Environmental noise and self-rated health in older surgical patients undergoing general anesthesia: a cross-sectional study of anxiety as a behavioral pathway for healthy aging

Abstract

Background: Promoting healthy aging—a core public-health objective—demands hospital environments that support functional recovery and well-being. Excessive ward noise, however, is a modifiable environmental factor that may thwart this goal by amplifying anxiety and diminishing older adults’ self-rated health, yet the magnitude and mechanism of this effect remain poorly quantified. Methodology: We undertook a cross-sectional survey in March–August 2024 at a tertiary hospital in Hebei Province, China. Continuous bedside monitoring captured 24-h A-weighted equivalent sound levels (LAeq) for 270 surgical in-patients aged ≥ 60 years. Exposure was grouped into quartiles [≤ 45, 45.1–50, 50.1–55, > 55 dB(A)]. Poor self-rated health (SRH, scores 1–3/5) and anxiety (Generalized Anxiety Disorder-7) were assessed concurrently. Hierarchical logistic models estimated associations per 5 dB(A) increment; bias-corrected bootstrap mediation quantified the proportion of the noise–health relation transmitted through anxiety. Results: Median LAeq was 52.1 dB(A), well above the WHO daytime limit of 35 dB(A). The prevalence of poor SRH rose from 28% in the quietest quartile to 58% in the noisiest (p < 0.001). After adjustment for demographic, socioeconomic, clinical and ward factors, each 5 dB(A) increase in LAeq raised the odds of poor SRH by 16% (OR = 1.16, 95% CI 1.00–1.33, p = 0.047). Anxiety independently predicted poor SRH (OR = 1.10 per GAD-7 point) and mediated 23% of the total noise effect (indirect β = 0.048, 95% CI 0.019–0.086, p = 0.002). Conclusion: Hospital sound levels substantially above international guidelines constitute a modifiable environmental barrier to healthy aging, deteriorating older adults’ self-perceived health partly by intensifying anxiety. Integrating acoustic standards into hospital quality metrics and coupling noise reduction with early anxiety management represent feasible public-health strategies to support functional recovery and well-being in rapidly aging populations.