The Direct and Indirect Effects of Hearing Loss on Loneliness in Older Adults.

Objectives: The objective of this study was to determine if and how hearing loss leads to loneliness in older adults.

Design: We examined data from wave 5 (2013, n = 66.188) and wave 6 (2015, n = 68.186) from the Survey of Health, Ageing and Retirement which is a cross-national panel database of older adults from 27 European countries and Israel. Hearing abilities were self-rated on a 5-point Likert scale ranging from "excellent" to "poor." Analyses included longitudinal models, as well as mediation analysis to examine indirect effects.

Results: Poor hearing was reported by 3.8% of participants. A generalized linear mixed model (GLMM) revealed that participants with poor hearing in wave 5 reported significantly higher loneliness scores in wave 6 compared with those with better hearing (β = 0.509, p < 0.001). Loneliness increased across all hearing ability groups from wave 5 to 6, with a steeper increase for those with poorer hearing. Older age (β = 0.004, p < 0.001) and female gender (β = 0.239, p < 0.001) were also associated with greater loneliness. There was no significant moderating effect of hearing aid use on the relationship between hearing ability and loneliness. Mediation analysis demonstrated a significant direct effect of poor hearing on loneliness (B = 0.109, p < 0.001), as well as significant indirect effects through depressive symptoms (B = -0.043, p < 0.001), functional limitations (B = -0.013, p < 0.001), verbal fluency (B = -0.007, p < 0.001), and self-rated health (B = -0.005, p = 0.006). The total effect of hearing on loneliness, combining direct and indirect effects, was significant (B = 0.042, p < 0.001).

Conclusions: The findings highlight the direct and indirect pathways through which hearing loss contributes to loneliness in older adults. Poor hearing exacerbates functional limitations, depression, and cognitive decline, all of which can further increase the risk of loneliness.