School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China.
WHO Collaborating Centre for Community Health Services, School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China.
Int J Geriatr Psychiatry. 2023 Aug;38(8):e5982. doi: 10.1002/gps.5982.
Age-related hearing loss (ARHL) is the third leading cause of years lived with disability. Connections among ARHL, depressive symptoms, social engagement and cognitive status are increasingly reported but the underlying mechanisms leading to these relationships are largely unknown. Exploring these mechanisms is a worthy goal, especially in older adults. This study aimed to examine the mediating effect of social engagement and depressive symptoms on the relationship between ARHL and cognitive status.
Structural equation modeling (SEM) with path analysis were performed with data from a cross-sectional study conducted in 11 community centers in 2021, which assessed older adults' intrinsic and sensory capacities using the WHO ICOPE framework. Demographic information, health profile, a binary measure of hearing capacity, depressive symptoms, social engagement, and cognitive status of participants were gathered.
A total of 304 participants were included. ARHL was positively associated with depressive symptoms (β = 0.18, p = 0.009) and negatively related to social engagement (β = -0.13, p = 0.026). Social engagement was positively associated with cognitive status (β = 0.17, p = 0.005) and negatively associated with depressive symptoms (β = -0.23, p < 0.001). Greater depressive symptoms were negatively associated with the participants' cognition (β = -0.13, p = 0.009). Both social engagement (β = -0.02, p = 0.029) and depressive symptoms (β = -0.02, p = 0.032) mediated the negative associations between ARHL and cognitive status.
Addressing hearing loss, depressive symptoms, and enhancing social engagement should be investigated as a potential means of minimizing cognitive decline. Well-designed studies are needed to comprehensively inform the clinical practice development, particularly large prospective studies that will facilitate further elucidate possible causal mechanisms behind these observed associations.
与年龄相关的听力损失（ARHL）是导致伤残调整生命年的第三大原因。ARHL、抑郁症状、社会参与和认知状态之间的联系越来越多，但导致这些关系的潜在机制在很大程度上尚不清楚。探索这些机制是一个有价值的目标，尤其是在老年人中。本研究旨在探讨社会参与和抑郁症状在 ARHL 与认知状态之间的关系中的中介作用。
使用 2021 年在 11 个社区中心进行的横断面研究的数据，采用结构方程模型（SEM）进行路径分析，该研究使用世界卫生组织 ICOPE 框架评估老年人的内在和感觉能力。收集参与者的人口统计学信息、健康状况、听力能力的二分测量、抑郁症状、社会参与和认知状态。
共纳入 304 名参与者。ARHL 与抑郁症状呈正相关（β=0.18，p=0.009），与社会参与呈负相关（β=-0.13，p=0.026）。社会参与与认知状态呈正相关（β=0.17，p=0.005），与抑郁症状呈负相关（β=-0.23，p<0.001）。更多的抑郁症状与参与者的认知能力呈负相关（β=-0.13，p=0.009）。社会参与（β=-0.02，p=0.029）和抑郁症状（β=-0.02，p=0.032）都介导了 ARHL 与认知状态之间的负相关关系。
应将听力损失、抑郁症状和增强社会参与作为最小化认知衰退的潜在手段进行研究。需要进行精心设计的研究，以全面为临床实践的发展提供信息，特别是需要进行大型前瞻性研究，以进一步阐明这些观察到的关联背后可能的因果机制。
