Longitudinal Relationships Among Visual Acuity, Daily Functional Status, and Mortality

Abstract

IMPORTANCE Determination of the mechanisms by which visual loss increases mortality risk is important for developing interventional strategies. OBJECTIVE To evaluate the direct and indirect effects of loss of visual acuity (VA) on mortality risk through functional status changes among aging adults. DESIGN, SETTING, AND PARTICIPANTS Prospective longitudinal study of a population-based sample of 2520 noninstitutionalized adults aged 65 to 84 years from September 16, 1993, through July 26, 2003, in the greater Salisbury area of Maryland. Participants underwent reassessment 2, 6, and 8 years after baseline. Mortality status was ascertained from linkage with the National Death Index through 2009.EXPOSURES Results of VA testing and self-reported functional status based on activities of daily living (ADL) and instrumental ADL (IADL). MAIN OUTCOMES AND MEASURE Mortality.RESULTS Worse VA levels at baseline were associated with an increased the risk for mortality (hazard ratio [HR], 1.16 [95% CI, 1.04-1.28]; P < .01) through their effect on lower IADL levels at baseline. Declines in VA over time were associated with increased mortality risk (HR, 1.78 [95% CI, 1.27-2.51]; P < .001) by way of decreasing IADL levels over time. Participants experiencing the mean linear decline in VA of 1 letter on the Early Treatment Diabetic Retinopathy Study acuity chart per year are expected to have a 16% increase in mortality risk during the 8-year study exclusively through associated declines in IADL levels. CONCLUSIONS AND RELEVANCEIn this longitudinal study of older adults, VA loss adversely affected IADL levels, which subsequently increased the risk for mortality. Prevention of disabling ocular conditions, treatment of correctable visual impairment, and interventions designed to prevent the effect of visual impairment on IADL declines may all reduce mortality risk in aging adults.

Trajectories of Limitations in Instrumental Activities of Daily Living in Frail Older Adults With Vision, Hearing, or Dual Sensory Loss

“…However, the effect of age differed per IADL activity and SL group. This is in contrast with other studies that found stronger associations for VL and/or DSL with IADL limitations over time than NSL (3,8,15). A study on HL and physical function found a 60% increased risk of IADL limitations and walking with each 25-dB increase in hearing deficit (16).…”

“…A study on HL and physical function found a 60% increased risk of IADL limitations and walking with each 25-dB increase in hearing deficit (16). However, the operationalization of IADL and SL is not comparable to our study as a variety of IADL definitions was used varying between any type of limitations to change in disability and questionnaires or objective measurements for SL (3,8,15,16). Reasons for no significant difference between SL groups could be related to coping mechanisms through cognitive resources (35,36) or use of technology (33); however, the latter may be limited to the younger old.…”

Trajectories of Limitations in Instrumental Activities of Daily Living in Frail Older Adults With Vision, Hearing, or Dual Sensory Loss

“…However, the effect of age differed per IADL activity and SL group. This is in contrast with other studies that found stronger associations for VL and/or DSL with IADL limitations over time than NSL (3,8,15). A study on HL and physical function found a 60% increased risk of IADL limitations and walking with each 25-dB increase in hearing deficit (16).…”

“…A study on HL and physical function found a 60% increased risk of IADL limitations and walking with each 25-dB increase in hearing deficit (16). However, the operationalization of IADL and SL is not comparable to our study as a variety of IADL definitions was used varying between any type of limitations to change in disability and questionnaires or objective measurements for SL (3,8,15,16). Reasons for no significant difference between SL groups could be related to coping mechanisms through cognitive resources (35,36) or use of technology (33); however, the latter may be limited to the younger old.…”

Association of glaucoma with 10-year mortality in a population-based longitudinal study in urban Southern China: the Liwan Eye Study

“…These confounding factors were chosen based on the previous evidence. [24][25][26][27][28] The significant association between PVI and long-term survival in this population have been reported previously. 29 Analysis of IOP and VCDR was based on both continuous and categorical level.…”

Visual Function, Physical Function, and Activities of Daily Living in Two Aging Communities

“… 35 Although both distance and near VI were associated with ADL and IADL limitations, 36 these tasks require different skills, with IADLs requiring overall better visual abilities. 5 , 37 We found that moderate or greater near presenting VAI were associated with greater IADL difficulties, but not ADL difficulties. These findings again highlight the importance of near vision in daily living functionality for older adults.…”

Trajectories of Limitations in Instrumental Activities of Daily Living in Frail Older Adults With Vision, Hearing, or Dual Sensory Loss

“…However, the effect of age differed per IADL activity and SL group. This is in contrast with other studies that found stronger associations for VL and/or DSL with IADL limitations over time than NSL (3,8,15). A study on HL and physical function found a 60% increased risk of IADL limitations and walking with each 25-dB increase in hearing deficit (16).…”

“…A study on HL and physical function found a 60% increased risk of IADL limitations and walking with each 25-dB increase in hearing deficit (16). However, the operationalization of IADL and SL is not comparable to our study as a variety of IADL definitions was used varying between any type of limitations to change in disability and questionnaires or objective measurements for SL (3,8,15,16). Reasons for no significant difference between SL groups could be related to coping mechanisms through cognitive resources (35,36) or use of technology (33); however, the latter may be limited to the younger old.…”

Association of glaucoma with 10-year mortality in a population-based longitudinal study in urban Southern China: the Liwan Eye Study

“…These confounding factors were chosen based on the previous evidence. [24][25][26][27][28] The significant association between PVI and long-term survival in this population have been reported previously. 29 Analysis of IOP and VCDR was based on both continuous and categorical level.…”

Visual Function, Physical Function, and Activities of Daily Living in Two Aging Communities

“… 35 Although both distance and near VI were associated with ADL and IADL limitations, 36 these tasks require different skills, with IADLs requiring overall better visual abilities. 5 , 37 We found that moderate or greater near presenting VAI were associated with greater IADL difficulties, but not ADL difficulties. These findings again highlight the importance of near vision in daily living functionality for older adults.…”

Trajectories of Limitations in Instrumental Activities of Daily Living in Frail Older Adults With Vision, Hearing, or Dual Sensory Loss

“…However, the effect of age differed per IADL activity and SL group. This is in contrast with other studies that found stronger associations for VL and/or DSL with IADL limitations over time than NSL (3,8,15). A study on HL and physical function found a 60% increased risk of IADL limitations and walking with each 25-dB increase in hearing deficit (16).…”

“…A study on HL and physical function found a 60% increased risk of IADL limitations and walking with each 25-dB increase in hearing deficit (16). However, the operationalization of IADL and SL is not comparable to our study as a variety of IADL definitions was used varying between any type of limitations to change in disability and questionnaires or objective measurements for SL (3,8,15,16). Reasons for no significant difference between SL groups could be related to coping mechanisms through cognitive resources (35,36) or use of technology (33); however, the latter may be limited to the younger old.…”

Association of glaucoma with 10-year mortality in a population-based longitudinal study in urban Southern China: the Liwan Eye Study

“…These confounding factors were chosen based on the previous evidence. [24][25][26][27][28] The significant association between PVI and long-term survival in this population have been reported previously. 29 Analysis of IOP and VCDR was based on both continuous and categorical level.…”

Visual Function, Physical Function, and Activities of Daily Living in Two Aging Communities

“… 35 Although both distance and near VI were associated with ADL and IADL limitations, 36 these tasks require different skills, with IADLs requiring overall better visual abilities. 5 , 37 We found that moderate or greater near presenting VAI were associated with greater IADL difficulties, but not ADL difficulties. These findings again highlight the importance of near vision in daily living functionality for older adults.…”