Perceived Hypoacusis and Loneliness: A Longitudinal Between- and Within-Individual Association in Mexican Older...

Hearing loss is highly prevalent among older adults and is associated with negative psychosocial outcomes such as loneliness. Loneliness is a major public health concern due to its links with functional decline, morbidity, and mortality. While international studies have identified associations between hearing loss and loneliness, few examine this relationship longitudinally, particularly in Latin America. Furthermore, little is known about whether these associations arise from structural differences between individuals or from changes within the same individual over time. We conducted a longitudinal observational study using data from the 2015, 2018, and 2021 waves of the Mexican Health and Aging Study (MHAS). The sample included participants aged 60 years and above with complete data on hearing, loneliness, and covariates. Subjective hearing was self-reported and loneliness was measured using the short-form UCLA scale. A hybrid random-effects model was employed to separate between-individual differences from within-individual changes, adjusting for sociodemographic characteristics, health conditions, and functional status. Progressive subjective hearing decline within the same individual was significantly associated with greater loneliness (p < 0.01), independent of socioeconomic and health factors. Between-individual effects lost significance after adjustment, suggesting that cross-sectional differences may be explained by underlying health and social conditions. Functional disability and multiple chronic conditions independently predicted loneliness. Progressive subjective hearing loss was associated with higher loneliness scores, highlighting the importance of valuing patients' self-reported hearing experiences. Findings underscore the need for timely hearing interventions, integrated geriatric assessments, and policies that address sensory health as part of healthy aging strategies.