y Hearing loss contributes to a cascading effect of decreased social engagement, mental well-being and physical activity, which can increase the risk of cognitive decline and dementia. y Hearing aids should be used to address hearing loss, not solely for the purpose of preventing dementia. y The effectiveness of interventions may vary by the type and severity of hearing loss, and the extent to which the device is used. At present, there is insufficient evidence to draw conclusions on the effects of cochlear implants on the risk of dementia. y Prevention, identification and management of hearing loss should be aligned with national and international guidance (22,149,150). y Over 400 million people with hearing loss could benefit from hearing devices, yet these needs are currently met in only an estimated 17% of those people (152). It is essential to expand access to affordable, culturally appropriate hearing care, especially in LMIC and among highrisk and underserved populations. y Hearing aids are the most used and widely available assistive technology for hearing loss. They are cost-effective and improve communication and quality of life. However, adherence and sustained use may be challenging, particularly among older adults (156). Barriers include stigma, low awareness, delays in identification and rehabilitation, cost, limited access to hearing care, shortages of trained personnel, and a shortage of infrastructure for fitting and maintaining devices (152). Public health campaigns and capacity-building initiatives (e.g. training audiologists, technicians and other health personnel) are needed to address these challenges. y WHO guidance calls for systematic screening of adults aged above 50 years, followed by prompt diagnosis and hearing aid fitting through community-based service delivery approaches, to promote access to hearing care in resource-limited settings (22,150,157). y Integration of hearing care into primary health services, combined with cognitive screening and referral pathways, can enhance feasibility and promote early detection of both hearing loss and cognitive decline. However, context must be considered when selecting screening tools, to ensure cultural appropriateness and relevance. y In addition to managing hearing loss, primary prevention is essential. Evidence-based measures (e.g. reducing exposure to loud sounds, implementing safe listening practices, preventing and treating childhood ear infections and ensuring vaccination for preventable infectious causes of hearing loss) should be integrated into public health and primary care strategies, to reduce the overall incidence of hearing loss (152).

Prevention, screening and management of hearing loss should be offered, in line with WHO guidance. Clinical practice: y Package of interventions for rehabilitation: module 6: sensory conditions (40) Service delivery and care pathways: y Integrated care for older people (ICOPE): guidance for personcentred assessment and pathways in primary care, 2nd ed (4) Public health and policy: y Hearing screening: considerations for implementation (41)