Hearing difficulty and cognitive function in socioeconomically disadvantaged older adults in rural China: the roles of IADL limitations, physical exercise, and social support

Hearing difficulty is highly prevalent yet undertreated among socioeconomically disadvantaged older adults (SDOAs) in rural China, who also experience a disproportionate burden of cognitive impairment. This study examines the association between hearing difficulty and cognitive function and explores potential pathways involving instrumental activities of daily living (IADL) limitations, physical exercise, and social support among this underserved population. Cross-sectional data were collected from 312 welfare-recipient older adults in a rural county of Shaanxi Province. Hearing difficulty was assessed using a combined self-reported and interviewer-rated item, supplemented by indicators of severity, duration, and laterality. Cognitive function was measured using the Mini-Mental State Examination (MMSE). Ordinary Least Squares (OLS) and the Ordered Logit Model estimated associations, while Structural Equation Modeling (SEM) assessed pathway patterns. Self-reported and interviewer-observed hearing difficulty affected 33.0% of participants, and 76.0% exhibited moderate-to-severe cognitive impairment (59.0% moderate; 17.0% severe). Hearing difficulty was significantly associated with lower cognitive function in both unadjusted ( \(\:\text{β}\) = -0.221, p < 0.05) and adjusted models ( \(\:\text{β}\text{}\) = -0.162, p < 0.05). The association was generally similar in direction across alternative specifications. SEM suggested that part of the association was statistically related to IADL limitations (17.0% of the total association) and reduced physical exercise (19.5%), whereas social support did not significantly account for the relationship. Hearing difficulty was significantly associated with poorer cognitive function among SDOAs in rural China. Functional limitations and reduced physical exercise were statistically linked to this relationship. Integrating hearing screening with support for daily functioning and community-based physical engagement may help address cognitive vulnerability.