**1. Introduction**

The proportion of elderly aged ≥80 years of age (the 80+) is expected to increase dramatically over the next few decades and is projected to triple in Europe by 2060 [1]. Both the World Health Organization (WHO) and the European Union (EU) are concerned with programs on successful aging [2], and since hearing impairment is a known risk factor for functional decline, reduced social participation, withdrawal, and accidents [3–6], good functional hearing is therefore crucially important for elderly to be able to manage themselves and take care of their own lives and maybe also help their partner or spouse [7–10]. For patients in a homecare setting, hearing impairment can cause additional stress along with reduced capacity and other health challenges [11].

Hearing impairment is however a natural part of old age, and most people will experience increasingly impaired hearing as they grow older, but because this impairment can threaten functioning and well-being, communication, and quality of life, it is important to shed light on this issue and to help the elderly with this problem [7, 11, 12]. Age-related hearing impairments are sometimes possible to remedy or improve, but it is important to discover and tend to this issue as early as possible [6, 13].

Traditionally, hearing impairments have to a large extent been an area for the elderly themselves or their relatives have been responsible for, but it seems that there is a lack of information because many elderly never check their hearing, apply for hearing aids, or seek any other professional help for their hearing impairment [13, 14].

Hearing is connected to the memory function and there is evidence that hearing impairment can have an impact on the mental functioning [15–17]. Age-related hearing impairment is correlated with Alzheimer disease, and reduced hearing can contribute to falls and fractures [18], greater dependence on others, and loneliness [19–21]. For those who have ailments and chronic diseases, hearing impairments constitute an additional negative factor to the other problems and perhaps an unnecessary burden, which may lead to the latter part of life being more troublesome than necessary [11, 22]. Since age-related sensory impairments in general have been taken care by the elderly themselves, it has largely been overlooked by nurses in the home-care service and by health authorities in general [4, 23]. Knowledge and understanding about how to maintain the hearing function in old age seem to be crucial in order to manage every day activities, daily living, and participation in social activities, even if one has other health challenges and is receiving home care [24].

Decline in sensory abilities and their effects on physical and psychosocial capacities in older individuals have been discussed in previous studies [15–17], however, most prevalence studies of hearing impairments involve population from the general community and include people from younger age groups, so studies among older people over 80 years receiving home care are few.

Grue [11] has discussed the burden of dual sensory impairment in the elderly and also the risk of falling when hearing is impaired.

One would think that it is in the elderly's own interest to maintain the function of the hearing sense throughout the life course, but our randomized, controlled trial indicated that many elderly could not be expected to do all the self-care activities necessary to improve their hearing function themselves. Close monitoring and assistance is necessary.
