Visual impairment and multimorbidity in a representative sample of the Spanish population

Abstract

BackgroundIn the context of population aging, visual impairment has emerged as a growing concern in public health. However, there is a need for further research into the relationship between visual impairment and chronic medical conditions in the elderly. The aim of our study was to examine the relationship between visual impairment and three main types of co-morbidity: chronic physical conditions (both at an independent and additive level), mental health and cognitive functioning.MethodsData were collected from the COURAGE in Europe project, a cross-sectional study. A total of 4,583 participants from Spain were included. Diagnosis of chronic medical conditions included self-reported medical diagnosis and symptomatic algorithms. Depression and anxiety were assessed using CIDI algorithms. Visual assessment included objective distance/near visual acuity and subjective visual performance. Descriptive analyses included the whole sample (n = 4,583). Statistical analyses included participants aged over 50 years (n = 3,625; mean age = 66.45 years) since they have a significant prevalence of chronic conditions and visual impairment. Crude and adjusted binary logistic regressions were performed to identify independent associations between visual impairment and chronic medical conditions, physical multimorbidity and mental conditions. Covariates included age, gender, marital status, education level, employment status and urbanicity.ResultsThe number of chronic physical conditions was found to be associated with poorer results in both distance and near visual acuity [OR 1.75 (CI 1.38-2.23); OR 1.69 (CI 1.27-2.24)]. At an independent level, arthritis, stroke and diabetes were associated with poorer distance visual acuity results after adjusting for covariates [OR 1.79 (CI 1.46-2.21); OR 1.59 (CI 1.05-2.42); OR 1.27 (1.01-1.60)]. Only stroke was associated with near visual impairment [OR 3.01 (CI 1.86-4.87)]. With regard to mental health, poor subjective visual acuity was associated with depression [OR 1.61 (CI 1.14-2.27); OR 1.48 (CI 1.03-2.13)]. Both objective and subjective poor distance and near visual acuity were associated with worse cognitive functioning.ConclusionsArthritis, stroke and the co-occurrence of various chronic physical diseases are associated with higher prevalence of visual impairment. Visual impairment is associated with higher prevalence of depression and poorer cognitive function results. There is a need to implement patient-centered care involving special visual assessment in these cases.

Vision loss and 12-year risk of dementia in older adults: the 3C cohort study

“…Most of the previous research in this area has focused on cognition rather than dementia [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16]. Within cross-sectional studies, the results show either a significant association between VI and cognition [2][3][4][5][6][7][8] or no association [9,10].…”

“…The leading cause of VL is uncorrected refractive error [1], easily avoidable with corrective eyeglasses, lenses or refractive surgery. VL has been associated with cognitive impairment, but mainly in cross-sectional studies [2][3][4][5][6][7][8][9][10], whereas longitudinal studies have shown conflicting results [11][12][13][14][15][16]. Furthermore, little is known about the longitudinal association between VL and dementia, with only one previous study among participants aged 71 and older, showing that those who perceived that their vision was good or excellent had a lower risk of developing dementia [17].…”

The association of vision loss and dimensions of depression over 12 years in older adults: Findings from the Three City study

“…This study adopted a novel dimensional approach to extend past research which has previously established cross-sectional (Court et al, 2014;Garin et al, 2014;Hayman et al, 2007) and…”

The association amongst visual, hearing, and dual sensory loss with depression and anxiety over 6 years: The Tromsø Study

“…To date, the majority of sensory loss and mental health literature has focused on VL and depression. Prior research consistently demonstrates that older adults with VL have an increased risk of depression . Possible mechanisms include a reduction in social activities and subsequent social isolation .…”

“…Prior research consistently demonstrates that older adults with VL have an increased risk of depression. [9][10][11][12][13] Possible mechanisms include a reduction in social activities and subsequent social isolation. 14,15 It has also previously been demonstrated that depression and worse mental health outcomes are observed in those with poorer mobility and physical health, [16][17][18] as well as being more common amongst women 17 and those who are less educated and unmarried or live alone.…”