**Background:** Hearing loss affects approximately 25% of individuals aged 65–74 and 50% of those 75 or older in the United States. Untreated hearing loss is associated with increased risk of cognitive decline and dementia; individuals with mild hearing loss are twice as likely to develop dementia compared to those with normal hearing. The link is correlational, not causative, but hearing loss remains one of the most modifiable risk factors for dementia. Comorbidities such as vision loss and manual dexterity problems frequently coexist with hearing loss and cognitive decline, further complicating aural rehabilitation. Audiologists are within their scope of practice to conduct cognitive screening, yet most do not integrate it into routine care. Speech-language pathologists are well-prepared to assess and intervene in cognition and communication. This paper presents a collaborative, interprofessional approach to aural rehabilitation for adults with hearing loss and cognitive concerns, based on the authors' experiences at the Arizona State University Speech and Hearing Clinic.
**Methods:** This is a narrative review and clinical perspective article. The authors describe their interprofessional model, which includes cognitive screening, selection and fitting of hearing technology, instruction in environmental management and communication strategies, and counseling for clients and caregivers. Cognitive screening tools used include the Mini Mental State Exam (MMSE), Montreal Cognitive Assessment (MoCA), Saint Louis University Mental Status Exam (SLUMS), and Cognivue Thrive. Screening is conducted in a quiet, distraction-free environment with optimized communication (e.g., personal amplifier, hearing aids, glasses, visual cues). Hearing technology considerations include signal processing with slower release time and wide dynamic range compression, automatic programs with directivity, and T-coil activation. Device options range from traditional hearing aids to Hearing Assistive Technology (HAT) and personal amplifiers, with decisions based on visual acuity, dexterity, and cognitive status. Instruction in environmental management, communication strategies, and self-advocacy is provided by a speech-language pathologist, often immediately after the audiology appointment. Counseling addresses emotional well-being of both clients and caregivers, using techniques such as reflective silence, naming emotions, affirmations, and motivational interviewing. The authors also discuss lessons learned, including the use of a one-page handoff form, weekly staffing, shared documentation, and community resources.
**Key Results:** The paper does not present original quantitative results but summarizes relevant literature and clinical observations. Key points include: (1) Cognitive screening is recommended for older adults with communication difficulties, attention or memory concerns, vestibular problems, excessive speech-in-noise difficulties, or family history of MCI/dementia. (2) Hearing aid use was associated with lower prevalence of dementia in participants with moderate to severe hearing loss compared to non-users. (3) A recent multicenter RCT showed that hearing intervention may reduce cognitive change in older adults at increased risk for cognitive decline. (4) Speech-in-noise impairment is linked with dementia risk. (5) For clients with cognitive concerns, signal processing with slower release time and wide dynamic range compression may facilitate speech perception. (6) Written instructions in client-friendly language with large font, pictures, and graphics support understanding. (7) Caregiver training in device maintenance and use supports device care. (8) Teaching strategies such as explicit categorization, repeating important information, and breaking complex information into smaller chunks are effective. (9) The Client Oriented Scale of Improvement (COSI) and TELEGRAM tool are used to set and track communication goals. (10) Barriers to interprofessional care include lack of time for collaborative planning and higher cost of dual-provider services.
**Clinical Implications:** The authors propose that an interprofessional approach involving audiologists and speech-language pathologists can improve outcomes for adults with hearing loss and cognitive concerns. Key recommendations include: (1) Integrate cognitive screening into aural rehabilitation for at-risk individuals, using tools that account for hearing loss. (2) Tailor hearing technology selection to cognitive, visual, and dexterity needs (e.g., rechargeable aids, custom earmolds, Bluetooth connectivity). (3) Provide communication training and self-advocacy scripts, with caregiver involvement. (4) Use counseling techniques to support emotional well-being. (5) Break information into smaller chunks, provide printed materials, and schedule multiple appointments as needed. (6) Consider teletherapy and group therapy as supplements, though more research is needed. (7) Foster interprofessional collaboration through shared documentation, handoff forms, and regular staffing. The authors acknowledge that controlled research studies are needed to establish evidence-based approaches for this population.