Vision and hearing impairments are among the most common age-related conditions affecting the elderly. While there is an emerging literature regarding the profound functional, social, and physical and mental health consequences of either a vision or hearing impairment in later life, there is a dearth of existing knowledge regarding both short- and long-term consequences of dual sensory impairment for older persons. Yet, with the aging of the population, the numbers of older people experiencing a concurrent age-related loss in vision and hearing can be expected to grow substantially. Even current estimates of the prevalence of dual sensory impairments among the elderly range from 4% to 21%, depending upon used definitions and/or sources of data. However, our current body of knowledge on sensory loss is largely defined by a specific focus on either vision or hearing, with relatively little attention to the confounding effects of a concurrent age-related loss in both vision and hearing. While it has been suggested that "...the presence of two sensory losses increases the functional significance of each one..." (Luey, Belser, & Glass, 1989), little data exist to support or refute this hypothesis.
Thus, the primary purpose of this study is to identify the correlates and long-term consequences of dual sensory impairment among the elderly relative to functional ability; social support and social activities; use of formal community-based services; health and health care utilization; and mortality. Furthermore, this research is examining whether the short-term and long-term consequences of dual sensory impairment among the elderly are more consistent with the additive hypothesis (i.e., hearing + vision) versus the interactive hypothesis (hearing X vision) of the consequences of dual sensory impairment. Lastly, the study will test the generalizability of findings to major subgroups of the elderly in terms of race/ethnicity (i.e., African-Americans), gender (i.e., females), and age (i.e., the oldest-old 85 years or more).
Secondary analyses were conducted utilizing the Longitudinal Study of Aging (LSOA) Version 5 dataset. The 1984 Supplement On Aging (SOA) study, comprised of a representative, national sample of persons 55 years of age and older, provides baseline data from the 1984 interview. In the LSOA, persons age 70 and older at baseline were reinterviewed every two years (i.e., 1986, 1988, and 1990). Cross-sectional and time-lagged hypothesized relationships addressing the research objectives have been examined through the use of binary/ordered/multinomial logistic, tobit, negative binomial and Cox regressions, depending upon the level of measurement of the outcome and type of analysis performed. Structural equation modeling is being employed to examine the effects of dual sensory loss on global outcome domains over time (i.e., PADL functioning from 1984 to 1990) and to further test the additive vs. interactive effects of this chronic condition.
Sensory impairment status was determined by the following two questions: "Which statement best describes your (vision or hearing) even when wearing (glasses/contact lenses or hearing aid, respectively): no trouble, a little trouble, or a lot of trouble?" Respondents were classified as nonimpaired, singly vision or hearing impaired, or dual impaired based on these items.
The LSOA data clearly indicate a high prevalence of sensory impairments among elders age 70 and older; vision and hearing impairments were reported by 35% and 42% of respondents, respectively. Significantly, dual sensory impairment was found to affect more than one-fifth (21%) of the adults age 70 years and older in the United States. Findings also supported the supposition that minority populations are at greater risk for both single and dual sensory impairments.
A major trend in the current findings was the consistent negative relationship between sensory impairment and the major outcome domains, with the exception of mortality. Significantly, a vision impairment alone or in combination with concurrent hearing impairment accounted for greater functional disability, dissatisfaction with social interaction, more informal help received with PADL/IADL tasks, difficulties with physical functioning, greater risk of falls, and greater levels of health service utilization compared to persons with no sensory impairment or moderate hearing loss alone. However, there were relatively few instances where dual sensory loss increased the risk of poor outcomes over a single impairment in vision. Thus, the impact of dual sensory impairment in the lives of older people appears to stem largely from the negative effects of vision loss and fits the additive model (i.e., vision + hearing). However, in some instances (e.g., IADL function, formal and informal help received with IADL tasks), the combined negative effects of vision and hearing loss were found to be significant, and interacted in a way that could not be explained by considering the two sensory impairment statuses separately, thus supporting the interactive model (i.e., vision X hearing). Current findings underscore the need for expanded educational, rehabilitation and outreach programs for elders with concurrent vision and hearing impairments to support them in efforts to remain independent in their communities. The negative effects of sensory impairments also highlight the need to address sensory functioning as part of the regular clinical health assessment process for older adults. 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.
The final report on this project was submitted to the AARP Andrus Foundation in August 2001. Manuscripts based on the final report are in preparation for publication.
Brennan, M. (2003). Impairment of both vision and hearing among older adults: Prevalence and impact on quality of life. Generations, 27 (1), 52-56.
Brennan, M., Horowitz, A., & Su, Y. (2005). Dual sensory loss and its impact on everyday competence. The Gerontologist, 45 (3), 337-346.
Brennan, M., Su, Y., & Horowitz, A. (2005). Dual impairment of vision and hearing and its effects on everyday competence in older adults over time. Manuscript under review.
Horowitz, A., Brennan, M., & Su, Y. (2001). Dual sensory impairment among the elderly. Final report submitted to the AARP Andrus Foundation. New York: Arlene R. Gordon Research Institute of Lighthouse International.
Brennan, M., Horowitz, A., & Su, Y. (2002, November). The widespread consequences of dual sensory loss among older U. S. adults. In I. Lissman and K. Boerner (Chairs), Consequences of sensory loss in old age. Symposium conducted at the annual scientific meeting of The Gerontological Society of America, Boston, MA.
Brennan, M., Horowitz, A., & Su, Y. (2003, December). Sensory impairment and risk of falling among older adults: The special case of dual impairment of vision and hearing. Poster session presented at the International Conference on Aging, Disability and Independence, Arlington, VA.
Brennan, M., Su, Y., & Horowitz, A. (2001, August). Dual sensory impairment and cognitive function in older adults. Poster session presented at the annual convention of the American Psychological Association, San Francisco, CA.
Horowitz, A., Su, Y., & Brennan, M. (2000, November). The impact of vision, hearing and dual sensory impairment on received informal support. Poster session presented at the annual scientific meeting of The Gerontological Society of America, Washington, D.C.
Su, Y., & Brennan, M. (2001, November). Examining the effects of dual sensory loss on change in PADL and IADL function over time using latent growth curve analysis. In J. T. Newsom (Chair), Growth curve approaches to longitudinal data in gerontology research. Symposium conducted at the annual scientific meeting of The Gerontological Society of America, Chicago, IL.
Su, Y., Brennan, M., & Horowitz, A. (2000, October). The effects of dual sensory impairment on living arrangements among older adults. Poster session presented at the annual conference of the State Society on Aging of New York, Albany, NY.
Su, Y., Horowitz, A., & Brennan, M. (2000, November). The effects of dual sensory impairment on functional ability among elderly adults. Poster session presented at the annual scientific meeting of The Gerontological Society of America, Washington, D.C.
Su, Y., Brennan, M., & Horowitz, A. (2001, November). Dual sensory impairment and change in ADL function among elderly over time: A SEM latent growth curve approach. In J. Newsom (Chair), Growth curve approaches to longitudinal data in gerontology research. Symposium conducted at the annual scientific meeting of The Gerontological Society of America, Chicago, IL.
Su, Y., Brennan, M., & Horowitz, A. (2001, November).Dual sensory impairment and health service use among elderly adults. Poster session presented at the annual scientific meeting of The Gerontological Society of America, Chicago, IL.
Investigators: Amy Horowitz, DSW/PhD, Principal Investigator
Mark Brennan, PhD, Co-Investigator
Ya-Ping Su, PhD, Research Associate
Funded by: AARP Andrus Foundation
Project Period: 1/1/99 - 6/30/00 - 12/30/00