Vision Impairment and Combined Vision and Hearing Impairment Predict Cognitive and Functional Decline in Older Women
To determine the association between vision and hearing impairment and subsequent cognitive and functional decline in community-residing older women.
Prospective cohort study.
Four metropolitan areas of the United States.
A total of 6,112 women aged 69 and older participating in the Study of Osteoporotic Fractures (SOF) between 1992 and 1994.
Five thousand three hundred forty-five participants had hearing measured, 1,668 had visual acuity measured, and 1,636 had both measured. Visual impairment was defined as corrected vision worse than 20/40. Hearing impairment was defined as the inability to hear a tone of 40 dB or greater at 2,000 hertz. Participants completed the modified Mini-Mental State Examination and/or a functional status assessment at baseline and follow-up. Cognitive and functional decline were defined as the amount of decline from baseline to follow-up that exceeded the observed average change in scores by at least 1 standard deviation.
About one-sixth (15.7%) of the sample had cognitive decline; 10.1% had functional decline. In multivariate models adjusted for sociodemographic characteristics and chronic conditions, vision impairment at baseline was associated with cognitive (odds ratio (OR)=1.78, 95% confidence interval (CI)=1.21-2.61) and functional (OR=1.79, 95% CI=1.15-2.79) decline. Hearing impairment was not associated with cognitive or functional decline. Combined impairment was associated with the greatest odds for cognitive (OR=2.19, 95% CI=1.26-3.81) and functional (OR=1.87, 95% CI=1.01-3.47) decline.
Sensory impairment is associated with cognitive and functional decline in older women. Studies are needed to determine whether treatment of vision and hearing impairment can decrease the risk for cognitive and functional decline.
Available from: ggm.sagepub.com
- "Studies have demonstrated a relationship between visual impairment, auditory impairment, and combined visual and auditory impairment with cognitive impairment (Heyl & Wahl, 2012;M. Y.Lin et al., 2004;F. R. Lin et al., 2013;Reyes-Ortiz et al., 2005). "
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ABSTRACT: Objective: The objective of this study was to assess the relationship of disability (activities of daily living [ADL] and instrumental ADL [IADL]), self-rated health (SRH), and 6-year mortality with co-existing impairments in vision (self-rated), hearing (self-rated), and/or cognition (Short Portable Mental Status Questionnaire) in older adults. Method: The study sample comprised of 3,871 participants from the North Carolina Established Populations for Epidemiologic Studies of the Elderly study (NC EPESE). Results: Persons with all three impairments had increased odds of ADL/IADL disability and low SRH. Participants with combined visual and cognitive impairments had increased odds of mortality. Whereas sensory impairments were associated with poor SRH, cognitive impairment was not unless both sensory impairments were present. Conclusion: Co-existent sensory and cognitive impairments were associated with higher risk of impaired functional status. Self-rated auditory impairment alone was not associated with higher odds of death, but mortality was linked to visual and, particularly, cognitive impairment, alone or combined.
Available from: Gertrudis I J M Kempen
- "People with DSI experience barriers in communication, mobility, and information access [2,3], and DSI seniors are at higher risk of depressive feelings [4,5], functional decline [6,7], and social isolation . The consequences of DSI are believed to go beyond those difficulties experienced by seniors suffering from single sensory loss , endangering their social participation and autonomy [10,11]. "
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ABSTRACT: Five to 25 percent of residents in aged care settings have a combined hearing and visual sensory impairment. Usual care is generally restricted to single sensory impairment, neglecting the consequences of dual sensory impairment on social participation and autonomy. The aim of this study is to evaluate the effectiveness of a self-management program for seniors who acquired dual sensory impairment at old age..Methods/designIn a cluster randomized, single-blind controlled trial, with aged care settings as the unit of randomization, the effectiveness of a self-management program will be compared to usual care. A minimum of 14 and maximum of 20 settings will be randomized to either the intervention cluster or the control cluster, aiming to include a total of 132 seniors with dual sensory impairment. Each senior will be linked to a licensed practical nurse working at the setting. During a five- to six-month intervention period, nurses at the intervention clusters will be trained in a self-management program to support and empower seniors to use self-management strategies. In two separate diaries, nurses keep track of the interviews with the seniors and their reflections on their own learning process. Nurses of the control clusters offer care as usual. At senior level, the primary outcome is the social participation of the seniors measured using the Hearing Handicap Questionnaire and the Activity Card Sort, and secondary outcomes are mood, autonomy and quality of life. At nurse level, the outcome is job satisfaction. Effectiveness will be evaluated using linear mixed model analysis.
The results of this study will provide evidence for the effectiveness of the Self-Management Program for seniors with dual sensory impairment living in aged care settings. The findings are expected to contribute to the knowledge on the program's potential to enhance social participation and autonomy of the seniors, as well as increasing the job satisfaction of the licensed practical nurses. Furthermore, an extensive process evaluation will take place which will offer insight in the quality and feasibility of the sampling and intervention process. If it is shown to be effective and feasible, this Self-Management Program could be widely disseminated.Clinical trials registrationClinicalTrials.gov NCT01217502.
Available from: Norio Sugawara
- "Multiple cross-sectional studies [12,27,28] have found a significant relationship between hearing impairment and cognitive function, even after adjusting for confounding factors. Furthermore, in longitudinal study on women who were at least 69 years old, Lin et al.  demonstrated that hearing impairment had tendency to associate with cognitive decline (OR 1.38, 95% CI 0.95 to 2.00). "
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Hearing impairment is a prevalent and chronic condition in older people. This study investigated the relationship between cognitive function and hearing impairment in a Japanese population.
A pure-tone average (0.5-2.0 kHz) was used to evaluate hearing impairment in 846 participants of the Iwaki Health Promotion Project who were aged at least 50 years old (310 men and 536 women). We also administered the Mini-Mental State Examination (MMSE), the Center for Epidemiologic Studies for Depression (CES-D) scale, Starkstein's apathy scale (AS) and the Short Form Health Survey Version 2 (SF-36v2). A multiple linear regression analysis assessed the association between hearing impairment and mental correlates.
The overall prevalence of hearing impairment in this study population was 37.7%. The participants with hearing impairment were older and less educated compared to those with no hearing problems. We observed significant differences in the MMSE and AS scores between the mild/moderate to severe groups versus the non-impaired group. After adjusting for age, gender and amount of education, hearing impairment was significantly associated with MMSE and AS scores, but not with CES-D scores. Hearing impairment was significantly related to the social functioning (SF) and role emotional (RE) scores of the SF-36v2.
Hearing impairment is common among older people and is associated with cognitive impairment, apathy and a poor health-related quality of life. Screening for and correcting hearing impairments might improve the quality of life and functional status of older patients.
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