Article(id=1322167961809437275, tenantId=1146029695717560320, journalId=1220038315760373764, issueId=1322167871413796899, articleNumber=null, orderNo=null, doi=10.12102/j.issn.1009-6493.2026.03.023, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1740326400000, receivedDateStr=2025-02-24, revisedDate=1762617600000, revisedDateStr=2025-11-09, acceptedDate=null, acceptedDateStr=null, onlineDate=1793159006787, onlineDateStr=2026-10-28, pubDate=1770652800000, pubDateStr=2026-02-10, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1793159006787, onlineIssueDateStr=2026-10-28, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1793159006787, creator=13701087609, updateTime=1793159006787, updator=13701087609, issue=Issue{id=1322167871413796899, tenantId=1146029695717560320, journalId=1220038315760373764, year='2026', volume='40', issue='3', pageStart='353', pageEnd='528', issueExtLink='null', onlineDate='null', pubDate='1770652800000', pubDateStr='2026-02-10', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1793158985236, creator='13701087609', updateTime=1793158985236, updator='13701087609', preIssue=null, nextIssue=null, articleTotal=null, ext=null, issueFiles=null, downloadFileDto=null}, startPage=509, endPage=513, ext={EN=ArticleExt(id=1322167961998180956, articleId=1322167961809437275, tenantId=1146029695717560320, journalId=1220038315760373764, language=EN, title=Research progress on social isolation in elderly patients with hearing impairment, columnId=1220689485315101342, journalTitle=Chinese Nursing Research, columnName=Review Articles, runingTitle=null, highlight=null, articleAbstract=

This study systematically sorted that the epidemiological characteristics,influencing factors and mechanisms of hearing impairment in the elderly,revealed the bidirectional association between hearing impairment and social isolation,and proposed social alienation interventions for elderly patients with hearing impairment.It aimed to provide reference for the social alienation intervention for elderly patients with hearing impairment in China,and to improve their quality of life and sense of well-being.

, authors=Xiangling ZHOU1, Fang WANG2, Huiyu LI3, Xinhua XIE4, Chi ZHANG5, Jiahui DONG1, Li DU1, Yongqi ZHEN3, authorsList=Xiangling ZHOU, Fang WANG, Huiyu LI, Xinhua XIE, Chi ZHANG, Jiahui DONG, Li DU, Yongqi ZHEN, authorCompany=null, correspAuthors=Fang WANG, authorNote=null, correspAuthorsNote=
WANG Fang, E-mail:
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系统梳理老年听力障碍的流行病学特征、影响因素及机制,揭示听力障碍与社会隔离的双向关联现象,提出老年听力障碍病人社会疏离的干预措施。旨在为我国听力障碍老年病人的社会疏离干预提供参考,提高其生命质量和生活幸福感。

, authors=周想玲1, 王芳2, *, *, 李惠玉3, 谢鑫华4, 张驰5, 董嘉慧1, 杜力1, 甄永琪3, authorsList=周想玲, 王芳, 李惠玉, 谢鑫华, 张驰, 董嘉慧, 杜力, 甄永琪, authorCompany=null, correspAuthors=王芳, authorNote=

周想玲,护士,硕士研究生在读

, correspAuthorsNote=
王芳,E-mail:
WANG Fang, E-mail:
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老年听力障碍病人社会隔离的研究进展
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周想玲 1 , 王芳 2, *, * , 李惠玉 3 , 谢鑫华 4 , 张驰 5 , 董嘉慧 1 , 杜力 1 , 甄永琪 3
护理研究 | 科研综述 2026,40(3): 509-513
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护理研究 |科研综述 2026 , 40 (3) : 509 -513
老年听力障碍病人社会隔离的研究进展
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周想玲1, 王芳2, *, * , 李惠玉3, 谢鑫华4, 张驰5, 董嘉慧1, 杜力1, 甄永琪3
作者信息
  • 1南京中医药大学护理学院,江苏 210023
  • 2南京中医药大学附属金陵临床医学院
  • 3东部战区总 医院秦淮院区
  • 4蚌埠医科大学护理学院
  • 5南京大学医学院
通讯作者:
王芳,E-mail:
WANG Fang, E-mail:
作者简介:

周想玲,护士,硕士研究生在读

Research progress on social isolation in elderly patients with hearing impairment
Xiangling ZHOU1, Fang WANG2 , Huiyu LI3, Xinhua XIE4, Chi ZHANG5, Jiahui DONG1, Li DU1, Yongqi ZHEN3
Affiliations
  • 1School of Nursing, Nanjing University of Chinese Medicine, Jiangsu 210023 China
  • 2Jinling Clinical Medical College, Nanjing University of Chinese Medicine
  • 3Qinhuai Medical Treatment Area of General Hospital of Eastern Theater Command PLA
  • 4School of Nursing, Bengbu Medical University
  • 5Medical School of Nanjing University
  • Corresponding Author:
    WANG Fang, E-mail:
出版时间: 2026-02-10 doi: 10.12102/j.issn.1009-6493.2026.03.023
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系统梳理老年听力障碍的流行病学特征、影响因素及机制,揭示听力障碍与社会隔离的双向关联现象,提出老年听力障碍病人社会疏离的干预措施。旨在为我国听力障碍老年病人的社会疏离干预提供参考,提高其生命质量和生活幸福感。

听力障碍  /  社会隔离  /  老年人  /  护理  /  综述

This study systematically sorted that the epidemiological characteristics,influencing factors and mechanisms of hearing impairment in the elderly,revealed the bidirectional association between hearing impairment and social isolation,and proposed social alienation interventions for elderly patients with hearing impairment.It aimed to provide reference for the social alienation intervention for elderly patients with hearing impairment in China,and to improve their quality of life and sense of well-being.

hearing impairment  /  social isolation  /  the elderly  /  nursing  /  review
周想玲, 王芳, 李惠玉, 谢鑫华, 张驰, 董嘉慧, 杜力, 甄永琪. 老年听力障碍病人社会隔离的研究进展. 护理研究, 2026 , 40 (3) : 509 -513 . DOI: 10.12102/j.issn.1009-6493.2026.03.023
Xiangling ZHOU, Fang WANG, Huiyu LI, Xinhua XIE, Chi ZHANG, Jiahui DONG, Li DU, Yongqi ZHEN. Research progress on social isolation in elderly patients with hearing impairment[J]. Chinese Nursing Research, 2026 , 40 (3) : 509 -513 . DOI: 10.12102/j.issn.1009-6493.2026.03.023
自我国进入老龄化社会以来,老年人口规模持续扩大,老龄化程度不断加深。截至2024年底,我国60岁及以上老年人口达22.0%[1]。随着年龄的增长,老年人失能程度逐渐加深,其中听力障碍尤为常见。我国老年人身体状况调查研究显示,约有17.6%的老年人自我报告存在听力障碍,而客观调查发现其听力损失发生率为69%[2],远高于全球听力障碍发生率[3]。听力障碍通常被病人及其家属忽视或认为是无可避免的衰老后果[4],无须进行干预。然而,未经治疗的听力障碍对病人的行动、心理及认知等多方面造成巨大负担。听力障碍会导致沟通能力下降,进而减少病人的社交活动机会和欲望,最终产生社会隔离。老年人社会隔离是指个人缺乏社交归属感,缺乏与他人的互动,社交接触数量极少,并且缺乏充实和高质量的关系[5]。社会隔离不仅加剧了老年人的生理、心理健康问题,还增加了医疗服务资源的使用频率[6]。近年来,国内外关于老年人听力障碍、身心状况和社会疏离之间的内在机制及相互影响展开了大量研究,这些研究为了解老年人听力障碍对生活质量的影响提供了重要依据。现对相关研究进行综述,为进一步探索听力障碍干预策略和改善老年人生活质量提供理论依据。
听力障碍是指人由于各种原因双耳不同程度的永久性听力障碍,听不到或听不清周围环境声音及言语声音,以致影响日常生活和社会参与。老年听力障碍多由年龄相关退行性病变引起,表现为感音神经性聋,且常伴随高频听力下降和言语分辨能力受损[7]。老年群体的听力障碍具有高发性、隐蔽性和复杂性的特点。我国社区老年人听力损失状况调查显示,听力损失率高达69.8%,且以>25 dB为界值,《世界听力报告》中将平均听阈提高至20 dB,以此为准,老年听力损失率将更高[8]。由于听力损失进程缓慢,老年人适应性强,常延迟发现听力障碍情况,7 223例客观测量存在听力损失的人群中,仅有29.3%的老年人主观报告听力下降[9];且老年病人听力障碍不仅涉及感觉器官退化,还与中枢神经系统功能(如认知、情绪调节)衰退相关,如高频听力损失导致语言理解困难,尤其在嘈杂环境中更为明显。
一项对澳大利亚7 442例老年病人的在线调查中,1 274例(17%)病人报告存在听力障碍,研究指出,社会疏离状态与听力障碍严重程度存在正相关关系[10]。美国65岁以上老年人中,18.9%的老年人自我报告患听力障碍,其中28.1%的老年病人报告存在社会隔离[11]。在我国,听力障碍老年病人社会疏离发生率为35.67%[12]。上述研究均表明,有听力障碍的老年病人社会疏离和社会活动的限制性普遍较高,高于正常听力老年人群。听力障碍病人社会隔离的主要表现形式为社交退缩、情感孤立和家庭关系疏远[13]。病人常因听力减退而误解对话内容或沟通困难,尤其是在背景嘈杂环境中,这种误解可能导致他们在社交场合中感到尴尬和矛盾。为了避免这些尴尬和误解,病人可能会主动回避家庭或社会活动,从而减少社交参与。
年龄、文化程度、是否独居以及听力障碍的严重程度等个体因素均会影响老年听力障碍病人社会疏离水平。研究表明,中度以上听力障碍者的社会疏离风险是轻度者的1.09倍[14],当老年听力障碍病人伴有合并症时,如抑郁和认知障碍等情况会与听力损失协同加剧社会隔离。这可能与老年听力障碍病人的认知负荷增加有关,听力障碍越严重,处理退化听觉信号所需的认知资源越多,从而增加了认知负担,认知障碍会导致社交退缩和互动障碍,减少外界活动对大脑的刺激和神经重组,增加病人感知到的社会疏离感[15]。
关于年龄对听力障碍病人的影响,尚未有统一的定论。况莉等[12]研究认为,年龄较小的老年人自身精力更加充沛,社交活动网络更为宽广,社会疏离感更弱;随着年龄的增大,社交网络和朋友网络都逐渐萎缩,与外界活动逐渐减少,社会疏离感更强。Huang等[16]研究表明,听力障碍病人年龄与社会疏离的相关性在60~69岁最强,在70岁以上的人群中的相关性逐渐减弱至0,认为随着时间增长,老年人已经适应听力状况的变化,随着沟通技巧的改变或提高,听力障碍对其社会功能的影响逐渐减弱。这些研究结果可能与研究对象选取的范围和地区不一致,以及确定听力障碍严重程度的方法不同等因素有关。因此,在实际应用中,应综合考虑多种因素,制定针对性的干预措施,以减轻老年听力障碍病人的社会疏离感。
农村地区老年听力障碍病人发生社会疏离的概率高于城市病人。首先,农村地区的医疗保健资源和健康教育信息获取机会较少,导致老年病人出现听力障碍时未能及时接受相关治疗,从而在发现时往往已达到严重程度,影响了病人的沟通能力[17]。其次,农村老龄化问题更为严重,中青年人口大量迁往城市,老年人多以独居或与配偶生活为主,可交流人群进一步减少。此外,农村的公共设施与志愿组织少于发达城市,可参与的社交活动较少,这使得老年人更容易感受到孤独和社会孤立[18]。而在具有完备社会服务的地区,听力障碍老年病人的社会隔离感较弱。听力障碍老年病人倾向参加“听力友好活动”,如提供扩音设备和出行交通支持的宗教活动。扩音设备可以帮助病人更好地听见活动内容,减少听不见的不适感;而拼车或旅行服务则避免了病人因无法开车或不敢乘坐公共交通而导致的出行不便。这些活动通常不需要较强的沟通能力,更方便听力障碍病人参与,并且具有包容性强、节奏舒缓的特点,能够为听力障碍老年病人提供一个低压力的社交环境。
听力障碍在老年病人中较为常见,这一群体对外界刺激的反应往往较为迟缓。这种反应迟钝不仅归因于他们生理上的感知能力下降,还可能受到社会互动中负面体验的影响,例如周围人群对他们沟通困难表现出的不耐烦或排斥态度。这些负面体验可能进一步削弱老年病人参与社交活动的动机,从而减少了他们获得社会联系和支持的积极体验。研究显示,社交活动的减少和愉快体验的缺乏是抑郁症发生和持续的重要因素[19]。因此,对于处于社会隔离状态的听力障碍老年人来说,其心理状况可能会随着时间的推移而逐渐恶化。研究表明,听力障碍并不仅仅是听觉器官的问题,其还与大脑的认知和情绪功能退化紧密相关[20]。此外,听力障碍可能导致一系列心理问题,包括焦虑、孤立和猜疑。由于听力障碍病人需要依赖他人进行日常活动,降低了病人的自我效能感和价值感,进一步加剧了病人心理负担[21]。研究发现,听力障碍是抑郁症状的一个显著负面预测因子,而抑郁症状又通过降低社会参与度间接地对老年人的心理健康产生不利影响[13]。
老年听力障碍病人由于多种生理因素跌倒风险显著增加。首先,听力障碍直接影响病人对外界声音的感知能力,使其难以察觉环境中的危险信号,从而增加了跌倒的风险。其次,随着年龄的增长,前庭功能减退和姿势稳定性下降进一步加剧了平衡功能障碍[22]。研究表明,这些因素的叠加使老年听力障碍病人的跌倒发生率明显高于同龄听力正常人群[23]。跌倒事件对病人的社会参与度产生深远影响。经历过跌倒的病人往往会产生“跌倒恐惧症”,这种心理状态导致其主动减少日常活动范围和频率,进而降低社会接触机会,增加了社会隔离的风险[24]。社会隔离状态的持续又会进一步限制病人获取预防跌倒的相关知识和支持性干预措施的机会,形成恶性循环[25]。这种双向作用机制使得老年听力障碍病人面临的社会隔离和跌倒后果日益严重。
研究表明,听力损伤病人发生认知障碍的概率显著高于听力正常的老年人。听力损伤病人发生认知障碍的风险较听力正常老年人显著升高[26-28]。尽管听力障碍已被证实是认知衰退的独立预测因子,但其作用机制仍存在多维度解释框架,目前常由剥夺假说、资源分配假说和认知负荷感知假说解释。剥夺假说是指长期缺乏听觉输入可能减少大脑整体神经活动,导致广泛性神经连接减弱,导致“用进废退”;资源分配和认知负荷假说则认为听力损失增加大脑处理声音的难度,尤其是在嘈杂环境中,为补偿听觉输入的模糊性,大脑需要调动更多的认知资源(注意力、工作记忆)用于声音解码,导致其他认知任务资源(如记忆、决策)分配不足,这种“认知超载”可能加速整体认知功能的衰退。社会孤立可能是通过代偿性神经反应增加认知障碍的风险,这些反应可能会影响神经退行性疾病的发展。此外,社交孤立通常与不健康的行为有关,例如吸烟、饮酒和缺乏身体活动,这反过来又增加了认知障碍的风险。听力障碍老年病人在双重影响下,其认知功能受到严重影响。
2021年,世界卫生组织(WHO)更新的听力损失分级中提高了正常听力的标准(从25 dB提高到20 dB),细化听力损失分级,表明听力损失对病人日常生活的影响日益严重,有助于更早地发现隐性听力损失,从而采取及时的保护和治疗措施。英国大规模队列研究表明,50岁以上人群接受听力筛查和干预后,5年内社会隔离发生率下降25%[29]。尽早干预老年病人的听力情况,有助于延缓其认知障碍的发生情况。Lin等[30]研究跟踪了1 000例年龄70~84岁之间患有严重听力损失的老年人,随访3年,比较接受及没有接受助听器老年人的认知能力,结果显示,接受助听器的老年病人认知能力下降减少了近50%。80.8%的听力障碍病人经干预后社会孤立感显著降低[31]。研究显示,佩戴助听器后老年人的抑郁程度随助听器佩戴时间延长而持续降低,社会参与度显著提升,社会隔离和孤独感明显下降[32]。
社交媒体的使用可以有效改善听力障碍老年人的社会关系结构,并帮助他们与更多的群体或个体进行交流。尤其当老年病人遇到困难时,可以通过线上网络寻求社会支持。对于有听力障碍的老年人来说,社交媒体提供了一种新的交流方式[33]。社交媒体具有丰富的表达方式,例如通过图片、文字、视频和表情符号进行交流,可以弥补听力损失造成的沟通障碍。此外,在社交媒体的帮助下,老年人可以与因空间限制而不经常联系的朋友和亲戚重新联系,并帮助他们恢复原来的社交网络;通过加入亲戚朋友活跃的各种社交圈(如微信群),老年人可以结交新朋友[34]。在社交媒体上发布公共信息可以吸引其他人的回应,这也可以扩大老年人的社交网络。Casanova等[35]研究认为老年人的社会孤立主要来自他们的家人和朋友,老年人使用社交媒体的目的是将他们与牢固的社会关系联系起来,而不是扩大他们的社交网络。尽管社交媒体扩大了他们的社交网络规模,但他们仍然最关心亲戚或亲密朋友。因此,他们的朋友和家人以及社区工作者不仅应该在社交媒体上与他们互动,还应该增加有针对性的线下互动,例如陪伴他们外出和在家中与他们聊天。提高听力受损老年人的听力水平,提高他们的独立生活和线下社交能力,降低歧视的风险。
国家还应重视听力障碍老年病人的线下社交活动,支持老年听力健康公益活动,派遣专业人员深入社区与养老机构,为老年人提供免费听力检查、个性化干预指导及听力健康知识普及服务。通过这些措施,可以带领听力障碍老年病人走出家庭,积极参与社会活动,延缓听力障碍及其相关症状的发生。美国一项为期10周的社区健康教育和锻炼计划:Walk,Talk 'n' Listen面向面临社会孤立和孤独风险的老年人开展[36]。该项目由团体听力康复(GAR)会议+教育课程(SHE)+锻炼和步行课程组成,GAR会议中通过破冰活动、参与者的基本规则、目标设定、多种沟通策略、应对听力障碍、处理困难的听力情况、听力辅助技术的类型和用途、当地资源以及“为自己和患有听力障碍的人辩护”等多种形式优化听力障碍病人的听力和沟通能力;健康教育课程则根据参与者的需求动态调整教育内容;体育锻炼是通过YMCA Fit for Life 50+计划认证的1 h锻炼和30 min的步行训练。该项目除了解决跌倒的危险因素外,还强调健康的生活方式、社交、赋权,以及通过GAR会议优化参与者的听力和交流,提高病人的沟通能力。类综合干预措施不仅有助于改善老年人的身体健康,还能显著减少情感上的孤独感,提升他们的生活质量。此外,通过定期的社交互动和团体活动,参与者能够建立新的社交联系,增强归属感,并感受到对健康和福祉的积极影响。
听力障碍的早期筛查、诊断和治疗对于老年人的负面情绪、认知障碍和社会疏离具有积极意义。未来,如何提高社区听力筛查的普及率和准确率将是研究的重点。目前,相关研究多采用自评量表对病人的听力障碍程度进行分级,但自评量表对听力障碍的检出率和准确率存在一定影响。因此,未来应根据国家标准,采用符合标准的筛查型纯音听力计进行气导纯音听阈测试或气导纯音筛选测听法,并由经过专业培训的合格人员实施。对于确诊听力障碍的病人,应给予相应的补助,以提高其治疗依从性。研究表明,医疗补助保险与助听器使用率之间存在重要关联。例如,美国加州的助听器采用率为27.5%,远高于平均水平(14.0%),其主要原因为加州将助听器纳入医疗补助涵盖范围[37]。在我国,浙江省、江苏省、安徽省和海南省将人工耳蜗纳入报销范畴,报销比例为70%~90%,极大降低了病人的经济负担。通过医保政策的支持,结合国家组织高值医用耗材集采的推进,相关设备的费用有望进一步降低,从而惠及更多病人。探究听力辅助设备的使用对听力障碍老年病人的成本效益,有利于未来公共政策的制定,避免康复资源的过度集中,确保医疗资源的合理分配。
现有研究已证实,以助听器适配、沟通策略训练及多维度康复方案为核心的听力干预措施能够有效改善老年听力障碍病人的社交网络质量,其作用机制主要体现在提升言语感知能力、优化日常沟通效能及增强社会参与度等方面。然而,该领域研究仍存在显著局限性:首先,多数干预研究样本量偏小,且干预周期普遍较短(5~12周),缺乏系统性纵向追踪数据[38];其次,现有研究在结局评估工具选择上存在显著异质性,既有采用标准化量表评估,也有使用焦点小组等质性研究方法评估,导致干预效果的横向比较困难;此外,虽然短期效果已被随机对照试验证实[39],但关于干预效果的持续时间、作用衰减规律及其与认知功能改善的剂量-效应关系等重要问题仍缺乏高质量证据。未来研究需通过多中心、大样本随机对照试验,结合标准化评估体系和≥1年的长期随访,系统揭示听力干预对社交网络重建的持续作用机制,同时探索助听器使用与认知训练等联合干预模式的协同效应。
随着人口老龄化的不断加深,老年病人听力障碍的人群比例显著增加。听力障碍不仅会导致老年人交流困难,还会引发负面情绪、身体功能障碍和社交网络的缩小,从而加重社会隔离现象。目前,我国对老年听力障碍病人的社会隔离现象关注较少,相关研究相对不足,未能充分重视听力障碍对老年病人社会活动的影响。这导致听力障碍的老年病人社会参与度不足,尤其是农村听力障碍老年病人的身心健康需要得到进一步关注。加强老年听力障碍的早期筛查、干预和康复,提供综合性的健康支持和社会支持,是改善老年人生活质量、减少社会隔离的重要途径。

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doi: 10.12102/j.issn.1009-6493.2026.03.023
  • 接收时间:2025-02-24
  • 首发时间:2026-10-28
  • 出版时间:2026-02-10
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  • 收稿日期:2025-02-24
  • 修回日期:2025-11-09
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    1南京中医药大学护理学院,江苏 210023
    2南京中医药大学附属金陵临床医学院
    3东部战区总 医院秦淮院区
    4蚌埠医科大学护理学院
    5南京大学医学院

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