The role of gender in the association between sensory impairments and well-being, depression symptoms, and relationship satisfaction among older adults

Abstract

Objectives:
This study aimed to investigate the impact of sensory impairments on well-being, depression symptoms, and relationship satisfaction among older adults, and to examine whether these associations vary by gender.

Method:
The study analyzed a sample of 640 Danish individuals aged 60 and older. Multilevel modeling was conducted using PROC MIXED in SAS to assess the impact of sensory impairments on well-being, depression symptoms, and relationship satisfaction. A two-step approach was employed to evaluate the main effects and interaction terms of sensory impairments and gender, controlling for covariates such as age, education, and relationship length.

Results:
Both vision and hearing impairments were significantly associated with lower well-being and higher depression symptoms in men and women. However, a gender difference was observed for the association between vision impairment and relationship satisfaction: greater vision impairment was associated with lower relationship satisfaction among men but not among women.

Conclusion:
The findings add nuance to the understanding of how sensory impairments may affect older men and women, highlighting both gender similarities and differences. The study also discusses possible interpretations of the findings, suggesting that social and cultural factors may influence how sensory impairments affect mental and relational health outcomes differently for men and women.

Full text

Aging & Mental Health
ISSN: (Print) (Online) Journal homepage: www.tandfonline.com/journals/camh20
The role of gender in the association between sensory
impairments and well-being, depression symptoms, and
relationship satisfaction among older adults
Andreas Nielsen Hald, Freja Nannerup Kjærgaard, Gert Martin Hald &
Camilla S. Øverup
To cite this article: Andreas Nielsen Hald, Freja Nannerup Kjærgaard, Gert Martin Hald &
Camilla S. Øverup (29 Jan 2025): The role of gender in the association between sensory
impairments and well-being, depression symptoms, and relationship satisfaction among older
adults, Aging & Mental Health, DOI: 10.1080/13607863.2025.2456483
To link to this article: https://doi.org/10.1080/13607863.2025.2456483
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UK Limited, trading as Taylor & Francis
Group
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AGING & MENTAL HEALTH
The role of gender in the association between sensory impairments and
well-being, depression symptoms, and relationship satisfaction among older adults
Andreas Nielsen Halda,b , Freja Nannerup Kjærgaarda, Gert Martin Halda and Camilla S. Øverupa
aDepartment of Public Health, University of Copenhagen, Copenhagen, Denmark; bDepartment of Public Health, Aarhus University, Aarhus,
Denmark
ABSTRACT
Objectives:This study aimed to investigate the impact of sensory impairments on well-being, depres-
sion symptoms, and relationship satisfaction among older adults, and to examine whether these
associations vary by gender.
Method:The study analyzed a sample of 640 Danish individuals aged 60 and older. Multilevel mod-
eling was conducted using PROC MIXED in SAS to assess the impact of sensory impairments on
well-being, depression symptoms, and relationship satisfaction. A two-step approach was employed
to evaluate the main effects and interaction terms of sensory impairments and gender, controlling
for covariates such as age, education, and relationship length.
Results:Both vision and hearing impairments were significantly associated with lower well-being
and higher depression symptoms in men and women. However, a gender difference was observed
for the association between vision impairment and relationship satisfaction: greater vision impairment
was associated with lower relationship satisfaction among men but not among women.
Conclusion:The findings add nuance to the understanding of how sensory impairments may affect
older men and women, highlighting both gender similarities and differences. The study also discusses
possible interpretations of the findings, suggesting that social and cultural factors may influence how
sensory impairments affect mental and relational health outcomes differently for men and women.
Introduction
Hearing and vision impairments are common chronic disabili-
ties globally (Oosthuizen etal., 2023). Approximately 1.5 billion
individuals worldwide experience some degree of hearing
impairment, while an estimated 2.2 billion are affected by vision
impairment (Oosthuizen etal., 2023; World Health Organization,
2019, 2021). These sensory impairments are particularly preva-
lent among older adults, and the prevalence and severity of
impairment increase with age (World Health Organization,
2019, 2021). With an aging global population, hearing and
vision impairments thus present significant public health chal-
lenges (Nocini etal., 2023; World Health Organization, 2017,
2019, 2021).
Sensory impairments carry significant personal difficulties
for the affected individuals and the people close to them. Both
hearing impairment and vision impairment are associated with
reduced cognitive functioning (Guo etal., 2023; Wallhagen etal.,
2001; Zhao etal., 2021; Zhou etal., 2023), lower levels of physical
activity (Sweeting etal., 2020), and withdrawal from interper-
sonal relationships leading to social exclusion (Olsson etal.,
2021; Palmer etal., 2019; Stevelink etal., 2015). Generally, these
impairments hamper individuals’ ability to communicate and
participate in daily activities, leading to adverse effects on their
mental health, physical health, and interpersonal relationships
(Palmer etal., 2019; Stevelink etal., 2015; Sweeting etal., 2020;
Wallhagen etal., 2001; Zhao etal., 2021). Of particular concern
are depression and well-being, as these serve as indicators of
people’s mental health (Ruggeri et al., 2020; World Health
Organization, 2022). Both depression and poor well-being are
prevalent issues among individuals with sensory impairments,
often following from social isolation and decreased functional
capability (Pardhan etal., 2021; Sun etal., 2021; Zhao etal.,
2021). Hearing loss, for example, can make communication
challenging, leading to frustration and withdrawal from social
activities (Scinicariello etal., 2019). Similarly, vision impairment
can hinder one’s ability to engage in everyday tasks and hob-
bies, contributing to feelings of reduced well-being and depres-
sion (Virgili etal., 2022).
Relationship satisfaction is another important factor, as
well-functioning interpersonal relationships are pivotal to indi-
viduals’ mental and physical health (e.g. Bookwala & Gaugler,
2020; Downward etal., 2022). Sensory impairment is associated
with lower relationship satisfaction and relational well-being
(Lehane etal., 2017a). More specifically, sensory impairments
can strain interpersonal relationships, often requiring adjust-
ments in communication and shared activities (Olsson etal.,
2021; Stevelink etal., 2015). Hearing impairment is associated
with misunderstandings and decreased quality of interactions,
thereby affecting relationship satisfaction (Scarinci etal., 2009).
Vision impairment also poses challenges, as individuals may
rely more on their partners for daily tasks, potentially altering
relationship dynamics (Stevelink etal., 2015).
Research suggests that there are gender differences with
respect to sensory impairment. Generally, women are more
likely to experience vision impairments, whereas men are more
© 2025 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group
CONTACT Andreas Nielsen Hald andreas.hald@sund.ku.dk, andreas_hald123@yahoo.dk
Supplemental data for this article can be accessed online at https://doi.org/10.1080/13607863.2025.2456483.
https://doi.org/10.1080/13607863.2025.2456483
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, dis-
tribution, and reproduction in any medium, provided the original work is properly cited. The terms on which this article has been published allow the posting of the Accepted Manuscript in
a repository by the author(s) or with their consent.
ARTICLE HISTORY
Received 7 October 2024
Accepted 12 January 2025
KEYWORDS
Hearing impairment; vision
impairment; well-being; gender;
older adults

2 A. N. HALD ETAL.
prone to hearing loss (Delhez etal., 2020; Hansen etal., 2024;
Raymond etal., 2019; Rius Ulldemolins etal., 2019; Shuster etal.,
2019; Wallhagen etal., 2001; Zhao etal., 2021). These differences
stem from various factors, including hormonal differences
(Delhez etal., 2020; Raymond etal., 2019; Shuster etal., 2019),
healthcare access (Rius Ulldemolins etal., 2019), and lifestyle
choices. For instance, men have higher exposure to occupa-
tional noise, contributing to greater rates of hearing loss (Eng
etal., 2011). On the other hand, women may face societal bar-
riers to accessing eye care services, leading to untreated vision
problems (Rius Ulldemolins etal., 2019).
These gender differences raise the question of whether sen-
sory impairment is also differentially associated with negative
mental and relational health outcomes for men and women.
There seems to be relatively little research concerning such inter-
action effects (Lyu & Kim, 2018; Pardhan etal., 2021; Scinicariello
etal., 2019; Zhao etal., 2021). The few identified studies show
contradicting results; one study suggests that women with
dual-sensory impairments are more likely to experience depres-
sion and anxiety than men with dual-sensory impairments
(Pardhan etal., 2021), while another study suggests that men
with sensory impairments (hearing and vision impairment) have
higher levels of depression and anxiety than women (Chen &
Zhou, 2023), and yet other studies showing mixed associations
(Lyu & Kim, 2018), or no differences (Ahrenfeldt etal., 2024).
Different theories may explain the presence or absence of
gender-based interaction effects. On one hand, evolutionary
perspectives suggest that gender-based differences arise due
to natural and sexual selection pressures (Hyde, 2014). In line
with this theory, one might expect that sensory impairments
hinder gender-stereotyped behaviors. For example, women
may be more adversely affected by sensory impairments in
terms of relationship satisfaction because nurturing traits have
been more strongly selected for in women. When sensory
impairments hinder communication and social engagement, it
disproportionately impacts women’s ability to fulfill nurturing
roles, potentially leading to lower satisfaction in relationships
compared to men. On the other hand, the gender similarity
hypothesis argues that men and women are alike on most psy-
chological variables and that observed differences—such as
gender-based differences in how sensory impairments affect
mental and relational health—are due to social and cultural
factors (Hyde, 2005, 2014). However, more empirical research is
needed to support any theoretical interpretation. This is import-
ant, as without knowledge about gender-based differences in
the association between sensory impairment and mental and
relational health outcomes, we cannot properly tailor support
to individuals affected by sensory impairments (Lyu & Kim, 2018).
Using a large sample of older Danish adults, this study aims
to contribute to the literature by examining (1) whether greater
sensory impairments (vision and hearing impairment, respec-
tively) are associated with depression symptoms, well-being,
and relationship satisfaction, and (2) whether these potential
associations differ for men and women.
Methods
Transparency and openness
The data comes from a larger study investigating the effects of
a digital intervention for elderly sensory-impaired individuals
and their partners. The larger study’s preregistration, including
procedure, measures, and power analysis, can be found at:
https://doi.org/10.17605/OSF.IO/5WTR3. Moreover, the larger
study’s procedure and measures are also described in detail by
Øverup etal. (2022) and the results are presented in Øverup and
Hald (2024). The current study’s data comes from the baseline
assessment (run-in period and main trial period) and represents
post-hoc (not preregistered) analyses. The measures document
and codebook, with both English and Danish language versions
of the items, can be found at https://osf.io/39gj6/?view_only=
ea7fe21af065475dbd4861ae81f3e95e. The data, code, and anal-
ysis output files associated with this article can be found at
https://osf.io/9j2e3/?view_only=23b4241bbacb46afa3611c0
f959cc690.
Participants
We requested that the Danish Agency of Health Research
Services draw a random sample of individuals and their spouses
from the Central Person Registry, providing the following spec-
ifications in drawing our sample: People had to be (1) Danish
citizens, (2) 60 years of age or older, (3) registered as residing at
the same address in Denmark, and (4) married or registered
partners (for individuals in same-sex relationships) with
each other.
Additional eligibility criteria were assessed via self-report at
the baseline survey. These included (5) being able to read and
write in Danish (response options were ‘yes’ and ‘no’), (6) being
in a relationship with their partner for one year or longer
(response options were ‘yes’ and ‘no’), and (7) perceiving that
they or their partner has a sensory impairment that affects their
daily life. The eligibility questions regarding sensory impairment
(point 7 above) were asked for hearing and sight separately. For
self-report, the question was asked in the following manner: Do
you have reduced vision or hearing, which you feel affects your
daily functioning? Vision: (1) yes, (0) no; hearing (1) yes, (0) no.
For partner report, the question asked, ‘Does your partner have
reduced vision or hearing, which you feel affects their daily
functioning?’, with the same response options. Participants were
ineligible for the study if they reported receiving psychological
therapy (response options were ‘yes’ and ‘no’).
Because the data comes from a larger study the sample size
was already determined. The power analysis (in a spreadsheet)
can be found here: https://osf.io/39gj6/?view_only=ea7fe21af
065475dbd4861ae81f3e95e. A total of 12,000 people were
invited to participate, and 799 were eligible and consented to
study participation. Participants completed the survey between
June and December 2021. One person was deleted from the
sample, as he later contacted the study staff to say that he had
answered concerning a knee injury instead of sensory impair-
ment. Moreover, 159 people failed to report their gender,
degree of vision impairment, degree of hearing impairment, or
covariates (age, education length, and relationship length), and
thus, were dropped. The final sample consisted of 640 partici-
pants (102 couples), of which there were 332 men and 308
women. Please see Table 1 for a breakdown of demographic
characteristics. The male participants were a few years older
than the female participants but had shorter education. The
female participants reported lower levels of well-being and
relationship satisfaction, and greater depression symptoms as
compared to the male participants. Most participants reported
using glasses or contact lenses (91%), but only ~36% of the

AGING & MENTAL HEALTH 3
sample reported using hearing aids. Sensory impairments
stemmed primarily from age-related macular degeneration or
age-related sensorineural hearing loss (see Supplemental mate-
rials for more details); only few endorsed diabetes and/or blood
clots as the cause of the sensory impairment (14 endorsements
for vision and 2 endorsements for hearing; please see the
Supplemental materials). Most people (97%) did not receive
assistance in completing the questionnaire, though a few par-
ticipants reported getting help from a family member (not their
partner), a friend/neighbor/colleague, or someone else.
Procedure
All procedures followed the institutional and national research
committee’s ethical standards and the 1964 Declaration of
Helsinki and its later amendments or comparable ethical stan-
dards. We received ethical approval from the University of
Copenhagen Research Ethics Committee for Science and Health
(protocol number 504-0225/20-5000) and the Danish Data
Protection Agency. The study was exempt from further ethical
evaluations following the rules and regulations set forth by the
Scientific Ethical Committees of Denmark (i.e. national ethics
approval was not required). This work was supported by ‘VELUX
FONDEN’ under Grant No. 00022361.
Participants received an invitation letter through their indi-
vidual national online mailbox (e-Boks: a secure electronic mail-
box used to receive digital mail from the public and private
sector, such as one’s bank). The invitation letter indicated that
invitees were eligible for study participation, regardless of their
level of impairment, as long as the participants felt that the
impairment affected their daily lives. The invitation letter
included a link to an informational page that described the
study aims and procedures and an online screening survey,
which assessed eligibility for the study. Those not meeting the
eligibility criteria were routed out of the study.
1
Those who met
the eligibility criteria were routed to the consent form. Those
who provided study consent proceeded to the demographic
questions and the online survey.
Measures
General demographic questions
Participants report on their gender (0 = male, 1 = female), the
gender of their romantic partner (0 = male, 1 = female), age of
their romantic partner, and their highest level of education;
educational level was transformed into three categories:
1 = shorter length education (e.g. primary school, high school,
business high school, vocational education), 2 = medium-length
education (e.g. medium-cycle tertiary education, bachelor’s
degree), and 3 = longer length education (e.g. master’s degree
or higher). Participants also reported the length of their rela-
tionship with their partner in years. Additionally, we asked
whether anyone helped them complete the survey, with
instructions that the partner must not be the helper.
Sight impairment questions
Participants were asked, with or without glasses, as they would
normally wear, (1) how good their vision is in general (‘Is your
vision:’; 1 = Excellent, 2 = Very good, 3 = Good, 4 = Fair, 5 = Poor,
6 = Legally blind), (2) in terms of far-sight (‘How good is your vision
with respect to seeing things at a distance?’; 1 = Excellent, 2 = Ver y
good, 3 = Good, 4 = Fair, 5 = Poor), and (3) in terms of near-sight
(‘How good is your vision with respect to seeing things up close?’;
1 = Excellent, 2 = Very good, 3 = Good, 4 = Fair, 5 = Poor, 6 = Legally
blind). These questions were taken from the Danish language
version of the Survey of Health, Ageing and Retirement in Europe
(SHARE) project (http://www.share-project.org/home0.html).
Hearing impairment questions
Participants are asked, with or without hearing aid, as they
would normally wear, (1) how good their hearing is in general
(1 = Excellent, 2 = Very good, 3 = Good, 4 = Fair, 5 = Poor,
6 = Legally deaf), and (2) whether it is difficult to follow a con-
versation when there is background noise (e.g. from a TV or
radio) (0 = No, 1 = Yes), (3) if they could hear clearly in a conver-
sation with multiple people (0 = No, 1 = Yes), and (4) if they could
hear clearly in a conversation one-on-one (0 = No, 1 = Yes). These
questions were taken from the Danish language version of the
SHARE project (http://www.share-project.org/home0.html).
Well-being
The 5-item WHO well-being measure was used in its Danish ver-
sion (Bech, 2012). Participants were asked to what extent the state-
ments reflected how they had felt over the last two weeks, and
the statements were rated on a scale ranging from ‘at no time’ (0)
to ‘all the time’ (5). An example item includes ‘I have felt active and
vigorous.’ Higher scores indicate greater well-being (α = 0.892).
Depression
Depression was measured using the Danish version of the
9-item Patient Health Questionnaire (PHQ-9), which maps onto
Table 1. Sample characteristics, for men and women separately.
Men
(n = 332)
Women
(n = 308)
Group dierence test
p
M/%SD M/%SD
Age 72.39 6.26 69.62 5.63 <.001
Partner age 70.21 6.37 72.23 6.24 <.001
Level of education <.001
Low 54.52 48.05
Medium 24.10 40.91
High 21.39 11.04
Relationship length (in years) 44.52 11.50 42.45 12.39 0.029
Outcome variables
Well-being 73.44 17.15 70.34 16.83 .023
Depression symptoms 3.56 3.37 4.41 3.36 .002
Relationship satisfaction 16.24 4.04 14.96 4.06 <.001
Note: The table provides the mean and standard deviation for own age, partner age, relationship length, and the three outcome variables; the values for level of
education are percentages. The p value provides a test of whether the means (or, for educational level, distribution) are dierent for men and women.

4 A. N. HALD ETAL.
DSM-IV criteria for depression (Kroenke etal., 2001). Participants
were asked to what extent the statements reflected how they
had felt over the last two weeks; the statements were rated on
a scale ranging from ‘not at all’ (0) to ‘nearly every day’ (3). The
nine items were as follows: (1) ‘Little interest or pleasure in doing
things?’, (2) ‘Feeling down, depressed, or hopeless?’, (3) ‘Trouble
falling or staying asleep, or sleeping too much?’, (4) ‘Feeling tired
or having little energy?’, (5) ‘Poor appetite or overeating?’, (6)
‘Feeling bad about yourself—or that you are a failure or have
let yourself or your family down?’, (7) ‘ Trouble concentrating on
things, such as reading the newspaper or watching television?’,
(8) ‘Moving or speaking so slowly that other people could have
noticed? Or the opposite—being so fidgety or restless that you
have been moving around a lot more than usual?’, and (9)
‘Thoughts that you would be better off dead or of hurting your-
self in some way?’ Items were summed together; in cases where
scales had up to two missing values, missing values are replaced
with the average score of the completed items (Kroenke etal.,
2010). Higher scores indicate greater depression symptomology
(α = 0.765).
Relationship satisfaction
The 4-item version of the Couple Satisfaction Index (Funk &
Rogge, 2007) was used to measure relationship satisfaction. The
items assessed participants’ feelings of happiness and satisfac-
tion with the relationship. An example item is ‘In general, how
satisfied are you with your relationship?’ and the response
options ranged from ‘not at all’ (0) to ‘completely’ (5). Higher
scores indicate greater relationship satisfaction (α = 0.907). As
no Danish version existed, the third and last authors translated
the items from English to Danish.
Plan of analysis
Analyses were conducted in SAS, version 9.4. We first examined
whether there were gender differences in sensory impairment,
using Pearson chi-square tests and independent samples t-tests.
These were followed by an examination of the zero-order
Pearson correlations between sensory impairment and the
mental and relational health variables. Finally, we examined
whether sensory impairment was associated with mental (i.e.
well-being and depression symptoms) and relational (i.e. rela-
tionship satisfaction) health through a series of multilevel mod-
els specified in PROC MIXED. These were employed to account
for the nesting of participants within couples (using a repeated
statement), though the unit of analysis was the individual par-
ticipant responses. We conducted the analyses in two steps: in
step 1, we entered gender, and vision and hearing impairment
as main effects. We elected to focus on the global assessments
of sensory impairment, given that these variables represent the
participants’ evaluation of their overall impairment (Lehane
etal., 2017b). We controlled for participant age, educational
level, and relationship length; these were entered as covariates,
as past research has found them to be associated with the indi-
cator variables (i.e. well-being, depression symptoms, and rela-
tionship satisfaction, e.g. Alonso Debreczeni & Bailey, 2021;
Bjelland etal., 2008; Blom etal., 2020; Bühler etal., 2021). In step
2, we entered interaction terms between sensory impairment
(vision and hearing impairment) and gender to see whether the
association between sensory impairment and the indicators
varied by gender.
Results
Gender dierences in sensory impairment
Table 2 provides an overview of the endorsement of sensory
impairment, comparing men and women. There were no gen-
der differences in terms of the use of eyewear (glasses or con-
tact), the overall assessment of vision impairment (t(638) =
−0.22, p = .827), far sight (t(633) = −1.57, p = .116), or near sight
(t(634) = −1.30, p = .195).
Conversely, men more than women endorsed wearing a
hearing aid, greater impairment in terms of overall hearing
(t(638) = 3.77, p < .001, Cohen’s d = 0.30), and that it was difficult
to follow a conversation when there was background noise.
Men, more than women, also endorsed that it was difficult to
clearly hear what is said in a conversation with multiple people.
There were no gender differences with respect to being able to
hear during conversations with only one other person.
Zero-order associations between sensory impairment
and mental and relationship health
Table 3 details the zero-order Pearson correlations and means
and standard deviations for the study variables, for men and
women separately. Vision and hearing impairment were mod-
erately and positively associated for both men and women.
Moreover, for men and women, greater vision and hearing
impairment was associated with lower well-being and more
depression symptoms. Greater vision impairment was associ-
ated with less relationship satisfaction for men, but not for
women. For both men and women, hearing impairment was
unrelated to relationship satisfaction.
Gender, vision, and hearing impairment as predictors of
mental and relational health: main eects and
moderations
Table 4 provides the results of the regression analyses that inves-
tigated whether vision and hearing impairment were associated
with mental and relational health. We found, controlling for all
other predictors in the model, that there were gender differ-
ences in mental and relational health, such that women
reported lower well-being and relationship satisfaction and
more depression symptoms than men. Moreover, both vision
and hearing impairment were associated with mental health,
such that greater impairment was associated with lower
well-being and more depression symptoms. Only (greater)
vision impairment was associated with (lower) relationship
satisfaction.
Concerning the covariates, older age was associated with
more depression symptoms, while longer relationship lengths
were associated with higher well-being and fewer depression
symptoms. Additionally, those with shorter educations endorsed
lower well-being and more depression symptoms than those
with medium-length educations.
Examination of the interaction terms for sensory impairment
and gender revealed that all interactions but one was nonsig-
nificant. The one significant interaction indicated that the asso-
ciation between vision impairment and relationship satisfaction
varied by gender. Simple slopes were estimated by reverse
coding the gender variable. We found a nonsignificant simple
slope for women (b = −0.17, SE = 0.23, p = .462), but a significant

AGING & MENTAL HEALTH 5
Table 2. Gender dierences in vision and hearing impairment.
Men
(n = 332)
Women
(n = 308)
Group dierence
test
p
Count/M %/SD Count/M %/SD
Vision
Do you normally use glasses or contacts?
No 35 10.57 25 7.14 0.128
Yes 296 89.43 286 92.86
Global assessment: Is your vision?
2.51 0.93 2.52 1.00 0.8271
Far-sight: How good is your vision with respect to seeing
things at a distance?
2.16 0.96 2.29 1.02 0.116
Near sight: How good is your vision with respect to seeing
things up close?
2.44 0.94 2.54 1.06 0.195
Hearing
Do you normally use a hearing aid?
Yes 147 44.68 80 26.06 <.001
No 182 55.32 227 73.94
Global assessment: Is your hearing?
3.00 1.07 2.67 1.13 <.001
Dicult to follow a conversation when there is background
noise?
Yes 199 60.49 146 48.18 0.002
No 130 39.51 157 51.82
Can you clearly hear what is said in a conversation with
multiple people?
Yes 121 36.78 145 48.17 0.004
No 208 63.22 156 51.83
Can you clearly hear what is said in a conversation with one
person?
Yes 303 91.82 283 94.02 0.283
No 27 8.18 18 5.98
Note. The table provides mean and standard deviation for vision impairment questions and the global hearing assessment; the values for other hearing impairment
questions are counts and percentages. The p value provides a test of whether the means (or, for the hearing impairment questions, distribution) are dierent for
men and women.
Table 3. Zero-order Pearson correlations among study variables, for men and women separately.
1 2 3 4 5 6 7 8
1 Vision impairment – 0.25*** −0.23*** 0.23*** −0.11 0.05 0.05 0.01
2 Hearing impairment 0.30*** – −0.20*** 0.21*** −0.11 0.06 −0.03 0.14*
3 Well-being −0.28*** −0.17** – −0.65*** 0.37*** 0.00 0.11 0.05
4 Depression symptoms 0.27*** 0.18** −0.62*** – −0.30*** 0.01 −0.17** −0.04
5 Relationship satisfaction −0.25*** −0.09 0.38*** −0.29*** – −0.04 0.08 −0.01
6 Participant age 0.14* 0.05 −0.02 0.08 −0.05 – −0.01 0.44***
7 Educational level −0.02 −0.04 0.09 −0.11* −0.03 0.08 – −0.13*
8 Relationship length 0.11 0.08 0.06 −0.08 0.03 0.46*** 0.05 –
Women mean 2.52 2.67 70.34 4.41 14.96 69.62 1.63 42.45
Women SD 1.00 1.13 16.83 3.36 4.06 5.63 0.67 12.39
Women range 1–5 1–6 4–100 0–17 1–21 60–86 1–3 3–80
Men mean 2.51 3.00 73.44 3.56 16.24 72.39 1.67 44.52
Men SD 0.93 1.07 17.15 3.37 4.04 6.26 0.81 11.50
Men range 1–5 1–5 8–100 0 − 21.4 4–21 61–91 1–3 5–71
Note: Correlations for women are above the diagonal, while correlations for men are below the diagonal. Additionally, the table provides mean, standard deviation,
and range for all study variables, for women and men separately.
*p < .05, **p < .01, ***p < .001.
Table 4. Regression results for models predicting psychological health.
Well-being
(N = 626)
Depression symptoms
(N = 620)
Relationship satisfaction
(N = 621)
Parameter b p 95% CI b p 95% CI b p 95% CI
Step 1
Intercept 89.69 <.001 [73.16; 106.22] −1.90 0.253 [−5.16; 1.36] 20.90 <.001 [16.83; 24.98]
Gender −3.60 0.007 [−6.21; −0.98] 1.08 <.001 [0.57; 1.60] −1.59 <.001 [−2.20; −0.98]
Vision impairment −3.94 <.001 [−5.31; −2.58] 0.74 <.001 [0.47; 1.01] −0.58 <.001 [−0.91; −0.26]
Hearing impairment −1.96 0.001 [−3.16; −0.76] 0.44 <.001 [0.20; 0.68] −0.19 0.200 [−0.47; 0.10]
Age −0.08 0.501 [−0.33; 0.16] 0.05 0.049 [0.00; 0.10] −0.04 0.160 [−0.10; 0.02]
Educational level—long 1.13 0.572 [−2.79; 5.05] −0.17 0.66 [−0.95; 0.60] −0.69 0.155 [−1.63; 0.26]
Educational level—short −3.01 0.041 [−5.91; −0.12] 0.93 0.001 [0.37; 1.50] −0.62 0.082 [−1.31; 0.08]
Relationship length 0.16 0.012 [0.03; 0.28] −0.04 0.002 [-0.06; −0.01] 0.02 0.154 [−0.01; 0.05]
Step 2
Vision impairment*Gender 1.79 0.1979 [−0.94; 4.51] −0.27 0.330 [−0.80; 0.27] 0.85 0.010 [0.20; 1.50]
Hearing
impairment*Gender
−0.68 0.5818 [−3.11; 1.75] 0.18 0.476 [−0.31; 0.66] −0.29 0.342 [−0.87; 0.30]
Note: b = unstandardized regression coecient. Gender = men as reference group; coecient shows the dierence for women. Education = medium-length educa-
tion as the reference group.
Bold denote statistical signicance at p < .05.

6 A. N. HALD ETAL.
simple slope for men (b = −1.02, SE = 0.24, p < .001), such that
when men reported greater vision impairment, they reported
lower relationship satisfaction.
Discussion
This study investigated whether vision and hearing impair-
ments were associated with older Danish adults’ depression
symptoms, self-perceived well-being, and relationship satisfac-
tion, with a specific focus on differential gender effects.
While previous studies have noted possible gender differ-
ences in how sensory impairments may adversely affect indi-
viduals, we saw no such interaction effect for the two mental
health indicators (Chen & Zhou, 2023; Pardhan etal., 2021).
Instead, we found that, regardless of gender, both hearing and
vision impairments were associated with worse well-being and
more depression symptoms. This gender similarity could be
attributed to several factors. For example, it might be that pre-
viously identified gender differences were chance findings. This
could also explain the highly heterogeneous findings in the
field, where some studies find that men are most adversely
affected by sensory impairments (e.g. Chen & Zhou, 2023), some
find that women are more adversely affected (Lyu & Kim, 2018;
Pardhan etal., 2021), and some—like the current study—find
no seeming difference (Ahrenfeldt etal., 2024; Chan etal., 2021).
However, it may also be that societal differences explain the
inconsistency in findings. In other words, gender differences in
how sensory impairments affect health outcomes are more
likely socially constructed than biologically determined. For
example, Rius Ulldemolins & colleagues’ Rius Ulldemolins etal.,
Rius Ulldemolins etal., (2019) study of gender inequalities in
visual impairment highlights how women in Spain wait twice
as long as men for cataract surgery in the public system, leading
to women having higher rates of vision impairment and being
more adversely affected by it. This point aligns with the gender
similarity hypothesis, stating that men and women are mostly
similar on psychological variables, and measured differences
are primarily driven by the influences of societal norms, struc-
tures, and values (Hyde, 2005; 2014).
In line with these findings, we hypothesize that our lack of
gender interactions may stem from Denmark’s universal access
to healthcare services, the low stigma around disability, and
generally egalitarian society (Birk etal., 2024; European Institute
for Gender Equality, 2023; Ministry of Health, 2017). Hence,
Danish society’s prevailing norms, structures, and values may
support gender similarity.
Interestingly, we did find that the association between vision
impairment and relationship satisfaction differed by gender,
such that men, but not women, experienced lower relationship
satisfaction with higher vision impairment. We can only specu-
late as to why we found this result. Research suggests that
greater vision impairment is associated with a reduced capacity
to care for self and others and maintain independence (Hassell
etal., 2006; Stevenson etal., 2004), which may lead to changes
in roles and division of labor within the relationship (McCloud
etal., 2014). It may be that men feel worse about such changes
in the relationship dynamic, compounded by the distress felt
from being a support receiver (instead of a support provider;
Dunbar etal., 1998) from their partner, leading to lower rela-
tionship satisfaction. Future research may wish to qualitatively
examine the reasons for the lower relationship satisfaction, and
whether men and women with vision impairment experience
support provision (from their partner) differently. Overall, this
study contributes to the literature on gender differences in the
association between sensory impairments and health out-
comes, highlighting both gender differences and similarities.
Implications
The findings suggest that sensory impairments were negatively
associated with mental health and relationship satisfaction
among older adults, regardless of gender. From a healthcare
perspective, these results imply a continued need for healthcare
strategies and interventions to mitigate the potential adverse
effects caused by or co-occurring with sensory impairments.
This could, for example, be early detection strategies aimed at
preventing and mitigating the escalation of sensory impair-
ments or rehabilitation and support programs aimed at allevi-
ating the adverse effects of sensory impairments once they are
experienced (Ahrenfeldt etal., 2024; Chan et al., 2021). Such
strategies and interventions may include advertising support
services through optometrists and audiologists, given that
those professions serve people at the early stages of sensory
impairment. Moreover, digital interventions may supplement
face-to-face services provided by ophthalmologists, otolaryn-
gologists, or other health professionals supporting people with
sensory impairments. This could be particularly relevant in
countries with greater digitalization of social and health services
(e.g. the Nordic countries). Limited research has found mixed
results for digital interventions for those with sensory impair-
ment (Malmberg etal., 2017; Molander etal., 2018; Øverup &
Hald, 2024; Thorén etal., 2014) and more research is needed to
establish the topics included in and format of such interven-
tions, particularly given the heterogeneity of the target popu-
lation. However, early detection strategies and interventions
may reduce the societal cost of sensory impairments and the
personal burden of the individuals experiencing them
(Oosthuizen etal., 2023; World Health Organization, 2019, 2021),
thus highlighting that sensory impairment and its potential
downstream effects remain a research and societal priority
(Lehane etal., 2016).
Furthermore, the results imply that in a setting like Denmark,
where there appear to be no large gender differences in how
sensory impairments are associated with mental and relational
health indicators among older adults, healthcare strategies and
interventions should be universally applicable. Hence, they
should be based on the individual needs of those experiencing
sensory impairments. However, this may be different in less
developed or more inequitable societies, where there could be
a need for gender-specific strategies and interventions to man-
age gender differences in the association between sensory
impairments and mental, relational, and social health outcomes
(Pardhan etal., 2021; Rius Ulldemolins etal., 2019).
Limitations and future directions
There are some limitations to keep in mind. First, we recruited
participants from the general population and could not verify
their level of sensory impairment. The reliance on self-reported
data introduces uncertainty about the accuracy of participants’
level of sensory impairment, as no objective measures, such as
hearing tests or vision examinations, were used. Self-reported
measures may function differently than objective measures and

AGING & MENTAL HEALTH 7
thus, future research should consider incorporating objective
assessments conducted by health professionals to validate
self-reported data and provide a more reliable understanding
of the associations examined.
Second, self-selection bias is a potential concern in the cur-
rent study. Because the sample was recruited through invitation
letters sent to the general population, the individuals who
chose to participate may systematically differ from the individ-
uals who chose not to participate. For example, individuals who
elected to participate may have had less severe impairments
compared to non-participants, potentially leading to an under-
representation of individuals with more pronounced sensory
impairments or psycho-social struggles. This bias could reduce
the observed associations between sensory impairment and
mental and relational health, as the sample may not fully cap-
ture the variance of experiences in the general population. To
address this limitation, future studies could adopt alternative
recruitment strategies, such as partnering with optometrists
and audiologists to recruit a more diverse sample. However,
such strategies may still be prone to self-selection bias, as indi-
viduals with greater personal resources are often more likely to
respond (Søgaard etal., 2004; Wellstead, 2011). Alternatively,
future research could explore the feasibility and relevance of
population-based designs that link register-based data on sen-
sory impairment with health outcomes.
Third, this study uses cross-sectional data, which limits our
ability to draw causal inferences. Although our findings sug-
gest associations between sensory impairments and mental
and relational health indicators for men and women, they
cannot demonstrate direct causal associations. To address this,
future research should adopt longitudinal designs to track
changes in sensory impairments and their effects over time,
enabling an examination of temporal sequencing and causal
links. Such approaches could also identify mediating and mod-
erating factors. For instance, chronic diseases like diabetes,
which are prevalent among older adults, are strongly linked
to sensory impairments such as retinal diseases and hearing
loss, as well as broader health outcomes like perceived
well-being (Samocha-Bonet etal., 2021; Tan & Wong, 2022).
Diabetes—or other chronic diseases—may therefore serve as
a moderating factor by influencing the strength or direction
of the associations between sensory impairments and health
outcomes, or as a mediating factor by exacerbating or explain-
ing these associations. Future research may thus incorporate
chronic diseases like diabetes into longitudinal analyses to
gain deeper insights into the complex interplay between sen-
sory impairments, chronic conditions, and mental and rela-
tional health outcomes, offering valuable insights for targeted
interventions.
Fourth, Denmark’s universal healthcare access and relatively
egalitarian culture may limit the generalizability of our findings
to other settings. That the study is conducted on a Danish pop-
ulation likely reduced gender disparities in health outcomes,
potentially obscuring gender differences that might be more
pronounced in contexts with less equitable healthcare systems
or greater gender inequality. To address this limitation, future
research may conduct larger comparative cross-country studies
that examine the impact of different cultural contexts on gender
differences in the effects of sensory impairment. For example,
studies comparing countries with varying levels of healthcare
access and gender equity could help examine how cultural and
systemic factors shape the gendered experiences of sensory
impairments and related outcomes. This would provide
valuable insights into the social construction of gender differ-
ences and how this may influence the mental and relational
health effects of sensory impairments.
Lastly, many of the measures used in the study did not exist
in Danish versions, and the third and last authors conducted
most of the translations. Thus, the measures are not validated
in the Danish language, and it is unknown whether the con-
structs are perceived the same in Danish culture as in US culture
(the country from which much of the scale development work
originates).
Note
1. It was possible for one partner in the couple to be eligible for study
participation and the other to not be eligible. Given that partici-
pants were able to sign up asynchronously, that eligibility was
based on participants’ own perceptions of their/their partner’s sen-
sory impairment, and that participants had to provide individual
consent and contact information, we were unable to direct both
partners to participate. Thus, people were included in the study
even if their partner did not participate.
Authors’ contribution
Andreas Nielsen Hald: Writing—original draft, Writing—review and
editing; Freja Nannerup Kjærgaard: Writing—original draft,
Writing—review and editing; Gert Martin Hald: Conceptualization,
Funding acquisition, Methodology, Supervision; Camilla S. Øverup:
Conceptualization, Data curation, Formal analysis, Funding acquisi-
tion, Investigation, Methodology, Project administration, Writing—
original draft, Writing—review and editing.
Disclosure statement
The authors report no competing interests concerning the article’s
research and publication.
Ethic approval statement
The manuscript has not been previously published and is not being
considered for publication elsewhere. The study adhered to all ethical
and informed consent guidelines, with approval from the Danish Data
Protection Agency and the University of Copenhagen Research Ethics
Committee for Science and Health (protocol number 504-0225/20-
5000). Following the Scientic Ethical Committees of Denmark’s regu-
lations, national ethics approval was not required.
Funding
This work was supported by ‘VELUX FONDEN’ under Grant No.
00022361.
ORCID
Andreas Nielsen Hald http://orcid.org/0000-0002-4451-0542
Data availability statement
The data used in the article’s analysis comes from a larger study inves-
tigating the eects of a digital intervention for elderly sensory-im-
paired individuals and their partners. The larger study’s preregistration,
including procedure, measures, and power analysis, can be found at:
https://doi.org/10.17605/OSF.IO/5WTR3. Moreover, the larger study’s
procedure and measures are also described in detail by Øverup et al.
(2022) and the results are presented in Øverup and Hald (2024). The
current article’s measures document and codebook, with both English
and Danish language versions of the items, can be found at https://osf.

8 A. N. HALD ETAL.
io/39gj6/?view_only=ea7fe21af065475dbd4861ae81f3e95e.
Additionally, the data, code, and analysis output les associated with
this article can be found at https://osf.io/9j2e3/?view_only=23b4241b
bacb46afa3611c0f959cc690.
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