Association between subjective hearing difficulty and cognitive impairment among community-dwelling older adults: A secondary analysis of the 2023 National Survey of Older Koreans.

PURPOSE: Age-related hearing loss (ARHL) is a significant public health concern affecting older adults' health. Although its association with cognitive impairment is increasingly recognized, evidence among South Korean older adults remains limited. This study examined the association between subjective hearing difficulty and cognitive impairment and factors associated with cognitive impairment according to subjective hearing difficulty status. METHODS: This secondary analysis used data from the 2023 National Survey of Older Koreans, including 7,419 participants. The main variables were subjective hearing difficulty and cognitive impairment; complex-sample multivariable logistic regression analyses were conducted. RESULTS: Of the 7,419 participants, 20.1% reported subjective hearing difficulty. Among these, only 13.1% had been diagnosed with ARHL and 26.3% used hearing aids. Subjective hearing difficulty was associated with higher odds of cognitive impairment (odds ratio [OR]=1.50, 95% confidence interval [CI]=1.26~1.80, p<.001), whereas hearing aid use was associated with lower odds (OR=0.65, 95% CI=0.49~0.86, p=.003). Factors associated with cognitive impairment differed by subjective hearing difficulty status. Sociodemographic and health-related factors were associated with cognitive impairment in both groups, whereas lifestyle factors were associated only among those without subjective hearing difficulty, and depression and hearing aid use only among those with subjective hearing difficulty. CONCLUSION: Subjective hearing difficulty may serve as an important screening indicator for cognitive impairment, supporting the need for management strategies tailored to subjective hearing difficulty status. The low rates of ARHL diagnosis and hearing aid use among those with subjective hearing difficulty highlight the need to strengthen linkages to hearing healthcare services to support cognitive health in this population.