Potential mediators of the relationship between vision impairment and self-rated health in older adults: A comparison between long-term care insurance claimants in residential care institutions versus those living in the community

Abstract

ObjectivesThe objective of this study was to examine the mediating roles of functional and psychological factors on the relationship between vision impairment (VI) and self-rated health (SRH) in older adults in residential care institutions versus those living in the community. DesignA cross-sectional survey study. Setting and ParticipantsWe obtained data for this study from the public Long-term Care Insurance (LTCI) database of Yiwu, Zhejiang province, China. Our data included adults aged ≥ 60 years who had received the qualification assessment from September through December 2018. In total, 2,427 elderly individuals were included for analysis, including 747 older adults in residential care institutions and 1,680 older adults living in the community. MeasuresVI and SRH were measured using participants’ self-reported information. Potentially relevant functional and psychological factors were assessed using LTCI qualification assessment data, including self-care activities, mobility, incontinence, perceived usefulness, perceived fatigue, and perceived interest. The Karlson-Holm-Breen (KHB) method was used to examine whether functional and psychological factors mediated the relationship between VI and SRH and to calculate the mediated percentage among older adults. ResultsControlling for sociodemographic characteristics, all functional and psychological factors except mobility mediated the effect of severe VI on SRH in older adults living in the community. For older adults living in residential care institutions, self-care activities, mobility, and perceived usefulness mediated the effects of both moderate and severe VI on SRH, while perceived fatigue and perceived interest mediated the effect of severe VI on SRH. ConclusionsThe findings of this study support the idea that functional and psychological factors mediate the relationship between vision impairment and self-rated health in older adults, and that different mediating pathways exist between older adults in residential care institutions and those living in the community. Our research highlights the importance of developing tailored interventions for visually impaired older adults through an integrative model to improve their overall well-being.