IMPORTANCE Worsening vision and declining cognitive functioning are common conditions among elderly individuals. Understanding the association between them could be beneficial in mitigating age-related cognitive changes.OBJECTIVE To evaluate the longitudinal associations between visual impairment and cognitive function over time in a population-based study of older US adults. DESIGN, SETTING, AND PARTICIPANTSProspective longitudinal population-based study of older adults in the greater Salisbury area in Maryland. Overall, 2520 community-residing adults aged 65 to 84 years were assessed at baseline between September 1993 and August 1995 (round 1) and 2 (round 2), 6 (round 3), and 8 (round 4) years later. MAIN OUTCOMES AND MEASURES Visual acuity (VA) was measured using Early Treatment Diabetic Retinopathy Study charts, and cognitive status was assessed using the Mini-Mental State Examination (MMSE).RESULTS Of 2520 individuals, the mean (SD) age was 73.5 (5.1) years, 1458 (58%) were women, and 666 (26%) were black. There were 2240 (89%), 1504 (61%), and 1250 (50%) participants in the second, third, and fourth round of study, respectively, with more than half of the loss being due to death. Both VA and MMSE score worsened over time. The mean biannual decline of VA was 0.022 logMAR (approximately 1 line during 8 years; 95% CI, 0.018-0.026), and the mean biannual worsening of MMSE score was −0.59 (95% CI, −0.64 to −0.54; both P < .001). Worse baseline VA was associated with worse baseline MMSE score (r = −0.226; 95% CI, −0.291 to −0.16; P < .001). The rate of worsening VA was associated with the rate of declining MMSE score (r = −0.139; 95% CI, −0.261 to −0.017; P = .03). Cross-lagged models indicated VA in the previous round was associated with MMSE score in the subsequent round (β = −0.995, P < .001), and MMSE score in the previous round was associated with VA in the following round (β = −0.003, P < .001). However, the standardized effect size of VA on MMSE score (β = −0.074; SE, 0.015; P < .001) is larger relative to the reverse effect (β = −0.038; SE, 0.013; P < .001), demonstrating VA is likely the driving force in these dynamic associations. CONCLUSIONS AND RELEVANCEIn a population-based sample of older US adults, visual impairment measured at distance is associated with declining cognitive function both cross-sectionally and longitudinally over time with worsening vision having a stronger association with declining cognition than the reverse. Worsening vision in older adults may be adversely associated with future cognitive functioning. Maintaining good vision may be an important interventional strategy for mitigating age-related cognitive declines.

Analysis of data from a nationally representative sample of US adults (n=195801) showed that concurrent hearing and visual impairment prevalence rates were highest for participants older than 79 years of age (16.6%); a 3-fold increase in age-adjusted rates of reported hearing and visual impairment was observed for Native Americans compared with Asian Americans. Research on preventing concurrent hearing and visual impairment and countering its consequences is warranted, especially in population subgroups, such as Native and older Americans.

Background Understanding patterns of multimorbidity in the US older adult population and their relationship with mortality is important for reducing healthcare utilization and improving health. Previous investigations measured multimorbidity as counts of conditions rather than specific combination of conditions. Methods This cross-sectional study with longitudinal mortality follow-up employed latent class analysis (LCA) to develop clinically meaningful subgroups of participants aged 50 and older with different combinations of 13 chronic conditions from the National Health Interview Survey 2002–2014. Mortality linkage with National Death Index was performed through December 2015 for 166,126 participants. Survival analyses were conducted to assess the relationships between LCA classes and all-cause mortality and cause specific mortalities. Results LCA identified five multimorbidity groups with primary characteristics: “healthy” (51.5%), “age-associated chronic conditions” (33.6%), “respiratory conditions” (7.3%), “cognitively impaired” (4.3%) and “complex cardiometabolic” (3.2%). Covariate-adjusted survival analysis indicated “complex cardiometabolic” class had the highest mortality with a Hazard Ratio (HR) of 5.30, 99.5% CI [4.52, 6.22]; followed by “cognitively impaired” class (3.34 [2.93, 3.81]); “respiratory condition” class (2.14 [1.87, 2.46]); and “age-associated chronic conditions” class (1.81 [1.66, 1.98]). Patterns of multimorbidity classes were strongly associated with the primary underlying cause of death. The “cognitively impaired” class reported similar number of conditions compared to the “respiratory condition” class but had significantly higher mortality (3.8 vs 3.7 conditions, HR = 1.56 [1.32, 1.85]). Conclusion We demonstrated that LCA method is effective in classifying clinically meaningful multimorbidity subgroup. Specific combinations of conditions including cognitive impairment and depressive symptoms have a substantial detrimental impact on the mortality of older adults. The numbers of chronic conditions experienced by older adults is not always proportional to mortality risk. Our findings provide valuable information for identifying high risk older adults with multimorbidity to facilitate early intervention to treat chronic conditions and reduce mortality.

To determine the association between reported concurrent visual and hearing impairment and risk of mortality. Design, Setting, and Participants: Annual crosssectional multistage area probability surveys of the US civilian noninstitutionalized population living at addressed dwellings were conducted by the National Center for Health Statistics, Hyattsville, Md. Mortality linkage with the National Death Index of participants from 1986 to 1994 was performed through 1997. Complete reported visual and hearing impairment data and survival status were available for 116 796 adults aged 18 years and older. A total of 3620 participants reported visual impairment only, 12 330 reported hearing impairment only, and 1461 reported concurrent visual and hearing impairment. Main Outcome Measure: Risk of mortality. Results: Mortality linkage identified 8949 deaths with an average follow-up of 7.0 years. After controlling for survey design, age, marital status, educational level, selfrated health, and number of nonocular and nonauditory conditions, white participants and "other-race" par