Older Adults In US Research Articles

Association of Symptomatic Dizziness With All-Cause and Cause-Specific Mortality

Dizziness is a highly prevalent complaint with wide-ranging causes and resultant morbidity. Whether symptomatic dizziness and its various manifestations are associated with all-cause and cause-specific mortality is unknown. To examine the associations of symptomatic dizziness and its manifestations with all-cause and cause-specific mortality. This cohort study is a mortality follow-up study based on the 1999-2004 National Health and Nutrition Examination Survey. The study cohort included adults 40 years and older who completed questions about symptomatic dizziness, including problems with dizziness, balance, falling, and positional dizziness, within the past 12 months. Respondents were linked to mortality data through December 31, 2019. Data were analyzed from February to August 2023. Self-reported symptomatic dizziness. All-cause and cause-specific (cardiovascular disease, diabetes, cancer, and unintentional injuries) mortality. Cox proportional hazard regression models were used to examine associations between symptomatic dizziness and all-cause and cause-specific mortality while adjusting for demographics and medical history. In this nationally representative cohort of 9000 middle-aged and older US adults (mean [SD] age, 61.8 [13.8] years; 4570 [50.8%] female), prevalence of symptomatic dizziness was 23.8%. Specifically, 18.3% reported problems with dizziness, 14.5% reported problems with balance, 5.7% reported problems with falling, and 3.8% reported dizziness when turning in bed (positional dizziness). At a median (range) of 16.2 (0.1-20.6) years of follow-up, all-cause mortality for adults with symptomatic dizziness was higher than for those without (45.6% vs 27.1%). Symptomatic dizziness was associated with elevated risk for cause-specific mortality from diabetes (hazard ratio [HR], 1.66; 95% CI, 1.23-2.25), cardiovascular disease (HR, 1.33; 95% CI, 1.12-1.55), and cancer (HR, 1.21; 95% CI, 0.99-1.47) but not unintentional injuries (HR, 0.98; 95% CI, 0.51-1.88). Reporting problems with balance or falling was associated with increased all-cause mortality (balance: HR, 1.27; 95% CI, 1.17-1.39; and falling: HR, 1.52; 95% CI, 1.33-1.73), cardiovascular disease-specific mortality (balance: HR, 1.41; 95% CI, 1.20-1.66; and falling: HR, 1.49; 95% CI, 1.15-1.94), and diabetes-specific mortality risks (balance: HR, 1.74; 95% CI, 1.26-2.39; and falling: HR, 2.01; 95% CI, 1.26-3.18). There was no association between positional dizziness and mortality (HR, 0.98; 95% CI, 0.82-1.19). In this cohort study, symptomatic dizziness was associated with increased risk for all-cause and diabetes-, cardiovascular disease-, and cancer-specific mortality. The imprecision of the effect size estimate for cancer-specific mortality prevents making a definitive conclusion. Future studies are needed to determine whether symptomatic dizziness indicates underlying health conditions contributing to mortality or if early intervention for imbalance and falls can reduce mortality risk.

Genetic influences on depression and selection into adverse life experiences

Genome-wide association studies find that a large number of genetic variants jointly influence the risk of depression, which is summarized by polygenic indices (PGIs) of depressive symptoms and major depression. But PGIs by design remain agnostic about the causal mechanisms linking genes to depression. Meanwhile, the role of adverse life experiences in shaping depression risk is well-documented, including via gene-environment correlation. Building on theoretical work on dynamic and contingent genetic selection, we suggest that genetic influences may lead to differential selection into negative life experiences, forging gene-environment correlations that manifest in various permutations of depressive behaviors and environmental adversities. We also examine the extent to which apparent genetic influences may reflect spurious associations due to factors such as indirect genetic effects. Using data from two large surveys of middle-aged and older US adults, we investigate to what extent a PGI of depression predicts the risk of 27 different adversities. Further, to glean insights about the kinds of processes that might lead to gene-environment correlation, we augment these analyses with data from an original preregistered survey to measure cultural understandings of the behavioral dependence of various adversities. We find that the PGI predicts the risk of majority of adversities, net of class background and prior depression, and that the selection risk is greater for adversities typically perceived as being dependent on peoples’ own behaviors. Taken together, our findings suggest that the PGI of depression largely picks up the risk of behaviorally-influenced adversities, but to a lesser degree also captures other environmental influences. The results invite further exploration into the behavioral and interactional processes that lie along the pathways intervening between genetic differences and wellbeing.

Changes in surgical mortality during COVID-19 pandemic by patients’ race, ethnicity and socioeconomic status among US older adults: a quasi-experimental event study model

ObjectivesTo examine changes in the 30-day surgical mortality rate after common surgical procedures during the COVID-19 pandemic and investigate whether its impact varies by urgency of surgery or patient race,...

Preoperative Concerns of Older US Adults and Decisions About Elective Surgery

This cross-sectional study examines the preoperative concerns among US adults aged 50 to 80 years who considered elective surgery.

Genome-Related Mechanisms Contributing to Differences in Alzheimer's Disease Incidence Between White and Black Older US Adults.

In this manuscript, we leverage a modified GWAS algorithm adapted for use with multidimensional Cox models and data from the Health and Retirement Study to explore how genetic variation influences the size of the disparity in Alzheimer's disease (AD) incidence between older Black and White US adults. We identified four loci that were associated with higher AD incidence levels in older Black adults: (1) rs11077034 (hazard ratio (HR), 4.98) from the RBFOX1 gene; (2) rs7144494 (HR, 1.68) from the HISLA gene; (3) rs7660552 (HR, 3.07) from the SLC25A4 gene; and (4) rs12599485 (HR, 3.181) from the NIP30 gene. The RBFOX1, HISLA, SLC25A4, and NIP30 genes are known to be associated with AD (RBFOX1, NIP30) directly, and also influence the risk of AD risk-related morbidities such as hypertension (RBFOX1, SLC25A4), depression (SLC25A4), and certain cancers (HISLA, SLC25A4). A likely disparity-generating mechanism may lie in endocytosis and abnormal tissue growing mechanisms, depending on inherited gene mutations and the structure of proxies as well as gene-environment interactions with other risk factors such as lifestyle, education level, and access to adequate medical services.

Association between oxidative balance score and prostate specific antigen among older US adults.

Oxidative Balance Score (OBS) is an index affecting the oxidative stress of dietary and lifestyle factors. We aimed to explore the association of OBS with prostate specific antigen (PSA) among older males. A total of 5,136 samples were collected in this study to investigate the relationship between OBS and PSA from the National Health and Nutrition Examination Survey. Logistic regression models and restricted cubic spline were used to assess the associations between OBS and PSA. Compared with the Q1 group, the odds ratios for the association between OBS and PSA were 1.005 (1.003, 1.009), 1.003 (1.001, 1.006), and 1.001 (0.978, 1.022) for Q2, Q3, and Q4, respectively. In the age-specific analyses, the association was significant among individuals aged 65 years old and over: the odds ratios for the association between OBS and PSA were 1.019 (1.005, 1.028), 1.028 (1.018, 1.039), and 1.038 (1.022, 1.049) for Q2, Q3, and Q4, respectively. But it was not significant among individuals aged less than 65 years old: the odds ratios for the association between OBS and PSA were 1.016 (0.995, 1.026), 1.015 (0.985, 1.022), and 0.988 (0.978, 1.016) for Q2, Q3, and Q4, respectively. The restricted cubic splines also indicated a nonlinear relationship between OBS and PSA among individuals aged 65 years old and over (Poverall = 0.006, Pnonlinear = 0.021). Our findings provide evidence that OBS is positively associated with higher levels of PSA among older adults. Further large-scale prospective cohort studies are needed to verify our findings.

The role of physical activity in the association between disability and mortality among US older adults: a nationwide prospective cohort study

To examine whether physical activity can mitigate the mortality risk associated with disability in activities of daily living and instrumental activities in daily living among older adults. This analysis comprised 177,360 US participants (104,556 women), aged ≥ 60 years, with valid data from the 1997 through 2018 waves of the US National Health Interview Survey. Participants reported the frequency and duration of leisure-time PA, and their disabilities in activities of daily living and instrumental activities in daily living. Mortality data were obtained from the National Death Index. Over a mean (SD) follow-up of 8.02 (5.43) years, 66,694 deaths occurred from all-cause, 22,673 from cardiovascular disease, and 13,845 from cancer. Among people with disability in activities in daily living, those reaching physical activity recommendations had 25%, 24% and 33% lower risk of all-cause mortality, cardiovascular diseases, and cancer death, respectively, compared with those who do not meet physical activity recommendations. Values were 23%, 22% and 24% for those with disability in instrumental activities in daily living. Risk reductions associated with reaching the recommended physical activity ranged 16% to 29% for people without disability. Combining disability type and compliance with physical activity, individuals with disability in activities of daily living or instrumental activities in daily living who meet the recommended physical activity had moderately higher mortality than those without disability who did not achieve the recommended physical activity. Compliance with physical activity recommendations can partially mitigate excess mortality resulting from disability in activities in daily living or instrumental activities in daily living in older adults.

Association Between Subjective Cognitive Decline and Twice-Weekly Muscle-Strengthening Activities in Middle-Aged and Older US Adults: An Analysis of the 2019 Behavioral Risk Factor Surveillance System.

Adults with subjective cognitive decline (SCD), the self-reported concern of reduced cognitive function, are recommended to do physical activity for its brain health benefits. US adults aged ≥45 with SCD are less likely to meet the American College of Sports Medicine (ACSM) aerobic activity recommendations. Their engagement in muscle-strengthening activities is unknown. We aimed to identify if US adults aged ≥45 with SCD are less likely to do twice-weekly muscle-strengthening activities compared to those without SCD. Secondary analysis of the 2019 Behavioral Risk Factor Surveillance System (BRFSS) data. 114164 respondents, representing approximately 59 million US adults aged ≥45. SCD was indicated if the respondent reported confusion or memory loss during the past 12months (yes/no). Respondents reported the frequency of muscle-strengthening activities, which we categorized as meeting the ACSM's recommendations (2+ times per week) or not (<2 times per week). Crude and adjusted logistic regression models controlling for variables associated with SCD and muscle-strengthening activities. The models used sample weights to represent US adults in the included 31 states and Washington D.C. US adults aged ≥45 with SCD were less likely to do twice-weekly muscle-strengthening activities than those without SCD (28.6% [SE: .8%] vs 33.5% [SE: .3%], adjusted OR, .9; 95% CI: .9-1.0). Primary care providers should encourage middle-aged and older patients to engage in muscle-strengthening and aerobic activities.

Perceived neighborhood disorder and type 2 diabetes disparities in Hispanic, Black, and White Americans.

Approximately 32 million Americans have type 2 diabetes, and that number continues to grow. Higher prevalence rates are observed among certain subgroups, including members of marginalized racial/ethnic groups as well as residents of disordered neighborhoods (i.e., those with more trash and vandalism). Institutionalized discriminatory practices have resulted in disproportionate representation of marginalized racial/ethnic groups in disordered neighborhoods compared to non-Hispanic Whites. These neighborhood disparities may partially contribute to health disparities, given that signs of neighborhood disorder often relate to a general withdrawal from the neighborhood, minimizing opportunities for both physical and social engagement. Yet, research suggests variability across racial/ethnic groups both in reporting rates of neighborhood disorder and in the extent to which neighborhood disorder is interpreted as posing a threat to health and well-being. Using 2016-2018 Health and Retirement Study data (n = 10,419, mean age = 67 years), a representative sample of older US adults, this study examined the possibility of racial/ethnic differences in associations between perceived neighborhood disorder and type 2 diabetes risk. Participants reported their perceptions of neighborhood disorder and type 2 diabetes status. Weighted logistic regression models predicted type 2 diabetes risk by perceived neighborhood disorder, race/ethnicity, and their interaction. Non-Hispanic Blacks and Hispanics had higher type 2 diabetes risk; these two groups also reported more disorder in their neighborhoods compared to non-Hispanic Whites. Perceiving more neighborhood disorder was associated with increased type 2 diabetes risk, but the interaction between race/ethnicity and disorder was not significant. Findings from the current study suggest that the negative effects of perceiving neighborhood disorder, a neighborhood-level stressor, extend to increased type 2 diabetes risk.

COVID-19 Testing and Vaccination Among US Older Adults with Vision Impairment: The National Health and Aging Trends Study 2021

ABSTRACT Purpose To examine the associations between vision impairment (VI) and COVID-19 testing and vaccination services in older US adults. Methods This cross-sectional study assessed data from adults ≥ 65 years who participated in the National Health and Aging Trends Study (year 2021), a nationally representative sample of Medicare beneficiaries. Exposure: Distance VI (<20/40), near VI (<20/40), contrast sensitivity impairment (CSI) (<1.55 logCS), and any VI (distance, near, or CSI). Outcomes: Self-reported COVID-19 testing and vaccination. Results Of 2,822 older adults, the majority were female (weighted; 55%) and White (82%), and 32% had any VI. In fully-adjusted regression analyses, older adults with any VI had similar COVID-19 vaccination rates to adults without any VI (OR:0.77, 95% CI:0.54–1.09), but had lower odds of COVID-19 testing (OR:0.82, 95% CI:0.68–0.97). Older adults with distance (OR:0.47, 95% CI:0.22–0.99) and near (OR:0.68, 95% CI:0.47–0.99) VI were less likely to be vaccinated for COVID-19, while those with CSI were less likely to test for COVID-19 (OR:0.76, 95% CI:0.61–0.95), as compared to peers without respective impairments. The remaining associations were not significant (p > .05). Conclusions and Relevance These findings highlight inequities in the COVID-19 pandemic response for people with vision disability and emphasize the need for equitable prioritization of accessibility of healthcare services for all Americans.

Bidirectional associations between alcohol drinking and depressive symptom scores among US older adults

BackgroundThis study examines the bidirectional associations between alcohol drinking and depression in which low to moderate alcohol drinking may reduce the risk of depression, while the occurrence of depression may increase the amount of alcohol drinking as a coping strategy. MethodData for the community-dwelling older adults from the Medicare Current Beneficiary Survey (MCBS) 2016 to 2019 were analyzed using random intercept cross-lagged panel models to explore the within-individual causal associations for males and females separately. Socioeconomic status (SES), smoking and comorbidities were adjusted in the models. ResultsAmong 3388 older adults with three measures for the number of alcohol drinks and Patient Health Questionnaire (PHQ) depression scores, a prior increase in the number of drinks was related to a moderate non-significant decrease in PHQ scores in the follow-up, but a previous increase in the PHQ scores was significantly associated with a decrease in the number of drinks at the follow-up visit in the adjusted models (regression coefficient = −0.144, p = 0.017 for males; and coefficient = −0.11, p < 0.001 for females). ConclusionPrior depression may lead to reduced drinking in the follow up visits, but no bidirectional association was found among US older adults.

Association between Family Household Income and Cognitive Resilience among Older US Adults: A Cross-Sectional Study.

Cognitive resilience has emerged as a mechanism that may help explain individual differences in cognitive function associated with aging and/or pathology. It is unknown whether an association exists between family income level and cognitive resilience. We performed a cross-sectional study to estimate the relationship between family income level and high cognitive resilience using the National Health and Nutrition Examination Survey (NHANES) among older adults (age≥60). Logistic regression was used to estimate the association between income level and high cognitive resilience adjusted for other factors. Accounting for differences in education, occupation, and health status, older adults in the highest income category were twice as likely compared to those with very low income to have high cognitive resilience (OR: 1.90, 95% CI: 1.05,3.43). A doseresponse was apparent between income category and high cognitive resilience. The finding that income, above and beyond that of known factors, affects cognitive function is important for future public health strategies that aim to prevent or delay cognitive impairment.

Food insecurity and oral health in older adults.

Household food insecurity, defined as inconsistent access to sufficient food in a household, affects 1 in 15 individuals over the age of 60 years in the US. In these individuals it is associated with numerous chronic conditions, medication underuse leading to poorly controlled conditions such as diabetes and hypertension, and poor oral health. However, the relationship between food insecurity and oral health is understudied. We therefore evaluated the associations between food insecurity and aspects of oral health in older US adults. We prospectively evaluated a subset of participants of the Health and Retirement Study (HRS) who responded to questions evaluating food insecurity in 2013 and a supplemental questionnaire regarding dental health and dental health services in 2018 (N = 472). Approximately 1 in 5 people in our study reported being food insecure in the last year. Food insecurity was correlated with poor oral health-related quality of life scores and more tooth loss. Individuals who were food insecure reported worse self-rated oral health (OR = 2.67), greater odds of losing 8 or more teeth (OR = 2.35), and lower odds of receiving oral care (OR = 0.60) compared to their food secure peers. Though individuals experiencing food insecurity were likely to have more unmet oral health needs than their peers, they were less likely to seek dental care. To improve the oral health status of this group, in addition to making oral health care more accessible, it may also be necessary to address the social and environmental factors preventing these people from seeking oral health care.

Use of At-Home Medical Tests Among Older US Adults: A Nationally Representative Survey.

The availability of direct-to-consumer, at-home medical tests has grown over the last decade, but it is unknown how frequently older adults purchase at-home tests, how they perceive such tests, and how interested they are in using at-home tests in the future. We conducted a cross-sectional, nationally representative survey of non-institutionalized US adults aged 50 to 80 about their previous use of, perceptions of, and future intentions to use at-home medical tests. We found that nearly half of older adults (48.1%) have purchased an at-home medical test (95% CI 45.2%-51.0%), including 32.0% (95% CI 29.3%-34.8%) who purchased a COVID-19 test, 16.6% (95% CI 14.7%-18.7%) who purchased an at-home DNA or genetic test, 5.6% (95% CI 4.5%-7.0%) who purchased a screening test for cancer, and 4.4% (95% CI 3.4%-5.6%) who purchased a test for an infection other than COVID-19. Compared with White, non-Hispanic adults, Black, non-Hispanic adults were less likely to have purchased an at-home test (35.5% vs 49.6%, P < .01). Those with a college degree and those with an annual household income greater than $100K were more likely than others to have purchased at-home tests (55.5% vs 42.0%, P < .01; 60.6% vs 39.0%, P < .001, respectively). Most older adults had positive perceptions about at-home tests and expressed interest in using at-home tests in the future. At-home medical testing is now common among older adults. Clinicians should be familiar with different tests that patients can purchase and be prepared to discuss the potential advantages and disadvantages of at-home testing.

Association between psychological resilience and all-cause mortality in the Health and Retirement Study

BackgroundPsychological resilience refers to an individual’s ability to cope with and adapt to challenging life circumstances and events.ObjectiveThis study aims to explore the association between psychological resilience and all-cause mortality...

The Quantitative Impact of Visual Function on Accelerometer-measured Physical Activity in Older United States Adults: A Nationwide Cross-sectional Analysis

ObjectiveTo explore the impact of objective vision measures on novel metrics of objectively-measured physical activity (PA) in a nationally representative sample of US older adults. DesignCross-sectional analysis using data from the National Health and Aging Trends Study. ParticipantsAdults had their distance and near visual acuity (VA) and contrast sensitivity (CS) tested. Any objective vision impairment (VI), defined as any VI in distance VA, near VA, or CS, was the primary exposure. PA data were collected using the Actigraph CentrePoint Insight Watch worn for 7 days. MethodsMultivariable regression models were used to investigate the association between vision and PA measures. All analyses accounted for the survey design and models were adjusted for age, sex, race, living arrangement, education, and comorbidities. Main OutcomesPA metrics included: 1) total daily activity (active minutes per day, number of active bouts, and mean length of active bouts), 2) activity fragmentation, and 3) time until 75% activity. An active bout was defined as ≥1 consecutive active minute. Activity fragmentation was defined as the probability of an active minute being followed by a sedentary minute, with higher values indicating more fragmented activity. Time until 75% activity was defined as the time taken to complete 75% of daily PA starting from their first active bout. ResultsAmong 723 participants, sampled from 10,443,338 older adults in the US, 30% had any objective VI. Any objective VI was significantly associated with lower number of active minutes per day (7.8% fewer, [95% CI: −1.7% to −13.6%]), shorter active bouts (7.0 % shorter, [95% CI: −1.4% to −12.3%]), and greater activity fragmentation (β= 2.5%, [95% CI: 0.8% to 4.2%]), while no associations were found with number of active bouts. Time until 75% activity did not significantly differ between adults with any objective VI and those without (p=0.34). ConclusionsOlder US adults with any objective VI displayed lower total daily activity, as well as more fragmented, shorter periods of PA, despite having a similar number of active bouts compared to their normally sighted counterparts. Implementing interventions that increase bout duration may help promote physical activity in adults with VI.

Negative Wealth Shock and Cognitive Decline and Dementia in Middle-Aged and Older US Adults

As a financial hardship, negative wealth shock has been implicated in some adverse health outcomes. However, associations between negative wealth shock and cognitive decline and dementia have not been examined. To investigate whether negative wealth shock was associated with cognitive decline and incident dementia among middle-aged and older US adults. The Health and Retirement Study (HRS) is a prospective cohort study conducted biennially among US adults older than 50 years. Data from the HRS from calendar years 1996 to 2020 were analyzed from July 1 to 31, 2023. The final sample included 8082 participants with complete data of interest. Wealth status was quantified with questionnaires. Negative wealth shock was defined as a loss of 75% or more in total wealth over a 2-year period. Asset poverty was defined as zero or less total net wealth. Cognitive function was assessed with the modified Telephone Interview for Cognitive Status (TICS-m). Dementia status was determined with TICS-m scores and proxy assessment. Among 8082 participants included (mean [SD] age, 63.7 [5.7] years; 4179 women [51.7%] and 3903 men [48.3%]; 1111 Black [13.7%], 6689 White [82.7%], and 282 other [3.5%]), 1441 developed incident dementia over a median follow-up time of 14 (IQR, 7-20) years. Compared with participants who had positive wealth without shock, those with negative wealth shock had accelerated cognitive decline (β coefficient, -0.014 [95% CI, -0.027 to -0.001]; P = .03) and increased risks of dementia (hazard ratio [HR], 1.27 [95% CI, 1.11-1.46]; P < .001). Higher dementia risks were also found in participants with asset poverty at baseline (HR, 1.61 [95% CI, 1.30-2.00]; P < .001). Associations were found in White participants (HR, 1.34 [95% CI, 1.14-1.58]; P < .001) and participants younger than 65 years (HR, 1.38 [95% CI, 1.13-1.68]; P = .001) but not in other races and ethnicities or those 65 years or older. In this cohort study, negative wealth shock was associated with accelerated cognitive decline and elevated risks of dementia among middle-aged and older US adults, with modifications by age and ethnicity. These findings should be confirmed by further prospective and interventional studies.

Association of perceived discrimination with the risk of depression among US older adults: A prospective population-based cohort study

AimsAssociation between perceived discrimination and depression has been demonstrated in some sources of discrimination, such as age, sex, and race. However, the effects of perceived discrimination both in any domain and each domain on development of depression are still unclear. We aimed to estimate the association of any and each domain of perceived discrimination with the risk of depression among US older adults. MethodsWe did a population-based cohort study using eight waves (from 2006 to 2020) of data from the Health and Retirement Study (HRS), a nationally representative study of US older adults aged 51 years and above. Perceived discrimination was measured by the shortened 5-item version of Williams’ discrimination scale, including five domains (less courtesy, service setting, not smart, threatened or harassed, and medical setting). Depressive symptoms were assessed with shortened 8-item version of the Center for Epidemiological Depression scale (8-item CES-D). Cox proportional hazards models were used to estimate the crude and adjusted hazards ratio (HRs) and their 95 % confidence intervals (CIs) between perceived discrimination and risk of depression, after controlling for potential confounders. ResultsA total of 18502 participants were included in our final analyses. 42.8 % of them had any perceived discrimination at baseline, and the most prevalent perceived discrimination was feeling less courtesy, which was observed in 5893 people (31.6 %). During a median of 9.8 years follow-up, 44.7 % of participants developed depression. The risk of depression was 46 % (adjusted HR: 1.46, 95 % CI: 1.39–1.52) higher among people with perceived discrimination than those without. The associations between perceived discrimination in each domain and risk of depression were all prominent. ConclusionsBoth any and each domain of perceived discrimination were associated with an increased risk of depression. Considering the high prevalence of perceived discrimination and the following poor health outcomes, our findings suggested the integrated measures of providing public education and diversified communication to reduce discrimination, as well as accessible emotional supports to prevent depression are urgently needed.

CONCURRENT VISION AND HEARING IMPAIRMENTS, SOCIAL ISOLATION, DEPRESSION, AND ANXIETY: FINDINGS FROM THE NHATS

Abstract Sensory impairments are contributors to poor health for older adults, and the likelihood of having more than one sensory impairment increases with age. There has been little research on population-level associations of visual and hearing function with social and mental health. This study examined the associations between objectively measured hearing and vision impairment, social isolation, depression, and anxiety among older US adults. Using nationally representative data from the 2021 National Health and Aging Trends Study, we conducted cross-sectional analysis among adults aged &amp;gt;70 (n=2,520). Visual impairment (VI) was defined as distance (&amp;lt;20/40), near (&amp;lt;20/40), and/or contrast sensitivity (&amp;gt;1SD below mean) impairment. Hearing impairment (HI) was defined as a better ear pure-tone average &amp;gt;25 decibel hearing level. Respondents with VI and HI were identified as having dual sensory impairment (DSI). Social isolation was assessed by living arrangement, core network size, religious attendance, and social participation. Depressive and anxiety symptoms were measured with the PHQ-2 and GAD-2, respectively. Weighted sample characteristics showed that 25.53% of older adults had DSI. Logistic regression analyses revealed that, compared to those without HI or VI, older adults with DSI were more likely to report social isolation (OR=1.71, 95% CI=1.12-2.60), have depression (OR=4.57, 95% CI=2.34-8.92), and anxiety (OR=2.65, 95% CI=1.36-5.17). Associations with DSI were stronger than for single impairments. All models controlled for age, gender, education, race/ethnicity, marital status, number of chronic conditions. Findings suggested that older adults experiencing DSI are at greater risk of having social isolation and emotional distress.

VISION LOSS AND PSYCHOSOCIAL FUNCTIONING: WHAT’S THE CONNECTION?

Abstract This study assessed the associations between vision impairment (VI) and psychological and social function in older adults. We conducted a cross-sectional analysis of the National Health and Aging Trends Study, a nationally representative sample of Medicare beneficiaries aged 65 years and older. VI was measured using categorical and continuous scales. Depression and anxiety symptoms were assessed via the Patient Health Questionnaire for Depression and Anxiety (PHQ-4) questionnaire. Social isolation and severe social isolation were defined based on responses to questions on living arrangement, frequency of communication with others, and participation in activities. Results showed that depressive symptoms, social isolation, and severe social isolation were more prevalent in adults with any objective VI measure compared to those without impairment. In adjusted models, objective vision measures were not associated with higher odds of depression or anxiety symptoms, though both outcomes were strongly associated with self-reported VI (OR: 1.82 [95% CI: 1.27 – 2.60], OR: 1.81 [95% CI: 1.30 – 2.53], respectively). In contrast, worse distance and near acuity (per 0.1 logMAR), and worse contrast sensitivity (per 0.1 logCS units) were associated with higher risk of being severely socially isolated (RRR: 3.79 [95% CI: 1.13 – 12.78], 3.26 [95% CI: 1.16 - 9.17], 2.82 [95% CI: 1.11 – 7.18], respectively), however, no associations were found with self-reported VI. This study demonstrates that worse vision is associated with symptoms of depression, anxiety, and social isolation among older US adults. Approaches are needed to enhance the psychological and social well-being of individuals with VI.