Abstract
Although concurrent vision and hearing loss are common in older adults, population-based data on their relationship with mortality is limited. This cohort study investigated the association between objectively measured dual sensory impairment (DSI) with mortality risk over 10 years. 2812 Blue Mountains Eye Study participants aged 55 years and older at baseline were included for analyses. Visual impairment was defined as visual acuity less than 20/40 (better eye), and hearing impairment as average pure-tone air conduction threshold greater than 25 dB HL (500–4000 Hz, better ear). Ten-year all-cause mortality was confirmed using the Australian National Death Index. After ten years, 64% and 11% of participants with DSI and no sensory loss, respectively, had died. After multivariable adjustment, participants with DSI (presenting visual impairment and hearing impairment) compared to those with no sensory impairment at baseline, had 62% increased risk of all-cause mortality, hazard ratio, HR, 1.62 (95% confidence intervals, CI, 1.16–2.26). This association was more marked in those with both moderate-severe hearing loss (>40 dB HL) and presenting visual impairment, HR 1.84 (95% CI 1.19–2.86). Participants with either presenting visual impairment only or hearing impairment only, did not have an increased risk of mortality, HR 1.05 (95% CI 0.61–1.80) and HR 1.24 (95% CI 0.99–1.54), respectively. Concurrent best-corrected visual impairment and moderate-severe hearing loss was more strongly associated with mortality 10 years later, HR 2.19 (95% CI 1.20–4.03). Objectively measured DSI was an independent predictor of total mortality in older adults. DSI was associated with a risk of death greater than that of either vision loss only or hearing loss alone.
Highlights
Impaired vision and hearing are common among older adults [1,2] and can occur separately or in combination [3]
Among participants with presenting visual impairment and bilateral hearing impairment at baseline, 64% had died 10 years later compared to 11% without any sensory loss, and 26% and 30% with only a vision or hearing loss, respectively
Participants with dual sensory impairment (DSI) had a 62% increased risk of dying 10 years later compared to those without any sensory impairment, hazard ratios (HR) 1.62
Summary
Impaired vision and hearing are common among older adults [1,2] and can occur separately or in combination [3]. There are prospective data to suggest that vision loss was associated with a greater mortality risk in older adults [14,15,16]. Karpa et al [14] showed in the Blue Mountains Eye Study (BMES) of adults aged 49 years and over that the presence of presenting visual impairment increased the risk of all-cause mortality by 29%, after adjusting for potential confounders. Agerelated hearing loss has been shown to be associated with a greater risk of all-cause mortality in older adults [17]. In the Blue Mountains Hearing Study of adults aged 55 years and over, indirect path analyses showed that any level of hearing loss (.25 dB HL) was associated with increased all-cause mortality via three mediating variables: disability in walking, cognitive impairment and self-rated health [17]
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