Inclusion Criteria:  being 65 or older Pure-Tone Average (PTA) more than 40 decibel (dB) Hearing Level (HL) and aid users less than half a year living in the community having normal cognitive articulate in the Mandarin Chinese language signing a consent form to participate  Exclusion Criteria:  severe psychiatric disorders acoustic neuroma lead to hearing impairment chronic otitis media lead to hearing impairment