A metacognitive approach to hearing and listening in older adults

Hearing loss is one of the most prevalent age-related sensory changes, with major consequences for communication and quality of life. Yet, many older adults respond to listening challenges with maladaptive strategies, such as delayed help-seeking or denial, even when aware of their difficulties. This thesis examined this paradox through the lens of metacognition, focusing on how monitoring, beliefs, and perceptions shape older adults’ responses to auditory challenges. Across six experimental studies, I investigated the effects of aging and hearing loss on metacognitive processes. Studies 1–3 showed that aging alone does not impair monitoring. Older adults tracked their performance, effort, and confidence as accurately as younger adults, and sometimes more so. However, hearing loss was linked to weaker self-efficacy, a more external locus of control, and less frequent use of adaptive strategies. In Study 4, aimed at assessing awareness of listening strategy benefits, I found that perceived effort emerged as a key moderator: strategies like lip-reading, although objectively beneficial, were less likely to be adopted when judged as too demanding. Study 5 developed and validated the Listening Challenges Attitude Scale (LiCAS), a novel tool to assess beliefs about listening difficulties, enabling the detection of metacognitive vulnerabilities beyond audiological measures. Finally, study 6 tested augmented reality training with metacognitive prompts. While group-level shifts in beliefs were limited, individual performance improvements predicted increased self-efficacy, suggesting self-monitoring of progress as a lever for change. Key findings: (1) monitoring is preserved in aging; (2) hearing loss can undermine internal beliefs, rather than monitoring accuracy; (3) effort perceptions can shape strategy use; (4) perceiving improvement in listening can foster metacognitive adaptation. Metacognition still represents a largely neglected dimension in hearing science and clinical practice. Beyond audiograms and speech scores, beliefs about control, efficacy, and effort crucially determine coping behavior. Supporting these dimensions—through tools like LiCAS and interventions targeting self-monitoring—may promote more effective and empowered listening in older adults.