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Self-Reported Serious Sensory Impairments and Associations With Cognitive and Functional Difficulties
TAKE-HOME MESSAGE
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Analysis of data from the 5-year American Community Survey 2011–2015 Public Use Microdata Sample (from the United States Census) revealed that individuals with dual sensory impairment (DSI), comprised of both serious visual impairment (SVI) and serious hearing impairment (SHI), self-report greater cognitive and functional difficulties than do those with SVI or SHI alone.
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The prevalence of DSI (1.6% in the population 45 years and older) increases with increasing age, and those with serious DSI were approximately 14 years older than those with no sensory impairment. The results also showed that those with SVI were more likely to report difficulties in all functional domains than were those with SHI; however, those with serious DSI had greater functional and cognitive difficulties than those reporting only SVI or SHI alone.
– Kathleen Freeman, OD, FAAO
abstract
This abstract is available on the publisher's site.
Access this abstract now Full Text Available for ClinicalKey SubscribersPURPOSE
To estimate the nationwide prevalence of self-reported serious vision impairment (SVI), serious hearing impairment (SHI), and serious dual sensory impairment (DSI; i.e., concomitant SVI and SHI) and to characterize their associations with self-reported cognitive, independent living, self-care, and ambulatory difficulties.
DESIGN
The American Community Survey (ACS) is a nationwide cross-sectional survey administered by the United States Census Bureau.
PARTICIPANTS
The 2011-2015 ACS sample contains data on 7 210 535 individuals 45 years of age or older.
METHODS
Descriptive statistics for each of the 4 mutually exclusive sensory impairment categories no sensory impairment (NSI), SVI, SHI, and serious DSI were calculated using the weighted sample. Adjusted odds ratios using several logistic regressions were calculated using the unweighted sample to measure the magnitude of associations between sensory impairment status and the outcome difficulties.
MAIN OUTCOME MEASURES
Self-reported cognitive, independent living, self-care, and ambulatory difficulty.
RESULTS
Among individuals 45 years of age or older, the estimated nationwide prevalence of self-reported SVI alone is 2.8%, that of SHI alone is 6.0%, and that of serious DSI is 1.6%. The prevalence of each sensory impairment increases with age. A greater proportion of American Indians or Alaskan Natives experience SVI (4.8%), SHI (8.5%), and serious DSI (3.7%) than any other race or ethnic group (P < 0.001). Individuals reporting serious DSI are more likely to report cognitive impairment, independent living difficulty, self-care difficulty, and difficulty ambulating than individuals with NSI across all age groups (all P < 0.001). Furthermore, serious DSI is associated with greater cognitive and functional difficulties than SVI or SHI alone, and SVI alone has a greater association with cognitive and functional difficulties than SHI alone.
CONCLUSIONS
The nationwide prevalence of self-reported serious sensory impairment increases with age and is distributed unequally among different racial and ethnic groups. Any sensory impairment is associated with greater cognitive and functional difficulties than NSI. Additionally, serious DSI is associated with greater difficulties than SVI or SHI alone, and SVI alone is more serious than SHI alone in each of the 4 cognitive and functional difficulties.
Additional Info
Disclosure statements are available on the authors' profiles:
Nationwide Prevalence of Self-Reported Serious Sensory Impairments and Their Associations With Self-Reported Cognitive and Functional Difficulties
Ophthalmology 2018 Jan 03;[EPub Ahead of Print], SD Fuller, LI Mudie, C Siordia, BK Swenor, DS FriedmanFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.
The findings that serious visual impairment, serious hearing impairment, and serious dual sensory impairment increase with aging are not surprising. It is also not surprising that these impairments are associated with cognitive and functional difficulties, and that having a dual impairment is more impactful on these difficulties than either vision or hearing alone. But it might be a surprise that vision impairment is more serious than hearing impairment with respect to these difficulties. This is important public health information. At least from a visual perspective, optimizing sensory function in these populations would suggest that low vision rehabilitative intervention should be considered.
As the authors note, there are more than 1,400,000 individuals 65 years of age and older currently residing in the United States with self-reported serious sensory impairments at present, and that estimate is expected to reach 3 million by 2050. Minority populations experience the greatest amount of functional difficulties, and this is a serious and growing public health issue. With the aging of the population, the combination of physical and cognitive disabilities, and the burden they impose on the individual as well as society demands more serious attention, including the funding of preventive studies.
The findings are disturbing, but not surprising. Addressing them seems to be a cost-effective goal from the perspective of maximizing functionality and reducing further dependence on supportive services. Nevertheless, such action requires an ability to glimpse the obvious, for which there seems to be a parallel disability among our health services leadership in Washington.
This important public health information needs attention and action. Unfortunately, like so many current important issues, money is the sticking point. In the present political environment, it seems unlikely that much can be done to improve the situation.
This article by Fuller et al uses the cross-sectional 2011–2015 American Community Survey (ACS) administered by the United States Census Bureau to more closely examine the impact of serious sensory impairments on cognitive, independent living, self-care, and ambulatory difficulties. With a sample size of over 7 million self-reporting or proxy responders, it provides an interesting look at perceptions of functional difficulties from the patient perspective. Not surprisingly, sensory impairments increase with age. In comparing serious vision impairment (SVI) and serious hearing impairment (SHI), SVI appears to have a larger impact on cognitive and functional difficulties. This may have public health implications in terms of research priority and funding for early detection and intervention.
Serious dual sensory impairment (DSI) involving both vision and hearing has the greatest impact on cognitive and functional difficulties, a finding not uncommon to optometric and ophthalmological practice. Patients with any sensory impairment, but particularly SVI and DSI, should be considered for rehabilitative referral to improve function, which in turn may improve quality of life. A lesser highlighted but interesting aspect of the article is its summary of geographic areas within the United States where sensory impairments are most common. These areas may benefit from additional eye care and audiology providers, including those with an interest in vision or dual sensory rehabilitation.