If your hearing begins to decline, your risk of falling may rise.

Research shows older adults with mild hearing loss are at a greater risk — more than double — of falling. Though it's not exactly clear how hearing loss increases the risk, it's known that falls are the top cause of death from injury among people 65 and older.

Now, new evidence shows that restoring hearing through the use of hearing aids may be protective, especially when people wear them consistently. That's according to a study published this summer in the Journal of the American Geriatrics Society.

"We found, quite significantly, that individuals that wore hearing aids compared to those that didn't, did show a significantly lower prevalence," explains Laura Campos, an audiologist and researcher at UCHealth in Colorado and the study's lead author. "They reported fewer falls," she explains, and their scores on a falls risk questionnaire showed they were at lower risk.

There are other strategies to prevent falls, including exercises to improve strength and balance, which are key risk factors.

As part of the study, Campos and her collaborators surveyed about 300 people with hearing loss about their use of hearing aids and asked about their previous falls. The researchers also accounted for factors that could affect fall risk, such as the use of medication that can cause dizziness.

Overall, people who wore hearing aids had about a 50% reduced odds of experiencing a fall, compared to non-users. And, the reduction was even greater among those who wore hearing aids at least four hours per day. "The effect size is pretty significant," she says. These consistent hearing aid users had even lower odds – up to 65% – of falling.

Prior research on whether hearing aids can help prevent falls has led to mixed findings. One challenge is that many people who get hearing aids don't use them every day or stop using them altogether. "A lot of people don't like them," says Catherine Jewett, 67, who started wearing a hearing aid on one ear about four years ago. She has hearing loss caused by Meniere disease.

For some people the sound amplification can be hard to adjust to, Jewett says, and others are self-conscious of how they will look with hearing aids. "Most people see it as a mark of age," she says. Vanity can be a barrier, but Jewett says hers is barely visible and blends in with her hair.

As part of the research, Campos saw an opportunity to tease out the effects of consistent use of hearing aids, since much of the prior research hadn't differentiated between people who wore them a lot, compared to those who wore them less. What the study found is that there's likely a dose-response relationship, meaning the more consistently people wear them, the more benefit they may experience.

One theory to explain the connection between hearing loss and falls, is that we use our hearing to sense what is around us. "Humans can echolocate," Campos explains.

If we close our eyes, we can sense whether we're in a big auditorium compared to a small closet, based on the sound echoing off walls and objects around us. "We have to be able to hear high frequencies to do that well," she explains. So, it makes sense that restoring hearing can be helpful.

Also, people with hearing loss must work harder to piece together conversation. They often rely on linguistic knowledge and contextual clues to fill in words they didn't hear. "That uses a lot more resources," and can be taxing, Campos explains. As a result, she says people are left with "less cognitive resources," to navigate their surroundings. So, perhaps they don't notice a step or a fall hazard until it's too late.

It's also possible that a fall risk is linked to a decline of the vestibular system of the inner ear, which is very important for balance. "One hypothesis for connecting hearing loss and falls is that perhaps hearing loss is serving almost as a proxy for reduced vestibular function," explains Erin Piker, an audiologist and director of the Vestibular Sciences Laboratory at James Madison University. So when it's not working well, falls can be more likely.

Multiple factors may help explain the relationship between the risk of falling and hearing loss.

"We still have more work to do to understand this underlying mechanism," Campos says. But she's pleased when she sees patients benefiting from hearing aids.

Jewett says she feels safer when she wears her hearing aid since she can hear the sounds of a car, for instance, if she's crossing a street. "A hearing aid has just made a massive amount of difference in my life," she says.

And she's more stable on her feet. "It improves my balance," she says. "It's a huge benefit."