October has been an especially relevant month for reflecting on the health and social challenges of aging. On the International Day of Older Persons, observed last October 1, the National Congress of the Spanish Society of Otolaryngology and Head and Neck Surgery (SEORL-CCC), held in Madrid from the 14th to the 17th, and the Week Against Unwanted Loneliness, promoted by San Juan de Dios from the 19th to the 25th of October, have also been added. These initiatives offer an opportunity to focus on the importance of preserving the health, autonomy, and social ties of older people.
In Spain, people aged 65 and over already account for 21.1% of the population and, according to the latest projections of the National Statistics Institute, this proportion will continue to increase over the coming decades. This demographic change requires strengthening policies aimed at preserving autonomy, functional capacity, and social participation among older people.
Approximately 4.6 million people live with hearing loss in Spain, a condition whose prevalence increases considerably with age: it affects 18.2% of people aged between 65 and 74 and 35.8% of those over 74. Its consequences go far beyond difficulties in hearing, since it can limit personal relationships and favor situations of social isolation and unwanted loneliness, in addition to being associated with a higher risk of depression, cognitive decline, and falls. Therefore, addressing hearing loss is essential to promote healthy aging, also understood as the ability of people to maintain their autonomy, their ties, and their relationship with their surroundings.
From the Federation of Associations of Cochlear Implant Recipients of Spain (AICE), through the Ser Oído campaign, we want to put the focus on those who have severe or profound hearing loss. When hearing aids do not provide sufficient benefit, the cochlear implant is an effective therapeutic alternative, also at advanced ages. It is also a consolidated technology, included in the service portfolio of the National Health System for those who meet the established clinical criteria. However, according to the estimates collected in the White Paper on cochlear implants in adults and older people from 2023, "only 5.7% of adult candidate people accessed this treatment in Spain."
The existence of effective technology that is publicly financed does not, by itself, guarantee that those who need it can access it. Among the main barriers, we find a lack of knowledge about the available alternatives, delays in diagnosis, and difficulties in referral. In fact, barely 24% of people with severe or profound hearing loss have received information about cochlear implants from healthcare professionals. To these difficulties are added ageism and self-ageism, which contribute to normalizing hearing loss as an inevitable consequence of aging. These prejudices, present both in the social and care environment and among older people themselves, can delay the search for specialized care and limit access to treatments capable of significantly improving their quality of life.
Overcoming these barriers requires a coordinated response that makes it possible to improve access to cochlear implantation across the entire territory. From Federación AICE, we consider it a priority to move forward with a National Strategic Plan for Cochlear Implantation that recognizes the health and social consequences of severe and profound hearing loss and sets out a common roadmap to improve care. This framework should make it possible to standardize access criteria, strengthen care coordination, and develop action plans tailored to the needs of each autonomous community, reducing territorial inequalities.
One of the priorities of this strategy should be facilitating the identification and early assessment of people who are candidates for a cochlear implant. To do so, it is necessary to strengthen the training of healthcare professionals, improve detection mechanisms from Primary Care, and establish clear care pathways that ensure continuous care, from diagnosis to treatment, rehabilitation, and follow-up. Along these lines, from AICE we view positively the SEORL-CCC proposal to establish a national hearing screening program starting at age 60, as a measure that could favor early detection and facilitate access to specialized care.
Another priority must be making available information that allows guiding health decisions and evaluating the results of interventions. To this end, the National Strategic Plan should include the creation of a state registry and a common evaluation model that make it possible to know the needs of the candidate population and measure not only the clinical benefits of cochlear implantation, but also its impact on quality of life and its social return. Likewise, these actions should be accompanied by greater awareness of the possibilities of this technology, promoting collaboration between scientific societies, patient organizations, and organizations of older people to overcome prejudices associated with age and improve knowledge of the solutions available.
The main challenge no longer lies solely in having effective technologies to treat hearing loss, but in ensuring that people can access them at the right time and under conditions of equity.
"In a society that is aging, improving hearing care should be understood as an investment in prevention and quality of life, whose benefits go beyond the strictly health field and reach the affected people, their families, and society as a whole."
Helping people hear better also means helping them preserve their autonomy, stay connected with their environment, and continue to participate fully in social life. Effectively incorporating hearing health into healthy aging policies is therefore essential: we cannot talk about healthy aging without talking about hearing health.