Super-Aging, Super-Agers and Super-Hearing: Another Year Older, Another Year Wiser and Healthier

With Kathy Pichora-Fuller, PhD, Aud(C), RAUD, FCAHS

Championing Super-hearing Care

Canada is expected to become a “super-aged” society within the next five years. In 2025, are audiologists poised to become “super-hearing” care experts? Many older adults have delayed help-seeking for hearing loss by years, often because of ageism and the stigma of hearing loss and hearing aids. Audiologists have often been avoided because people feared hearing testing that would result in bad news about hearing loss and dreaded recommendations to start using hearing aids. 2025 is a super time to transform the old negative view of hearing loss as an age-related decline that leads to more age-related declines into a new positive view of hearing health as a key to healthy aging and even “super aging.”

As argued in a UK position paper published in December 2024, it is time for all hearing health professionals to stop misleading older people with information implying that hearing loss causes dementia (British Society of Audiology, British Academy of Audiology, the British Society of Hearing Aid Audiologists, 2024). We need to end using negative messages about declines to motivate hearing aid purchases. Alternative and more positive “super-hearing” messaging would emphasize how taking action to improve hearing health is a lifestyle choice to promote healthy aging. By taking a “super-hearing” approach to audiologic rehabilitation, public perceptions could shift such that hearing care becomes highly sought after and audiologists develop a widespread reputation among older adults for being highly valued and trusted health professionals. Such “super-hearing” champions of healthy aging would be distinguished by how they help older individuals to optimize functioning in everyday life so that they can be and do what they value (Pichora-Fuller, 2020; WHO, 2020). This new positive positioning of super-hearing care should also guide audiologists as they lobby for policy and funding changes that align with trends in healthy aging policies globally (Rudnicka et al., 2020) and in Canada (Iciaszczyk et al., 2022).

Super-aged Societies

The World Health Organization (WHO) and the United Nations (UN, 2019: Kaneda et al., 2019) define an “aging society” as one in which more than 7% of the population is 65 years or older, an “aged society” as a society in which more than 14% of the population is 65 years or older, and a “super-aged society” as a society in which more than 21% of the population is 65 years of age or older. According to a 2019 UN report, there were seven countries (Japan, Italy, Finland, Portugal, Greece, Germany, Bulgaria) in the “super-aged“ category, with more than 21% of their populations being 65+ years of age. Of the rest of the top 50 countries ranked by the percentage of adults 65+ years of age in their national populations, all were in the “aged” category. Canada ranked 31^st, with 17.2% of the population being 65+ years of age. However, the percentage of those over 65 years of age is increasing rapidly. In the 2021 census, 19% of the Canadian population had reached 65+ years of age. It is estimated that Canada will become a “super-aged” country by 2030. However, as of July 2024, half ot the Canadian provinces were already “super-aged”, with more than 1/5 of their population being 65+ years old.

See Table below based on a Statistics Canada interactive tool at https://www150.statcan.gc.ca/n1/pub/71-607-x/71-607-x2020018-eng.htm). To look more locally, data at the municipal level can be found using the Statistics Canada interactive tool at https://www12.statcan.gc.ca/census-recensement/2021/dp-pd/prof/index.cfm?Lang=E).

Province or Territory	% of Population 65+ Years of Age
Newfoundland and Labrador	24.6
New Brunswick	23
Nova Scotia	22.2
Quebec	21.1
Prince Edward island	20.6
British Columbia	19.8
Ontario	18.3
Saskatchewan	17.5
Manitoba	16.8
Alberta	15.2
Northwest Territories	11.2
Nunavut	4.8

Beyond Healthy Aging: Super Ager Individuals

The super aging of the population across Canada will increase the need for hearing healthcare. Beyond simply expanding services as caseloads increase, there is also an imperative for a new ‘super-hearing’ approach that promotes healthy aging, and even super aging. A subset of older adults, called “super-agers,” push the limits of healthy aging. Super-agers are in the elite of cognitive aging; they maintain midlife levels of function and activity into ages of 80 and older (Powell et al., 2023). Hearing health could enable people to become super-agers from the age of 80 years up to and beyond 100 years. Importantly, while genetic factors are not modifiable, a number of lifestyle choices are common in older individuals who become super-agers. Seven of these super-ager lifestyle choices and the literature supporting their potential benefits were summarized in an article published for the American Association of Retired Persons (AARP: Harrar, 2023). The message to AARP members is that super-agers typically make choices to:

1. control their blood sugar and blood pressure;
2. push themselves physically (but not exercising more than peers);
3. prioritize mental health and avoid stress;
4. protect and seek help for vision and hearing;
5. prioritize sleep;
6. engage in a wide variety of cognitive activities, including learning new skills;
7. talk to friends – a lot.

Some of these choices may be related to risk factors for dementia (Livingstone et al., 2024); however, the emphasis is boosting cognitive prowess rather than avoiding decline. Notably, hearing health is on the list that has been shared among AARP members.

Using a lifespan view of age-related hearing loss (ARHL), hearing health care can promote healthy aging at different ages. It can begin with prevention and counselling as middle-aged people begin to experience difficulties communicating in challenging situations, even though their audiograms may not need amplification to restore audibility. Rather than sending people away because they are not yet candidates for hearing aids, a discussion about communication strategies and assistive technology options may be beneficial and set those in the early stages of ARHL on a positive path to maintaining participation in the workforce and in the community. Eventually, people may become candidates for amplification. Whether or not people become hearing aid users, before and after reaching age 65, hearing health choices can complement other healthy lifestyle choices and individuals’ priorities for healthy aging so that they continue to function optimally as they engage in physical, mental, and social activities. An even bolder ‘super-hearing’ approach could enhance the possibilities for more people to become super-agers as they live longer than average life expectancy. Life expectancy in Canada for those born in 2022 is 81.6 years (83.8 for females; 79.4 for males), with a healthy life expectancy of 69.8 years (https://data.who.int/countries/124). Notably, life expectancy for baby boomers at the time of their birth was about 63 years, but it is now estimated to be 79 years (i.e., the population is living longer than would have been expected historically). Currently, the issue of how to live better is as or more important than the issue of how to live longer. Over the next few years, super-hearing approaches to audiologic rehabilitation will be honed as we will learn more about the role of communication for super-agers from research being conducted in Canada at Western University (https://news.westernu.ca/2024/11/superaging-canada/; https://superagingcanada.uwo.ca/about/).

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References

1. British Society of Audiology, British Academy of Audiology, the British Society of Hearing Aid Audiologists (2024). The link between adult-onset hearing loss and dementia. https://www.thebsa.org.uk/adult-onset-hearing-loss-and-dementia-statement-and-practiceguidance-bshaa-baa-and-bsa/
2. Harrar, S. (2023). 7 Super Secrets of the Super Agers - Psst: Here’s what you need to do to ensure you have a chance at super aging. American Association of Retired Persons(AARP). https://www.aarp.org/health/healthy-living/info-2023/super-ager-secrets.html
3. Iciaszczyk, N., Arulnamby, A., Brydges, M., Marshall, M., Cheng, S. M., Feil, C., & Sinha, S. (2022). Ageing in the Right Place: Supporting Older Canadians to Live Where They Want. National Institute on Ageing. Toronto Metropolitan University, Toronto, Ontario, Canada. https://www.niageing.ca/airp
4. Kaneda, T., Greenbaum, C., & Kaitlyn Patierno. (2019). World Population Data Sheet (Washington, DC: Population Reference Bureau, 2019). https://www.prb.org/resources/countries-with-the-oldest-populations-in-the-world/
5. Livingston, G., Huntley, J., Liu, K. Y., Costafreda, S. G., Selbæk, G, Alladi, S., et al. (2024). Dementia prevention, intervention, and care: 2024 report of the Lancet standing Commission. The Lancet, published online July 31, 2024 https://doi.org/10.1016/S0140-6736(24)01296-0
6. Pichora-Fuller, M. K. (2023). Views of Aging: Positive Beliefs and Attitudes Matter for Hearing and Other Health Issues. Canadian Audiologist, 10(3). https://canadianaudiologist.ca/views-of-aging-positive-beliefs-and-attitudes-matter-for-hearing-and-other-health-issues/
7. Powell, A., Page, Z.A., Close, J.C.T., Sachdev, P.S., & Brodaty, H. (2023). Defining exceptional cognition in older adults: A systematic review of cognitive super-ageing. Int J Geriatr Psychiatry. e6034. https://doi.org/10.1002/gps.6034
8. Rudnicka, E., Napierała, P., Podfigurna, A., Męczekalski, B., Smolarczyk, R., & Grymowicz, M. (2020). The World Health Organization (WHO) approach to healthy ageing. Maturitas, 139, 6–11. https://doi.org/10.1016/j.maturitas.2020.05.018
9. United Nations (2019). World Population Prospects.  https://population.un.org/wpp/Download/Standard/Population/
10. World Health Organization. (2020). Healthy ageing and functional ability. Geneva, Switzerland. https://www.who.int/news-room/questions-and-answers/item/healthy-ageing-and-functional-ability