Hearing impairment impacts on the lives of almost half of people over the age of 65. For many people, a hearing aid or other assistive device can enhance communication. However, there is a high rate of dissatisfaction with hearing aids among those who currently use, or have used them in the past. This study of 227 elders with hearing impairment sought to gain a description of their multiple needs relative to demographics, health status physical status, and psychosocial status. Furthermore, we compared along the same dimensions the 227 elders with hearing impairment with 495 frail elders who reported no hearing impairment. We found that hearing-impaired elders are older, have poorer eyesight and have a high level of co-morbidity, especially with arthritis and heart and circulatory conditions. We also found a higher rate of depression among those with hearing impairment. Although hearing aid use increased as the impact of impairment on activity increased, three-quarters of those who reported that hearing impairment had a large impact on daily life did not use a hearing aid. A factor relating to hearing aid use was race; being Caucasian, and living alone. Study participants listed their reasons for dissatisfaction or non-use of their hearing aids and provided suggestions for hearing aid design.