Objective To identify the subgroups of lifestyle and cognitive function in community-dwelling middle-aged and older adults at risk of hearing loss, to analyze the characteristics and differences among these subgroups, and to provide a reference for developing targeted intervention strategies. Methods From January to July 2024, a survey was conducted among 200 middle-aged and older adults at risk of hearing loss in two communities in Chongqing. The instruments included the Dementia Risk Reduction Lifestyle Scale, the Montreal Cognitive Assessment Scale, objective hearing test, and the Cognitive Reserve Index Questionnaire. Two-step cluster analysis was utilized to identify the subgroups based on hearing, cognitive function, and lifestyle, then univariate analysis was also performed to determine the differences among the subgroups. Results Three subgroups were identified:hearing loss risk-high cognitive function-poor behavior (23.0%), hearing loss-high cognitive function-good behavior (49.5%), and hearing loss-low cognitive function-poor behavior (27.5%). Significant differences were found among the three subgroups in terms of age, gender,years of education, living conditions, marital status, monthly personal income, hearing-related medical treatment, and cognitive reserve scores (all P<0.05). Conclusion There is heterogeneity in the lifestyle and cognitive function in middle-aged and older adults at risk for hearing loss. Healthcare professionals should formulate targeted intervention strategies to slow hearing loss and cognitive decline.