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

Abstract

OBJECTIVES Vision and hearing impairment may impact both life expectancy (LE) and health expectancy, that is, duration of life with and without health problems, among older adults. We examined the impact of self‐reported vision and hearing impairment on years of life with and without limitation in physical function and in activities of daily living (ADLs). DESIGN Life table analysis, using a nationally representative longitudinal survey of community‐dwelling older adults aged 60 years or older, Panel on Health and Ageing of Singaporean Elderly. SETTING Singapore. PARTICIPANTS Survey participants (n = 3452) who were interviewed in 2009 and followed up in 2011‐2012 and 2015. MEASUREMENTS Participants reporting difficulty with any of nine tasks involving upper or lower extremities were considered to have a limitation in physical function. Those reporting health‐related difficulty with any of six basic ADLs or seven instrumental ADLs were considered to have a limitation in ADLs. We used the multistate life table method with a microsimulation approach to estimate health expectancy, considering self‐reported sensory impairment status as time varying. RESULTS Either or both impairments, vs neither, were associated with less years without limitation in physical function and in ADLs and more years with limitation in physical function and in ADLs, with the greatest impact on health expectancy among those with both impairments, who also had the lowest LE. For example, at age 60, those with both impairments, vs neither, could expect not only shorter LE (4.2 [95% confidence interval [CI] = 1.9‐5.7] less years; 20.7 [95% CI = 18.9‐22.5] vs 24.9 [95% CI = 23.8‐26.0]) but also more years of life with limitations in physical function (3.3 [95% CI = .9‐5.8] more years; 12.8 [95% CI = 10.7‐14.8] [about 61.7% of LE] vs 9.5 [95% CI = 8.4‐10.5] [about 38.0% of LE]). CONCLUSION Timely and appropriate management of vision and hearing impairment, especially when coexisting, among older adults has the potential to reduce the years of life they live with limitation in physical function and in ADLs. J Am Geriatr Soc 67:2528–2536, 2019

Associations between vision, hearing and tooth loss and social interactions: the JAGES cross-sectional study

“…Vision, hearing and tooth loss have been shown to cause difficulties in performing ADL and IADL, respectively. 3 16–19 Therefore, these impairments seem to decrease social interaction. The impact of vision loss could have been the largest PR for individuals at risk of having fewer social interactions because the eyes are supplying an estimated 80% of our information regarding the outside world.…”

“…Older people with difficulty in communicating due to impairments in vision and hearing and a reduction in the number of teeth are at significant risk for social isolation as these impairments cause difficulties in performing activities of daily living (ADL) 3 16 and instrumental activities of daily living (IADL). 17–19 Social isolation has been found to increase the risk of coronary heart disease, 20 depressive symptoms, 21 cognitive impairment 22 and mortality. 23…”

Continuum of Care for Older Adults With Concurrent Hearing and Vision Impairment: A Systematic Review Protocol

“…communication di culties and undiagnosed associated cognitive impairment among those with DSI may lead to signi cant challenges in clinical assessment and care delivery (8,22,35,36). Evidence from the United Kingdom and Nordic countries indicate challenges faced by older adults with DSI in accessing healthcare, such as making a medical appointment, reading prescriptions, to dependency on others to explain their concerns to the doctor due to inaccessible information, lack of awareness about DSI among staff, and limited communication support (37,38). Often, information related to health is not available in accessible formats, such as braille or large print, that affect the ability of individuals with DSI to make health-related decisions (38,39).…”

“…Evidence from the United Kingdom and Nordic countries indicate challenges faced by older adults with DSI in accessing healthcare, such as making a medical appointment, reading prescriptions, to dependency on others to explain their concerns to the doctor due to inaccessible information, lack of awareness about DSI among staff, and limited communication support (37,38). Often, information related to health is not available in accessible formats, such as braille or large print, that affect the ability of individuals with DSI to make health-related decisions (38,39). Most healthcare professionals are not adequately trained to conduct assessments or design interventions for clients with DSI considering the unique needs of this population (8,22,40,41).…”

“…These older adults access health services in long-term care, community care, home care, and hospitals, and yet, these organizations often do not have policies, programmes or protocols that provide guidance and training to the healthcare professionals to work with or simply to communicate with individuals with DSI (34, 40). Older adults with DSI feel anxious when accessing healthcare services, owing to fears that communication di culties will result in their needs being misunderstood, and it becomes even more challenging in the absence of continuity of care when they have to see a different doctor each time they visit a hospital or clinic (37)(38)(39).…”