Concurrent Vision Impairment Research Articles

Self-reported hearing and vision impairment and incident frailty in Japanese older people: A 3-year longitudinal analysis of the Japan Gerontological Evaluation Study

BackgroundWe examined the associations and interactions of hearing impairment (HI) and vision impairment (VI) with frailty. MethodsWe performed a 3-year longitudinal analysis of the Japan Gerontological Evaluation Study (JAGES), a nationwide prospective cohort study of functionally independent Japanese older people (age ≥ 65 years). Frailty status at baseline and follow-up was defined according to the Kihon Checklist. HI and VI at baseline were self-reported. Logistic regression models were used to examine the main and interaction effects of HI and VI on incident frailty during a 3-year follow-up period. ResultsOf the 7,852 participants (mean age 73.2 years, standard deviation 5.6; 50.7% women), 9.7%, 5.3%, and 1.9% reported HI, VI, and concurrent HI and VI, respectively. After adjusting for possible confounders and the other sensory impairment, VI (odds ratio [OR] 2.50, 95% confidence interval [CI] 1.62–3.85, p < 0.001), but not HI (OR 1.29, 95% CI 0.97–1.72, p = 0.081), was significantly associated with incident combined pre-frailty and frailty from a robust baseline. No interaction was observed between HI and VI (OR 0.83, 95% CI 0.38–1.81, p = 0.636). We observed no significant associations between sensory impairments and incident frailty from a pre-frail baseline (HI: OR 1.26, 95% CI 0.88–1.80, p = 0.205; VI: OR 1.44, 95% CI 0.90–2.31, p = 0.127; interaction between HI and VI: OR 1.16, 95% CI 0.53–2.53, p = 0.718). ConclusionsVI, rather than HI, may be an independent risk factor for frailty, without any interaction between the two.

Satisfaction With Health Care by Dual Sensory Impairment Status

Sensory impairment is a barrier to patient-provider communication and access to care, which may impact satisfaction with care. Satisfaction with the quality of care received in the past year was assessed in the 2017 Medicare Current Beneficiary Survey (weighted sample=53,905,182 Medicare beneficiaries). Self-reported sensory impairment was categorized as no sensory impairment, hearing impairment (HI)-only, vision impairment (VI)-only, and dual sensory impairment (DSI) – concurrent HI and VI. In a model adjusted for sociodemographic characteristics and health determinants, having DSI was associated with higher odds of dissatisfaction with the quality of care received (Odds Ratio [OR]=1.53, 95%Confidence Interval [CI]=1.14-2.06) relative to no sensory impairment; however, having HI-only or VI-only were not (OR=1.33, 95%CI=1.94-1.89, and OR=1.32, 95%CI=0.95-1.93, respectively). These findings have implications for healthcare providers as Medicare shifts to value-based reimbursement. Moreover, previous work that singularly focused on HI or VI alone may have failed to recognize the compounded effect of DSI.

IMPACT OF DUAL SENSORY IMPAIRMENT ON HEALTH CARE INTERACTION

Using data from 46,029,364 Medicare beneficiaries included in the 2015 Current Beneficiary Survey (MCBS), we examined the relationship between dual sensory impairment (DSI) – concurrent vision impairment (VI) and hearing impairment (HI) – and accompaniment to physician visits. Analyses examined reasons for accompaniment and self-reported sensory impairment was categorized as: no sensory impairment (89%), hearing impairment (HI) only (5%), vision impairment only (4%), and DSI (1%). There was no difference in odds of accompaniment among HI compared to those without sensory impairment (odds ratio [OR] = 1.04; 95% Confidence Interval [CI]: 0.84,1.29); however, VI and DSI were associated with accompaniment: (OR=2.14; [CI]:1.6,2.8 and [OR]= 2.70; [CI]:1.55,4.72, respectively). Our study further demonstrates that older adults with sensory impairment are accompanied to physician visits more often than those without sensory impairment, and transportation is the most frequently reported reason for accompaniment among adults with VI and communication for those with HI.