Association of Co-occurring Dementia and Self-reported Visual Impairment With Activity Limitations in Older Adults

Abstract

IMPORTANCEThe 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 PARTICIPANTSThis 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 MEASURESMultivariable 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 ma...

Caring for Older Adults With Vision Impairment and Dementia

“…An overlooked aspect of the caregiving paradigm is the role of co-occurring dementia and vision impairment on the caregiving needs of older adults, and the impact on those caring for them. While multimorbidity or the coexistence of any two or more health conditions is a risk factor for disability in older adults, and therefore can be argued to be associated with a magnified caregiving need profile, co-occurring vision and cognitive impairments have been shown to have an especially strong impact on functioning ( 9 , 10 ). Although vision and cognitive impairments affect various areas of daily functioning such as self-care, mobility, and household activities, activity limitations are not always analogous.…”

“…Although vision and cognitive impairments affect various areas of daily functioning such as self-care, mobility, and household activities, activity limitations are not always analogous. For example, mobility limitations are particularly relevant to adults with vision impairment while an impact on activities of daily living (ADLs) is more pertinent to cognitive impairment ( 9 , 10 ).…”

Metabolic Syndromes as Important Comorbidities in Patients of Inherited Retinal Degenerations: Experiences from the Nationwide Health Database and a Large Hospital-Based Cohort

“…Whitson et al’s study suggested that people with vision impairment had greater odds of mobility disability [ 19 ]. Patel et al’s study also suggested that those with visual impairment would have lower mobility activities compared to those without [ 20 ]. However, both authors acknowledged that self-reported data were the limitation of their studies [ 19 , 20 ], particularly in the dementia group [ 20 ].…”

“…Patel et al’s study also suggested that those with visual impairment would have lower mobility activities compared to those without [ 20 ]. However, both authors acknowledged that self-reported data were the limitation of their studies [ 19 , 20 ], particularly in the dementia group [ 20 ]. In contrast, we chose to gain disability data on an objective basis, and 84% of our patients with IRD (383 of 456) were officially in the decreased “disability status”, with an average of 54.17% loss of working disability being disclosed.…”

The Association of Late-Life Self-Reported Vision and Hearing Impairments with Cognitive Function: A 3-Year Longitudinal Mediation Analysis Through Social Isolation

“…The impact of sensory impairments on various developmental outcomes has been well documented. Self-reported vision impairment, which affects approximately 9% of adults age 65 and older in the United States (Patel et al, 2020), and self-reported hearing impairment, which affects 31% of those ages 60 to 69 and 63.1% of those age 70 and older (Goman & Lin, 2016), have a negative impact on many domains of health, functioning, and quality of life (Bainbridge & Wallhagen, 2014; Swenor et al, 2019; Teutsch et al, 2016). These challenges are compounded in the case of dual sensory impairment, which is present in up to 11% of adults age 60 and older (Correia et al, 2016; Saunders & Echt, 2007; Schneider et al, 2011; Swenor et al, 2013).…”