Up to 40 percent of people over age 65 are hearing impaired. More than 80 percent of people over age 85 have hearing loss. And many don't realize it. According to doctors, a lot of older Americans who have hearing loss tend to blame their inability to understand conversation on their spouse's inability to speak loudly enough. Dr. Bevan Yueh and his colleagues at Veterans Affairs Puget Sound Health Care System, University of Washington and three other institutions, wanted to know if primary care doctors should regularly screen their older patients for hearing loss. They reviewed all the research available on the subject, and reported their findings in the Journal of the American Medical Association. Researchers found that people with hearing loss have twice as high rates of depressions. And many of them are severely isolated socially. But the researchers also found that about a third of elderly hearing loss cases are caused by things like impacted ear wax or an ear infection, and can be treated by a primary care doctor. In other cases the patient may need a specialist, and may need hearing aids. But the first step is screening. The researchers recommend a screening with an audioscope, which emits tones that the patient tries to identify, or a simple questionairre that helps people recognize how hearing loss may be affecting their lives. The researchers say screening for hearing should be part of the primary care visit.