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The Impact of COVID-19 and Pandemic Mitigation Measures on Persons with Sensory Impairment
Abstract
Purpose:
To assess the impact of the COVID-19 pandemic and associated mitigation measures on persons with sensory impairments (SI), including visual (VI) and hearing impairments (HI).
Design:
Cross-sectional survey.
Methods:
Adults with VI (best-corrected visual acuity <20/60 in the better-seeing eye), HI (ICD-10 codes), and age- and sex-matched controls (n=375) were recruited from the University of Michigan. The 34-item Coronavirus Disability Survey was administered. Chi-squared and logistic regression were used to compare survey responses between groups.
Results:
All groups reported high levels of disruption of daily life with 80% reporting "a fair amount" or "a lot" of disruption (VI:76%, HI:83%, CT: 82%, p=0.33). Participants with VI had greater difficulty with day-to-day activities and were more likely to cite the following reasons: caregiver was worried about COVID-19 (ORVI=7.2, [95% CI 3.5-14.4], p<.001) and decreased availability of public transportation (ORVI=5.0, [95% CI 1.5-15.6], p=.006). Those with VI, but not HI, showed a trend toward increased difficulty accessing medical care (ORVI=2.0, [95% CI 0.99-4.0], p=.052) and they began relying more on others for day-to-day assistance (ORVI=3.1, [95% CI 1.6-5.7], p<.001). Overall, 30% reported difficulty obtaining trusted information about the pandemic. Those with VI reported more difficulty seeing or hearing trusted information (ORVI=6.1, [95% CI 1.6-22.1], p=.006). Employed participants with HI were more likely to report a reduction in wages (ORHI=2.5, [95% CI 1.2-5.3], p=0.02).
Conclusions:
Individuals with VI have experienced increased disruption and challenges in daily activities related to the pandemic. People with SI may benefit from targeted policy approaches to the current pandemic and future stressors. Minimal differences in some survey measures may be due to the large impact of the pandemic on the population as a whole.
... Acknowledging the danger of the virus amidst the era of information uncertainties prompts people to actively seek out information on COVID-19 (Soroya et al., 2021). It includes PWD, particularly people with visual impairments, as they are more challenged when accessing visual information which can be trusted (Bernard et al., 2021). Considering PWD are more vulnerable during the COVID-19 Pandemic, the interest in providing reliable and trusted information is urgent. ...
Persons with disabilities are a vulnerable group when obtaining reliable information, particularly during the current Pandemic of COVID-19. This group needs accurate and dependable information related to the effort of prevention, treatment, and other information on the Pandemic. Each 34 provincial government of Indonesia has their own dedicated COVID-19 information websites providing such information to the public. This study attempt to find accessibility issues that would impact a person with disabilities on all 34 COVID-19 websites managed by each respective provincial government. This study uses aXe (https://www.deque.com), an online tool that measures the total accessibility issues, types of issues, and impacts on people with disabilities on a website. Most COVID-19 websites managed by the provincial government have shown many issues, indicating failure to comply with the web content accessibility guidelines. The biggest issue is insufficient color contrasts in elements and images and the absence of illustrative text, which are very important for a person with visual impairment. We also find that level of accessibility is not correlated with the number of visitors.
The text, based on the author’s own research, describes the case of a student with a hearing impairment in the context of the effects of the COVID-19 pandemic. The main aim of the research was to answer the question: how did a person with a hearing impairment function during the pandemic and in what dimensions is the pandemic situation a crisis for the examined student with a hearing impairment? The article begins with an introduction to the discussed issues, then takes into account a short description of the studied student and the results of the analysis of the research material obtained with the use of a free-form interview. The article ends with conclusions and a summary. It should be emphasized that the described case can only be treated as a pilot study and preparation of the ground for further explorations of a wider scope.
Objectives:
During social isolation imposed by the COVID-19 pandemic, older adults with impaired hearing and vision potentially experienced more communication challenges, increasing their risk for poor mental health. Digital communication (e.g. video calls, email/text/social media) may alleviate in-person isolation and protect against depression. We addressed this question using data from the National Social Life, Health, and Aging Project, a nationally representative panel study of community-dwelling older adults.
Method:
2558 adults aged 55+ comprised the analytic sample. Interviewer rating at baseline (2015-16) classified those with vision impairment (VI) or hearing impairment (HI). Olfactory impairment (OI) was measured by objective testing. During COVID-19 (2020-21), respondents reported how often they contacted non-household family or friends and whether this was by phone, email/text/social media, video, or in-person. They also quantified frequency of depressive feelings.
Results:
Older adults with VI or HI but not OI at baseline were significantly less likely to report regular use of video calling and email/text/social media during the pandemic compared to those without impairment. Sensory impairments did not affect frequency of phone or in-person communication. Adults with VI or HI were more likely to experience frequent depressive feelings during COVID. Video calls mitigated this negative effect of VI- and HI-associated depressive feelings in a dose-dependent manner.
Discussion:
Among communication modalities, video calling had a protective effect against depressive feelings for people with sensory impairment during social isolation. Improving access to and usability of video communication for older adults with sensory impairment could be a strategy to improve their mental health.
Discriminatory health systems and inequalities in service provision inevitably create barriers for certain populations in a health emergency. Persons with disabilities have been disproportionately affected by the COVID-19 pandemic. They commonly experience three increased risks - of contracting the disease, of severe disease or death, and of new or worsening health conditions. These added risks occur due to a range of barriers in the health sector, including physical barriers that prevent access to health facilities and specific interventions; informational barriers that prevent access to health information and/or reduce health literacy; and attitudinal barriers which give rise to stigma and exclusion, all of which add to discrimination and inequality. Furthermore, national health emergency preparedness and planning may fail to consider the needs and priorities of persons with disabilities, in all their diversity, thus leaving them behind in responses. This commentary discusses the importance of inclusive health systems strengthening as a prerequisite for accessible and comprehensive health emergency preparedness and response plans that reach everyone. Lessons learned relating to disability inclusion in the COVID-19 pandemic can inform health systems strengthening in recovery efforts, addressing underlying barriers to access and inclusion, and in turn improving preparedness for future health emergencies.
Purpose:
Assistive technology users may encounter challenges and inequality in having an access to health information and care during the emergency or in a crisis time. This issue seems to be understudied in most developing countries. The aim of this study was to explore the challenges faced by Iranian people with disabilities faced during the COVID-19 pandemic as far as the use of assistive technology is concerned.
Method:
A thematic analysis approach was employed to collect and analyse the data. We interviewed 10, 12 and 20 participants with physical, visual, and hearing disability, respectively during the pandemic between May to July 2020. A six-step thematic analysis method was used to identify categories and main themes.
Results:
The results revealed that people with disability were faced with some challenges in accessing information or receiving it on time during the emergency time. The lack of clear information may increase uncertainty about providing, using or maintaining assistive products. With no clear information or instruction, increased fear of infection, as well as the lack of necessary infrastructure for using available online applications, people with a disability had to rely more on others and seemed to feel disempowered.
Conclusion:
Assistive technology (AT) users may not receive enough care and attention during health crisis, nor may be included in crisis management programs. Actions to create preparedness plans to meet the needs of AT users in possible future crisis seem to be necessary.IMPLICATIONS FOR REHABILITATIONAssistive technology users' voice and needs should be given priority in crisis management programs.Web accessibility barriers and information accessibility challenges need more research attention in order to create effective and timely information dissemination programs.There seems to be a research gap about AT users during health crisis, and more research in this area is needed.
Importance
Despite documented disparities in health care for patients with significant vision impairments and legal mandates that patients with disability receive equitable care, little is known about the extent to which physicians practicing in the US accommodate these patients in outpatient clinical settings.
Objective
To empirically explore the extent of basic accommodations physicians practicing in the US provide to patients with significant vision limitations in outpatient care.
Design, Setting, and Participants
In this physician survey study, randomly selected physicians were surveyed throughout the US on their attitudes toward patients with disability. A total of 1400 randomly selected active board-certified physicians representing 7 specialties (family medicine, general internal medicine, rheumatology, neurology, ophthalmology, orthopedic surgery, and obstetrics-gynecology) were surveyed. Data were collected from October 2019 to June 2020.
Main Outcomes and Measures
Reported use of basic accommodations when caring for patients with significant vision limitations (defined here as blind or significant difficulty seeing even with glasses or other corrective lenses). Physicians’ accommodation performance was assessed based on whether they always or usually described the clinic space and always or usually provided printed material in large font. Use of Braille materials was reported too rarely to include in analyses.
Results
Of the 462 survey participants, 297 of 457 (65.0%) were male. The weighted response rate was 61.0%. Only 48 physicians (9.1%; 95% CI, 6.6-12.3) provided both accommodations (always or usually describing clinic spaces and providing large-font materials), while 267 (60.2%; 95% CI, 55.3-65.0) provided neither of these accommodations. Although 62.8% (95% CI, 57.5-67.8; n = 245) of nonophthalmologists did not provide either accommodation, 29.3% (95% CI, 20.1-40.7; n = 22) of ophthalmologists also did not do so; only 24.0% (95% CI, 15.6-35.0; n = 18) of ophthalmologists provided both accommodations compared with 8.4% (95% CI, 5.4-12.7) of other physicians.
Conclusions and Relevance
This survey study suggests that less than one-tenth of physicians practicing in the US who care for patients with significant vision limitations usually or always describe clinic spaces or provide large-font materials, and less than one-third of ophthalmologists do so. Actions to address this seem warranted.
The risk of excluding people wiTh sensory disabiliTies from educaTion as a consequence of The coVid-19 pandemic abstract the authors refer to the risk of people with sensory disabilities dropping out of higher education in Poland due to the move towards online learning during the COVID-19 pandemic. they present information on the unique situation of students with sensory dysfunctions, refer to the issues of distance learning in higher education, and present the methodological assumptions behind their research. the outcome of the research and observations resulting from the authors' practical experiences allowed them to formulate conclusions that relate to various areas of distance learning, including technology and methodology, the social-psychological area, the need for equipment, the evaluation of distance education and its negative vs positive aspects. this allowed them to reveal certain aspects of online learning of people with disabilities associated with the need to further explore the issues raised in theoretical, empirical, and practical dimensions.
Background: The SARS-CoV-2 virus has infected millions of people, overwhelming critical care resources in some regions. Many plans for rationing critical care resources during crises are based on the Sequential Organ Failure Assessment (SOFA) score. The COVID-19 pandemic created an emergent need to develop and validate a novel electronic health record (EHR)-computable tool to predict mortality.
Research Questions: To rapidly develop, validate, and implement a novel real-time mortality score for the COVID-19 pandemic that improves upon SOFA.
Study Design and Methods: We conducted a prospective cohort study of a regional health system with 12 hospitals in Colorado between March 2020 and July 2020. All patients >14 years old hospitalized during the study period without a do not resuscitate order were included. Patients were stratified by the diagnosis of COVID-19. From this cohort, we developed and validated a model using stacked generalization to predict mortality using data widely available in the EHR by combining five previously validated scores and additional novel variables reported to be associated with COVID-19-specific mortality. We compared the area under the receiver operator curve (AUROC) for the new model to the SOFA score and the Charlson Comorbidity Index.
Results: We prospectively analyzed 27,296 encounters, of which 1,358 (5.0%) were positive for SARS-CoV-2, 4,494 (16.5%) included intensive care unit (ICU)-level care, 1,480 (5.4%) included invasive mechanical ventilation, and 717 (2.6%) ended in death. The Charlson Comorbidity Index and SOFA scores predicted overall mortality with an AUROC of 0.72 and 0.90, respectively. Our novel score predicted overall mortality with AUROC 0.94. In the subset of patients with COVID-19, we predicted mortality with AUROC 0.90, whereas SOFA had AUROC of 0.85.
Interpretation: We developed and validated an accurate, in-hospital mortality prediction score in a live EHR for automatic and continuous calculation using a novel model, that improved upon SOFA.
Summary
Background To contribute to the WHO initiative, VISION 2020: The Right to Sight, an assessment of global vision
impairment in 2020 and temporal change is needed. We aimed to extensively update estimates of global vision loss
burden, presenting estimates for 2020, temporal change over three decades between 1990–2020, and forecasts
for 2050.
Methods We did a systematic review and meta-analysis of population-based surveys of eye disease from January, 1980,
to October, 2018. Only studies with samples representative of the population and with clearly defined visual acuity
testing protocols were included. We fitted hierarchical models to estimate 2020 prevalence (with 95% uncertainty
intervals [UIs]) of mild vision impairment (presenting visual acuity ≥6/18 and <6/12), moderate and severe vision
impairment (<6/18 to 3/60), and blindness (<3/60 or less than 10° visual field around central fixation); and vision
impairment from uncorrected presbyopia (presenting near vision <N6 or <N8 at 40 cm where best-corrected distance
visual acuity is ≥6/12). We forecast estimates of vision loss up to 2050.
Findings In 2020, an estimated 43·3 million (95% UI 37·6–48·4) people were blind, of whom 23·9 million (55%;
20·8–26·8) were estimated to be female. We estimated 295 million (267–325) people to have moderate and severe
vision impairment, of whom 163 million (55%; 147–179) were female; 258 million (233–285) to have mild vision
impairment, of whom 142 million (55%; 128–157) were female; and 510 million (371–667) to have visual impairment
from uncorrected presbyopia, of whom 280 million (55%; 205–365) were female. Globally, between 1990 and 2020,
among adults aged 50 years or older, age-standardised prevalence of blindness decreased by 28·5% (–29·4 to –27·7)
and prevalence of mild vision impairment decreased slightly (–0·3%, –0·8 to –0·2), whereas prevalence of moderate
and severe vision impairment increased slightly (2·5%, 1·9 to 3·2; insufficient data were available to calculate this
statistic for vision impairment from uncorrected presbyopia). In this period, the number of people who were blind
increased by 50·6% (47·8 to 53·4) and the number with moderate and severe vision impairment increased by 91·7%
(87·6 to 95·8). By 2050, we predict 61·0 million (52·9 to 69·3) people will be blind, 474 million (428 to 518) will have
moderate and severe vision impairment, 360 million (322 to 400) will have mild vision impairment, and 866 million
(629 to 1150) will have uncorrected presbyopia.
Interpretation Age-adjusted prevalence of blindness has reduced over the past three decades, yet due to population
growth, progress is not keeping pace with needs. We face enormous challenges in avoiding vision impairment as the
global population grows and ages.
Background: As a major virus outbreak in the 21st century, the Coronavirus disease 2019 (COVID-19) pandemic has led to unprecedented hazards to mental health globally. While psychological support is being provided to patients and healthcare workers, the general public's mental health requires significant attention as well. This systematic review aims to synthesize extant literature that reports on the effects of COVID-19 on psychological outcomes of the general population and its associated risk factors.
Methods: A systematic search was conducted on PubMed, Embase, Medline, Web of Science, and Scopus from inception to 17 May 2020 following the PRISMA guidelines. A manual search on Google Scholar was performed to identify additional relevant studies. Articles were selected based on the predetermined eligibility criteria.
Results: Relatively high rates of symptoms of anxiety (6.33% to 50.9%), depression (14.6% to 48.3%), post-traumatic stress disorder (7% to 53.8%), psychological distress (34.43% to 38%), and stress (8.1% to 81.9%) are reported in the general population during the COVID-19 pandemic in China, Spain, Italy, Iran, the US, Turkey, Nepal, and Denmark. Risk factors associated with distress measures include female gender, younger age group (≤40 years), presence of chronic/psychiatric illnesses, unemployment, student status, and frequent exposure to social media/news concerning COVID-19.
Limitations: A significant degree of heterogeneity was noted across studies.
Conclusions: The COVID-19 pandemic is associated with highly significant levels of psychological distress that, in many cases, would meet the threshold for clinical relevance. Mitigating the hazardous effects of COVID-19 on mental health is an international public health priority.
People living with visual disabilities/impairment are more likely vulnerable to get contracted from the severe acute respiratory syndrome coronavirus-2 (SARS-CoV 2) than people without visual impairment. This means more than 253 million people globally will be at higher risk of affecting by the COVID-19. The current pandemic, followed by a nationwide emergency lockdown to slow the unprecedented spread of the virus, will have a serious impact on people living with visual disabilities and even endangers their lives in the long run. Many restrictive and control measures, including the adoption of new behavioural changes (for example, social distance during outdoor movement, limiting touch or tactile contact) recommended by the government will pose immense challenges to individuals with a visual loss. This serious impact, including challenges in healthcare access, can be minimized through inclusive service approaches, involving persons with visual disabilities, caregivers, family members, and healthcare providers, along with the community to a large extent, and finally, support to improve the overall outcomes. The government, along with profit or non-profit private sectors, should consider initiating such inclusive approaches while planning responses to the pandemic. Indeed, the present COVID-19 pandemic provides an opportunity for health care planners and decision-makers of various organizations across India for a reformation of disabilities care. Impacts due to the pandemic and lockdown can be reduced substantially if planning and policy are in place before any emergency happened in the future.
Given that hearing loss currently affects 72.4% of persons over 651 and older individuals tend to be hospitalized when affected by COVID‐19, it is likely that the global COVID‐19 pandemic will impact numerous individuals with hearing loss. Based on these overlapping demographics, we should assume that communication needs will be heightened during this pandemic. The Massachusetts Eye and Ear (MEE) Audiology Leadership Council met virtually to discuss department and hospital policies during the COVID‐19 pandemic. The following key points grew from this discussion to ensure optimal communication with people with hearing loss.
Importance
For research involving big data, researchers must accurately identify patients with ocular diseases or phenotypes of interest. Reliance on administrative billing codes alone for this purpose is limiting.
Objective
To develop a method to accurately identify the presence or absence of ocular conditions of interest using electronic health record (EHR) data.
Design, Setting, and Participants
This study is a retrospective analysis of the EHR data of patients (n = 122 339) in the Sight Outcomes Research Collaborative Ophthalmology Data Repository who received eye care at participating academic medical centers between August 1, 2012, and August 31, 2017. An algorithm that searches structured and unstructured (free-text) EHR data for conditions of interest was developed and then tested to determine how well it could detect the presence or absence of exfoliation syndrome (XFS). The algorithm was trained to search for evidence of XFS among a sample of patients with and without XFS (n = 200) by reviewing International Classification of Diseases, Ninth Revision or International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-9 or ICD-10) billing codes, the patient’s problem list, and text within the ocular examination section and unstructured (free-text) data in the EHR. The likelihood that each patient had XFS was estimated using logistic least absolute shrinkage and selection operator (LASSO) regression. The EHR data of all patients were run through the algorithm to generate an XFS probability score for each patient. The algorithm was validated with review of EHRs by glaucoma specialists.
Main Outcomes and Measures
Positive predictive value (PPV) and negative predictive value (NPV) of the algorithm were computed as the proportion of patients correctly classified with XFS or without XFS.
Results
This study included 122 339 patients, with a mean (SD) age of 52.4 (25.1) years. Of these patients, 69 002 (56.4%) were female and 99 579 (81.4%) were white. The algorithm assigned a less than 10% probability of XFS for 121 085 patients (99.0%) as well as an XFS probability score of more than 75% for 543 patients (0.4%), more than 90% for 353 patients (0.3%), and more than 99% for 83 patients (0.07%). Validated by glaucoma specialists, the algorithm had a PPV of 95.0% (95% CI, 89.5%-97.7%) and an NPV of 100% (95% CI, 91.2%-100%). When there was ICD-9 or ICD-10 billing code documentation of XFS, in 86% or 96% of the records, respectively, evidence of XFS was also recorded elsewhere in the EHR. Conversely, when there was clinical examination or free-text evidence of XFS, it was documented with ICD-9 codes only approximately 40% of the time and even less often with ICD-10 codes.
Conclusions and Relevance
The algorithm developed, tested, and validated in this study appears to be better at identifying the presence or absence of XFS in EHR data than the conventional approach of assessing only billing codes; such an algorithm may enhance the ability of investigators to use EHR data to study patients with ocular diseases.
Background
Little is known about whether and to what extent loneliness impacts the lives of people with visual impairment (VI). Thus, the aim of this study was to examine the prevalence of and factors associated with loneliness in adults with VI, and to examine its association with life satisfaction.
Methods
This cross-sectional interview study included a probability sample of 736 adults (≥18 years old) with VI who were members of the Norwegian Association of the Blind and Partially Sighted. The interviews took place from January to May 2017, collecting information about sociodemographics, VI characteristics, adverse life events, loneliness (Three Item Loneliness Scale), and life satisfaction (Cantril’s Ladder of Life Satisfaction). The prevalence of loneliness was compared to data obtained from the general Norwegian population (N = 14,884; mean age 46.4 years; 50.7% females).
Results
The prevalence of moderate and severe loneliness in the VI population was 28.7% (95% CI: 25.4, 32.1) and 19.7% (95% CI: 16.9, 22.8), respectively. The rates were consistently higher across age groups compared to the general population. Loneliness was associated with younger age, blindness, having other impairments, unemployment, and a history of bullying or abuse. In addition, higher scores on loneliness were associated with lower levels of life satisfaction (fully adjusted β = − 0.48, 95% CI: − 0.55, − 0.41).
Conclusions
Loneliness is common in adults with VI. Strategies capable of reducing loneliness could improve life satisfaction among people who are blind or visually impaired.
Electronic supplementary material
The online version of this article (10.1186/s12955-019-1096-y) contains supplementary material, which is available to authorized users.
Poor vision is associated with lower socioeconomic status, but less is known about its relationship to area deprivation.
The European Prospective Investigation into Cancer and Nutrition study Norfolk Eye Study was a cross-sectional study of 8563 participants with completed eye examinations. Logarithm of the minimum angle of resolution (logMAR) visual acuity (VA) was measured using standard protocols and low vision (LV) was defined as Snellen equivalent (VA) ≤6/12 in the better eye. Uncorrected refractive error (URE) was defined as improvement of VA by 2 logarithm of the minimum angle of resolution lines with pinhole. The lowest 5% of index of multiple deprivation rank was used to define the most deprived areas. The index of multiple deprivation is a composite measure using routine data from seven domains of deprivation to identify the most disadvantaged areas in England. Logistic regression was used to examine univariable and multivariable associations with LV.
Ninety-six participants with missing data were excluded, leaving 8467 for analysis (98.9%). The mean age of the study group was 68.7 years (SD=8.1, range=48-92), with 55.1% women. LV was present in 263 participants (3.1%, 95% CI 2.7 to 3.5%). LV was associated with deprivation after adjusting for age, sex, education, social class and cataract surgery (OR=1.7, 95% CI 1.1 to 2.6, p=0.03), but this effect was mitigated by additionally adjusting for URE (OR=1.5, 95% CI 1.0 to 2.4, p=0.09).
People with LV are more likely to live in the most deprived areas; this association was independent of socioeconomic status and partly mediated by URE. Targeting URE in deprived areas may reduce health inequalities associated with LV.
A national mail survey of 176 employed persons who are blind or have low vision found that employment barriers included attitudes of employers and the general public; transportation problems; and lack of access to print, adaptive equipment, and accommodations. Strategies to overcome barriers appear to be addressed on an individual basis, rather than from a macro or policy perspective.
age-related hearing loss is a common chronic condition; hence, it is important to understand its influence on the functional status of older adults. We assessed the association between hearing impairment with activity limitations as assessed by the activities of daily living (ADL) scale.
a total of 1,952 Blue Mountains Hearing Study participants aged ≥60 years had their hearing levels measured using pure-tone audiometry. A survey instrument with questions on functional status as determined by the Older Americans Resources and Services ADL scale was administered.
one hundred and sixty-four (10.4%) participants reported ADL difficulty. A higher proportion of hearing impaired than non-impaired adults reported difficulties in performing three out of the seven basic ADL and six out of the seven instrumental ADL tasks. After multivariable adjustment, increased severity of hearing loss was associated with impaired ADL (P(trend )= 0.001). Subjects with moderate to severe hearing loss compared with those without, had a 2.9-fold increased likelihood of reporting difficulty in ADL, multivariate-adjusted odds ratio (OR): 2.87 [95% confidence interval (CI): 1.59-5.19]. Participants aged <75 years with hearing loss compared with those without, had 2-fold higher odds of impaired ADL. Having worn or wearing a hearing aid was also associated with a 2-fold increased likelihood of impaired ADL.
functional status as measured by a common ADL scale is diminished in older hearing impaired adults. Our findings suggest that severely diminished hearing could make the difference between independence and the need for formal support services or placement.
Census data are widely used for assessing neighborhood socioeconomic context. Research using census data has been inconsistent in variable choice and usually limited to single geographic areas. This paper seeks to a) outline a process for developing a neighborhood deprivation index using principal components analysis and b) demonstrate an example of its utility for identifying contextual variables that are associated with perinatal health outcomes across diverse geographic areas. Year 2000 U.S. Census and vital records birth data (1998-2001) were merged at the census tract level for 19 cities (located in three states) and five suburban counties (located in three states), which were used to create eight study areas within four states. Census variables representing five socio-demographic domains previously associated with health outcomes, including income/poverty, education, employment, housing, and occupation, were empirically summarized using principal components analysis. The resulting first principal component, hereafter referred to as neighborhood deprivation, accounted for 51 to 73% of the total variability across eight study areas. Component loadings were consistent both within and across study areas (0.2-0.4), suggesting that each variable contributes approximately equally to "deprivation" across diverse geographies. The deprivation index was associated with the unadjusted prevalence of preterm birth and low birth weight for white non-Hispanic and to a lesser extent for black non-Hispanic women across the eight sites. The high correlations between census variables, the inherent multidimensionality of constructs like neighborhood deprivation, and the observed associations with birth outcomes suggest the utility of using a deprivation, index for research into neighborhood effects on adverse birth outcomes.
The Coronavirus Disease 2019 (COVID-19) pandemic and the measures of social distancing and national lockdown had a significant impact on everyday life. Individuals with BVI (blindness and visual impairment) are assumed to face increased barriers in numerous domains of their lives. This online survey research investigates, among Hungarian adults with BVI ( N = 132), the impact of the lockdown on their access to shopping, daily support needs, access to remote studies of higher education or work, and leisure habits. Respondents accounted for negative impacts of the lockdown on their participation and independence in all research topics. Issues of accessibility were common both concerning shopping for essential goods and access to remote study and work.
Objective
To rapidly develop, validate, and implement a novel real-time mortality score for the COVID-19 pandemic that improves upon SOFA for decision support for a Crisis Standards of Care team.
Materials and Methods
We developed, verified, and deployed a stacked generalization model to predict mortality using data available in the EHR by combining five previously validated scores and additional novel variables reported to be associated with COVID-19-specific mortality. We verified the model with prospectively collected data from 12 hospitals in Colorado between March 2020 and July 2020. We compared the area under the receiver operator curve (AUROC) for the new model to the SOFA score and the Charlson Comorbidity Index.
Results
The prospective cohort included 27,296 encounters, of which 1,358 (5.0%) were positive for SARS-CoV-2, 4,494 (16.5%) required intensive care unit care, 1,480 (5.4%) required mechanical ventilation, and 717 (2.6%) ended in death. The Charlson Comorbidity Index and SOFA scores predicted mortality with an AUROC of 0.72 and 0.90, respectively. Our novel score predicted mortality with AUROC 0.94. In the subset of patients with COVID-19, the stacked model predicted mortality with AUROC 0.90, whereas SOFA had AUROC of 0.85.
Discussion
Stacked regression allows a flexible, updatable, live-implementable, ethically defensible predictive analytics tool for decision support that begins with validated models and includes only novel information that improves prediction.
Conclusion
We developed and validated an accurate in-hospital mortality prediction score in a live EHR for automatic and continuous calculation using a novel model that improved upon SOFA.
Importance:
Preventive care is associated with decreased morbidity and mortality among older adults. Vision impairment may be a barrier to accessing care and health promotion information and therefore may contribute to decreased preventive care uptake.
Objective:
To examine the association between self-reported vision impairment and uptake of preventive care services (ie, breast and colon cancer screenings and influenza and pneumococcal vaccinations).
Design, setting, and participants:
Cross-sectional study using the 2015 and 2018 National Health Interview Survey (NHIS) and 2016 and 2018 Behavioral Risk Factor Surveillance System (BRFSS) data, national surveys of US residents conducted through in-person household interviews in NHIS, and state-based telephone interviews in BRFSS. Participants included respondents 50 years and older based on eligibility for each preventive care service examined.
Exposures:
Vision impairment, defined as self-reported trouble seeing, in NHIS, and self-reported blindness/serious difficulty seeing in BRFSS.
Main outcomes and measures:
Self-reported uptake of breast cancer screening (women aged 50-74 years), colon cancer screening (aged 50-74 years), influenza vaccination (50 years and older), and pneumococcal vaccination (65 years and older). Multivariable regression models adjusted for relevant confounders, including age, were used to examine the uptake of each preventive care service by vision impairment status.
Results:
Among NHIS participants, older US individuals with vision impairment (prevalence between 14.3% and 16.3% in the different age groups; n = 12 120-29 654) were less likely to report breast cancer screening (odds ratio [OR], 0.82; 95% CI, 0.71-0.96) and colon cancer screening (OR, 0.89; 95% CI, 0.79-0.99) but not influenza (OR, 1.06; 95% CI, 0.97-1.15) and pneumococcal vaccination (OR, 1.03; 95% CI, 0.91-1.16), as compared with their counterparts without vision impairment. In BRFSS (n = 228 649-530 027), those with vision impairment (5.9%-6.8%) were less likely than those without vision impairment to report breast cancer screening (OR, 0.67; 95% CI, 0.59-0.75), colon cancer screening (OR, 0.70; 95% CI, 0.65-0.76), and pneumococcal vaccination (OR, 0.89; 95% CI, 0.81-0.99) but not influenza vaccination (OR, 0.95; 95% CI, 0.89-1.00).
Conclusions and relevance:
Older Americans with vision impairment may be less likely to use cancer-related preventive services as compared with their counterparts without vision impairments. These findings suggest that interventions to improve access to health information and health care services for individuals with vision impairment may be needed to improve cancer screening among this population.
Importance
The number of older adults with visual impairment (VI) and dementia is projected to increase in the US because of the aging of the population. Dementia and VI commonly co-occur and are each independently associated with disability. To care for an aging population, it may be important to characterize the association of coexisting dementia and self-reported VI on daily functioning.
Objective
To evaluate the association of co-occurring dementia and self-reported VI on daily functioning.
Design, Setting, and Participants
This cross-sectional analysis of a nationally representative cohort study used data from the National Health and Aging Trends Study (NHATS), an annual study of US adults 65 years and older. Participants in the 2015 survey with complete data on outcomes, associated factors, and covariates were included in this study. Data analysis took place from January 2019 to November 2019.
Main Outcomes and Measures
Multivariable Poisson regression was used to model the independent associations and interaction of dementia and self-reported VI status on 3 functional activity scales (self-care, mobility, and household activities). Marginal predicted proportions were calculated. Analyses were adjusted for sociodemographic and medical factors and accounted for the complex survey design.
Results
A total of 7124 participants were included. The weighted proportion of female respondents was 55.3% (95% CI, 54.0%-56.6%), and 56.1% (95% CI, 54.1%-58.1%) were between 65 and 74 years old. Self-reported VI was present in 8.6% (95% CI, 7.8%-9.3%) of participants, while 8.3% (95% CI, 7.8%-8.9%) had possible dementia and 6.3% (95% CI, 5.7%-6.9%) had probable dementia. Self-reported VI was associated with an expected decrease in mobility score of 14.7% (functional scale scores: no VI, 10.82 vs VI, 9.23), self-care score of 9.5% (no VI, 14.54 vs VI, 13.16), and household activity score of 15.2% (no VI, 18.23 vs VI, 15.45), while probable dementia was associated with expected decreases of 27.8% (no dementia, 10.82 vs probable dementia, 7.81), 22.9% (no dementia, 14.54 vs probable dementia, 11.20), and 34.7% (no dementia, 18.23 vs probable dementia, 11.90), respectively. Among those with probable dementia and self-reported VI, there was an expected decrease in mobility score of 50.1% (functional ability scores: no VI and no dementia, 10.82 vs VI and probable dementia, 5.40), self-care score of 42.4% (no VI and no dementia, 14.54 vs VI and probable dementia, 8.38), and household activity score of 52.4% (no VI and no dementia, 18.23 vs VI and probable dementia, 8.68), suggesting that respondents with co-occurring dementia and self-reported VI had lower functional activity scores than would be associated with the independent contributions of these conditions.
Conclusions and Relevance
Older adults with both dementia and self-reported VI may be at high risk for disability, and their co-occurrence may potentiate this risk. These findings suggest that the growing population of older adults with both visual impairment and dementia may benefit from interventions to maximize vision and cognition and promote functioning and independence.
Objective
Social isolation and loneliness are associated with increased mortality and higher health care spending in older adults. Hearing loss is a common condition in older adults and impairs communication and social interactions. The objective of this review is to summarize the current state of the literature exploring the association between hearing loss and social isolation and/or loneliness.
Data Sources
PubMed, Embase, CINAHL Plus, PsycINFO, and the Cochrane Library.
Review Methods
Articles were screened for inclusion by 2 independent reviewers, with a third reviewer for adjudication. English-language studies of older adults with hearing loss that used a validated measure of social isolation or loneliness were included. A modified Newcastle-Ottawa Scale was used to assess the quality of the studies included in the review.
Results
Of the 2495 identified studies, 14 were included in the review. Most of the studies (12/14) were cross-sectional. Despite the heterogeneity of assessment methods for hearing status (self-report or objective audiometry), loneliness, and social isolation, most multivariable-adjusted studies found that hearing loss was associated with higher risk of loneliness and social isolation. Several studies found an effect modification of gender such that among women, hearing loss was more strongly associated with loneliness and social isolation than among men.
Conclusions
Our findings that hearing loss is associated with loneliness and social isolation have important implications for the cognitive and psychosocial health of older adults. Future studies should investigate whether treating hearing loss can decrease loneliness and social isolation in older adults.
Vision impairment (VI) is an important contributor to the global burden of disability and is associated with decreased well-being. Recent research has attempted to devise a conceptual framework to explain the health consequences of VI. One proposed mechanism by which VI leads to declines in well-being and other adverse health and disability outcomes is through limitations in social participation (SP). SP is an integral component of overall functioning, optimal aging, and well-being, and reductions in SP are associated with lower health-related quality of life. The purpose of this systematic review was to appraise the existing literature on the relationship between VI and SP. The protocol for this review was registered on PROSPERO (CRD42018102767) and adhered to PRISMA guidelines. A comprehensive search of five databases (MEDLINE, EMBASE, PsycINFO, Scopus, Sociology Database) yielded 881 unique studies, of which 19 met inclusion criteria. Among the 19 included studies, 18 concluded that VI was associated with reduced SP and one reported mixed results. Bias was assessed using the Effective Public Health Practice Project Quality Assessment. In the quality assessment, four studies were rated “moderate” and fifteen were rated “weak.” There was wide variation in study populations and measurement of VI and SP. In conclusion, there is consensus that VI is associated with reduced SP. However, more rigorous study design and better standardization in the assessment of VI and SP could facilitate valid comparisons across populations, diseases, and levels of VI. Attempts to provide vision rehabilitation and mitigate the effects of VI on overall health and well-being might consider strategies to improve SP.
Importance
Nearly 38 million individuals in the United States have untreated hearing loss, which is associated with cognitive and functional decline. National initiatives to address hearing loss are currently under way.
Objective
To determine whether untreated hearing loss is associated with increased health care cost and utilization on the basis of data from a claims database.
Design, Setting, Participants
Retrospective, propensity-matched cohort study of persons with and without untreated hearing loss based on claims for health services rendered between January 1, 1999, and December 31, 2016, from a large health insurance database. There were 154 414, 44 852, and 4728 participants at the 2-, 5-, and 10-year follow-up periods, respectively. The study was conceptualized and data were analyzed between September 2016 and November 2017.
Exposures
Untreated hearing loss (ie, hearing loss that has not been treated with hearing devices) was identified via claims measures.
Main Outcomes and Measures
Medical costs, inpatient hospitalizations, total days hospitalized, 30-day hospital readmission, emergency department visits, and days with at least 1 outpatient visit.
Results
Among 4728 matched adults (mean age at baseline, 61 years; 2280 women and 2448 men), untreated hearing loss was associated with $22 434 (95% CI, $18 219-$26 648) or 46% higher total health care costs over a 10-year period compared with costs for those without hearing loss. Persons with untreated hearing loss experienced more inpatient stays (incidence rate ratio, 1.47; 95% CI, 1.29-1.68) and were at greater risk for 30-day hospital readmission (relative risk, 1.44; 95% CI, 1.14-1.81) at 10 years postindex. Similar trends were observed at 2- and 5-year time points across measures.
Conclusions and Relevance
Older adults with untreated hearing loss experience higher health care costs and utilization patterns compared with adults without hearing loss. To further define this association, additional research on mediators, such as treatment adherence, and mitigation strategies is needed.
Introduction: This study evaluated transportation-related stress
and factors predicting stress among persons with visual impairments. Methods:
Participants with visual impairments completed electronic surveys rating their stress
levels experienced when completing various walking and public transportation tasks.
They also indicated activities they avoided due to transportation stress. Results:
Higher stress was reported for navigating unfamiliar bus routes, walking in urban
areas without sidewalks, and walking in unfamiliar places. Significant predictors of
walking stress were age, years since vision loss, dog guide use, physical limitations,
and frequency of public transportation use. Significant predictors of public transportation
stress were age, orientation and mobility (O&M) training, physical limitations,
and frequency of public transportation use. Most-avoided activities due to
transportation-related stress were entertainment or leisure activities and visiting
family and friends. Discussion: Unfamiliar situations and unpredictable environments
were associated with higher stress. Frequent public transportation use and
longer time since vision loss predicted lower stress, which indicates that increased
and varied experiences may affect transportation-related stress. Older persons and
persons with physical limitations had more transportation-related stress. Social
activities, which are important in managing stress, were most frequently avoided due
to transportation stress. Implications for practitioners: O&M instructors should keep
in mind that providing varied experiences and longer training is indicated for persons
with high stress, particularly for older persons, and those with recent vision loss or
physical limitations. Everyone involved in the rehabilitation process should remember
that building relationships with consumers, encouraging public transportation
use, participating in support groups, and overcoming travel barriers for social
activities may help reduce transportation stress.
Focus groups of rehabilitation providers identified barriers to the employment of persons who are visually impaired and strategies to overcome them. The barriers included negative attitudes of employers and of persons with visual impairments, inadequate transportation, the lack of access to print, and administrative issues. Strategies for overcoming each barrier are discussed.
A number of self-administered questionnaires are available for assessing depression severity, including the 9-item Patient Health Questionnaire depression module (PHQ-9). Because even briefer measures might be desirable for use in busy clinical settings or as part of comprehensive health questionnaires, we evaluated a 2-item version of the PHQ depression module, the PHQ-2.
The PHQ-2 inquires about the frequency of depressed mood and anhedonia over the past 2 weeks, scoring each as 0 ("not at all") to 3 ("nearly every day"). The PHQ-2 was completed by 6000 patients in 8 primary care clinics and 7 obstetrics-gynecology clinics. Construct validity was assessed using the 20-item Short-Form General Health Survey, self-reported sick days and clinic visits, and symptom-related difficulty. Criterion validity was assessed against an independent structured mental health professional (MHP) interview in a sample of 580 patients.
As PHQ-2 depression severity increased from 0 to 6, there was a substantial decrease in functional status on all 6 SF-20 subscales. Also, symptom-related difficulty, sick days, and healthcare utilization increased. Using the MHP reinterview as the criterion standard, a PHQ-2 score > or =3 had a sensitivity of 83% and a specificity of 92% for major depression. Likelihood ratio and receiver operator characteristic analysis identified a PHQ-2 score of 3 as the optimal cutpoint for screening purposes. Results were similar in the primary care and obstetrics-gynecology samples.
The construct and criterion validity of the PHQ-2 make it an attractive measure for depression screening.
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