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.

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 ( 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.