Abstract
Background and aims: Our aim was to determine the impact of visual impairment on self-rated health, function and mortality amongst a community-dwelling elderly cohort. Methods: The study design was prospective and longitudinal, subjects being taken from an age-homogeneous, community-dwelling cohort comprising 452 subjects aged 70 in 1990 and 839 subjects aged 77 in 1998. Comprehensive data were collected by structured interviews and medical examinations carried out during home visits. Data included each subject’s demographic and socio-economic profile, medical history, physical findings, functional status and self-rated health status. Visual acuity was measured using a Snellen chart and visual impairment was defined as best-eye corrected visual acuity of 20/40 or worse on Snellen chart testing. Results: Measured and self-reported visual impairment correlated closely, and were significantly more prevalent amongst subjects with low education and poor financial status. Visually impaired subjects showed significantly greater dependence in ADL and IADL, poor self-rated health, less ability to rely on friends, increased loneliness and, in men aged 77, increased visits to the emergency room and hospital admissions. Visual impairment at age 70 significantly predicted poor self-rated health (p=0.029, OR 2.36, 95% CI 1.09–5.10), dependence in ADL (p=0.007, OR 2.91, 95% CI 1.34–6.33), general tiredness (p=0.037, OR 2.40, 95% CI 1.06–5.44), and mortality, with a two-and-a-half-fold increase in risk of death at seven years (p=0.0017,OR 2.84, 95% CI 1.48–5.46). Conclusions: Visual impairment in the elderly increases the risk of social, functional and medical decline.
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McCarty CA, Nanjan MB, Taylor H, et al. Vision impairment predicts 5 year mortality. Br J Ophthalmol 2001; 85: 322–6.
Klein R, Klein BEK, Moss SE, et al. Age-related eye disease and survival. The Beaver Dam Eye Study. Arch Ophthalmol 1995; 113: 333–9.
Thompson JR, Gibson JM, Jagger C. The association between visual impairment and mortality in elderly people. Age Ageing 1989; 18: 83–8.
Reuben DB, Mui S, Damesyn M, et al. The prognostic value of sensory impairment in older persons. J Am Geriatr Soc 1999; 47: 930–5.
Nevitt MC, Cummings SR, Kidd S, et al. Risk factors for recurrent nonsyncopal falls: a prospective study. JAMA 1989; 261: 2663–8.
Tinetti ME, Williams TF, Mayewsky R. Fall risk index for elderly patients based on number of chronic disabilities. Am J Med 1986; 80: 429–34.
Cummings SR, Nevitt MC, Browner WS, et al. Risk factors for hip fracture in white women. N Engl J Med 1995; 332: 767–73.
Felson DT, Anderson JJ, Hannan MT, et al. Impaired vision and hip fracture: the Framingham Study. J Am Geriatr Soc 1989; 37: 495–500.
Wang JJ, Mitchell P, Smith W, et al. Impact of visual impairment on use of community support services by elderly persons: the Blue Mountains Eye Study. Invest Ophthalmol Vis Sci 1999; 40: 12–9.
Klein R, Klein BE, Lee KE. Changes in visual acuity in a population: the Beaver Dam Study. Ophthalmology 1996; 103: 1169–78.
Mitchell P, Hayes P, Wang JJ. Visual impairment in nursing home residents: the Blue Mountains Eye Study. Med J Aust 1997; 166: 73–6.
DiNuzzo AR, Black SA, Lichtenstein MJ, et al. Prevalence of functional blindness, visual impairment and related functional deficits among elderly Mexican Americans. J Gerontol 2001 56: M548–51.
Keller BK, Morton JL, Thomson US, et al. The effect of visual and hearing impairments on functional status. J Am Geriatr Soc 1999; 47: 1319–25.
Ip SP, Leung YF, Mack WP. Depression in institutionalized older people with impaired vision. Int J Geriatr Psychiatry 2000; 15: 1120–4.
Carabellese C, Appollonio I, Rozzini R, et al. Sensory impairment and quality of life in a community elderly population. J Am Geriatr Soc 1993; 41: 401–7.
Wahl HW, Schilling O, Oswald F, et al. Psychosocial consequences of age-related visual impairment: comparison with mobility impaired older adults and long term outcome. J Gerontol 1999; 54: P304–16.
Stessman J, Cohen A, Ginsberg GM, et al. The Jerusalem longitudinal 70-year-olds study. I: Description of the initial cross-sectional survey. Eur J Epidemiol 1995; 11: 675–84.
Stessman J, Hammerman-Rozenberg R, Maaravi Y, et al. Effect of exercise on ease in performing ADL and IADL from age 70 to 77: the Jerusalem longitudinal study. J Am Geriatr Soc 2002; 50: 1934–8.
West SK, Munoz B, Rubin GS, et al. Function and visual impairment in a population-based study of older adults. Invest Ophthalmol Vis Sci 1997; 38: 72–82.
Klein R, Klein BEK, Linton KL, et al. The Beaver Dam Eye Study, visual acuity. Ophthalmology 1991;98; 1310–5.
Rehabilitation: the management of adult patients with low vision: preferred practice patterns. San Francisco: American Academy of Ophthalmology 1994. In Hazzard WR, et al, eds. Principles of geriatric medicine and gerontology, 4th ed. New York: McGraw-Hill, 1998: 614.
Sonn U, Grinby G, Svanborg A. Activities of daily living studied longitudinally between 70 and 76 years of age. Disabil Rehabil 1996; 18: 91–100.
Stessman J, Ginsberg GM, Klein M, et al. Determinants of loneliness in Jerusalem’s 70-year-old-population. Isr J Med Sci 1996; 32: 639–48.
Eekhof JA, De Bock GH, Schaapveld K, et al. Screening for hearing and visual loss among elderly with questionnaires and tests: which method is the most convincing for action? Scand J Prim Health Care 2000; 18: 203–7.
Mossey JM, Shapiro E. Self- related health: a predictor of mortality among the elderly. Am J Public Health 1982; 72: 800–8.
Idler EL, Benyamini Y. Self-related health and mortality: a review of twenty-seven community studies. J Health Soc Behav 1997; 38: 21–37.
Wang JJ, Mitchell P, Smith W. Vision and low self-related health: the Blue Mountains Eye Study. Invest Ophthalmol Vis Sci 2000; 41: 49–54.
Rudberg MA, Furner SE, Dunn JE, et al. The relationship of visual and hearing impairments to disability: an analysis using the Longitudinal Study of Aging. J Gerontol 1993; 48: M261–5.
Appollonio I, Carabellese C, Magni E, et al. Sensory impairments and mortality in an elderly community population: a six year follow-up. Age Ageing 1995; 34: 30–6.
Mackenzie PJ, Chang TS, Scott IU, et al. Assessment of vision-related function in patients with age-related macular degeneration. Ophthalmology 2002; 109: 720–9.
Mangione CM, Phillips RS, Seddon JM, et al. Development of the “Activities of Daily Vision Scale.” A measure of visual functional status. Med Care 1992; 30: 1111–26.
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Jacobs, J.M., Hammerman-Rozenberg, R., Maaravi, Y. et al. The impact of visual impairment on health, function and mortality. Aging Clin Exp Res 17, 281–286 (2005). https://doi.org/10.1007/BF03324611
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DOI: https://doi.org/10.1007/BF03324611