DUAL SENSORY IMPAIRMENT AND CHANGE IN ADL ABILITY AMONG ELDERLY OVER TIME: A SEM LATENT GROWTH CURVE APPROACH

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DUAL SENSORY IMPAIRMENT AND CHANGE IN ADL ABILITY
AMONG ELDERLY OVER TIME A SEM LATENT GROWTH
CURVE APPROACH

• Ya-ping Su, PhD,
• The Peer Review Organization of New Jersey
• Mark Brennan, PhD and Amy Horowitz, DSW
• Arlene R. Gordon Research Institute

Research funded by the AARP Andrus Foundation
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Dual Sensory Loss (Vision 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).

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Vision Loss and ADL Functioning

• Consistent Finding
• A growing body of research highlighting the
  relationship between vision loss and functional
  disability among community-based elderly.
• More severe impact on everyday functioning than
  other physical impairments.
• Risk for decline in functional ability over time.

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Hearing Loss and ADL Functioning

• Mixed Evidence
• Greater functional disability compared to the
  non-imparied
• Relationship not as strong as vision impairment
• No relationship not an independent predictor of
  ADL disability over time

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Dual Sensory and Functional Ability

• Limited and Contradictory Evidence
• Did not lead to additional deterioration of PADL
  and IADL over a single sensory deficit in either
  vision or hearing
• 40 greater risk of functional decline over a
  single vision loss
• A greater impact on functional disability than
  that seen with a single impairment

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Purpose and Rationale

• To examine the effects of dual sensory
  impairments of vision and hearing and single
  sensory impairments on changes in PADL and IADL
  ability over the 4 waves of the LSOA.
• Hypothesis One the additive model of dual
  sensory impairment (i.e., vision hearing) would
  better explain changes in PADL ability from 1984
  to 1990
• Hypothesis Two the interactive model of dual
  sensory impairment (i.e., vision x hearing) would
  better explain changes in IADL ability over the
  course of the LSOA

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Method

• 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 (N2,211)
• Design/Analysis
• SEM Latent Growth Curve
• Only the slope function, or rate of change,
  latent variable was estimated
• Unweighted Least Square estimation (ULS)

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Sample Age and Sex

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Sample Race and Health

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Sensory 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.
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Prevalence of Sensory Loss of Persons 70 Years of
Age and Over in the US, 1984

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

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Comparison of Models
Notes RMSEA root mean square of
approximation AGFI adjusted
goodness-of-fit index NFI normed fit index
CFI comparative fit index
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Discussion

• The effects of dual sensory impairment on changes
  in PADL and IADL function over time were both
  additive.
• 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 impairment and comorbid physical health
  measures were the strongest predictors.

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Conclusions

• Vision 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.

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Implications

• 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 independent.
• 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.

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Limitations

• Secondary data.
• Sensory impairment status was available only at
  the baseline.
• Conservative in estimating the consequences of
  dual impairment.

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For further information, please
contactYa-ping Su, PhDThe Peer Review
Organization of New Jersey557 Cranbury Road,
Suite 21East Brunswick, NJ 08816TEL (732)
238-5570 ext. 2111/FAX [phone]email
nj1pro.ysu_at_sdps.org Mark Brennan,
PhDLighthouse International111 East 59th
StreetNew York, NY 10022-1202TEL (212)
821-9536/FAX [phone]email
mbrennan_at_lighthouse.org