Prof Dr Tan Maw Pin’s recent statement on behalf of Dementia Alliance of Malaysia (DAMAI), Alzheimer’s Disease Foundation Malaysia (ADFM), Johor Bahru Alzheimer’s Disease Support Association (JOBADA), Dementia Society Perak, and Penang Dementia Association is a vital call to action.
As we confront the NHMS 2025 findings that 10 per cent of our elderly population is living with dementia, we must acknowledge that audiology is not just a peripheral service. It is a core component of the risk.
According to the 2024 Lancet Commission, untreated hearing loss is the largest modifiable risk factor for dementia, accounting for roughly 8% of cases globally.
Yet, in Malaysia, our elderly are preyed upon by an unregulated audiology market that prioritises retail markups over clinical science.
The Clinical Reality: Best Practice Vs The Bare Minimum
We must acknowledge that a hearing aid is a medical treatment, not a consumer electronic. However, audiology in Malaysia often operates at a “bare minimum” level that fails the very patients it claims to help:
- The Omission of Real Ear Measurement (REM): The gold standard for fitting is REM, which uses a probe microphone to verify sound pressure at the eardrum. Most local centers skip this step and rely instead on First Fit software averages.
- The Clinical Failure: Research shows software estimates are inaccurate nearly 70 per cent of the time. Without REM, devices often fail to provide the clarity needed to reduce cognitive load. This mental exhaustion from “guessing” sounds is the primary mechanism that accelerates cognitive decline.
- Speech-in-Noise Testing: Best practice mandates testing the brain’s ability to decode speech in noise. Without this data, a clinician cannot program a device to keep a senior socially engaged, leading to the isolation that fuels dementia.
The Pricing Scandal: A Global Comparison
The cost of hearing technology in Malaysia is unrealistic and predatory. While we advocate for senior citizen rights, we must address the fact that a medical necessity is being priced as a luxury status symbol.
Below is the cost for a pair (two units) of premium Receiver-in-Canal (RIC) technology like Oticon Intent 1.
| Country | Price For A Pair (In RM) | Market Context |
| South Korea | RM13,500 to RM15,000 | Competitive and price-transparent. |
| United Kingdom | RM15,050 to RM18,660 | Standard retail includes professional after care. |
| Malaysia | RM30,000 to RM38,000 | Private retail price in local centres. |
The price of a pair of hearing aids is as much as a Perodua Axia. This price barrier forces the elderly to accept a life of silence, which directly contributes to cognitive decline.
The RIC Shift: The Myth Of Customisation
The industry has shifted to RIC models. These are “instant-fit” devices using interchangeable domes. Unlike old custom-moulded models, they do not require weeks of lab work or physical ear impressions (the “ear plug” moulds).
In a healthy market, this shift should have reduced costs and increased access speed. In Malaysia, however, clinics continue to charge “custom” prices for “off-the-shelf” convenience. They pocket the overhead savings while the elderly pay for manual labour that is no longer performed.
The Failure Of The Safety Net And The OKU Stigma
The current government’s safety net is failing those who cannot afford these RM 30,000 price tags.
- The Stigma of Registration: To access significant Department of Social Welfare (JKM) aid, seniors must often register for OKU (person with disability) status. Many hesitate to adopt this label not because it diminishes their inherent dignity, but because of the deep-rooted ableist discrimination they fear facing as a result.
- The Funding Gap: JPA subsidies are capped at RM 7,000 per pair.
- Entry-Level Only: Schemes like Peka B40 generally only provide basic models. These lack the AI-driven processors required to filter background noise, leaving the senior socially isolated even with a device in their ear.
A Call For Structural Reform
We cannot have an effective National Dementia Action Plan while audiology remains an unregulated retail playground. To support the mission of DAMAI and its partners, we must demand:
- Price Regulation: Implement a price ceiling on RIC hearing devices to bring Malaysian costs in line with global standards.
- Mandatory REM Verification: Ensure any government-funded device is verified using Real Ear Measurement to ensure clinical and cognitive efficacy.
- Dignified Access: Decouple hearing aid subsidies from the rigid OKU registration process. Hearing health is a geriatric priority, not a disability label.
- M40 Support: Expand subsidies to include the sandwich generation, who currently cannot cope with their parents’ health care needs.
The elderly are a vulnerable population being preyed upon by these practices. Those who can afford to pay are being overcharged for under-verified care, while those who cannot afford it simply accept their fate.
If we do not regulate the cost and quality of hearing health today, our health care system will pay a much higher price for dementia wards tomorrow.
The author is a general practitioner (GP) in Melaka.
Editor’s note: The sentence beginning with “the stigma on registration” was amended upon the author’s request.
- This is the personal opinion of the writer or publication and does not necessarily represent the views of CodeBlue.
