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标题：Vision Impairment and Hearing Loss Among Community-Dwelling Older Americans: Implications for Health and Functioning
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作者：John E. Crews ; Vincent A. Campbell
期刊名称：American journal of public health
印刷版ISSN：0090-0036
出版年度：2004
卷号：94
期号：5
页码：823-829
语种：English
出版社：American Public Health Association
摘要：Objectives . We investigated the health, activity, and social participation of people aged 70 years or older with vision impairment, hearing loss, or both. Methods . We examined the 1994 Second Supplement on Aging to determine the health and activities of these 3 groups compared with those without sensory loss. We calculated odds ratios and classified variables according to the International Classification of Functioning, Disability and Health framework. Results . Older people with only hearing loss reported disparities in health, activities, and social roles; those with only vision impairment reported greater disparities; and those with both reported the greatest disparities. Conclusions . A hierarchical pattern emerged as impairments predicted consistent disparities in activities and social participation. This population’s patterns of health and activities have public health implications. Sensory problems are common experiences within the older US population. Of people aged ≥ 70 years, 18% report blindness in 1 or both eyes or some other trouble seeing, 33.2% report problems with hearing, and 8.6% report problems with both hearing and seeing. 1 Precisely because these experiences are so common, they are often overlooked or dismissed. 2 Moreover, normal age-related changes in hearing and vision may be confused with abnormal sensory changes that can compromise function. Likewise, abnormal changes due to eye and ear pathology may be confused with normal age-related sensory changes. Hearing and vision problems are not manifest disabilities, and both can lead to misdiagnosis or misunderstanding. For example, an older person with vision problems may appear timid, hesitant, or confused, especially when confronted with a new situation. 3 Similarly, older people with hearing loss may miss the nuances of conversation and appear confused, creating unjustified impatience on the part of those with whom they are speaking. 4 These experiences may lead to isolation, disappointment, and frustration. 5 When decrements in vision and hearing exceed normal age-related changes that are due to eye pathology, they may begin to compromise an older person’s ability to carry out routine activities that define social roles and quality of life. 6 Either hearing or vision loss can affect the most common and simple tasks. Sensory decline may compromise one’s ability to hear whispered conversation or side remarks, write notes, read the newspaper, and recognize facial expressions. The relation between vision and various health conditions and activity limitations among older people is well documented, but few studies are population based. Diminished vision is associated with decreases in leisure activities, 7, 8 Instrumental Activities of Daily Living (IADL) performance and social function, 2 Activities of Daily Living (ADL), 9 and compromised mobility 10, 11 ; it is also associated with increases in hip fractures, 12 falls, 13 depression, 14, 15 physician visits and hospitalizations, 16 mortality, 17 and family stress. 18– 20 Hearing loss is associated with decreased functional and psychosocial impairments 21 ; increased social isolation, 22 depression, 23, 24 and rates of dementia 25 ; it is also associated with accelerated cognitive decline in dementia. 26 Declines in vision and hearing are associated with decreased quality of life, 27 increased physical disability measured by IADL among women, 28 imbalance, 29, 5 falls, 30, 31, 13 hip fracture, 12 and mortality. 32, 33 Few investigators have examined the discrete concerns associated with sensory loss as defined by hearing loss, vision impairment, and both vision impairment and hearing loss. Two recent articles are of particular interest. Keller et al. 34 examined ADL and IADL among a group of 576 older people seen at the University of Nebraska Medical Center. Vision impairment was defined as a near visual acuity of 20/70 or less, and hearing was measured by a whisper test. In this study, 51% of subjects were classified as having a hearing impairment only; 5% had a vision impairment only; 13% had a dual sensory impairment, and 32% had none. These 4 groups were compared in terms of mean ADL and IADL scores. Participants with sensory impairments showed diminished functional status as measured by ADL and IADL. Those with combined vision impairment and hearing loss demonstrated the greatest differences in functional status. The sample was not population based. A population-based investigation, however, by Reuben et al. 35 examined the National Health and Nutrition Examination Survey (NHANES I) to determine the relation between vision and hearing loss within a 10-year period and mortality and overall functional decline. The NHANES I provided a large sample (n = 5677) whose subjects, aged 55–74 years, were followed for a decade. Those with hearing loss, vision impairment, and both vision impairment and hearing loss demonstrated higher rates of mortality, ADL dependency, and IADL dependency than did people without sensory impairment 10 years after collection of baseline data. Those with combined vision and hearing problems demonstrated the greatest declines in function and the greatest rates of mortality. Those who acquired vision and hearing problems after baseline data were collected were not identified, and thus changes in their function were not recorded. Comprehension of the magnitude of sensory problems in the older US population and the impact of these changes on this population’s behaviors are important public policy and public health concerns in terms of surveillance, research, and intervention design.