| Objective:The purpose of this study was to understand the current situation of hearing function,psychological factors(depression,anxiety),social factors(social participation,social contact and loneliness)factors and cognitive function in community-based middle-aged and elderly people in Changchun,Jilin Province,to analyze the correlation among hearing function,psychological factors(depression,anxiety)social factors(social participation,social contact and loneliness)factors and cognitive function and the factors influencing cognitive function,and to explore the mediating effects among hearing function,psychological factors(depression,anxiety)social factors(social participation,social contact and loneliness)factors and cognitive function.Methods:This study used a cross-sectional research design to send questionnaires to community-based middle-aged and older adults who met the inclusion criteria in Changchun from December 2021 to June 2022 through a convenience sampling method.The survey instruments included the sociodemographic information questionnaire,Mini-Mental State Examination,the 10-Item Center for Epidemiologic Studies Depression Scale,Self-Rating Anxiety Scale,The short-form of the UCLA Loneliness Scale-8,the Social Participation Index Questionnaire of the National Health Status of the Elderly Population Survey of Peking University,and the Social Contact Assessment Tool.In addition,hearing function was assessed using the Simple Equipment Screening Method.Data were entered using Epidata 3.1,statistical analysis was performed using SPSS 26.0,and mediated effects analysis was performed using Amos 24.0.Results:1.A total of 402 middle-aged and elderly participants were included,of which the proportion of female(53.7%),60 years old and above(67.2%),normal BMI(66.2%),high education level(75.9%),high monthly income(60.0%),and currently married with spouse(67.4%)were higher.In terms of living habits,most participants have no special preference for diet(35.6%)and do not currently drink alcohol(62.7%)or smoke(83.8%).Mild hearing loss had the highest number of participants(38.8%)and severe hearing loss the lowest(11.4%).Most participants said they had never used a hearing aid(80.6%)and had no history of ear disease(62.7%).Participants’ scores for cognitive function,depression,anxiety,loneliness,social engagement and social contact were22.18±5.43,4.82±2.87,53.67±8.67,12.97±2.94,27.58±5.01 and 9.17±2.96,respectively.2.Across age groups,hearing function(P<0.001),cognitive function(P=0.017)and social contact(P=0.043)were significantly lower and anxiety was significantly higher(P=0.013)in older adults compared to middle-aged adults,but for depression,loneliness and social engagement,there were no statistical differences between the two groups.3.There were significant differences in gender(P=0.037),age(P<0.001),education(P<0.001),alcohol consumption(P=0.003),smoking(P=0.022),hearing aid use(P<0.001)and history of ear disease(P=0.007)across hearing function,while BMI,monthly income,marital status and dietary habits were not statistically significant.In terms of psychosocial factors,depression(P=0.045),anxiety(P<0.001)and cognitive function(P=0.003)were significantly different among different hearing functions,while social participation,social contact and loneliness were not statistically different.4.Regarding the interaction of hearing function and sociodemographic information on cognitive function in middle-aged and older adults,age(F=2.809,P=0.039),education(F=5.760,P=0.001),monthly income(F=12.415,P<0.001),smoking(F=3.168,P=0.024),and the use of hearing aids(F= 4.329,P=0.014)all had significant interactions with hearing function,while gender(F=0.380,P=0.767),BMI(F=0.784,P=0.503),marital status(F=0.975,P=0.405),dietary habits(F=1.832,P=0.061),alcohol consumption(F=0.485,P= 0.693)and history of ear disease(F=1.011,P=0.388)did not interact significantly with hearing function.In terms of age,the cognitive function of middle-aged people was significantly stronger than that of elderly people only when hearing function was normal(P=0.022).At the level of education,the cognitive function of participants with severe hearing loss was significantly higher in those with secondary education and above than in those with illiterate education and primary school(P<0.001);In terms of monthly income,there were significant differences in the effects of different monthly income on cognitive function of middle-aged and elderly people with normal hearing or severe hearing loss(P<0.001).In the case of mild hearing loss,there was a statistical difference in the influence of smoking on cognitive function of middle-aged and elderly people(P=0.027).In terms of hearing aids use,participants who had used hearing aids had significantly higher cognitive function at moderate hearing loss than participants who had never used hearing aids(P=0.016).5.Under different cognitive functions,marital status(P=0.003),age(P=0.017),education(P<0.001),dietary habits(P=0.009),and hearing function(P=0.003)were significantly different,whereas gender,BMI,monthly income,alcohol consumption,smoking,hearing aid use,and history of ear disease were not statistically different.Depression(correlation coefficient-0.483,P<0.001),anxiety(correlation coefficient-0.237,P<0.001),social engagement(correlation coefficient 0.349,P<0.001),social contact(correlation coefficient 0.550,P<0.001),and loneliness(correlation coefficient-0.516,P<0.001)were significantly correlated with cognitive function.Social contact,loneliness,anxiety,depression,education and social engagement entered the regression equation and together explained 43.6% of the variance in cognitive function.6.The fit indices of SEM were CMIN/DF=2.160,GFI=0.908,AGFI=0.881,NFI=0.862,IFI=0.921,CFI=0.920,TLI=0.905,and RMSEA=0.054.Hearing function(β=-0.152)did not have a direct effect on cognitive function in middle-aged and older adults,while having an indirect effect on it through the mediating effect of psychosocial factors.Among the psychosocial factors,there were direct of anxiety(β=-0.281)and social engagement(β=0.670)had direct effects on cognitive function,and depression(β=-0.503),social contact(β=0.651)and loneliness(β=-0.445)had indirect effects on cognitive function.Conclusions:1.The importance of hearing function in community-based middle-aged and elderly people should be increased,and those who are male,over 60 years old,with low education level,smoking,drinking alcohol,and have used hearing aids or have a history of ear disease should be considered as the key group,hearing screening and health education should be actively conducted to achieve early diagnosis,early prevention and early treatment.2.Social contact,loneliness,anxiety,depression,education level and social participation are the main influencing factors of cognitive function.We should actively obtain the basic information,psychological and social conditions of middle-aged and elderly people,conduct timely screening of key groups,and intervene from a multidisciplinary perspective to prevent or slow down the decline of cognitive function.3.Healthcare staffs can directly intervene in the hearing function of middle-aged and elderly people,and can also alleviate the negative emotions of middle-aged and elderly people through the mediating effect of psychosocial factors,enrich the content and form of daily activities in the community,encourage middle-aged and elderly people to actively participate in activities and increase the frequency of communication with relatives and friends,thus achieving the effect of delaying the decline of cognitive function.At the same time,health education can be provided to family members to increase their concern for the psychological and physical health of middle-aged and elderly people,and to emphasize the importance of social participation and social contact to jointly maintain the cognitive function health of middle-aged and elderly people. |
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