Association of Co-Existing Impairments in Cognition and Self-Rated Vision and Hearing With Health Outcomes in Older Adults

Abstract

OBJECTIVES 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. METHODS The study sample was comprised of 3871 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. While sensory impairments were associated with poor SRH, cognitive impairment was not unless both sensory impairments were present. DISCUSSION 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.

The Impact of Self‐Reported Vision and Hearing Impairment on Health Expectancy

“…Although some studies have reported the independent association of vision impairment and of hearing impairment with increased mortality, we observed LE estimates to be similar for those with neither or only one impairment. Presence of similar LE at age 65 for those with or without hearing impairment, although when considering hearing impairment as time invariant, was also reported from the United Kingdom .…”

“…Despite the importance of vision and hearing in the maintenance of functional ability and quality of life among older adults, vision and hearing impairments often remain undetected or underreported or untreated . Further, the impact of these impairments, especially hearing impairment, is poorly recognized.…”

“…Among the five classical senses, impairment in vision and in hearing, especially when coexisting, may have the greatest impact on the health of older adults. Impairment in vision is associated with limitation in physical function and in activities of daily living (ADLs; difficulty in basic or instrumental activities of daily living [IADLs]), cognitive decline, and poor self‐rated health (SRH) . Impairment in hearing contributes to limitation in ADLs and poor SRH .…”

“…Impairment in vision is associated with limitation in physical function and in activities of daily living (ADLs; difficulty in basic or instrumental activities of daily living [IADLs]), cognitive decline, and poor self‐rated health (SRH) . Impairment in hearing contributes to limitation in ADLs and poor SRH . And, when coexisting, that is, impairment in both vision and hearing, they have an even greater impact, vs either or none of the two impairments, on health outcomes.…”

“…One approach to gauge the holistic health impact, at the population level, is through the estimation of health expectancy, defined as “the analysis of both healthy and unhealthy years of life where health can be defined along various dimensions.” Health expectancy estimation is useful in monitoring population health because it captures both quantity and quality of life‐years by adding a quality‐of‐life aspect to life expectancy (LE) . Given the increasing importance placed on the need for assistance for daily activities and quality of life by older adults and their families, and the strong link of vision and/or hearing impairment with limitation in physical function and in ADLs, estimation of the years of life with and without limitation in physical function and in ADLs by vision and hearing impairment status is both pertinent and timely.…”