Vision problems for older adults can dim life expectancy
August 25, 2014
WEST LAFAYETTE, Ind. — Older adults losing vision as they age are more likely to face an increased mortality risk, according to new research from Purdue University.
“Participants who experienced visual decline of one letter on an eye chart were expected to have a 16 percent increase in mortality risk during the eight-year study because their vision affected daily activities,” said Sharon Christ, an assistant professor of human development and family studies. “These daily activities were not the necessary functioning activities such as bathing, dressing and eating, but rather instrumental daily activities, such as telephone use, shopping and preparing their own meals. When individuals were no longer able to engage in these activities because of visual impairments, their life expectancy was reduced.”
The findings are published in JAMA Ophthalmology. The researchers analyzed data from the Salisbury Eye Evaluation study that tracked the vision health of 2,520 older adults, ages 65-84. The research was funded by the National Eye Institute.
Previous research shows poorer ocular health is related to increased mortality risk, but the mechanisms of this relationship were not clear because they were limited by a lack of information regarding changes in visual acuity and in functioning as people age, Christ said. In this study, they were able to measure vision level as well as the rate at which it declined.
Sensory impairments, such as vision health, often deteriorate as people age, but today’s older adults also have higher incidences of Type 2 diabetes, which can create additional ocular problems.
“What we found reinforces the value of visual care through the life course,” Christ said. “Older individuals will benefit from early-detection services and as well as care to fix what are often correctable visual problems. A renewed focus on ocular health could save lives.”
Christ collaborated with D. Diane Zheng, Stacey Tannebaum and David J. Lee from the Department of Public Health Sciences at University of Miami’s Miller School of Medicine; Bonnielin K. Swenor, Sheila K. West and Beatriz E. Muñoz from the Dana Center for Preventive Ophthalmology at Wilmer Eye Institute at Johns Hopkins University School of Medicine; and Byron Lam from the Bascom Palmer Eye Institute at University of Miami’s Miller School of Medicine.
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Longitudinal Relationships Among Visual Acuity, Daily Functional Status and Mortality: The Salisbury Eye Evaluation Study
Sharon L. Christy, Ph.D.; D. Diane Zheng, MS; Bonnielin K. Swenor, Ph.D.; Byron L. Lam, MD; Sheila K. West, Ph.D.; Stacey L. Tannenbaum, Ph.D.; Beatriz E. Muñoz, MSc; David J. Lee, Ph.D.
IMPORTANCE: Determination of the mechanisms by which visual loss increases mortality risk is important for developing interventional strategies.
OBJECTIVE: To evaluate the direct and indirect effects of loss of visual acuity (VA) on mortality risk through functional status changes among aging adults.
DESIGN, SETTING AND PARTICIPANTS: Prospective longitudinal study of a population-based sample of 2,520 noninstitutionalized adults ages 65 to 84 years from September 16, 1993, through July 26, 2003, in the greater Salisbury area of Maryland. Participants underwent reassessment 2, 6, and 8 years after baseline. Mortality status was ascertained from linkage with the National Death Index through 2009.
EXPOSURES: Results of VA testing and self-reported functional status based on activities of daily living (ADL) and instrumental (IADL).
MAIN OUTCOMES AND MEASURE: Mortality.
RESULTS: Worse VA levels at baseline were associated with an increased risk for mortality (hazard ratio [HR], 1.16 [95% CI, 1.04-1.28]; P < .01) through their effect on lower IADL levels at baseline. Declines in VA over time were associated with increased mortality risk (HR, 1.78 [95% CI, 1.27-2.51]; P < .001) by way of decreasing IADL levels over time. Participants experiencing the mean linear decline in VA of 1 letter on the Early Treatment Diabetic Retinopathy Study acuity chart per year are expected to have a 16% increase in mortality risk during the 8-year study exclusively through associated declines in IADL levels.
CONCLUSIONS AND RELEVANCE: In this longitudinal study of older adults, VA loss adversely affected IADL levels, which subsequently increased the risk for mortality. Prevention of disabling ocular conditions, treatment of correctable visual impairment, and interventions designed to prevent the effect of visual impairment on IADL declines may all reduce mortality risk in aging adults.