Social engagement and depressive symptoms mediate the relationship between age-related hearing loss and cognitive status

Background and Objectives: 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. Methods: 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. Results: 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. Conclusions: 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.