Visual Impairment and Frailty: Examining an Understudied Relationship

Abstract Background Older adults with visual impairments are at increased risk of negative health outcomes. Here, we investigate the association between visual impairment and frailty. Methods Cross-sectional and longitudinal relationships between visual impairment (distance visual acuity) and frailty (frailty phenotype criteria) were examined using data from the National Health and Nutrition Examination Survey (NHANES, 1999–2002, ≥60 years) and the Women’s Health and Aging Studies (WHAS III). Imbalance of potential confounders, particularly age, was addressed using propensity score-based adjustment. Multinomial logistic regression determined the odds of prefrailty and frailty at baseline in NHANES and ordinal logistic regression examined the odds of baseline and incident frailty over 3 years in WHAS III after adjustment for confounders and probability weighting (survey weights × inverse propensity scores). Results In NHANES (n = 2,639, 9% vision impairment), participants with visual impairment were more likely to be prefrail (odds ratio [OR] = 3.2; 95% confidence interval [CI]: 1.9–5.3) and frail (OR = 3.7; 95% CI: 1.5–9.2) than those without visual impairment. In WHAS III (n = 796, 26% mild, 37% moderate/severe vision impairment), participants with mild and moderate/severe vision impairment were more likely to be frail (OR = 2.0; 95% CI: 1.5–2.5; OR = 5.5; 95% CI: 4.2–7.2, respectively). A one-line worse visual acuity (0.1 logMAR increase) was associated with greater odds of frailty (OR = 1.5; 95% CI: 1.4–1.7). Of those non-frail at baseline (n = 549), moderate/severe visual impairment and one-line worse visual acuity was associated with greater odds of incident frailty (OR = 3.5; 95% CI: 1.4–8.4; OR = 1.3; 95% CI: 1.1–1.5, respectively) over 3 years. Conclusions Visual impairment may be an important, yet understudied risk factor for frailty.

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VISUAL IMPAIRMENT AND ENGAGEMENT IN COGNITIVELY STIMULATING ACTIVITIES

Innovation in Aging ◽

10.1093/geroni/igz038.2432 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

pp. S656-S656

Author(s):

Bonnielin Swenor ◽

beatriz Munoz ◽

Eleanor M Simonsick

Keyword(s):

Visual Acuity ◽

Visual Impairment ◽

Significant Decline ◽

Cross Sectional ◽

Impaired Group ◽

Cognitive Activities ◽

Using Data ◽

The Relationship ◽

Stereo Acuity ◽

Over Time

Abstract We examined the relationship between visual impairment (VI) and engagement in cognitively stimulating activities using data from 924 participants in the Cognitive Vitality Sub-Study of the Health ABC Study. At Year 3 (baseline for these analyses), vision was assessed as: visual acuity (VA), contrast sensitivity (CS), and stereo acuity (SA). Participation in cognitively stimulating activities was determined based on responses to 12 questions (administered at Years 3, 5, 7, and 9) assessing frequency of participation ranging from none to daily. We calculated the total number of activities engaged in at least monthly. In cross-sectional analyses adjusted for age, race, and sex, impaired VA (≤20/40, 8%), CS (<1.55, 5%), and SA (<80 secs arc, 29%) was associated with participation in fewer cognitive activities (β=-0.54, 95% CI:-1.06, -0.03; β=-0.59, 95% CI:-0.12, 0.06; β=-0.40, 95% CI:-0.81, -0.18, respectively). Longitudinally, change per year in the number of activities differed by baseline participation levels. Those participating in ≥5 activities at baseline (population median) had a significant decline in the number of activities, irrespective of VI status. However, for those participating in <5 activities at baseline, the increase in these activities tended to be lesser in the VI than in non-VI groups, and for SA this increase was significantly lower for the impaired group (βimpaired=0.004; 95% CI:-0.05, 0.05; βnot-impaired=0.06; 95% CI: 0.03, 0.10; time x SA interaction p=0.0496). These data indicate that older adults with VI participate in fewer cognitive activities and the change in participation over time differs from than those without VI.

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Homelessness and incarceration among psychiatric patients in Brazil

Ciência & Saúde Coletiva ◽

10.1590/1413-812320182311.12522016 ◽

2018 ◽

Vol 23 (11) ◽

pp. 3719-3733

Author(s):

Ana Paula Souto Melo ◽

Eduardo de Paula Lima ◽

Fabiana Cristina Ribeiro de Barros ◽

Lidyane do Valle Camelo ◽

Mark Drew Crosland Guimarães

Keyword(s):

Multinomial Logistic Regression ◽

Psychiatric Patients ◽

Cross Sectional ◽

Sexually Transmitted ◽

Logistic Regression Models ◽

Multiple Sex Partners ◽

Psychiatric Hospitalizations ◽

Increased Risk ◽

History Of ◽

Using Data

Abstract Psychiatric patients are at increased risk of adverse life events, such as being incarcerated and homelessness in their life course. Using data from a cross-sectional multicenter study of 2,475 patients selected from 26 mental health services in Brazil, we examined the association of sociodemographic, clinical, behavioral, and adverse life characteristics with history of homelessness, incarceration or their co-occurrence during lifetime. Odds ratios were obtained by multinomial logistic regression models. The prevalence of homelessness, incarceration and co-occurrence of these two conditions were 8.6%, 16.4%, and 9.4%, respectively. Lower income, living in unstable condition, intellectual disability, and cigarette smoking were associated with homelessness. Being male, lower schooling, sex under effect of alcohol or drugs, and multiple sex partners were associated with incarceration. Psychiatric hospitalizations, substance use, and history of sexually transmitted diseases, and sexual, physical, or verbal violence were associated with co-occurrence of both conditions. Our findings suggest that incarceration and homelessness are very prevalent and correlated in psychiatric patients in Brazil. Many of the associated factors are potentially modifiable, and may act synergistically requiring integrated care.

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Sleep time and homework hours/daily are associated with reduced visual acuity among school students aged 9–18 in Shenyang in 2016

European Journal of Ophthalmology ◽

10.1177/11206721211008040 ◽

2021 ◽

pp. 112067212110080

Author(s):

Hezuo Liu ◽

Shi Ren ◽

Qi Sun ◽

Yinglong Bai ◽

Lingling Zhai ◽

...

Keyword(s):

Visual Acuity ◽

Associated Factors ◽

Sleep Time ◽

Cross Sectional Study ◽

Education Student ◽

Lifestyle Behaviors ◽

School Students ◽

Cross Sectional ◽

Increased Risk ◽

Using Data

Purpose: The purpose of this survey was to explore the prevalence of reduced visual acuity and its associated factors among school students in Shenyang in 2016. Methods: This was a cross-sectional study using data from the Ministry of Education’ Student Physical Fitness (MESPF) monitoring in 2016. A total of 13,642 students aged 9–18 years were surveyed in Shenyang. The unaided distance visual acuity was measured, and questionnaire on lifestyle behaviors that may affect visual acuity was investigated among students. The prevalence of reduced visual acuity and its associated factors were analyzed. Results: The average prevalence of reduced visual acuity among students aged 9–18 years was 65.8%, and severe reduced visual acuity was main (42.9%), and there were statistical effect of age, gender, and region on the prevalence of reduced visual acuity. Binary and multi variable logistic regression results revealed that students sleeping <8 h, homework hours ⩾1 h, and parental myopia had an increased risk of reduced visual acuity. Conclusions: Sleep time <8 h and homework time ⩾1 h may be associated with reduced visual acuity among students in Shenyang. Therefore, it is benefit for student to get enough sleep and decreasing studying time in order to prevent and reduce poor vision.

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The prevalence and causes of visual impairment in Dariyah, a rural community in Saudi Arabia

African Vision and Eye Health ◽

10.4102/aveh.v80i1.579 ◽

2021 ◽

Vol 80 (1) ◽

Author(s):

Waleed Alghamdi ◽

Godwin O. Ovenseri-Ogbomo

Keyword(s):

Saudi Arabia ◽

Visual Impairment ◽

Rural Community ◽

Refractive Error ◽

Population Based ◽

Vision Impairment ◽

Health Examination ◽

Refractive Errors ◽

Cross Sectional ◽

Eye Examination

Background: Visual impairment is disproportionately distributed between rural and urban dwellers. Rural dwellers have limited access to the eye care services that are available in urban cities.Aim: The aim of this study was to determine the prevalence and causes of visual impairment in Dariyah, a rural community in the Qassim region, Saudi Arabia.Setting: This research comprised a population-based assessment of the vision and visual status of the inhabitants of Dariyah community.Methods: A cross-sectional descriptive study was conducted amongst the inhabitants of the community of Dariyah. A comprehensive eye examination consisting of visual acuity, ocular health examination, objective and subjective refraction was performed. The examinations were conducted by registered ophthalmologists and optometrists from the Qassim University. Vision impairments were categorised according to the International Classification of Diseases (ICD), Section 9D90, ‘Vision impairment including blindness’ (2018).Results: In all, 68 (24.5%) participants had vision impairment (using the better-seeing eye), with refractive errors being the main cause of vision impairment. Other causes of vision impairment included cataract (20, 7.2%), trichiasis (5, 1.8%) and glaucoma (2, 0.7%). Refractive errors were present in 193 (69.7%), with astigmatism being the commonest refractive error. About 60% of those with refractive errors presented without spectacles for correction, and 20% reported that they had never had an eye examination. Refractive errors could not be determined in 19 (6.9%) of the subjects because of conditions such as matured cataract and other ocular abnormalities.Conclusion: Uncorrected refractive error was found to be the leading cause of vision impairment in this rural community in Saudi Arabia.

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The Longitudinal Association of Vision Impairment with Transitions to Cognitive Impairment and Dementia: Findings from The Aging, Demographics and Memory Study

The Journals of Gerontology Series A ◽

10.1093/gerona/glab157 ◽

2021 ◽

Author(s):

Joshua R Ehrlich ◽

Bonnielin K Swenor ◽

Yunshu Zhou ◽

Kenneth M Langa

Keyword(s):

Visual Acuity ◽

Logistic Regression ◽

Cognitive Impairment ◽

Proportional Hazards ◽

Population Based ◽

Cox Proportional Hazards ◽

Vision Impairment ◽

Logistic Regression Models ◽

Cox Proportional Hazards Models ◽

Longitudinal Association

Abstract Background Vision impairment (VI) is associated with incident cognitive decline and dementia. However, it is not known whether VI is associated only with the transition to cognitive impairment, or whether it is also associated with later transitions to dementia. Methods We used data from the population-based Aging, Demographics and Memory Study (ADAMS) to investigate the association of visual acuity impairment (VI; defined as binocular presenting visual acuity <20/40) with transitions from cognitively normal (CN) to cognitive impairment no dementia (CIND) and from CIND to dementia. Multivariable Cox proportional hazards models and logistic regression were used to model the association of VI with cognitive transitions, adjusted for covariates. Results There were 351 participants included in this study (weighted percentages: 45% male, 64% age 70-79 years) with a mean follow-up time of 4.1 years. In a multivariable model, the hazard of dementia was elevated among those with VI (HR=1.63, 95%CI=1.04-2.58). Participants with VI had a greater hazard of transitioning from CN to CIND (HR=1.86, 95%CI=1.09-3.18). However, among those with CIND and VI a similar percentage transitioned to dementia (48%) and remained CIND (52%); there was no significant association between VI and transitioning from CIND to dementia (HR=0.94, 95%CI=0.56-1.55). Using logistic regression models, the same associations between VI and cognitive transitions were identified. Conclusions Poor vision is associated with the development of CIND. The association of VI and dementia appears to be due to the higher risk of dementia among individuals with CIND. Findings may inform the design of future interventional studies.

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Abstract TMP50: A Polymorphism in HDAC9 was Associated with Large Vessel Stroke in the Vienna and German Stroke Studies

Stroke ◽

10.1161/str.44.suppl_1.atmp50 ◽

2013 ◽

Vol 44 (suppl_1) ◽

Author(s):

May M Luke ◽

Carmen H Tong ◽

Joseph J Catanese ◽

James J Devlin ◽

Christine Mannhalter ◽

...

Keyword(s):

Logistic Regression ◽

Ischemic Stroke ◽

Genome Wide Association Study ◽

Multinomial Logistic Regression ◽

Large Vessel ◽

Stroke Subtype ◽

German Study ◽

Genome Wide ◽

Increased Risk ◽

Large Vessel Stroke

Introduction The International Stroke Genetics Consortium (ISGC) and the Wellcome Trust Case Control Consortium 2 (WTCCC2) performed a large genome wide association study of ischemic stroke and its subtypes (large vessel stroke (LVD), small vessel stroke (SVD), cardioembolic stroke (CE)), and identified a polymorphism in HDAC9 (rs11984041) associated with the LVD subtype of ischemic stroke. Hypothesis We assessed the hypothesis that rs11984041 is associated with LVD in two additional studies. Methods The genotype of rs11984041 was determined for participants of the Vienna Study (815 controls, 122 LVD, 165 SVD, 202 CE) and of the German Study (1040 controls, 495 LVD, 230 SVD, 462 CE). The association of rs11984041 with LVD was assessed by logistic regression. Heterogeneity of the effect of rs11984041 on LVD, CE or SVD was assessed by testing the equality of the corresponding regression coefficients from a multinomial logistic regression model. Results Carriers of the minor (T) allele of rs11984041 (23.3% of LVD cases and 17.4% of controls), compared with noncarriers, had increased risk for LVD: the odds ratios (OR) were 1.92 (95%CI 1.25-2.96) for the Vienna Study and 1.33 (95%CI 1.02-1.74) for the German Study. Adjusting for covariates including sex, age, diabetes, and hypertension did not materially change the ORs. Heterogeneity of the effects of rs11984041 on LVD vs CE was significant in the Vienna Study (p = 0.009) and in the German Study (p = 0.005). Heterogeneity of the effects of rs11984041 on LVD vs SVD trended toward significance in the Vienna Study (p = 0.088) and was significant in the German Study (p = 0.047). Adjusting for covariates did not materially change the heterogeneity test p values. Conclusions The HDAC9 polymorphism rs11984041 was associated with the LVD stroke subtype in the Vienna Study and the German Study. These results replicated the ISGC/WTCCC2 findings.

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Prevalence and causes of visual impairment and blindness among school children in Muzaffarabad, Pakistan

International Journal of Scientific Reports ◽

10.18203/issn.2454-2156.intjscirep20181393 ◽

2018 ◽

Vol 4 (4) ◽

pp. 93

Author(s):

Abdul Rauf Awan ◽

Junaid Jamshed ◽

Muhammad Mushtaq Khan ◽

Zahid Latif

Keyword(s):

Visual Acuity ◽

Public Schools ◽

Visual Impairment ◽

Private Schools ◽

School Children ◽

School Health ◽

Vision Loss ◽

Screening Program ◽

Sampling Technique ◽

Cross Sectional

Background: Vision loss in childhood has serious implications in all stages of child’s growth and development. It poses social, educational and occupational challenges, with affected children being at greater risk of developing behavioral, psychological and emotional problems, lower self-esteem and poorer social integration. The aim of this study was to assess the prevalence and identify the causes of visual impairment and blindness in school children of UC Gojra, Muzaffarabad, Pakistan so that prevention strategies could be implemented.Methods: This was a school-based descriptive cross-sectional study conducted among public and private schools. A multi-stage stratified random sampling technique was used for selecting study participants aged 5-20 years from 24 schools in Muzaffarabad. The vision of school children was examined for visual acuity using standard Snellen chart. Those participants who had visual acuity of <6/18 in either eye underwent a more detailed ophthalmic examination to diagnose the causes of VI. An exploration of demographic variables was conducted using Chi-square test. Results: The mean age of participants was 10±2.83. The prevalence of visual impairment was 19.6% and 2.3% for severe visual impairment. The age group most affected by VI was 11-15 years (74.2%). There were increased chances of developing VI with advancing age of the participants. Males contributed 88.7% of the cases of VI while females contributed only 11.3%. The class category 5-6 had higher percentage of VI cases (32.7%). Public schools contributed 52.8% of the cases of VI while for private schools the corresponding percentage was 47.2%. The leading cause of VI was refractive error (89.3%) followed by amblyopia (5.0%). Other causes of VI included cataract (1.2%), corneal disease (1.8%), strabismus (1.8%) and nystagmus (0.6%).Conclusions: There is a need to implement school health policy on visual screening prior to admissions in schools and annual eye screening program for early detection and prompt treatment of eye problems among school children in Muzaffarabad.

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Prevalence of severe visual impairment and barriers to access eye care services in the Udupi district

Asian Journal of Ophthalmology ◽

10.35119/asjoo.v17i4.291 ◽

2021 ◽

Vol 17 (4) ◽

pp. 343-355

Author(s):

Lavanya G. Rao ◽

Dushyanth Sharma ◽

Sulatha V. Bhandary ◽

Divya Handa ◽

Yogish Kamath

Keyword(s):

Health Care ◽

Visual Acuity ◽

Confidence Interval ◽

Visual Impairment ◽

Tertiary Care ◽

Eye Care ◽

Cross Sectional ◽

Care Services ◽

Care Facilities ◽

Lack Of Knowledge

Aim: To assess the prevalence of severe visual impairment (SVI) and reasons for not accessing eye care services in a field practice area of a tertiary care hospital. Study design: Cross-sectional observational study. Materials and methods: Through a cross-sectional study using simple random sampling, a total of 1510, individuals above 18 years of age, from six rural and maternity welfare centers (RMCW) within a distance of 20 km from a tertiary hospital were approached. All participants underwent basic assessment of visual acuity, anterior segment evaluation using torch light, and answered a structured questionnaire on eye care. Results: Of 1510 subjects, 267 had SVI (defined as visual acuity < 6/60 either in one or both eyes) with a prevalence of 17.7%. SVI was higher among men and those above 60 years of age (52.8%). Significant association was found between barriers to accessing eye care facilities and lack of knowledge to access health care (p = 0.004), lack of financial support (95% CI, p = 0.006), and social reasons (95% CI, p = 0.028). Prevalence of SVI among diabetics was 32.7% as compared to non-diabetics (OR: 2.630; 95% confidence interval: 1.864–3.712), and among hypertensives was 34.61% as compared to non-hypertensives (OR: 2.836; 95% confidence interval: 1.977–4.068). Conclusion: In spite of being close to a tertiary care center, a prevalence of SVI in 17.7% of this population indicates a lack of knowledge regarding the importance of self-health care in subjects. This emphasizes the need to increase the awareness among the general public to access the ophthalmic health care facilities in order to improve the ocular health of the patients.

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LIVING AND HEALTH CONDITIONS ASSOCIATED WITH OVERWEIGHT AND OBESITY AMONG ELDERLY

Journal of Frailty & Aging ◽

10.14283/jfa.2015.55 ◽

2015 ◽

pp. 1-9

Author(s):

B.F. DO NASCIMENTO JACINTO DE SOUZA ◽

L. MARÍN-LEON

Keyword(s):

Chronic Diseases ◽

Eating Behaviors ◽

Multinomial Logistic Regression ◽

The Elderly ◽

Cross Sectional Study ◽

Overweight And Obesity ◽

Related Factors ◽

Cross Sectional ◽

Increased Risk ◽

Health Related

Background: The epidemiological and nutritional transition processes in the last decades underlie the rising trend of obesity in the elderly and is related to increased risk of chronic non-communicable diseases and decreased functional status. Objective: To analyze the association of demographic, socioeconomic, lifestyle and health-related factors with overweight and obesity in elderly. Design: Cross-sectional study. Setting: Carried out in Campinas-São Paulo, Brazil, in 2011. Participants: 452 non-institutionalized elderly (aged ≥60 years), half were users of a government-run soup kitchen and the other half were neighbors of the same sex. Results:Overweight frequency (BMI ≥25 and <30 kg/m2) was 44.5% and obesity (BMI ≥30 kg/m2) was 21.7%. In the multiple multinomial logistic regression model adjusted for sex, age group and economic class, there was greater chance of overweight among those that reported dyslipidemia; those that reported arthritis/ arthrosis/rheumatism and that once or more per week replaced supper by a snack were more likely to be obese. Elderly who did not leave home daily and reported diabetes had higher chance of overweight and obesity. Conclusions: Overweight and obesity are associated with worse living and health-related conditions, such as physical inactivity, changes in eating behaviors, and chronic diseases. Public health policies should encourage regular physical activity and healthy eating behaviors, focusing on traditional diet, through nutritional education, in order to reduce the prevalence of overweight and obesity and chronic diseases.

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Abstract TMP55: Polysomnographic and Sleep-related Variables Associated to Leukoaraiosis in Patients with Obstructive Sleep Apnea

Stroke ◽

10.1161/str.48.suppl_1.tmp55 ◽

2017 ◽

Vol 48 (suppl_1) ◽

Author(s):

Kevin R Duque ◽

Brian Villafuerte ◽

Fiorella Adrianzen ◽

Rodrigo Zamudio ◽

Andrea Mendiola ◽

...

Keyword(s):

Obstructive Sleep Apnea ◽

Logistic Regression ◽

Sleep Apnea ◽

Multinomial Logistic Regression ◽

Sleep Time ◽

Cross Sectional Study ◽

Apnea Hypopnea Index ◽

Cross Sectional ◽

Obstructive Sleep ◽

Medical Histories

Introduction: Obstructive sleep apnea (OSA) is a biological plausible risk factor for leukoaraiosis (LA). We tested the hypothesis that polysomnographic (PSG) and sleep-related variables are associated to LA in OSA patients. Methods: Cross-sectional study in which PSG records, medical histories and brain 1.5T MRI were collected from all consecutive patients who had attended a Sleep Medicine Center between 2009-2014. LA was graded from 0 to 9 with the ’Atherosclerosis Risk In Communities’ study scale. OSA was defined by The International Classification of Sleep Disorders, 2014, and its severity categorizing according to apnea-hypopnea index (AHI, <15 mild, 15 to <30 moderate, 30 to <45 severe and ≥45 very severe). A multinomial logistic regression was performed to describe the association between OSA severity and LA (divided into 2 groups: mild-to-moderate LA and non-to-minimal LA). The covariates for all regression models were age, gender, BMI, hypertension, ischemic stroke, myocardial infarction, diabetes and pack-year of smoking. Results: From 82 OSA patients (77% male; mean age 58±9 years, range 19-91), 54 (66%) had LA. Mild-to-moderate LA was found in 13 patients (8 mild and 5 moderate LA) and non-to-minimal LA in 69 (41 minimal and 28 non LA). Spearman’s correlation coefficient between AHI and LA grade was 0.41 (p<0.001). Furthermore, the higher OSA severity, the higher LA severity (p<0.001, for Jonckheere-Terpstra test for ordered alternatives). In the multinomial logistic regression model adjusted for cofounders, severe OSA patients had higher risk for mild or moderate LA (HR 12.8, 95% IC 1.2-141) compared to mild-to-moderate OSA patients. Additionally, self-reported habitual sleep duration from 7 to 9 hours (HR 0.36, 90% IC 0.14-0.90) and proportion of time in apnea/hypopnea over total sleep time (HR 1.04 for one unit increase, 90% IC 1.01-1.08) could be associated with the presence of LA (adjusted only for age and gender). In a multiple regression analysis with all the aforementioned variables, age (p=0.002), diabetes (p=0.003), and OSA severity (p=0.04) were predictors of the presence of LA. Conclusion: Patients with severe OSA had higher risk for mild to moderate LA when compared to patients with mild or moderate OSA.

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