Purpose: The authors investigate the impact of hearing loss on quality of life in a large population of older adults. Design and Methods: Data are from the 5-year follow-up Epidemiology of Hearing Loss Study, a population-based longitudinal study of agerelated hearing impairment conducted in Beaver Dam, WI. Participants (N ¼ 2,688) were 53–97 years old (mean ¼ 69 years) and 42% were male. Difficulties with communication were assessed by using the Hearing Handicap for the Elderly—Screening version (HHIE-S), with additional questions regarding communication difficulties in specific situations. Health-related quality of life was assessed by using measures of activities of daily living (ADLs), instrumental ADLs (IADLs) and the Short Form 36 Health Survey (SF-36). Hearing loss measured by audiometry was categorized on the basis of the puretone average of hearing thresholds at 0.5, 1, 2, and 4 kHz. Results: Of participants, 28% had a mild hearing loss and 24% had a moderate to severe hearing loss. Severity of hearing loss was significantly associated with having a hearing handicap and with self-reported communication difficulties. Individuals with moderate to severe hearing loss were more likely than individuals without hearing loss to have impaired ADLs and IADLs. Severity of hearing loss was significantly associated with decreased function in both the Mental Component Summary score and the Physical Component Summary score of the SF-36 as well as with six of the eight individual domain scores. Implications: Severity of hearing loss is associated with reduced quality of life in older adults.

http://web.clas.ufl.edu/users/mcolburn/Web-links/SPA4321/Impact%20of%20HL%20on%20QOL.pdf

The Impact of Hearing Loss on Quality of Life in Older Adults

Objective To test the reliability and validity of the 51-item Field Test Version of the National Eye Institute Visual Function Questionnaire (NEI-VFQ) across 5 common chronic eye conditions. Design Prospective observational cohort study of persons with 1 of 5 chronic eye diseases who were scheduled for nonurgent visits in ophthalmology practices or had low vision from any cause, and a reference sample of persons without eye disease. Setting Six university-based ophthalmology practices and the National Eye Institute Clinical Center, Bethesda, Md. Patients Eligible participants had to have 1 of the following eye conditions: age-related cataracts, age-related macular degeneration, diabetic retinopathy, primary open-angle glaucoma, cytomegalovirus retinitis, or low vision from any cause. Each of the 7 sites also enrolled persons in a reference sample. Reference sample participants had no evidence of underlying eye disease but were scheduled for either screening eye examinations or correction of refractive error. All eligible persons had to be aged 21 years or older, English speaking, and cognitively able to give informed consent and participate in a health status interview. Measurements and Main Results To provide the data needed to assess the reliability and validity of the 51-item NEI-VFQ, all subjects completed an interview that consisted of the 51-item NEI-VFQ, the Medical Outcomes Study 36-Item Short-Form Health Survey, and at least 1 measure of vision-targeted functional status. Estimates of internal consistency and test-retest reproducibility indicate that the 51-item NEI-VFQ is reliable. Tests of association with other scales and clinical variables support the construct validity of the survey. Conclusions In this cross-sectional study, the 51-item NEI-VFQ seems to be reliable and valid and should be a useful tool for group-level comparisons of vision-targeted, health-related quality of life in clinical research. Additionally, the psychometric properties of the NEI-VFQ were not influenced by the type or severity of the underlying eye disease, suggesting that the measure will provide reproducible and valid data when used across multiple eye conditions.

https://jamanetwork.com/journals/jamaophthalmology/articlepdf/264225/eeb8310.pdf

Psychometric properties of the National Eye Institute Visual Function Questionnaire (NEI-VFQ). NEI-VFQ Field Test Investigators

Hearing loss gives rise to a number of disabilities. Problems in recognizing speech, especially in difficult environments, give rise to the largest number of complaints. Other kinds of disabilities...

Negative consequences of uncorrected hearing loss--a review.

Background
Self-rated health (SRH), a subjective assessment of health status, is extensively used in the public health field. However, whether SRH can reflect the objective health status is still debatable. We aim to reveal the relationship between SRH and objective health status in the general population.

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The relationship between self-rated health and objective health status: a population-based study

Objectives. We investigated the health, activity, and social participation of people aged 70 years or older with vision impairment, hearing loss, or both. Methods. We examined the 1994 Second Supplement on Aging to determine the health and activities of these 3 groups compared with those without sensory loss. We calculated odds ratios and classified variables according to the International Classification of Functioning, Disability and Health framework. Results. Older people with only hearing loss reported disparities in health, activities, and social roles; those with only vision impairment reported greater disparities; and those with both reported the greatest disparities. Conclusions. A hierarchical pattern emerged as impairments predicted consistent disparities in activities and social participation. This population’s patterns of health and activities have public health implications.

Vision impairment and hearing loss among community-dwelling older Americans: implications for health and functioning.

Objective: To determine the association between quality of life measures and sensory impairment in aged individuals living at home.

Design: Survey

Setting: A community survey, carried out in the historical center of a town in Northern Italy.

Patients: 1191 non-institutionalized elders (age 70–75 years).

Measurements: Comprehensive QOL questionnaire, free-field voice testing, and Snellen eye chart.

Results: Single sensory impairments (either visual or auditory) were significantly and independently associated with increased risk for depression (odds ratio: 2.3, 95% confidence interval: 1.5–3.4; OR:1.8, CI:1.1–2.7, respectively) and decreased self-sufficiency in daily living activities (OR: 1.7, CI:1.1–2.6; OR:2.1, CI:1.4–3.2, respectively). Visual dysfunction, but not hearing dysfunction, was independently associated with lower social relationships (OR:2.0, CI:1.3–3.1).

Conclusion: The quality of life of community-dwelling elderly people is significantly linked to sensory impairment, which can be detected through simple physical examination. Mood level and social relationships are particularly affected by visual impairment, whereas self-sufficiency in daily living is more strongly related to hearing impairment.

Sensory Impairment and Quality of Life in a Community Elderly Population

Summary The present study aimed at clarifying the relationships between the use of sensory aids and the quality of life (QOL) and mortality of elderly people suffering from sensory deprivation. We carried out a cross-sectional survey on the QOL and the sensory status of an elderly cohort and a 6-year longitudinal follow-up of mortality rates among 1192 non-institutionalized people aged 70-75 years in a North Italian town. We classified respondents into three groups: those with functionally adequate visual and hearing acuity (n = 275); those with sensory impairment, corrected by the use of sensory aids (n = 680), and those with uncorrected sensory impairment (n = 245). In the whole sample, multiple logistic regression analyses showed that an uncorrected sensory deprivation was associated with a significant and independent impairment of mood, self-sufficiency in instrumental activities of daily living and social relationships. Such impairments were not apparent in the subjects with sensory impairments who were using sensory aids. In men with uncorrected sensory impairment the unadjusted 6-year mortality rate was almost twice that of the other two groups, which did not differ from each other. No corresponding differences were detected in women. Multivariate analysis showed that the effect of the sensory aid status on mortality was indirect and mediated through the global physical health status and the social relationships. We conclude that our cross-sectional data demonstrate an association between uncorrected sensory deprivation and a low QOL; such an association was not present in subjects with corrected sensory deprivation.

/pdf/effects-of-sensory-aids-on-the-quality-of-life-and-mortality-1jptco6ors.pdf

Effects of Sensory Aids on the Quality of Life and Mortality of Elderly People: A Multivariate Analysis

The nutritional intake of a large population of noninstitutionalized older people living in an urban area was studied in relation to socioeconomic conditions (living environment, income, and education) and health status (affective, functional, and physical health) to identify the subgroups at risk for malnutrition. Twenty-four-hour dietary recall was used to determine the percentage of older subjects with dietary intake of specific nutrients below two thirds of the 1980 Recommended Dietary Allowances. Ninety percent of the older people examined showed inadequate intake of thiamine and vitamin B6, and 30% to 40% demonstrated deficiencies of vitamin A, vitamin C, niacin, vitamin B12, calcium, and iron; only 10% of subjects had inadequate intake of protein. Poor nutritional intake was correlated more strongly with socioeconomic conditions, functional level, and affective status than with physical health status.

Nutritional Intake, Socioeconomic Conditions, and Health Status in a Large Elderly Population

Objective to evaluate the relationships between a functional measure of dental status (FDS), the nutrients intake profile (NIP) and mortality in a community elderly population. Design cross-sectional analysis for FDS and NIP and a prospective study for mortality. Setting the central district of Brescia, northern Italy. Participants of the entire cohort of 70-75-year-old elderly subjects living in the district (n = 1303), 1189 subjects were interviewed and examined at baseline. Fifty-two of these were lost to follow-up; data are presented for the remaining 1137 subjects. Measurements baseline data were collected by a door-to-door interview using a standardized questionnaire which included a section about the dietary intake in the 24 h preceding the interview. The 24-h NIP was calculated and compared with the US Food and Drug Administration's 1980 Recommended Dietary Allowances to obtain a percentage value of each nutrient for each respondent. The dental examination considered the direct assessment of the number and position of residual teeth as well as the use of dentures; subjects were classified into three groups: naturally adequate or naturally inadequate dentition and denture wearers. Association of NIP with FDS was computed using ANCOVA and multiple logistic regression models. Mortality data were collected over a 78-month follow-up period. Association of survival with FDS was estimated by Kaplan-Meier analysis and multivariate Cox proportional hazard models. Results multiple logistic regression showed a significant and independent association between the dental status and the intake of micronutrients, but not of macronutrients. Moreover, denture wearers had a dietary intake very similar to adequate dentition and substantially better than inadequate dentition. Inadequate dentition in women was associated with higher mortality than adequate dentition. In elderly women, both inadequate dental status and folate intake were significant and independent predictors of mortality in a multivariate analysis based on nutritional parameters. However, inadequate dentition did not remain an independent predictor of mortality in a general multivariate model. Conclusion in this cohort of urban elderly people, FDS is significantly associated with the NIP and indirectly with mortality.

/pdf/influence-of-dental-status-on-dietary-intake-and-survival-in-1z1qml223d.pdf

Influence of dental status on dietary intake and survival in community-dwelling elderly subjects

Previous studies have shown that sensory impairments adversely affect the quality of life of elderly people, but have failed to demonstrate consistent results on mortality. We examined the predictive value of hearing and visual impairments on mortality in an urban population of 1140 non-institutionalized elderly subjects, aged 70-75 years. Baseline information was collected in 1986 through a door-to-door interview with a standardized questionnaire and the sensory assessment was performed using bedside tasks: the whispered voice test for hearing and the Snellen chart for vision. Overall mortality rate at 6 years was 25.5%, with a significant sex difference (males = 37.5%; females = 19.8%) and a significant interaction between sex and sensory impairment. Bivariate logistic regression showed that hearing deficit was associated with a significant increase in mortality risk only in the men. This increase remained significant even after control for the demographic variables and the global physical health status. Multivariate logistic regression showed that the effect of hearing deficit on mortality was mediated by psychosocial parameters (mood and social relationships level). Sensory assessment through simple bedside tests should become part of the routine clinical evaluation of elderly people.

Corrado Carabellese

Papers

Sensory Impairment and Quality of Life in a Community Elderly Population

Effects of Sensory Aids on the Quality of Life and Mortality of Elderly People: A Multivariate Analysis

Nutritional Intake, Socioeconomic Conditions, and Health Status in a Large Elderly Population

Influence of dental status on dietary intake and survival in community-dwelling elderly subjects

Sensory Impairments and Mortality in an Elderly Community Population: A Six-year Follow-up Study