Pike JR, Albert MS, et al.; ACHIEVE Collaborative Research Group. Hearing intervention versus health education control to reduce cognitive decline in older adults with hearing loss in the USA (ACHIEVE): a multicentre, randomised controlled trial. The Lancet, 2023. europepmc.org/article/MED/37478886