Everyday challenges and solutions for individuals aging with deafness

Abstract

Background and Objectives

Approximately 11 million people in the United States self-identify as Deaf and use American Sign Language (ASL) as their primary form of communication. Yet, little is known about the challenges and solutions in everyday activities of individuals who are aging with long-term deafness.

Research Design and Methods

We used a community-engaged research approach to understand everyday challenges and solutions of 60 older ASL users who self-identified as Deaf. Semi-structured interviews were conducted in ASL to probe challenges and responses to those challenges across six everyday activity categories: Activities Within the Home; Activities Outside the home; Transportation; Managing Health; Shopping and Finances; and Basic Daily Activities.

Results

Older Deaf adults shared their lived experiences and reported challenges with unreliable technology, communication, and accessibility in the context of engaging in a myriad of everyday activities. For instance, they reported that technology alerts (e.g., airport announcements) are typically auditory, and healthcare accessibility is poor due to a lack of ASL interpreters. When probed about their solutions to these everyday challenges, participants reported relying on hearing family members, using their own methods, such as self-advocating, and using devices/technologies.

Discussion and Implications

Everyday challenges experienced by older Deaf adults may be mitigated by improving the reliability and accessibility of technologies used by this population, as well as improving communication accessibility across various public and private settings. Including older Deaf community members in the needs assessment and design process is critical for development of technology solutions to improve engagement in everyday activities.

Translational Significance.

We used a community-engaged research approach to explore the everyday challenges and solutions of 60 older American Sign Language (ASL) users who self-identified as Deaf. Our findings showed that although these older Deaf adults used various strategies, challenges with accessibility, technology, and communication persisted and hindered participation in everyday activities. Future researchers and innovators should involve older Deaf adults and address their needs when designing solutions. Particularly, improving the reliability of existing technologies and improving communication accessibility across all public and private sectors is pertinent to mitigate the everyday challenges of those aging with Deafness.

Recent estimates from the Annual Disability Status Report indicated that, in the United States, 23.9% of adults aged 65 to 74 years and 45.3% of those over 75 years have a disability (American Community Survey, 2023; Erickson et al., 2025). Among older adults with disabilities, a hearing disability, defined as deaf or having serious difficulty hearing, is the third most common condition, affecting over seven million individuals (Erickson et al., 2025). The terms deaf and serious difficulty hearing have been commonly used to refer to individuals with severe-to-profound hearing loss and/or who exhibit significant functional hearing difficulties (World Health Organization, 2025). Alternatively, the term, Deaf (with a capital “D”), has emerged from a cultural identity label to refer to individuals who self-identify as Deaf, being a Deaf community member, and use sign language as their primary language (Pudans-Smith et al., 2019; see also Marschark et al. [2017] for discussion). Given that varying definitions have been used in large-scale surveys, accurate population estimates of older Deaf individuals are lacking (Mitchell, 2005; Singleton et al., 2019), including stratification by those who use sign language and identify as Deaf versus those who do not.

Despite the lack of exact statistics, the older Deaf population in the United States is expected to grow, given the rising aging prevalence in the general population (Mather & Scommegna, 2024). This increasingly aging population includes approximately four million individuals who acquired significant hearing disability at younger ages (Erickson et al., 2025). Furthermore, this likely includes a high number of those who use sign language, considering that of all American Sign Language (ASL) users, the highest proportion is of those who self-identify as Deaf (Mitchell & Young, 2022). Individuals aging with deafness and who primarily sign constitute a unique subset of the population whose navigation of everyday activities and their potential support needs remain understudied. In this study, we focused on Deaf individuals who use ASL as their primary mode of communication and self-identify as Deaf, with the onset of deafness at a younger age.

Previous research, primarily focusing on younger and middle-aged Deaf adults, has highlighted the challenges experienced by these individuals. Studies have documented socioeconomic challenges, including educational disadvantages, limited access to competitive employment, and restricted financial resources (Batista & García, 2023; Lytle et al., 2005). Everyday challenges included difficulties in healthcare-related tasks (e.g., inadequate sign language interpreting services, Beaver & Carty, 2021; Morisod et al., 2022; Steinberg et al., 2006), social interactions/activities (e.g., social stigma and reduced opportunities in public and private settings, Crowe, 2019; Murray et al., 2007), and transportation (e.g., poor visual notifications, Lee et al., 2019). This growing evidence highlights how communication and accessibility barriers impact the daily lives of younger and middle-aged Deaf signers.

However, relatively few studies have examined the challenges experienced by those aging with long-term deafness. Older Deaf adults have long-term deafness but may also be experiencing age-related health conditions (e.g., diabetes, hypertension) and functional changes (e.g., vision, cognition), thus increasing their vulnerability to everyday challenges compared to younger individuals (Mitzner et al., 2018). Emerging studies show that older Deaf adults face similar communication challenges as younger ones, particularly in healthcare and social settings, but the consequences are exacerbated. For example, Xu et al. (2021) found that deafness and poor health worsened older adults’ access to health information during the pandemic, whereas Lesch et al. (2019) described how communication barriers in long-term care potentially impact critical tasks of eating and dressing. Furthermore, limited awareness of accessibility options, such as captioning services, further restricts social participation for older adults, an already concerning issue regardless of deafness (Murray et al., 2007; Shaw & Roberson, 2013). However, a comprehensive understanding of challenges experienced by older Deaf adults and the context of these challenges across a range of everyday activities is scant. Delineation of everyday challenges for aging Deaf signers is critical for creating solutions to support their independence and quality of life.

Technology solutions can potentially improve the lives of older Deaf adults by addressing their challenges. Assistive technologies, such as captioning, video relay services, and mobile applications, have long benefited Deaf individuals (Alshawabkeh et al., 2021; Rodríguez-Correa et al., 2023), but research on technology use by older Deaf signers is limited, with few exceptions (Maiorana-Basas & Pagliaro, 2014; Singleton et al., 2019; Xu et al., 2023). These studies show that many older Deaf adults use various technologies comfortably, though they no longer use outdated tools, such as teletypewriters (Singleton et al., 2019). Along with the obsolescence of older technologies, modern technologies present challenges. For example, innovations designed to aid communication between Deaf and hearing individuals (e.g., the “SignAloud Glove”), are not advanced enough for fluent translation, and when this technology fails, the communication repair responsibility predominantly falls on the Deaf person (Edwards & Harold, 2014; Hutter & Lawrence, 2018). Moreover, scholars have criticized the frequent exclusion of input from Deaf consumers in technology arenas relevant to this population (Angelini et al., 2025; Hutter & Lawrence, 2018). To facilitate effective technology use in Deaf adults, especially understudied older individuals, it is critical to examine their lived experiences to identify actual needs (i.e., the challenging contexts and whether they warrant technology innovations) and the usability of existing technologies.

To truly understand the needs of older Deaf adults, a community-engaged research approach, which emphasizes collaboration between researchers and community members, is essential (McKee et al., 2012; Ross et al., 2010; Singleton et al., 2014). This includes involving older Deaf adults in various aspects of research, including informing technology design, evaluating outcomes, and ensuring findings are shared in culturally appropriate formats. Best practices include fostering trust, involving Deaf researchers, engaging participants in ASL, and validating findings with the community (Singleton et al., 2014). These best practices informed the current research project, which used an ethical, community-engaged research paradigm to examine (a) the nature (e.g., frequency, type, context) of challenges with task performance in everyday activities faced by older Deaf adults, and (b) their strategies for dealing with these challenges.

ACCESS study

This study is part of a larger study called ACCESS: Aging Concerns, Challenges, and Everyday Solution Strategies, a mixed-method exploration of the everyday challenges of people aging with long-term disabilities (Koon et al., 2020; Remillard et al., 2023). ACCESS investigates challenges and strategies for managing those challenges among persons aging with long-term (a) mobility disabilities, (b) vision impairment, and (c) deafness. The current paper focuses on the Deaf group. See Koon et al. (2020) and Remillard et al. (2023) for findings from the mobility and vision groups, respectively. We used a similar methodological approach to the mobility and vision groups of the ACCESS study, but we did not assume that the challenges and solutions of these three groups living with long-term disability are similar.

Methods

The ACCESS study was conducted in accordance with the ethical standards of the Declaration of Helsinki, with protocols approved by the University of Illinois Urbana-Champaign (protocol no. 17373) and the Georgia Institute of Technology (protocol no. H16213), which collaborated on the study. Recruitment was conducted across the United States through outreach at local, state, and national Deaf community organizations using flyers, social media postings, participant registries, and participant referrals. Eligible participants were individuals between 60 and 79 years of age who self-identified as becoming Deaf or hard-of-hearing before 50 years of age, used ASL as their primary language, and resided in the United States. Informed consent was obtained from participants, who were provided the option to read the consent forms in English or watch an ASL version through a link to a video in which a native ASL signer explained the study details. For the purposes of this manuscript, the term native ASL signer refers to an individual who was exposed to ASL from birth and signs with high fluency. Data were collected between March 2017 and July 2019.

Participants

Sixty individuals (Mean age = 69.3 years, SD = 4.85) participated. Causes of hearing loss were diverse, with the most common being congenital (e.g., family history of deafness and Waardenburg Syndrome; 41.67%), followed by unknown etiologies (e.g., born hearing but becoming deaf with unknown etiology; 26.67%), and childhood illness/fever (e.g., German measles, meningitis; 23.33%). The remaining participants did not report an etiology for their hearing loss (8.33%). The mean age of onset of deafness was 1.67 years. 61% of our participants reported becoming Deaf before the age of 10 years, and 35.6% responded “unknown” when asked about their onset of deafness, which suggests their deafness started early in life, given that they could not remember a time of being with hearing. See Table 1 for participant details. Prior research suggests that data saturation can often be reached with as few as 12 participants (Guest et al., 2006), but we aimed to explore a broad set of research questions and complex contextual factors related to activity challenges. Therefore, consistent with recommendations that larger samples are warranted for studies with broad aims or heterogeneous populations (Malterud et al., 2016), we recruited a larger sample to enhance the depth of analysis, representativeness, and potential generalizability of our findings.

Table 1.

Participant demographic and descriptive data.

Variable	Category	N	%
Deafness	Age of onset ≤10 years	36	61.0
	Age of onset between 11–20 years	2	3.4
	Age of onset unknown	21	35.6
Gender	Female	39	66.1
	Male	20	33.9
Education	<High school	0	0.0
	High school graduate / GED	6	10.2
	Vocational training	3	5.1
	Some college/associate’s degree	10	16.9
	Bachelor’s degree	12	20.3
	Master’s degree	26	44.1
	Doctorate degree	1	1.7
	Do not wish to answer	1	1.7
Race	White/Caucasian	57	96.6
	Black/African American	1	1.7
	More than one race	1	1.7
Marital status	Single	7	11.9
	Married	36	61.0
	Separated	0	0.0
	Divorced	7	11.9
	Widowed	5	8.5
	Other	1	1.7
	Do not wish to answer	2	3.4
	No answer	1	1.7
Income	<$25,000	6	10.2
	$25,000–$49,000	16	27.1
	$50,000–$74,999	10	16.9
	>$75,000	18	30.5
	Do not wish to answer	9	15.3
Perceived health	Poor	0	0.0
	Fair	1	1.7
	Good	25	42.4
	Very good	24	40.7
	Excellent	9	15.2

Note. Data were missing for one participant, so the cells sum to 59.

Procedure

We aimed to mitigate any potential for miscommunication or misinterpretations of interviews with Deaf participants, hence, all data collection procedures (i.e., screening, interviews) were conducted in ASL by three ASL-fluent Deaf community members. The Deaf interviewers received training from one of the coauthors, who is a hearing, native ASL signer with over 30 years of experience engaging in research involving the U.S. Deaf community. The training included a review of recruitment and interview protocols as well as principles of human subjects protection.

Interested participants who contacted our research team were screened via email/videophone to determine eligibility. Semi-structured interviews were conducted with the eligible participants in ASL by the Deaf interviewers using remote video-based technologies (videophones/Facetime), with each interview (screen-recorded for later analysis) taking approximately 60–90 min.

The semi-structured interview scripts were designed to elicit conversations about potential challenges with everyday activities and solution strategies employed to address the challenges across six activity categories: Things Around the Home; Activities Outside the Home; Transportation; Shopping and Finances; Managing Health; and Basic Daily Activities. For each category, participants were asked about 5–8 specific activities (Table 2), using items developed by the research team and guided by previous research findings on understanding the needs of individuals aging with disability (Koon et al., 2020; Preusse et al., 2016) as well as experiences reported in a previous survey of Deaf seniors (Singleton et al., 2019). Specifically, in these previous studies, we interviewed Subject Matter Experts (SMEs) who had professional and/or personal experience working with Deaf older adults. The SMEs identified a number of challenges, such as technology use and acceptance, and accessibility to community and health resources, especially with regard to interpreter services. Findings from these SME interviews shed light on potential challenges to anticipate among this population and guided our efforts in selecting specific activity categories and corresponding activities.

Table 2.

Activity categories and activities discussed in the ACCESS interview study.

Activities outside the home	Activities around the home	Shopping & finances	Transportation	Managing health	Basic daily activities
Doing activities with a group or organization Going to entertainment events Participating in religious services Visiting family and friends Working, volunteering, or participating in other civic activities	Contacting others Doing hobbies at home Housekeeping Noticing alerts Repairing and maintaining home	Applying for financial resources Going shopping in person Managing finances Paying and signing for things Shopping online	Arranging for transportation Driving Flying on airplane Getting a ride from friend or family member Riding train or subway Taking a bus Walking Wayfinding	Accessing health information Caring for others Exercising Getting help in case of an emergency Going to healthcare appointments Managing diet and nutrition Managing medications Monitoring health	Bathing, showering, or grooming Dressing Eating or feeding self Moving around in the home Toileting Transferring

Note. ACCESS = Aging Concerns, Challenges, and Everyday Solution Strategies.

Participants were first asked to rate their perceived level of difficulty performing each activity on a 3-point scale (1 = not at all difficult, 2 = a little difficult, 3 = very difficult, or N/A = not applicable). For the activity or activities identified as most difficult, participants were asked follow-up, open-ended questions about the specific aspect of the activity that created the most challenge, followed by how they handled that challenge, including utilizing tools/technologies, coming up with their own strategies, or obtaining assistance from others (Table 3). The rating scale was first created and pilot-tested with the mobility and vision groups within the larger ACCESS study. The feasibility results were positive, following which we successfully pilot-tested with two older Deaf adults and adopted the scale for the Deaf participants.

Table 3.

Follow-up questions for activity/activities rated most difficult.

Follow-up challenge question	Follow-up response to challenge questions
1. Thinking about [insert most difficult activity], what aspect or part of this creates the most challenges for you?	How do you handle this challenge? Do you use any sort of devices, tools, or technologies to help you with this (task/activity)? Do you use any of your own methods or things you came up with to help you do that (task/activity)? Do you get help from anyone (e.g., services, care-providers, family members) to do that (task/activity)?

The video-call interviews, displaying both Interviewer and Participant, were screen-recorded and then translated from ASL into English text transcripts using one of two methods. In the first method, English voicing translations (recorded as audio files) of the interview were conducted by three hearing, native ASL signers and one hearing near-native signer, all certified sign language interpreters. For each translator, the accuracy of their first few completed translation audio files was fully checked by one of the coauthors, a hearing native ASL signer and (retired) certified sign language interpreter. Once a translator was verified as highly accurate, their later translations were only spot-checked by the same co-author. Translators flagged any ASL expressions where they had low confidence in their translations, and these were reviewed and clarified by the co-author. The audio files of the voicing translations, consisting of ASL-to-English translations for both the interviewer and participants, were then transcribed by a research assistant into text and checked by a second research assistant for accuracy. Forty-five transcripts were transcribed using this method.

The second method entailed direct translation of ASL to English-typed text by two Deaf native signers who were fluent in English and ASL. These transcripts were checked for accuracy by the same co-author (initial translations were fully reviewed; later translations were spot-checked). Fifteen transcripts were transcribed using direct translation from ASL to English typed text.

Data analysis

Development of the coding scheme

We conducted a content analysis (Erlingsson & Brysiewicz, 2012; Vaismoradi & Snelgrove, 2019) with four members of the research team using both inductive (Elo & Kyngas, 2008) and deductive (Preusse et al., 2016; Rogers et al., 1998) approaches. We iteratively developed a coding scheme that included challenge codes, subcodes, definitions, and example participant quotes. As a starting point, we used the coding scheme developed for the mobility/vision groups of the ACCESS study (Koon et al., 2020; Remillard et al., 2023). This coding scheme was then iteratively modified to capture the unique themes of challenges and responses of the older Deaf adults that emerged from the data. Transcripts from the Deaf group were unique in that, even though participants reported some activities to be “not difficult” (e.g., “Do you have any difficulty with managing your health, such as getting access to health information, or contacting Medicare/Medicaid, or your insurance?”), they often replied with strategies that allowed them to perform said activity with ease (e.g., “Not at all difficult because our insurance coverage¹ provides an interpreter. We have a Video Remote Interpreter system”). Thus, in addition to responses for the “most difficult” activity, such information-rich segments were included when coding the transcripts. The coding scheme was discussed and revised with the entire research team until a consensus was reached.

Subsequently, transcripts were coded using the MAXQDA qualitative software (VERBI Software, 2022). Two research team members coded three sample transcripts until independent coding reliability and agreement were met (r = 0.75). This process was then repeated for three additional sample transcripts to ensure reliability across coders. As needed, the team modified definitions and added examples to improve the clarity of the coding scheme. A third researcher, who had experience with qualitative data analysis and was trained on the procedures, was brought onto the team to assist with transcriptions. Any discrepancies were discussed, and the coding scheme definitions and examples were edited until the reliability of the third coder was ensured (r = 0.75). Subsequently, each transcript (n = 60) was randomly assigned to one of the three coding team members and coded independently. We used a less stringent inter-rater agreement threshold of 75% based on the greater variability observed in the transcripts of the Deaf group.

Final coding scheme

The coding scheme for the Deaf group was modified based on the coding scheme utilized for the mobility (Koon et al., 2020) and vision (Remillard et al., 2023) groups to ensure that we captured the unique challenges and response strategies reported by the Deaf participants. The resultant coding scheme included additional challenge codes to reflect barriers to accessing interpreters and the unique response strategies reported by participants, including self-advocacy, self-regulation, and seeking assistance from organizations/agencies to address challenges. See Table 4 for the final coding scheme and Supplementary Tables 1 and 2 for the complete coding scheme that includes challenge and response codes, subcodes, definitions, and illustrative example quotes.

Table 4.

Codes and subcodes for challenges and responses to challenges.

Codes	Subcodes (if applicable)
Challenges
Accessibility	Access to assistive devices
	Access to information
	Access to interpreter
	Physical access
	General
	Other
Assistance from others
Auditory limitations
Can’t do/don’t do the task
Cognitive/knowledge limitations
Communication challenges
Emotional/social challenges
Environmental challenges
Other challenges
Physical limitations	General health limitations
	Physical strength/endurance limitations
	Mobility limitations
Safety/pain/physical injury
Tools/technology challenges	Ease of use/complexity
	Features
	Reliability
	General
	Other
Transferring
Transportation challenges	Not accessible
	Not available
	General
	Other
Visual limitations
Responses to challenges
Devices, tools, and technology	Use tools, technology
	Don’t use tools, technology
Own methods	Home modification
	Perseverance/patience/assertiveness/self-advocacy
	Planning ahead/prioritizing
	Redesign/unconventional use
	Relying on familiarity, organization, learning, repetition, experience, and self-regulation
	Negative emotional response
Assistance from others	Gets assistance/outsource
	Does not get assistance
Previous, proposed, or other person’s response to challenge
Task not done

Application of the coding scheme

The coding scheme was applied to segments, including participants’ responses to the follow-up questions (Table 3), once the most difficult activity within each of the six activity categories was identified. Analyses explored frequency counts for the most common challenge and response codes across activities and the identification of themes related to the challenges and response strategies.

Confirmation of findings with community experts

As a final step, consistent with a community-engaged research paradigm (Ross et al., 2010; Singleton et al., 2014), we met with three Deaf older adults who are active members of the Deaf community and who held unique roles in this project: two served as our interviewers and one as a community advisor. At separate meetings with each, we reported our summarized findings, including our interpretation of thematic patterns, and asked them to share their reflections. They generally concurred with our findings but added several excellent suggestions for framing the thematic observations. In addition, the two community experts who had conducted some of our interviews provided further validation that our thematic findings aligned authentically with their memories of the experiences reported by the older Deaf interviewees. Additionally, all three confirmed that despite the elapsed time since the interviews (approximately four years), the challenges identified persist as ongoing issues for older Deaf adults.

Results

Broadly, we first acknowledge that although our older Deaf participants mentioned difficulties with everyday activities, many reported having no difficulties, often because they used adaptive solutions to mitigate their challenges. This finding suggests an overall resilience of the older Deaf community as they age with deafness. The information-rich data segments include those that documented the resiliency of older Deaf adults in being adaptive. As such, our results section provides a rich summary of the challenges and solutions, including depth of responses even when activities were deemed not difficult.

We first present the frequencies of challenges and response strategies for all activity categories. We then discuss the challenge and response themes commonly noticed across the top four most discussed activity categories and present illustrative quotes from participants.

Challenges

Including data from all participants and across all six activity categories, we coded a total of 555 challenges. In descending order of frequency, participants reported most difficulties related to Transportation (24.8%), followed by Activities Outside the Home (24.3%), Things Around the Home (22.5%), and Managing Health (16.0%). Less frequently mentioned but still notable were challenges associated with Shopping and Finances (7.2%) and Basic Daily Activities (5%).

Across all six activity categories, we identified three primary challenge themes. Technology challenges were highest, accounting for 20.1%. Communication challenges followed, representing 12.2%, and Accessibility challenges comprised 10%. Below, we provide a detailed overview of these themes, focusing on the top four most frequently discussed activity categories. See Table 5 for themes and representative quotes.

Table 5.

Challenge and response themes with representative quotes.

Challenge	Challenge themes and representative ouotes	Response themes and representative quotes
Things around the home	Technology barriers “The sonic thing for the doorbell which makes lights blink, that breaks a lot” “My doorbell light does not work” Accessibility issues “It is the batteries that go with the fire alarm. In the house, hearing people have all those things. Apparently when it beeps, it means you have got to change it or something. I am not sure how often you have to do” “If the lights go out, if there’s an emergency like a tornado, how would I know?” Communication issues “I will ask my neighbor…I knock on their door and ask them what happened with the power”	Uses devices/tools/technology “I just have to use the pager, text message, or my [tablet name]” “I have a computer…videophone is easy. I use email through the computer” Gets assistance from others “I would rather be able to call for an interpreter” “I have had trouble with my car, and my children would interpret for me on those kinds of things” Own methods “I will just leave the door open [to notice if someone is at the door]” “I keep checking the video phone to see if I missed a call”
Transportation	Technology barriers “I struggle to understand how [navigation app name] works” “There are kiosks with a list of numbers to different hotels [at airports]. I cannot call them with TTYs” Communication accessibility “At the airport, it is not easy to use the system of calling (for the hotel) transportation from the telephone” “It can be difficult to book with [vacation/home rental company name]…they [rental staff] get shocked when I get there, and I am Deaf” Poor information accessibility issues “I wish that all the train stations and airports used a display… some sort of visual way of announcing” “There is no visual information [at airports], and so that is frustrating”	Uses devices/tools/technology “I use GPS. So, that is not an issue” “I can use the videophone” Own methods, persevering/self-advocating “With [rideshare] communication issues…it is easy to get in touch with them and become an advocate for the Deaf community…I am not giving up” “I will tell them [airport staff] that I am Deaf, and I point to my card [which says I am Deaf]” Gets assistance from others “I have to go to the concierge desk or information desk and ask them to call for me” “Sometimes people have a [smartphone], and I ask them if they mind calling [for a taxi]”
Activities outside the home	Accessibility issues “I have a golf cart, but I wanted to go to this safety course for golf carts, but they wouldn’t provide an interpreter, so I was really frustrated” “When I asked for closed captions, they said no. They need to meet the federal law, but they do not care, know nothing about the law, and have no reason for training if they are out in the country. I will have to go to a bigger town, where people already made CC known” Communicating issues “I just kind of sit there [on vacation with family and friends] and be quiet. I do not really feel involved" “For going outside…I have difficulties with the hearing community…. because a lot of people do not know how to communicate with me, and they kind of stay away and withhold their communication”	Uses devices/tools/technology “I will chat on the video phone with friends to keep me company” “We have an office communicator; that is awesome. I mean, it is like IMs, we do have that where I can talk” Gets assistance from others “I would use my husband sometimes [to help communication with family]” Yeah, my sister-in-law will interpret for me sometimes” Own methods, perseverance/self-advocating “Finally, after advocating, I got two interpreters. They were alternating on Sundays, so it is a lot better, and I have been going to services” “I tell the theater, please do this…I fill out a complaint form. I do not yell at them; I try to educate them on the problem”
Managing Health	Accessibility issues “The neurologist had a nurse, who was still learning how to sign, and when she asked him how to sign this, it was a red flag for me” “I feel like I am left out [at exercise class/gyms] because they find out I’m Deaf” Communication issues “Well, if everyone’s all lined up, and the instructor is talking and shouting out instructions, I have to follow along with the people who are next to me, and it can be really confusing and challenging and hard to keep up with the class” “If something happens to a friend/family member, and I am not able to respond… I would worry. It scares me… If I would just be able to punch something in my phone, would there be an interpreter, or would I have to wait for an interpreter and inform, “I am Deaf? Let us use this phone to communicate” … communication is always these ifs, you know?” Technology barriers “Yeah, with Video-Remote Interpreting, there are always technical issues” “I use [health insurance name], and they are providing a new video-remote interpreter… they had difficulty moving the laptop to check for my eyes… They just dropped it, and they had to wait for a real interpreter to come and show up. Also, sometimes it gets blurry, and I cannot see the interpreter on the screen”	Uses devices/tools/technology “Videophone has 911, and I can text a neighbor for help” “I Google a lot for answers to questions" Gets assistance from others “There is always an interpreter there. Every place I go, making these appointments” “I have talked to police and Emergency Medical Services [EMS] and set it up, so they know that we are Deaf. The dog also lets them [EMS] know [that I am Deaf], so they were able to take me to the hospital” Own methods, Self-advocating “I had to communicate by just doing a thumbs up or a thumbs down to the doctor” “When it comes to meetings [talking in context of taking care of others] I definitely requested an interpreter. If there were any meetings must have an interpreter”

Technology challenges

Technology challenges were reported for various activities, including contacting others, noticing alerts, repair work in and around the home, and wayfinding activities. A common technology challenge stemmed from the physical size of the device or its features, which, when coupled with aging-related complications, such as vision and dexterity challenges, worsened the utility of the device. Additionally, challenges with the overall utility of the technology in activity engagement were also noted. For instance, one participant reported, “Texting is difficult for me because it [the phone] is very small to type,” and another commented, “I had difficulty reading GPS because I have a [smartphone name], and it is tiny my eyes are not great, plus I am Deaf, so a bigger screen is perfect.” Technology-related challenges were also related to a lack of useful features or changes in technology features, which were commonly reported in the context of noticing alerts at home, as evidenced by this quote, “We do not have a light-flashing fire alarm.” Finally, issues related to technology reliability (i.e., how well the technology works), were commonly observed for transportation and healthcare-related activities, particularly flying and emergency assistance. As one participant noted, “Some airports still have Teletypewriters (TTYs) but do not work,” and another stated, “I was trying to reach 911 directly so they could come quickly, but I wasted 10 minutes trying to use video relay [which connects to 911].” Our study findings highlight that technology challenges, ranging from device size to technology reliability, pose significant barriers to engagement in various daily activities for those aging with deafness. Of these, difficulties from the physical size of devices seem to compound with other aging-related challenges, such as vision and dexterity issues.

Communication barriers

Barriers were often reported for communicating with hearing nonsigners during various activities. For instance, participants reported challenges with exercising and seeking help in emergencies, as noted through these participant responses, “A [gym] trainer is no help because they turn around and walk away. They lack motivation to work with people who are Deaf,” “Communication was very difficult. They [police officers] were not expecting a Deaf person in the house. It would be nice to always have an interpreter with the police.” Similar communication barriers were noted while engaging in social activities, particularly while visiting family/friends. As one individual said, “I know my family loves me, but they do not realize that ASL is important for me to understand what is going on. They will just nod and are slow with ASL.” Also, communication barriers were closely related to technology issues. Specifically, in the context of arranging for transportation, one participant reported, “The [rideshare name] drivers tend to call, and I wish they would text because they cannot know if someone is Deaf or not. [And] because they could not find me, I got a five-dollar charge.” This example further highlights the potential financial implications of communication challenges experienced by older Deaf adults. In general, findings revealed similar communication barriers as have been previously noted in Deaf individuals, including younger adults. These findings underscore the pervasive impact of communication barriers across various activities of daily life, including in older age, highlighting the need to provide better communication support to Deaf individuals in everyday interactions.

Accessibility challenges

Participants reported varying accessibility-related challenges. Specifically, lack of access to qualified interpreters was commonly reported for attending healthcare appointments and participating in social events (e.g., volunteering, religious services). These accessibility issues often resulted in limitations to social participation, as one participant explained, “It is difficult to volunteer; I have to see if I can get someone to interpret,”. Similarly, another participant shared, “I have to go to theaters where there are more Deaf people,” highlighting the additional effort required to access inclusive social environments. Many participants reported inconsistent provision of interpreters in the context of healthcare appointments, as shared by one participant, “I went to physical therapy, they provided an interpreter initially, later they did not.” Other concerns were related to poor technology accessibility for activities inside the home, such as noticing alerts or contacting others, as evidenced by one participant’s response, “There are no Deaf friendly alarms,” whereas another mentioned, “There are no captions and no phone numbers that I can use to call the Videophone, so the relay service interprets a speaker. I miss out on the speech. I wish I had full accessibility to everything.” Poor accessibility to transportation-related information was also frequently reported, particularly in the context of air travel. One participant described a specific challenge, stating, “A flight delay… It is hard for me to find out what is going on, and I have to go up [to the airport personnel] and be assertive and ask. I have to tell them, remember I am Deaf, please let me know!”. In summary, our findings showcase the various accessibility issues, including information, technology, and interpreting services, experienced by older Deaf individuals in everyday activities. These findings did not point towards exacerbated accessibility issues due to general age-related issues but did highlight the continued accessibility issues experienced by these individuals over time.

Response themes

Including data from all participants and across all six activity categories, we coded a total of 1,009 responses to challenges (e.g., strategies or solutions). In descending order of frequency, strategy use was most common for Things Around the Home (24.7%), followed by Transportation (22.6%), Activities Outside the Home (22.2.%), and Managing Health (17.5%). Solutions were less frequently mentioned for Shopping and Finances (7.8%) and Basic Daily Activities (4.9%).

Across all six activity categories, we identified three primary response themes. Using one’s own method was the most common, representing 36.3% of all solutions discussed. This was followed by seeking assistance from family members or outsourcing help from organizations, contributing 27.3%, and using devices, tools, or technologies, which comprised 26.7%. Below, we provide a detailed discussion of these three response themes, focusing on the top four most frequently discussed activity categories. See Table 5 for the themes and representative quotes.

Using own methods

We defined own methods as a strategy that the participants themselves reported, which was not captured by other codes. Many reported using specific methods to navigate various everyday challenges. For instance, to improve their ability to notice alerts at home, one reported leaving their front door open or consistently checking the front door for visitors, whereas another relied on multiple light-flashing alarms. Written communication was another common strategy, as one participant explained, “I go to [SilverSneakers] and I am the only Deaf person in that group. I make it by writing on paper, but it would be nice to have interpreters to make it more accessible”; another described using this strategy when traveling, “I actually take my ticket up to the [airplane gate] counter, and they write it [the gate change] down.”

Participants reported persevering, displaying patience, and advocating for their needs as solutions to activity challenges. One participant described their approach to addressing accessibility issues at the theater, stating, “I make them [the theatre] give me credit, a coupon to come again, and I fill out a complaint form. I tell the theater to please do this, please do this.” Similarly, another participant shared their experience at the airport, explaining, “I just went right up to the front desk [at airport] and said, ‘What is going on?’ and asked them questions [about gate change announcement]. I will not give up.” These findings illustrate the resourcefulness of older Deaf adults in developing and implementing their own strategies to navigate activity challenges as well as the evident pattern of self-advocacy.

Getting assistance from others/outsourcing

Participants reported using assistance when communicating with others, noticing alerts, and repairing or maintaining the home. For example, one participant requested family members’ assistance with interpreting, “I have had trouble with my car, and my children would interpret for me on those kinds of things.” Another asked for assistance with changing alarm batteries, “When I wonder if I need to change batteries in the fire alarms, I call them [my hearing friends] and ask them to check.” Some also relied on assistance from pets. For example, one participant explained, “My dog barks and [comes to] get me when the phone rings.” Additionally, participants requested assistance from nonfamily members for transportation-related activities such as flying on an airplane, driving, and arranging for transportation, as one mentioned, “I have to go to the concierge desk or information desk and ask them [airport personnel] to call for me.” Moreover, some reported requesting assistance from agencies/organizations, such as using the Sorenson Relay service for emergency help. Similarly, participants mentioned frequently using rideshare services for transportation arrangements instead of asking for a ride from family members/friends, as was common in the past. In summary, older Deaf adults leveraged various support systems ranging from personal networks to specialized organizations to navigate daily challenges. Overall, these findings did not allude to specific aging-related concerns that worsen accessibility issues but predominantly indicated the continuity of accessibility concerns that older Deaf individuals experience.

Devices/tools/technology

Participants frequently employed devices, tools, and technology to support their daily activities, spanning a variety of contexts. At home, these solutions were used to contact others and notice alerts; e.g., one participant shared, “I have an alert master, which has a phone, clock, and doorbell signaler [that notifies me visually].” Outside the home, technology facilitated tasks such as working, volunteering, and attending entertainment events, often influencing venue choices, as one participant stated, “It is nice to have captioning glasses at the movies. I go where they provide captions.” Transportation-related activities also benefited from technology, with participants using GPS for wayfinding and rideshare applications for arranging transportation. Additionally, health management often involved device use, from accessing emergency help to receiving appointment reminders, as one participant noted, “The doctor sends me a text reminder so I can get to the appointment when I am supposed to.” Overall, our findings suggest the widespread use of devices, tools, and technology by older Deaf adults to enhance the functionality of tasks across diverse areas of daily living.

Discussion

With rising aging prevalence, the number of older adults aging with long-term deafness is expected to grow. Whether their challenges mirror those of younger Deaf individuals or whether they have unique needs is less known. We explored activity-specific challenges and subsequent response strategies to address the challenges experienced by adults aging with deafness. Broadly speaking, our findings mirror those found in younger and middle-aged Deaf individuals, suggesting the ubiquitous nature of challenges faced by Deaf individuals. We did find that a few concomitant aging-related challenges compounded the effects of deafness, and we discuss these nuances below. Overall, our qualitative approach enabled us to gain a deep understanding of how older adults with extensive lived experiences as Deaf individuals face challenges in everyday activities and the solutions they have developed over their lifetimes. These findings can help inform future research that considers the needs of this growing population.

Challenges

Everyday challenges were most frequently linked to difficulties with technology use, often from a lack of assistive technology features, such as flashing lights for smoke alarms or captioning services. When these technologies were available, they were functionally unreliable at times. These findings are not surprising and align with extant literature, which has long documented technology barriers for Deaf individuals (Maiorana-Basas & Pagliaro, 2014; Rivas Velarde et al., 2022), especially younger and middle-aged Deaf individuals. Our findings expanded on this work by highlighting similar challenges in older Deaf adults in daily activities while also providing valuable context to better understand these struggles. Furthermore, our findings indicated a unique technology challenge specific to this population. Namely, smaller device sizes (e.g., smaller smartphone models) have complicated technology use for older Deaf individuals, given aging-related vision and dexterity issues, indicating more pronounced technology barriers than younger Deaf adults. This finding aligns with emerging research (Debevc & Peljhan, 2004; Rodríguez-Correa et al., 2023) that highlights a continued lack of emphasis on visual elements in technology design for this population. Future technology design could benefit from a universal approach that accommodates the needs of older Deaf adults, enabling easier participation in daily activities (Sanford, 2012).

Communication accessibility was a persistent barrier for our study participants. Challenges included inconsistent access to qualified interpreters, assistive technology, and public information across various public sectors such as healthcare, transportation, and recreation. These findings align with prior research documenting similar communication concerns, particularly in healthcare and public transportation for Deaf individuals (Beaver & Carty, 2021; Lee et al., 2019). Considering that previous studies primarily focused on younger participants, our findings extended this work by highlighting similar challenges faced by older Deaf adults in everyday activities in public sectors. However, communication challenges also extended to personal spaces (e.g., own or family/friends’ homes). This was primarily related to hearing family/friends lacking fluent ASL skills or the willingness to learn it. Not surprisingly, some participants resorted to reduced engagement in family activities. Although similar findings have been reported in younger Deaf adults (Crowe, 2019; Murray et al., 2007), exclusion from social activities may be more detrimental to the well-being of older Deaf adults (Cheung & Zhang, 2023), who are already at greater risk for isolation and depression (Lesch et al., 2019). These risks could be further exacerbated because older adults, even those without disabilities, are vulnerable to social isolation and loneliness (Teo et al., 2023).

Response strategies

Broadly, participants’ solutions focused on the repair of communication challenges. A frequent strategy was developing their own unique methods, often as alternatives to ineffective solutions, such as inaccessibility to interpreters or assistive technology. These unique solutions included writing or using gestures to communicate, as well as persevering and self-advocating for communication accessibility, often during interactions with hearing, non-signing individuals. The use of these alternative communication methods was often reported in public sectors of healthcare, transportation, and recreational services. Our findings, consistent with prior studies (Iturriaga, 2024; Witte & Kuzel, 2000), confirmed the high communication burdens placed on Deaf individuals, including those who are aging.

Requesting assistance from others was another solution frequently used by older Deaf adults in both personal and public spaces. This included informal assistance (e.g., family/friends), formal help (e.g., hiring someone), and outsourcing to organizations (e.g., VideoRelay Services). Although these findings are positive, in that older Deaf adults can and do ask for help, they showcased their significant reliance on hearing family/friends. Our findings show that Deaf individuals’ dependence on others, as documented in other studies (Moroe & De Andrade, 2018; Steinberg et al., 2006), continues into old age, affecting activities both within and outside their homes. Moreover, we found that older Deaf individuals relied on their pets, especially with inconsistent/unreliable technology, contributing to emerging research on the benefits of service dogs for Deaf individuals (Hall et al., 2017; Rintala, 2008).

Participants reported using a wide array of devices, tools, or technologies, including mainstream technologies and assistive technologies. Given that unreliable technology often posed a barrier, older Deaf adults typically used technology for everyday activities when it functioned properly. This aligns with previous research highlighting the Deaf community’s use of well-designed, new technology (Maiorana-Basas & Pagliaro, 2014; Miguel-Cruz et al., 2019; Rivas Velarde et al., 2022), including emerging studies on older members of the U.S. Deaf community (Singleton et al., 2019). Our findings contribute to this growing body of work. Additionally, our work highlights that the stability and reliability of technologies are crucial for benefiting older Deaf adults, and this should be considered in future technology designs.

To summarize, we found that older Deaf adults experienced technology, accessibility, and communication challenges in everyday life. Their reported challenges were quite similar to those reported by younger and middle-aged Deaf individuals, indicating the pervasive and enduring nature of these difficulties across the life span. We observed a few aging-related nuances. One such challenge was in handling smaller technology devices (e.g., small phones), which may disproportionately hinder older Deaf adults relative to younger adults, given other aging-related sensory and physical challenges that may affect the utility of these devices. For instance, one participant mentioned this quote in the context of flying on an airplane “when I was younger, I was much more alert and aware to all the different signs [at an airport], but now with my vision going down in my left eye, I was able to write down and ask for service and help.” Additionally, poor accessibility and communication barriers persist as Deaf adults age, although these do not seem to be related to aging. However, the impact of accessibility and communication challenges, especially in personal settings, may worsen other conditions that older adults are more vulnerable to, such as increased social isolation, as demonstrated through another participant quote in the context of visiting friends/family, “I am an active person, and I dislike doing nothing. Now there are almost no Deaf people here and I become alone…but my age does not stop me.” Finally, older Deaf adults utilized strategies similar to those of their younger counterparts in addressing everyday challenges, including self-­advocacy. However, whether the long-term exposure to everyday barriers leads to greater resilience or, conversely, to cumulative exhaustion among older Deaf adults relative to their younger counterparts remains an open question warranting future research.

Limitations

Demographic factors, such as income, education, and race, can significantly affect how individuals age and perceive disability (Assari, 2019; Courtney-Long et al., 2017; Seeman et al., 2010). Our study participants were predominantly white with relatively high education and income, and as such, they may have possessed greater self-advocacy and technology experience (Wiltshire et al., 2006; Yardi & Bruckman, 2012). These factors may have played a positive role, potentially enabling older Deaf individuals in our study to navigate everyday challenges with greater ease than their counterparts with relatively lower income and/or education. For instance, it is plausible that their relatively higher income provided our older Deaf adults with access to technology, tools, and devices, which helped mitigate daily issues. Additionally, greater educational attainment in younger Deaf individuals has been linked to greater experience with technology (Maiorana-Basas & Pagliaro, 2014), better health (McKee et al., 2014), and greater social participation (Palmer et al., 2020), all of which could have aided in better adaption to, and thus alleviation of, everyday challenges in our older participants. In essence, our sample may have inherently faced fewer aging-related issues and had better access to resources, allowing them to navigate communication, technology, and accessibility challenges in a manner similar to their younger Deaf counterpart. However, we did not examine the influence of various demographic factors and their intersectionality on older Deaf adults’ experiences, and this should be examined in future research. Likewise, future studies with more diverse and representative population samples are needed to validate our findings, and as such, we caution against broad generalization of the current findings.

We exclusively focused on older Deaf ASL users and excluded nonsigners with hearing loss. We acknowledge and understand that education, social histories, and identities of these two groups are distinct. Thus, our findings are not generalizable to all older adults with long-term hearing loss, and we have conducted a parallel study with nonsigners (Kohl et al., 2025). We believe that comparing everyday challenges and solutions across these two groups may provide highly valuable information. Findings from our current and parallel study (Kohl et al., 2025) suggest some similarities in everyday challenges, specifically in communication. Similar to older Deaf signers, non-signing older adults also experience difficulties due to conversation partners relying primarily on verbal communication without adapting to the needs of nonsigners, and assistive technologies (e.g., hearing aids and smartphone captioning applications) not effectively working, and thereby, failing to provide adequate support. However, further analyses are necessary to obtain a comprehensive understanding of the similarities and differences in challenges experienced by older Deaf signers and nonsigners.

Our study is one of the very few that has explored aging and deafness using a community-engaged research design, and as such, replicability of these findings with a similar approach is essential. A broader range of participant backgrounds will be important for understanding general needs.

Implications and recommendations

Our findings can guide future work, focusing on two key areas that could significantly benefit older Deaf adults: (a) enhancing technologies and access to those technologies, and (b) improving communication accessibility to reduce reliance on others. Adopting a universal design approach (Sanford, 2012) when developing new technologies and enhancing the reliability of existing ones could help reduce barriers faced by older Deaf adults. Prioritizing visual elements in technology, such as designing larger devices to address vision challenges and ensuring prominent visual alerts in emergency notifications and public transportation, could be especially beneficial for this population. For instance, technology-enabled “pill reminder devices,” a common need among older adults, often only include auditory alerting functions and thus are rendered nonbeneficial to Deaf older adults. Additionally, it is crucial to not only provide assistive technologies but to ensure their reliable operation, such as ensuring captioning services are available and functioning in public spaces like movie theaters and gyms. Likewise, consistent accessibility to interpreters and information, especially in public spaces such as transportation and healthcare offices, is pertinent to reduce the difficulties faced by older Deaf adults.

Overall, the challenges of those aging with deafness will likely be better solved if the key stakeholders, older Deaf adults, are involved in designing solutions for them (see also the discussion of “Deaf Tech” by Angelini et al. [2025]). Creating effective solutions for this population may benefit not only them but also others, including those with acquired hearing loss and unaffected hearing. This supports the concept of “Deaf Gain,” which emphasizes the contribution of Deaf individuals to human diversity and takes on the “counterintuitive position that all individuals would be enriched by becoming a bit more Deaf” (Bauman & Murray, 2010, p. 222). The lack of awareness about the needs of individuals aging with disabilities is not new, as evident from our previous studies (Koon et al., 2020; Remillard et al., 2023), but the uniqueness of challenges experienced by older Deaf adults seems tied to barriers in communication, accessibility, and technology. To conclude, we hope that the insights and greater awareness of Deaf-centered technologies (see Angelini et al. [2025]), gained from this study of older Deaf adults will benefit future innovations and support intended for all older individuals with hearing loss.

Supplementary Material

Supplementary material is available online at Innovation in Aging (https://academic.oup.com/innovateage)

Author Notes

Although the participant said, “insurance coverage,” medical providers bear the cost of providing sign language interpreters to comply with the Americans with Disabilities Act.

Data Availability

Data are not publicly available. Researchers interested in analyzing the ACCESS data set can contact the study team to explore opportunities for archival analyses in partnership with the research team. Study methods, assessments, and the coding scheme are detailed in technical reports available from the authors. Preregistration is not applicable given the nature of the study.

Funding

This work was supported by the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR; 90REGE0006) under the auspices of the Rehabilitation and Engineering Research Center on Technologies to Support Aging Among People with Long-Term Disabilities (TechSAge; https://techsage.gatech.edu/).

Conflict of Interest

None declared.