Sensory impairment and all-cause mortality among the elderly adults in China: a population-based cohort study.

With age-related functional deterioration, sensory impairment including vision impairment (VI), hearing impairment (HI), and dual sensory impairment (DSI) usually occurred among the elderly population, causing a decrease in functional capacity and quality of life. The study aimed to explore how sensory impairment is associated with the risk of all-cause mortality among the elderly adults in China. We prospectively investigated the association among 37,076 participants enrolled from 1998 to 2019 in the Chinese Longitudinal Healthy Longevity Survey. We also, as a sensitivity analysis, explored the association among 11,365 newly incident sensory impairment participants. Cox regression model with sensory impairment as a time-varying exposure was performed to calculate the hazard ratios (HRs) and 95% confidence intervals (CIs). Compared with participants without sensory impairment, those with VI (HR=1.20, 95% CI: 1.15-1.24), HI (HR=1.26, 95% CI: 1.21-1.31), and DSI (HR: 1.46, 95% CI=1.41-1.52) had significant higher risk of all-cause mortality after adjusting for potential confounders. These associations were robust among subgroup analyses stratified by sex and entry age, and sensitivity analyses performed among newly incident sensory impairment participants. In conclusion, sensory impairment was associated with higher mortality risk among the elderly adults in China.

Hearing impairment and incident disability and all-cause mortality in older British community-dwelling men.

BACKGROUND AND OBJECTIVE: hearing impairment is common in older adults and has been implicated in the risk of disability and mortality. We examined the association between hearing impairment and risk of incident disability and all-cause mortality. DESIGN AND SETTING: prospective cohort of community-dwelling older men aged 63-85 followed up for disability over 2 years and for all-cause mortality for 10 years in the British Regional Heart Study. METHODS: data were collected on self-reported hearing impairment including hearing aid use, and disability assessed as mobility limitations (problems walking/taking stairs), difficulties with activities of daily living (ADL) and instrumental ADL (IADL). Mortality data were obtained from the National Health Service register. RESULTS: among 3,981 men, 1,074 (27%) reported hearing impairment. Compared with men with no hearing impairment, men who could hear and used a hearing aid, and men who could not hear despite a hearing aid had increased risks of IADL difficulties (age-adjusted OR 1.86, 95% CI 1.29-2.70; OR 2.74, 95% CI 1.53-4.93, respectively). The associations remained after further adjustment for covariates including social class, lifestyle factors, co-morbidities and social engagement. Associations of hearing impairment with incident mobility limitations, incident ADL difficulties and all-cause mortality were attenuated on adjustment for covariates. CONCLUSION: this study suggests that hearing problems in later life could increase the risk of having difficulties performing IADLs, which include more complex everyday tasks such as shopping and light housework. However, further studies are needed to determine the associations observed including the underlying pathways.

Impairments in hearing and vision impact on mortality in older people: the AGES-Reykjavik Study.

OBJECTIVE: to examine the relationships between impairments in hearing and vision and mortality from all-causes and cardiovascular disease (CVD) among older people. DESIGN: population-based cohort study. PARTICIPANTS: the study population included 4,926 Icelandic individuals, aged ≥67 years, 43.4% male, who completed vision and hearing examinations between 2002 and 2006 in the Age, Gene/Environment Susceptibility-Reykjavik Study (AGES-RS) and were followed prospectively for mortality through 2009. METHODS: participants were classified as having 'moderate or greater' degree of impairment for vision only (VI), hearing only (HI), and both vision and hearing (dual sensory impairment, DSI). Cox proportional hazard regression, with age as the time scale, was used to calculate hazard ratios (HR) associated with impairment and mortality due to all-causes and specifically CVD after a median follow-up of 5.3 years. RESULTS: the prevalence of HI, VI and DSI were 25.4, 9.2 and 7.0%, respectively. After adjusting for age, significantly (P < 0.01) increased mortality from all causes, and CVD was observed for HI and DSI, especially among men. After further adjustment for established mortality risk factors, people with HI remained at higher risk for CVD mortality [HR: 1.70 (1.27-2.27)], whereas people with DSI remained at higher risk of all-cause mortality [HR: 1.43 (1.11-1.85)] and CVD mortality [HR: 1.78 (1.18-2.69)]. Mortality rates were significantly higher in men with HI and DSI and were elevated, although not significantly, among women with HI. CONCLUSIONS: older men with HI or DSI had a greater risk of dying from any cause and particularly cardiovascular causes within a median 5-year follow-up. Women with hearing impairment had a non-significantly elevated risk. Vision impairment alone was not associated with increased mortality.

Severity of concurrent visual and hearing impairment and mortality: the 1986-1994 National Health Interview Survey.

PURPOSE: Visual impairment and, to a lesser extent, hearing impairment are independent predictors of reduced survival in selected studies of community-residing adults. To date, the association of severity of concurrent impairment and mortality has not been examined. METHOD: The National Health Interview Survey is a continuous, multistage, area probability survey of the U.S. civilian noninstitutionalized population. Mortality linkage with the National Death Index of 116,796 adult participants from 1986 to 1994 with complete impairment data was performed through 1997. RESULTS: Findings indicate that moderate to severe concurrent hearing and visual impairment in women is associated with significantly increased risk of mortality. More modest mortality associations are evident for men and for adults with less severe impairments, irrespective of gender. DISCUSSION: Prevention of severe visual and hearing impairment should be a national public health priority, especially given the aging of the U.S. population.

Survival of outpatients with Alzheimer-type dementia.

OBJECTIVE: To study the clinical course of Alzheimer-type dementia and those factors that might predict or influence the length of survival. DESIGN: A prospective cohort study. PARTICIPANTS: One hundred and twenty-six patients diagnosed with Alzheimer-type dementia were selected from among 200 consecutive outpatients evaluated for suspected dementia from 1980 to 1982. All 126 patients had at least 6 years of follow-up. SETTING: All patients were initially seen as outpatients at a university hospital. MEASUREMENTS AND MAIN RESULTS: Survival analysis was done using Kaplan-Meier estimates and the Cox proportional hazards model. The mean age at symptom onset was 73.9 years and at enrollment in the study, 77.6 years. The median survival from time of enrollment in the study was 5.3 years (range, 0.2 to 7.2+ years) and from symptom onset, 9.3 years (range, 1.8 to 16+ years). Dementia severity, as measured by the Mini-Mental State Examination (MMSE), was strongly associated with survival (P less than 0.001); the median survival of patients with scores of 18 or below was 3 years less than that of patients with scores above 18 (relative risk, 2.7; 95% CI, 1.6 to 4.4). Comorbid conditions and symptom duration were not related to survival. A multivariate analysis of age at symptom onset and of historical features showed that the combination of wandering and falling (relative risk, 2.1; 95% CI, 0.9 to 5.2) and the presence of behavioral problems (relative risk, 1.4; 95% CI, 0.7 to 2.9) at the time of evaluation appeared to adversely affect survival. CONCLUSIONS: Length of survival in patients with Alzheimer-type dementia is highly variable; severity of disease (not duration), the combination of wandering and falling, and behavioral problems are associated with shorter survival. Our findings, if confirmed, may provide prognostic information for families and professionals and suggest areas in which interventions to improve survival might be focused.