Hearing aid fitting follow-up non-compliance causing 40% device abandonment in Medicare beneficiaries after the OTC hearing aid deregulation

Since the 2022 FDA rule allowing over-the-counter hearing aid sales, Medicare beneficiaries aged 75+ are purchasing OTC devices at retail stores and online without audiological fitting, resulting in devices with incorrect gain profiles, poor physical fit, and no real-ear measurement verification, leading to 40% device abandonment within 6 months. So what? Abandoned hearing aids represent $500-$1,500 in wasted out-of-pocket spending per device (Medicare still does not cover hearing aids), and the senior concludes 'hearing aids don't work for me,' permanently opting out of amplification. So what? Untreated hearing loss in adults 75+ accelerates cognitive decline at 2-5x the rate of normal aging, because the brain reallocates auditory processing resources to compensate for degraded input, reducing cognitive reserve available for memory and executive function. So what? The accelerated cognitive decline advances dementia onset by an estimated 2-5 years, and each year of earlier dementia onset adds approximately $50,000-$80,000 in lifetime care costs per patient. So what? Family members notice the cognitive decline but attribute it to 'normal aging' or early dementia, not to the treatable hearing loss underneath, so they pursue neurological workups and dementia medications rather than addressing the hearing deficit that's driving 8% of modifiable dementia risk. So what? By the time the hearing loss is properly addressed (if ever), the cognitive decline has progressed past the point where amplification provides meaningful benefit, because neural plasticity for auditory processing diminishes after prolonged deprivation. This persists because the OTC hearing aid rule prioritized access and cost reduction over fitting quality; audiologists' professional association lobbied against OTC aids rather than advocating for covered follow-up fitting services; Medicare's statutory exclusion of hearing aids (dating to 1965) has never been overturned despite overwhelming evidence of downstream cost savings; and OTC device manufacturers have no financial incentive to emphasize professional fitting when their business model depends on eliminating the audiologist from the purchase pathway.