Self-perceived hearing impairment, hearing aid use, and willingness to use hearing aids among older adults in rural China

Despite the substantial health burden posed by hearing impairment (HI) in older adults and although hearing aids are effective interventions, population-level data on hearing aid use remain scarce, and the determinants of willingness to use hearing aids have not been comprehensively elucidated. This study aimed to estimate the prevalence of self-perceived HI, characterize the current status of hearing aid use and explore factors associated with willingness to use hearing aids among older adults in rural China. A cross-sectional analysis of the third wave of the Shandong Rural Elderly Health Cohort (SREHC) was conducted, encompassing 3,201 participants. Self-perceived HI was measured using the Hearing Handicap Inventory for the Elderly-Screening (HHIE-S). Willingness to use hearing aids and associated reasons were self-reported. Logistic regression models were used to identify factors associated with willingness to use hearing aids among older adults. Based on HHIE-S > 8, 28.3% of older adults had self-perceived HI, with an average score of 20.9 among those identified. Among older adults with self-perceived HI, 17.2% expressed a willingness to use hearing aids and 5.6% reported they had used hearing aids. Age (OR = 1.87, 95% CI:1.01–3.47), functional impairment level (Declining functioning: OR = 0.65, 95% CI: 0.42–0.99; Dysfunction: OR = 0.46, 95% CI: 0.25–0.81), and loneliness (OR = 1.49, 95% CI: 1.001–2.23) were significantly associated with willingness to use hearing aids among older adults with self-perceived HI. The top three reasons cited for unwillingness to use hearing aids were lack of a perceived need for hearing aids, unaffordability, and maladaptation to hearing aids. The prevalence and severity of self-perceived HI increased with age, yet the rate of hearing aid use is low. The identified reasons and factors underlying willingness to use hearing aids provide important entry points for intervention research and help address the low treatment rate of hearing loss in the community by targeting key populations.