The Association of Vision, Hearing, and Dual Sensory Impairments With Walking Speed and Incident Slow Walking

Abstract Vision (VI), hearing (HI) and dual sensory (DSI, concurrent VI and HI) impairments are increasing in prevalence as populations age. Walking speed is an established health indicator associated with adverse outcomes, including mortality. Using the population-based Health and Retirement Study, we analyzed the longitudinal relationship between sensory impairment and walking speed. In multivariable mixed-effects linear models, we found differences in baseline walking speed (m/s) by sensory impairment: Beta=-0.05 (95%CI=-0.07, -0.04), Beta=-0.02 (95%CI=--0.03, -0.003), and Beta=-0.07 (95%CI=--0.08, -0.05) for VI, HI and DSI, respectively, as compared to those without sensory impairment. However, similar annual declines (0.014 m/s) in walking speeds occurred in all groups. In time-to-event analyses, events were defined as “slow walking” (speed <0.60m/s) and “very slow walking” (<0.40m/s). Incident “slow walking” was 43% (95%CI=25%, 65%), 29% (95%CI=13%, 48%) and 35% (95%CI=13%, 61%) greater in VI, HI and DSI, respectively, than the no sensory impairment group, while incident “very slow walking” was 21% (95%CI=-4%, 54%), 30% (95%CI=3%, 63%) and 89% (95%CI=47%, 143%) greater; the increase was significantly greater in DSI than VI and HI. These results suggest that older adults with vision and hearing impairments walk slower and are at increased risk of slow walking than older adults without these sensory impairments. Additionally, older adults with DSI are at greatest risk of very slow walking.

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The Association of Sensory Impairment With Incident Disability-Related Cessation of Employment in Older Adults

Innovation in Aging ◽

10.1093/geroni/igaa057.697 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

pp. 216-216

Author(s):

Ahmed Shakarchi ◽

Emmanuel Garcia Morales ◽

Nicholas Reed ◽

Bonnielin Swenor

Keyword(s):

Older Adults ◽

Hearing Aids ◽

Population Based ◽

Sensory Impairment ◽

Loss To Follow Up ◽

Increased Risk ◽

Cox Proportional Hazard Regression ◽

Study Participants ◽

Adjusted Model

Abstract Sensory impairment (SI) is common among older adults, and it is an increasingly important public health challenge as the population ages. We evaluated the association between SI and incident disability-related cessation of employment in older adults using the population-based Health and Retirement Study. Participants employed in 2006 completed biennial interviews until self-reported incident disability-related cessation of employment. Participants were censored at loss to follow-up, retirement, or 2018. Participants rated their vision and hearing, using eyeglasses or hearing aids if applicable, on a Likert scale (poor, fair, good, very good, excellent). SI was defined as poor or fair ability, and SI was categorized as neither SI (NSI), vision impairment alone (VI), hearing impairment alone (HI), and dual SI (DSI). Cox proportional hazard regression assessed the association between SI and incident disability-related cessation of employment, adjusting for demographic and health covariates. Overall, 4726 participants were included: 421 (8.9%) were with VI, 487 (10.3) with HI, and 203 (4.3%) with DSI. Mean age was 61.0 ± 6.8 years, 2488 (52.6%) were women, and 918 (19.4) were non-White. In the fully adjusted model, incident disability-related cessation of employment over the 12-year follow-up period was higher in VI (Hazard Ratio (HR)=1.30, 95% confidence interval (CI)=0.92, 1.85), HI (HR=1.60, CI=1.16, 2.22), and DSI (HR=2.02, CI=1.38, 2.96). These findings indicate that employed older adults with SI are at increased risk of incident disability-related cessation of employment, and that older adults with DSI are particularly vulnerable. Addressing SI in older adults may lengthen their contribution to the workforce.

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Changes in the Dynamic Stability of Walking in Active Healthy Older Adults Independent of Changes in Walking Speed

Volume 2: Biomedical and Biotechnology Engineering ◽

10.1115/imece2008-67807 ◽

2008 ◽

Author(s):

Hyun Gu Kang ◽

Jonathan B. Dingwell

Keyword(s):

Older Adults ◽

Young Adults ◽

Dynamic Stability ◽

Walking Speed ◽

Age Groups ◽

Leg Strength ◽

Age Related ◽

Increased Risk ◽

Risk Of Falls ◽

Walking Speeds

Older adults commonly walk slower, which many believe helps improve their walking stability. However, they remain at increased risk of falls. We investigated how differences in age and walking speed independently affect dynamic stability during walking, and how age-related changes in leg strength and ROM affected this relationship. Eighteen active healthy older and 17 younger adults walked on a treadmill for 5 minutes each at each of 5 speeds (80–120% of preferred). Local divergence exponents and maximum Floquet multipliers (FM) were calculated to quantify each subject’s responses to small inherent perturbations during walking. These older adults exhibited the same preferred walking speeds as the younger subjects (p = 0.860). However, these older adults still exhibited greater local divergence exponents (p<0.0001) and higher maximum FM (p<0.007) than young adults at all walking speeds. These older adults remained more unstable (p<0.04) even after adjusting for declines in both strength and ROM. In both age groups, local divergence exponents decreased at slower speeds and increased at faster speeds (p<0.0001). Maximum FM showed similar changes with speed (p<0.02). The older adults in this study were healthy enough to walk at normal speeds. However, these adults were still more unstable than the young adults, independent of walking speed. This greater instability was not explained by loss of leg strength and ROM. Slower speeds led to decreased instability in both groups.

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Understanding the Sensory Loss–Cognitive Function Relationship in Older Adults: Biomarker or Causal Risk Factor?

Innovation in Aging ◽

10.1093/geroni/igaa057.2920 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

pp. 804-804

Author(s):

Jennifer Deal ◽

Heather Whitson

Keyword(s):

Older Adults ◽

Cognitive Decline ◽

Microvascular Disease ◽

Population Based ◽

Vision Impairment ◽

Sensory Loss ◽

Current Evidence ◽

Sensory Impairment ◽

Increased Risk ◽

Function Relationship

Abstract Sensory impairment in older adults is common, over 55% of Americans 60 years and older have either hearing or vision impairment, and it is linked to accelerated cognitive decline and increased risk of incident dementia in population-based observational studies. However, whether sensory impairment is a marker or a cause of cognitive decline and dementia is unknown. Both sensory impairment and cognitive decline/dementia may be caused by a common underlying pathology (e.g., microvascular disease), or sensory impairment may be a marker of dementia-related pathological changes in the brain. Alternatively, causal mechanisms include increased cognitive load, changes brain structure/function, depression, social isolation and/or reduced activity. This session will investigate the role of sensory impairment in cognitive decline and dementia in older adults and discuss the ramifications of these different possibilities for risk prediction and stratification, and potentially, for disease prevention. The co-occurrence of multiple sensory deficits will be described, and the potential utility of the use of retinal signs as predictive markers for cognitive decline/dementia will be discussed. We will also describe current evidence for both non-causal and causal relationships between sensory impairment and cognition with a focus on hearing impairment. Finally, we will describe the relationship of dual sensory (both hearing and vision) impairment on cognitive performance and dementia in a biracial population-based study.

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ASSOCIATION OF SENSORY AND COGNITIVE IMPAIRMENT WITH HEALTHCARE UTILIZATION AND COST IN MEDICARE BENEFICIARIES

Innovation in Aging ◽

10.1093/geroni/igz038.170 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

pp. S44-S44

Author(s):

William Deardorff ◽

Phillip liu ◽

Richard Sloane ◽

Courtney Van Houtven ◽

Susan N Hastings ◽

...

Keyword(s):

Older Adults ◽

Cognitive Impairment ◽

Healthcare Cost ◽

Functional Disability ◽

Hospital Admissions ◽

Adverse Outcomes ◽

Community Dwelling ◽

Vision Impairment ◽

Increased Risk ◽

Sensory Impairments

Abstract The combination of sensory and cognitive impairment is increasingly prevalent among older adults and may be an important driver of healthcare cost due to functional disability and reduced self-care. This presentation focuses on the relationship between hearing and/or vision impairment and cognitive impairment with hospital admissions and healthcare cost using data from the Medicare Current Beneficiary Survey, a nationally representative sample of community-dwelling adults. We show that the presence of sensory impairment is associated with increased risk of hospitalization regardless of dementia status. In adjusted models, annual total healthcare costs were generally higher among those with sensory impairments compared to those without sensory impairments. We will also discuss work related to the development of a prognostic model that provides estimates of hospitalization risk among older adults with self-reported hearing and/or vision impairment. This model may help inform allocation of health care resources to those at highest risk for adverse outcomes.

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The Study of Sensory Aging in Existing Cohorts of Older Adults

Innovation in Aging ◽

10.1093/geroni/igaa057.2946 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

pp. 810-810

Author(s):

Joshua Ehrlich

Keyword(s):

Older Adults ◽

Health Outcomes ◽

Cohort Studies ◽

Well Being ◽

Population Based ◽

Sensory Function ◽

Clear Understanding ◽

Sensory Impairment ◽

Sensory Data ◽

Sensory Impairments

Abstract Sensory impairments in later life are associated with numerous adverse health outcomes, including falls, depression, cognitive decline and dementia, and loss of independence. While population-based cohort studies offer a wealth of data for studying health and aging, these studies have not been widely leveraged to investigate the epidemiology of sensory impairment and the effect of sensory impairments on health outcomes and well-being in older adults. This symposium will provide attendees with examples from presenters’ own research using sensory function data from large-scale and population-based cohort studies. Presentations will also describe available sensory data and opportunities to improve measures of sensory function in cohort studies. Finally, presenters will focus on methodological considerations when studying the effect of sensory impairment on health outcomes, trends, and trajectories in older adults using data from cohort studies. The symposium will include presentations on vision, hearing, olfaction, and nesting of a randomized controlled trial within an existing cohort study. Participants will gain a clear understanding of the importance of measuring sensory function; methods for integrating sensory measures into existing cohorts; and the original results of analyses that have used sensory data from existing cohorts to study health and well-being in older adults. Sensory Health Interest Group Sponsored Symposium.

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Identification of Disability Risk in Addition to Slow Walking Speed in Older Adults

Gerontology ◽

10.1159/000516966 ◽

2021 ◽

pp. 1-10

Author(s):

Hiroyuki Shimada ◽

Takehiko Doi ◽

Sangyoon Lee ◽

Kota Tsutsumimoto ◽

Seongryu Bae ◽

...

Keyword(s):

Older Adults ◽

Regression Models ◽

Walking Speed ◽

Word List ◽

Normal Walking ◽

Slow Walking ◽

List Memory ◽

Walking Speeds ◽

Walking Group ◽

Slow Walking Speed

Introduction: A cutoff speed of 1.0 m/s for walking at a comfortable pace is critical for predicting future functional decline. However, some older adults with walking speeds below the cutoff point maintain an independent living. We aimed to identify specific predictors of disability development in older adults with slow walking speeds in contrast to those with a normal walking speed. Methods: This prospective cohort study on 12,046 community-dwelling independent Japanese older adults (mean age, 73.6 ± 5.4 years) was conducted between 2011 and 2015. Participants were classified into slow walking speed (comfortable walking speed slower than 1.0 m/s) and normal walking speed (speed of 1.0 m/s or faster) groups and followed up to assess disability incidence for 24 months after baseline assessments. Cox proportional hazards regression models were used to identify predictors of disability development in the slow and normal walking groups. Results: Overall, 26.8% of participants had a slow walking speed. At follow-up, 17.3% and 5.1% of participants in the slow and normal walking groups, respectively, developed disability (p < 0.01). Cox regression models revealed that age (hazard ratio 1.07, 95% confidence interval 1.05–1.09), walking speed (0.12, 0.07–0.22), grip strength (0.97, 0.95–0.99), Parkinson’s disease (4.65, 2.59–8.33), word list memory-immediate recognition score (0.90, 0.85–0.97), word list memory-delayed recall score (0.94, 0.89–1.00), Symbol Digit Substitution Test (SDST) score (0.98, 0.96–0.99), and 15-item Geriatric Depression Scale (GDS) score (1.04, 1.01–1.07) were significantly associated with disability incidence in the slow walking group. In the normal walking group, age, grip strength, depression, diabetes, cognition, GDS score, and reduced participation in outdoor activity were significantly associated with disability incidence; however, there was no significant association with walking speed. Conclusions: Decreased walking speeds have considerably greater impact on disability development in older adults with a slow walking speed than in those with a normal walking speed. Health-care providers should explore modifiable factors for reducing walking speed; they should also encourage improvement of risk factors such as muscle weakness and depression to reduce disability risk in older adults with slow walking speeds.

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Depressive and Anxiety Symptoms in Older Adults With Auditory, Vision, and Dual Sensory Impairment

Journal of Aging and Health ◽

10.1177/0898264318781123 ◽

2018 ◽

Vol 31 (8) ◽

pp. 1353-1375 ◽

Cited By ~ 13

Author(s):

Adam Simning ◽

Meghan L. Fox ◽

Steven L. Barnett ◽

Silvia Sorensen ◽

Yeates Conwell

Keyword(s):

Older Adults ◽

Late Life ◽

Well Being ◽

Anxiety Symptoms ◽

Self Report ◽

Sensory Impairment ◽

Depression And Anxiety ◽

Increased Risk ◽

Sensory Impairments ◽

Dual Sensory Impairment

Objective: The objective of the study is to examine the association of auditory, vision, and dual sensory impairment with late-life depressive and anxiety symptoms. Method: Our study included 7,507 older adults from the National Health & Aging Trends Study, a nationally representative sample of U.S. Medicare beneficiaries. Auditory and vision impairment were determined by self-report, and depressive and anxiety symptoms were evaluated by the two-item Patient Health Questionnaire (PHQ-2) and two-item Generalized Anxiety Disorder Scale (GAD-2), respectively. Results: Auditory, vision, and dual impairment were associated with an increased risk of depressive and anxiety symptoms in multivariable analyses accounting for sociodemographics, medical comorbidity, and functional impairment. Auditory, vision, and dual impairment were also associated with an increased risk for depressive and anxiety symptoms that persist or were of new onset after 1 year. Discussion: Screening older adults with sensory impairments for depression and anxiety, and screening those with late-life depression and anxiety for sensory impairments, may identify treatment opportunities to optimize health and well-being.

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Association between allostatic load and mortality among Chinese older adults: the Chinese Longitudinal Health and Longevity Study

BMJ Open ◽

10.1136/bmjopen-2020-045369 ◽

2021 ◽

Vol 11 (8) ◽

pp. e045369

Author(s):

Tianhang Zhang ◽

Lijing L Yan ◽

Hua-Shuai Chen ◽

Hai-Yu Jin ◽

Chenkai Wu

Keyword(s):

Older Adults ◽

Allostatic Load ◽

Strong Association ◽

Population Based ◽

Adverse Outcomes ◽

Ageing Population ◽

Cox Models ◽

Increased Risk ◽

Significant Difference ◽

All Cause Mortality

BackgroundAllostatic load (AL) has shown that high burden of AL is associated with increased risk of adverse outcomes, but little attention has been paid to China with largest ageing population in the world.ObjectiveThis study is to examine the association between AL and all-cause mortality among Chinese adults aged at least 60 years.DesignPopulation-based prospective cohort study.SettingIn 2011–2012, an ancillary study, in which a blood test was added, including a total of 2439 participants, was conducted in eight longevity areas in the Chinese Longitudinal Healthy Longevity Survey.ParticipantsThe final analytical sample consisted of 1519 participants (mean±SD age: men 80.5±11.3 years; women 90.2±11.8 years and 53% women).Primary outcome measureCox models were used to examine the association between AL and mortality among men and women, separately. Analyses were also adjusted for potential confounders including age, ethnicity, education and marital status, smoking and exercise.ResultsMale with a medium AL burden (score: 2–4) and high AL burden (score: 5–9) had a 33% and 118% higher hazard of death, respectively, than those with a low AL burden (score: 0–1). We did not find significant difference between females with different levels of AL burden.ConclusionHigher AL burden was associated with increased all-cause mortality among Chinese men aged at least 60 years. However, we did not find strong association among women. In conclusion, Intervention programmes targeting modifiable components of the AL burden may help prolong lifespan for older adults, especially men, in China.

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The Association of Vision, Hearing, and Dual-Sensory Loss with Walking Speed and Incident Slow Walking: Longitudinal and Time to Event Analyses in the Health and Retirement Study

Seminars in Hearing ◽

10.1055/s-0041-1726017 ◽

2021 ◽

Vol 42 (01) ◽

pp. 075-084

Author(s):

Ahmed F. Shakarchi ◽

Lama Assi ◽

Abhishek Gami ◽

Christina Kohn ◽

Joshua R. Ehrlich ◽

...

Keyword(s):

Walking Speed ◽

Linear Models ◽

Sensory Loss ◽

Health And Retirement Study ◽

Time To Event ◽

Slow Walking ◽

Public Health Challenges ◽

Nationally Representative ◽

Retirement Study ◽

Slow Walking Speed

AbstractWith the aging of the population, vision (VL), hearing (HL), and dual-sensory (DSL, concurrent VL and HL) loss will likely constitute important public health challenges. Walking speed is an indicator of functional status and is associated with mortality. Using the Health and Retirement Study, a nationally representative U.S. cohort, we analyzed the longitudinal relationship between sensory loss and walking speed. In multivariable mixed effects linear models, baseline walking speed was slower by 0.05 m/s (95% confidence interval [CI] = 0.04–0.07) for VL, 0.02 (95% CI = 0.003–0.03) for HL, and 0.07 (95% CI = 0.05–0.08) for DSL compared with those without sensory loss. Similar annual declines in walking speeds occurred in all groups. In time-to-event analyses, the risk of incident slow walking speed (walking speed < 0.6 m/s) was 43% (95% CI = 25–65%), 29% (95% CI = 13–48%), and 35% (95% CI = 13–61%) higher among those with VL, HL, and DSL respectively, relative to those without sensory loss. The risk of incident very slow walking speed (walking speed < 0.4 m/s) was significantly higher among those with HL and DSL relative to those without sensory loss, and significantly higher among those with DSL relative to those with VL or HL alone. Addressing sensory loss and teaching compensatory strategies may help mitigate the effect of sensory loss on walking speed.

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Exploring the Association between Multimorbidity and Cognitive Impairment in Older Adults Living in the Community: A Review of the Literature

Home Health Care Management & Practice ◽

10.1177/10848223211030468 ◽

2021 ◽

pp. 108482232110304

Author(s):

Grace F. Wittenberg ◽

Michelle A. McKay ◽

Melissa O’Connor

Keyword(s):

Older Adults ◽

Cognitive Impairment ◽

Assessment Tool ◽

Adult Population ◽

Home Health ◽

Adverse Outcomes ◽

Community Dwelling ◽

Cognitive Screening ◽

Review Of The Literature ◽

Increased Risk

Two-thirds of older adults have multimorbidity (MM), or co-occurrence of two or more medical conditions. Mild cognitive impairment (CI) is found in almost 20% of older adults and can lead to further cognitive decline and increased mortality. Older adults with MM are the primary users of home health care services and are at high risk for CI development; however, there is no validated cognitive screening tool used to assess the level of CI in home health users. Given the prevalence of MM and CI in the home health setting, we conducted a review of the literature to understand this association. Due to the absence of literature on CI in home health users, the review focused on the association of MM and CI in community-dwelling older adults. Search terms included home health, older adults, cognitive impairment, and multimorbidity and were applied to the databases PubMed, CINAHL, and PsychInfo leading to eight studies eligible for review. Results show CI is associated with MM in older adults of increasing age, among minorities, and in older adults with lower levels of education. Heart disease was the most prevalent disease associated with increased CI. Sleep disorders, hypertension, arthritis, and hyperlipidemia were also significantly associated with increased CI. The presence of MM and CI was associated with increased risk for death among older adults. Further research and attention are needed regarding the use and development of a validated cognitive assessment tool for home health users to decrease adverse outcomes in the older adult population.

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