DUAL SENSORY IMPAIRMENT DUAL SENSORY IMPAIRMENT AND CHANGE IN ADL ABILITY AND CHANGE IN ADL ABILITY AMONG ELDERLY OVER TIME: AMONG ELDERLY OVER TIME:

A SEM LATENT GROWTH A SEM LATENT GROWTH CURVE APPROACHCURVE APPROACH

Ya-ping Su, PhD, Ya-ping Su, PhD, The Peer Review Organization of New Jersey

Mark Brennan, PhD and Amy Horowitz, Mark Brennan, PhD and Amy Horowitz, DSW DSW

Arlene R. Gordon Research Institute

Research funded by the AARP Andrus FoundationResearch funded by the AARP Andrus Foundation

Dual Sensory Loss (Vision + Dual Sensory Loss (Vision + Hearing)Hearing)

Age-related vision and hearing impairments are two of the most prevalent chronic conditions affecting quality of life and medical service use among older Americans (NCHS, 1999).

In 1995, 18% of noninstitutionalized adults aged 70 and older were vision impaired, one-third were hearing impaired and 9% were dual impaired.

The prevalence of vision and hearing impairment increases sharply with age (e.g., among adults aged 85 and older, 31% were vision impaired, 50% were hearing impaired and 24% were dual impaired).

Vision Loss and ADL FunctioningVision Loss and ADL Functioning

Consistent FindingConsistent Finding

• A growing body of research highlighting the relationship between vision loss and functional disabilityfunctional disability among community-based elderly.

• More severeMore severe impact on everyday functioning than other physical impairments.

• Risk for declinedecline in functional ability over time.

Hearing Loss and ADL Hearing Loss and ADL FunctioningFunctioning

MixedMixed EvidenceEvidence

• GreaterGreater functional disability compared to the non-imparied

• Relationship not as strongnot as strong as vision impairment

• NoNo relationship & notnot an independent predictor of ADL disability over time

Dual Sensory and Functional Dual Sensory and Functional AbilityAbility

Limited and Contradictory EvidenceLimited and Contradictory Evidence

• Did notnot lead to additional deterioration of PADL and IADL over a single sensory deficit in either vision or hearing

• 40% greater40% greater risk of functional decline over a single vision loss

• A greatergreater impact on functional disability than that seen with a single impairment

Purpose and RationalePurpose and Rationale

To examine the effects of dual sensory To examine the effects of dual sensory impairments of vision and hearing and impairments of vision and hearing and

single sensory impairments on changes in single sensory impairments on changes in PADL and IADL ability over the 4 waves of PADL and IADL ability over the 4 waves of

the LSOA.the LSOA.

Hypothesis One: the additiveadditive model of dual sensory impairment (i.e., vision + hearing) would better explain changes in PADL ability from 1984 to 1990;

Hypothesis Two: the interactiveinteractive model of dual sensory impairment (i.e., vision x hearing) would better explain changes in IADL ability over the course of the LSOA

MethodMethod

Data: the Longitudinal Study of Aging (LSOA) 1984-1990 which was based on the 1984 National Health Interview Survey (NHIS), a continuous survey of the US population.

Sample: the 4-wave sample (N=2,211)

Design/Analysis: •SEM Latent Growth Curve •Only the slope function, or rate of change, latent variable was estimated•Unweighted Least Square estimation (ULS)

Sample: Age and SexSample: Age and Sex

Age

75-7926%

80-8425%

85-9916%

70-7433%

Sex

Female64%

Male36%

Sample: Race and HealthSample: Race and Health

Race

Black11%

White88%

Other1%

0510152025303540

%very poorpoor

fair

good

excellent

Self-rated health

Sensory Impairment StatusSensory Impairment Status

Measurement: Sensory impairment status was obtained with the following items:

“Which statement best describes your (vision or hearing) even when wearing (glasses/contact lenses or hearing aid): no trouble, a little trouble, or a lot of trouble?”

Respondents were classified as non-impaired, singly vision or hearing impaired, or dual impaired based on these items.

Prevalence of Sensory Loss of Prevalence of Sensory Loss of Persons 70 Years of Age and Over in Persons 70 Years of Age and Over in

the US, 1984the US, 1984

Hearing22% Vision

15%

Dual21%

None42%

Mean Changes in PADL (0-7 Mean Changes in PADL (0-7 items) and IADL (0-6 items) items) and IADL (0-6 items)

0

1

2

3

4

5

6

7

84 86 88 90

PADL IADL

Comparison of Models

Notes: RMSEA = root mean square of approximation;

AGFI = adjusted goodness-of-fit index;

NFI = normed fit index;

CFI = comparative fit index

PADL IADLAdditive Interactive Additive Interactive

X2 32.49 665.11 26.17 529.31df 27 40 27 40P .21 .00 .51 .00RMSEA .009 .084 .00 .084AGFI .99 .88 .99 .88NFI .99 .78 .99 .78CFI .99 .78 1.00 .78N 2200 2200 1751 1751

DiscussionDiscussion

• The effects of dual sensory impairment on changes in PADL and IADL function over time were both additiveadditive.

• Similar patterns were found for both PADL and IADL domains. Mean vector of change for both domains of -.07 indicating a gradual, linear increase in ADL disability over the six years of study.

• Vision impairmentVision impairment and comorbid physical healthcomorbid physical health measures were the strongest predictors.

ConclusionsConclusions

• Vision impairmentVision impairment appears largely responsible for functional limitations, regardless of the level of hearing loss and when controlling for the effects of comorbid physical health and cognitive functions.

• Future research should continue to address the issue of dual sensory impairment and functional ability over time, using repeated assessments of vision and hearing to examine how change in sensory abilities are related to change in ADL functioning over time.

ImplicationsImplications

• Findings reveal the far-reaching impact of sensory impairment on the quality of life among older adults, and thus underscore the need for expanded educational, rehabilitation and outreach programs for elders with concurrent vision and hearing impairment to support them in their efforts to remain independentindependent.

• Education of both public and professional audiences is also needed to specifically address the effects of sensory loss, and emphasize that sensory loss should neither be ignored nor considered to be a normal part of aging.

LimitationsLimitations

• Secondary data.

• Sensory impairment status was available only at the baseline.

• Conservative in estimating the consequences of dual impairment.

For further information, please contact:For further information, please contact:

Ya-ping Su, PhDYa-ping Su, PhDThe Peer Review Organization of New JerseyThe Peer Review Organization of New Jersey

557 Cranbury Road, Suite 21557 Cranbury Road, Suite 21East Brunswick, NJ 08816East Brunswick, NJ 08816

TEL: (732) 238-5570 ext. 2111/FAX: (732) 238-TEL: (732) 238-5570 ext. 2111/FAX: (732) 238-77667766

email: email: nj1pro.ysu@sdps.orgnj1pro.ysu@sdps.org

Mark Brennan, PhDMark Brennan, PhDLighthouse InternationalLighthouse International

111 East 59th Street111 East 59th StreetNew York, NY 10022-1202New York, NY 10022-1202

TEL: (212) 821-9536/FAX: (212) 821-9706TEL: (212) 821-9536/FAX: (212) 821-9706email: email: mbrennan@lighthouse.orgmbrennan@lighthouse.org