Vision Impairment and Combined Vision and Hearing Impairment Predict Cognitive and Functional Decline in Older Women

Authors

  • Michael Y. Lin MD,

    1. From the*Pritzker School of Medicine, University of Chicago, Chicago, IllinoisDavid Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CaliforniaSchool of Medicine, University of California at San Francisco, San Francisco, California§School of Medicine, University of Minnesota, Minneapolis, Minnesota.
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  • Peter R. Gutierrez MS,

    1. From the*Pritzker School of Medicine, University of Chicago, Chicago, IllinoisDavid Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CaliforniaSchool of Medicine, University of California at San Francisco, San Francisco, California§School of Medicine, University of Minnesota, Minneapolis, Minnesota.
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  • Katie L. Stone PhD,

    1. From the*Pritzker School of Medicine, University of Chicago, Chicago, IllinoisDavid Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CaliforniaSchool of Medicine, University of California at San Francisco, San Francisco, California§School of Medicine, University of Minnesota, Minneapolis, Minnesota.
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  • Kristine Yaffe MD,

    1. From the*Pritzker School of Medicine, University of Chicago, Chicago, IllinoisDavid Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CaliforniaSchool of Medicine, University of California at San Francisco, San Francisco, California§School of Medicine, University of Minnesota, Minneapolis, Minnesota.
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  • Kristine E. Ensrud MD, MPH,

    1. From the*Pritzker School of Medicine, University of Chicago, Chicago, IllinoisDavid Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CaliforniaSchool of Medicine, University of California at San Francisco, San Francisco, California§School of Medicine, University of Minnesota, Minneapolis, Minnesota.
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  • Howard A. Fink MD,

    1. From the*Pritzker School of Medicine, University of Chicago, Chicago, IllinoisDavid Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CaliforniaSchool of Medicine, University of California at San Francisco, San Francisco, California§School of Medicine, University of Minnesota, Minneapolis, Minnesota.
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  • Catherine A. Sarkisian MD, MSPH,

    1. From the*Pritzker School of Medicine, University of Chicago, Chicago, IllinoisDavid Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CaliforniaSchool of Medicine, University of California at San Francisco, San Francisco, California§School of Medicine, University of Minnesota, Minneapolis, Minnesota.
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  • Anne L. Coleman MD, PhD,

    1. From the*Pritzker School of Medicine, University of Chicago, Chicago, IllinoisDavid Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CaliforniaSchool of Medicine, University of California at San Francisco, San Francisco, California§School of Medicine, University of Minnesota, Minneapolis, Minnesota.
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  • Carol M. Mangione MD, MSPH

    1. From the*Pritzker School of Medicine, University of Chicago, Chicago, IllinoisDavid Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CaliforniaSchool of Medicine, University of California at San Francisco, San Francisco, California§School of Medicine, University of Minnesota, Minneapolis, Minnesota.
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  • Supported by Grants AG05407, AR35582, AG05394, AR35584, and AR35583 from the Public Health Service, National Institutes of Health, Bethesda, Maryland. Support for Dr. Mangione was provided by the UCLA Center for Health Improvement in Minority Elders/Resource Centers for Minority Aging Research, National Institutes of Health, National Institute of Aging (AG-02–004).

  • This paper was presented at the 2002 Society of General Internal Medicine National Meeting, Atlanta, Georgia.

Carol M. Mangione, MD, MSPH, Department of Medicine, Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at UCLA, 911 Broxton Plaza, Los Angeles, CA 90095. For the Study of Osteoporotic Fractures Research Group. E-mail cmangione@mednet.ucla.edu

Abstract

Objectives: To determine the association between vision and hearing impairment and subsequent cognitive and functional decline in community-residing older women.

Design: Prospective cohort study.

Setting: Four metropolitan areas of the United States.

Participants: A total of 6,112 women aged 69 and older participating in the Study of Osteoporotic Fractures (SOF) between 1992 and 1994.

Measurements: Five thousand three hundred forty-five participants had hearing measured, 1,668 had visual acuity measured, and 1,636 had both measured. Visual impairment was defined as corrected vision worse than 20/40. Hearing impairment was defined as the inability to hear a tone of 40 dB or greater at 2,000 hertz. Participants completed the modified Mini-Mental State Examination and/or a functional status assessment at baseline and follow-up. Cognitive and functional decline were defined as the amount of decline from baseline to follow-up that exceeded the observed average change in scores by at least 1 standard deviation.

Results: About one-sixth (15.7%) of the sample had cognitive decline; 10.1% had functional decline. In multivariate models adjusted for sociodemographic characteristics and chronic conditions, vision impairment at baseline was associated with cognitive (odds ratio (OR)=1.78, 95% confidence interval (CI)=1.21–2.61) and functional (OR=1.79, 95% CI=1.15–2.79) decline. Hearing impairment was not associated with cognitive or functional decline. Combined impairment was associated with the greatest odds for cognitive (OR=2.19, 95% CI=1.26–3.81) and functional (OR=1.87, 95% CI=1.01–3.47) decline.

Conclusion: Sensory impairment is associated with cognitive and functional decline in older women. Studies are needed to determine whether treatment of vision and hearing impairment can decrease the risk for cognitive and functional decline.

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