In the United Kingdom, two and a half million people over 70 are thought to have hearing impairment that would benefit from an aid. Only one-third of these will possess one, and as many as 10 per cent probably never use their aid. Although it is important to examine the relative merits of different aids, there is also a need to look at how audiological services may reduce the unmet need that results from underuse of aids. This review examines the important question of 'what is the most effective way of providing hearing aids for the elderly affected by presbyacusis?' Extensive searching of four electronic databases and hand searching of relevant journals revealed the paucity of evidence to guide audiology practice. In particular there is little consensus on the best outcome measures for evaluating audiological rehabilitation or hearing aid fitting. Audiological services for the elderly are another example of an area where there is a need to fund research and development rather than continue to commission services that are variable and poorly evaluated.