Falls, injuries from falls, health related quality of life and mortality in older adults with vision and hearing impairment—Is there a gender difference?

Vision and Hearing Health Inequities in the Roma population: A National Cross-Sectional Study in Spain

We analyzed vision and hearing health status in the Spanish Roma population compared with the general population and its influence on mental health and social participation. We conducted a Cross-sectional study on Roma population (n = 1.167) compared to general population in Spain (n = 21.007). We analyzed the use of optical and hearing aids, vision and hearing limitations and associations with mental health, diagnosed depression and social participation; through prevalence, odds ratio adjusted by age (AOR), Chi square independence test and contrast of proportions (p < 0.05). The Roma population are more likely to present vision limitations-far sight AOR = 3.76 (3.13-4.55), near sight AOR = 3.18 (2.33-4.35)-, hearing difficulties-AOR = 1.41 (1.15-1.72)-, and lower use of corrective aids than the general population. These findings were associated with poor mental health and lower social participation (p < 0.01). Vision and hearing limitations affect unequally in Spain. Addressing avoidable vision and hearing impairment among Roma population is needed to reduce health inequities.

Falls and Recurrent Falls among Adults in A Multi-ethnic Asian Population: The Singapore Epidemiology of Eye Diseases Study

We evaluated the rate and risk factors associated with falls and recurrent falls in a multi-ethnic Asian population. 10,009 participants aged ≥40 years (mean[SD] age = 58.9[10.4] years) underwent clinical examinations and completed interviewer-administered questionnaires. Participants who self-reported at least one fall or ≥2 falls in past 12 months were defined as fallers and recurrent fallers, respectively. Age-standardized rates for falls and recurrent falls were 13.8% (95%CI, 13.1–14.6%) and 4.6% (95%CI, 4.2–5.1%), respectively. Multivariable analyses showed older age (OR = 1.20; 95%CI, 1.11–1.30), female gender (OR = 1.79; 95%CI, 1.54–2.07), diabetes (OR = 1.22; 95%CI, 1.07–1.40), cardiovascular disease (CVD, OR = 1.37; 95%CI, 1.14–1.65), ≥3 systemic comorbidities (OR = 1.35; 95%CI, 1.09–1.67), lower European Quality of Life-5 Dimensions (EQ-5D) score (OR = 1.36; 95%CI, 1.29–1.44), alcohol consumption (OR = 1.41, 95%CI, 1.11–1.78) and presenting visual impairment (VI, OR = 1.23; 95%CI, 1.02–1.47) were associated with falls. For recurrent falls, female gender (OR = 2.27; 95%CI, 1.75–2.94), diabetes (OR = 1.28; 95%CI, 1.03–1.61), CVD (OR = 2.00; 95%CI, 1.53–2.62), ≥3 systemic comorbidities (OR = 1.69; 95%CI, 1.19–2.39), lower EQ-5D score (OR = 1.47; 95%CI, 1.35–1.59), living in 1–2 room public flat (OR = 1.57; 95%CI, 1.05–2.33), monthly income <2000 Singapore Dollar (OR = 1.62; 95%CI, 1.13–2.31), alcohol consumption (OR = 1.81, 95%CI, 1.23–2.66) and presenting VI (OR = 1.34; 95%CI, 1.01–1.79) were significant risk factors. These findings will be useful for the formulation of fall prevention programs.

A Cross-Sectional Study on the Hearing Threshold Levels Among People in Qinling, Qinghai, and Nanjing, China

PURPOSE

This study aimed to investigate the hearing threshold among different age groups, genders, and geographic areas in China to provide some insight into the appropriate clinical interventions for hearing loss.

METHOD

Using a systematic random sampling technique, 562 participants from Qinling, Qinghai, and Nanjing were included. Participants in the same area were divided into 3 groups according to their age. Pure-tone audiometric thresholds were measured at octave and interoctave frequencies of 0.125-16 kHz for each subject.

RESULTS

There were significant differences in auditory thresholds at nearly all frequencies among young, middle-aged, and elderly people, and hearing thresholds increased with increasing age. People generally had the best hearing ability in Nanjing, better hearing ability in Qinghai, and the worst hearing ability in Qinling. Significant differences in hearing thresholds were found between males and females at several frequencies in Qinling.

CONCLUSION

People living in the rural area of Qinling in China had higher hearing threshold levels, particularly males, and hearing thresholds increased with age.

Fall Risk Factors in Mid-Age Women: The Australian Longitudinal Study on Women's Health

INTRODUCTION

In contrast to older adults, little is known about risk factors for falls in adults aged 50-64 years, despite a high prevalence of falls in this age group. The aim was to identify risk factors for falls in mid-age women and explore how associations change with age.

METHODS

Data were analyzed in 2016 from women aged 50-55 years in 2001 (born 1946-1951) in the Australian Longitudinal Study on Women's Health. The predictor variables were health-related factors (measured 2001, 2004, 2007, 2010) and the outcome was falls in the past 12 months (measured 2004, 2007, 2010, 2013). Prospective associations between predictor variables and falls measured 3 years later were analyzed using logistic regression with complete data for 4,629, 7,096, 5,911, and 5,774 participants.

RESULTS

In surveys, 20.5% (2004), 30.7% (2007), 30.5% (2010), and 26.6% (2013) of women reported a fall in the previous 12 months. In the univariable models, most factors were associated with falls 3 years later. In the multivariable models, higher odds of falling were found for overweight and obese women compared with healthy weight women at all survey intervals (OR range, 1.15-1.43). Impaired vision (OR range, 1.25-1.35) and poor physical functioning (OR range, 1.24-1.66) were associated with falls at three survey intervals. Depression (OR range, 1.31-1.42), leaking urine (OR range, 1.25-1.49), stiff/painful joints (OR range, 1.26-1.62), severe tiredness (OR range, 1.29-1.49), osteoporosis (OR range, 1.25-1.52), and hormone replacement therapy (OR range, 0.69-0.79) were associated with falls at two survey intervals. There was no obvious age-related increase or decrease in the number of statistically significant associations.

CONCLUSIONS

Identified fall risk factors varied over time, highlighting that falling involves a complex interplay of risk factors in mid-age women.

Effect of hearing aids on static balance function in elderly with hearing loss

While a few studies have investigated the relationship between hearing acuity and postural control, little is known about the effect of hearing aids on postural stability in elderly with hearing loss. The aim was to compare static balance function between elderly with hearing loss who used hearing aids and those who did not use. The subjects asked to stand with (A) open eyes on rigid surface (force platform), (B) closed eyes on rigid surface, (C) open eyes on a foam pad, and (D) closed eyes on a foam pad. Subjects in the aided group (n=22) were tested with their hearing aids turned on and hearing aids turned off in each experimental condition. Subjects in the unaided group (n=25) were tested under the same experimental conditions as the aided group. Indicators for postural stability were center of pressure (COP) parameters including; mean velocity, standard deviation (SD) velocity in anteroposterior (AP) and mediolateral (ML) directions, and sway area (95% confidence ellipse). The results showed that within open eyes-foam surface condition, there was greater SD velocity in the off-aided than the on-aided and the unaided than the on-aided (p<0.0001 for SD velocity in AP and ML). Also, no significant differences were found between the off-aided and unaided group (p=0.56 and p=0.77 for SD velocity in AP and ML, respectively). Hearing aids improve static balance function by reducing the SD velocity. Clinical implications may include improving hearing inputs in order to increase postural stability in older adults with hearing loss.

Simple Tests Compare Well with a Hand-held Audiometer for Hearing Loss Screening in Primary Care

OBJECTIVES

To compare hearing loss screening results of four simple tests with those of hand-held audiometry.

DESIGN

Cross-sectional study of individuals screened during intake for physicals and other routine procedures.

SETTING

Two primary care clinics in the San Francisco Bay area.

PARTICIPANTS

Older adults not wearing hearing aids (N = 125, mean age 72.9, 63% female).

MEASUREMENTS

Direct question about hearing loss, indirect question, finger-rub test, whisper test, and audiometric results using a hand-held audiometer.

RESULTS

Sensitivity was 91% for the finger-rub test compared with 89% for the direct question, 85% for the indirect question, and 79% for the whisper test. For specificity, the whisper test was highest, followed by the finger rub, indirect, and direct.

CONCLUSION

Simple screening procedures can be used to identify older adults with hearing loss in primary care and facilitate early referral for additional testing and treatment.

Applications of direct-to-consumer hearing devices for adults with hearing loss: a review

Background

This systematic literature review is aimed at investigating applications of direct-to-consumer hearing devices for adults with hearing loss. This review discusses three categories of direct-to-consumer hearing devices: 1) personal sound amplification products (PSAPs), 2) direct-mail hearing aids, and 3) over-the-counter (OTC) hearing aids.

Method

A literature review was conducted using EBSCOhost and included the databases CINAHL, MEDLINE, and PsycINFO. After applying prior agreed inclusion and exclusion criteria, 13 reports were included in the review.

Results

Included studies fell into three domains: 1) electroacoustic characteristics, 2) consumer surveys, and 3) outcome evaluations. Electroacoustic characteristics of these devices vary significantly with some meeting the stringent acoustic criteria used for hearing aids, while others producing dangerous output levels (ie, over 120-dB sound pressure level). Low-end (or low-cost) devices were typically poor in acoustic quality and did not meet gain levels necessary for most adult and elderly hearing loss patterns (eg, presbycusis), especially in high frequencies. Despite direct-mail hearing aids and PSAPs being associated with lower satisfaction when compared to hearing aids purchased through hearing health care professionals, consumer surveys suggest that 5%–19% of people with hearing loss purchase hearing aids through direct-mail or online. Studies on outcome evaluation suggest positive outcomes of OTC devices in the elderly population. Of note, OTC outcomes appear better when a hearing health care professional supports these users.

Conclusion

While some direct-to-consumer hearing devices have the capability to produce adverse effects due to production of dangerously high sound levels and internal noise, the existing literature suggests that there are potential benefits of these devices. Research of direct-to-consumer hearing devices is limited, and current published studies are of weak quality. Much effort is needed to understand the benefits and limitations of such devices on people with hearing loss.

Hearing and Health Outcomes: Recognizing and Addressing Hearing Loss in Hospitalized Older Adults

As age increases, the prevalence of hearing loss significantly increases, reaching up to 89% of those 80 years and older. Hearing loss in older patients is often unrecognized and its consequences are often underappreciated. Hearing loss can interfere with the ability to exchange important health information and to participate in health care decision-making. Hearing loss during hospitalization increases the risk of misdiagnosis. There is a lack of empirical data regarding prevalence and recognition of hearing loss in hospitalized older adults. In this article, we describe a variety of negative outcomes that may result when older inpatients are functioning with unrecognized hearing loss.

Hearing loss education for older adults in primary care clinics: Benefits of a concise educational brochure

Hearing loss, common in older adults, is associated with negative health outcomes but screening rates in primary care clinics are low and individuals screened or referred often do not follow-through. To address these problems, we worked with 2 primary care clinics to design a simple screening and education protocol for integration into a standard office visit. To assess the effectiveness on the education brochure that was developed, we assessed its impact on individuals age 60 or older who screened positive for possible hearing loss. Ninety-four of 125 screened positive. Seventy-one agreed to participate and were given a brochure along with a brief review of the materials it contained. Of 67 completing follow-up, 23 (34%) sought further testing and 47 (70%) had used the information to enhance communication. A simple educational brochure accompanied by a brief review of its contents may enhance effective use of hearing healthcare services. (147).

Prevalence of Hearing Loss by Severity in the United States

OBJECTIVES

To estimate the age- and severity-specific prevalence of hearing impairment in the United States.

METHODS

We conducted cross-sectional analyses of 2001 through 2010 data from the National Health and Nutrition Examination Survey on 9648 individuals aged 12 years or older. Hearing loss was defined as mild (> 25 dB through 40 dB), moderate (> 40 dB through 60 dB), severe (> 60 dB through 80 dB), or profound (> 80 dB).

RESULTS

An estimated 25.4 million, 10.7 million, 1.8 million, and 0.4 million US residents aged 12 years or older, respectively, have mild, moderate, severe, and profound better-ear hearing loss. Older individuals displayed a higher prevalence of hearing loss and more severe levels of loss. Across most ages, the prevalence was higher among Hispanic and non-Hispanic Whites than among non-Hispanic Blacks and was higher among men than women.

CONCLUSIONS

Hearing loss directly affects 23% of Americans aged 12 years or older. The majority of these individuals have mild hearing loss; however, moderate loss is more prevalent than mild loss among individuals aged 80 years or older.

PUBLIC HEALTH IMPLICATIONS

Our estimates can inform national public health initiatives on hearing loss and help guide policy recommendations currently being discussed at the Institute of Medicine and the White House.

Lack of ear care knowledge in nursing homes

Background

Rising life expectancy means an increase in the number of elderly people with hearing loss in the population. Many elderly people live in nursing homes, with varying care needs. A substantial proportion of these people will need help with their hearing aids and other hearing devices.

Objective

The objective of the study has been to assess the knowledge, experience, skills, competence, and need for information of staff at nursing homes in relation to residents’ hearing loss and hearing aids.

Materials and methods

One hundred and ninety-five employees at seven nursing homes participated in the study. The main approach was a descriptive study, using questionnaires.

Results

The main findings are that 73% of informants found that many residents need help with their hearing aids. Only one-tenth report that they know enough about the residents’ hearing aids. Almost four out of five informants find that the residents become socially isolated as a result of hearing loss. Seventy-eight percent agree to some extent that more residents would benefit from hearing aids.

Conclusion

Staff at nursing homes have insufficient knowledge about hearing loss and hearing aids. Increased focus on the elderly with hearing impairment in nursing homes is needed. Contact between nursing homes and audiological specialists should be improved to best followup hearing loss and hearing aids.

Determinants of Quality of Life in Ageing Populations: Results from a Cross-Sectional Study in Finland, Poland and Spain

Purpose

To comprehensively identify the determinants of quality of life (QoL) in a population study sample of persons aged 18–50 and 50+.

Methods

In this observational, cross-sectional study, QoL was measured with the WHOQOL-AGE, a brief instrument designed to measure QoL in older adults. Eight hierarchical regression models were performed to identify determinants of QoL. Variables were entered in the following order: Sociodemographic; Health Habits; Chronic Conditions; Health State description; Vision and Hearing; Social Networks; Built Environment. In the final model, significant variables were retained. The final model was re-run using data from the three countries separately.

Results

Complete data were available for 5639 participants, mean age 46.3 (SD 18.4). The final model accounted for 45% of QoL variation and the most relevant contribution was given by sociodemographic data (particularly age, education level and living in Finland: 17.9% explained QoL variation), chronic conditions (particularly depression: 4.6%) and a wide and rich social network (4.6%). Other determinants were presence of disabling pain, learning difficulties and visual problems, and living in usable house that is perceived as non-risky. Some variables were specifically associated to QoL in single countries: age in Poland, alcohol consumption in Spain, angina in Finland, depression in Spain, and self-reported sadness both in Finland and Poland, but not in Spain. Other were commonly associated to QoL: smoking status, bodily aches, being emotionally affected by health problems, good social network and home characteristics.

Conclusions

Our results highlight the importance of modifiable determinants of QoL, and provide public health indications that could support concrete actions at country level. In particular, smoking cessation, increasing the level of physical activity, improving social network ties and applying universal design approach to houses and environmental infrastructures could potentially increase QoL of ageing population.

The Contribution of Hearing and Hearing Loss to Balance Control

This study investigated the hypothesis that a hearing ‘map' of our surroundings is used to maintain balance control. We investigated the effects of sound on postural sway using centre of pressure analysis in 50 subjects with normal hearing, 28 with hearing loss and 19 with vestibular dysfunction. The acoustic environments utilized sound cues that were either present or absent. It was found that auditory cues are utilized by subjects with normal hearing to improve postural sway. The ability to utilize sound for postural control is diminished when there is a hearing loss, but this appears to be overcome by the use of a hearing aid. Patients with additional vestibular deficits exploit auditory cues to a greater degree, suggesting that sensory weighting to enhance the use of auditory cues may be applied when there is diminished sensory redundancy.

Review of safety and mobility issues among older pedestrians

Although old people make up an extremely vulnerable road-user group, older pedestrians' difficulties have been studied less extensively than those of older drivers, and more knowledge of this issue is still required. The present paper reviews current knowledge of older-adult problems with the main components of pedestrian activity, i.e., walking and obstacle negotiation, wayfinding, and road crossing. Compared to younger ones, old pedestrians exhibit declining walking skills, with a walking speed decrease, less stable balance, less efficient wayfinding strategies, and a greater number of unsafe road crossing behaviors. These difficulties are linked to age-related changes in sensorial, cognitive, physical, and self-perception abilities. It is now known that visual impairment, physical frailty, and attention deficits have a major negative impact on older pedestrians' safety and mobility, whereas the roles of self-evaluation and self-regulation are still poorly understood. All these elements must be taken into consideration, not only in developing effective safety interventions targeting older pedestrians, but also in designing roads and cars. Recent initiatives are presented here and some recommendations are proposed.

Association of Hearing Impairment With Incident Frailty and Falls in Older Adults

OBJECTIVE

We aimed to determine whether hearing impairment (HI) in older adults is associated with the development of frailty and falls.

METHOD

Longitudinal analysis of observational data from the Health, Aging and Body Composition study of 2,000 participants aged 70 to 79 was conducted. Hearing was defined by the pure-tone-average of hearing thresholds at 0.5, 1, 2, and 4 kHz in the better hearing ear. Frailty was defined as a gait speed of <0.60 m/s and/or inability to rise from a chair without using arms. Falls were assessed annually by self-report.

RESULTS

Older adults with moderate-or-greater HI had a 63% increased risk of developing frailty (adjusted hazard ratio [HR] = 1.63, 95% confidence interval [CI] = [1.26, 2.12]) compared with normal-hearing individuals. Moderate-or-greater HI was significantly associated with a greater annual percent increase in odds of falling over time (9.7%, 95% CI = [7.0, 12.4] compared with normal hearing, 4.4%, 95% CI = [2.6, 6.2]).

DISCUSSION

HI is independently associated with the risk of frailty in older adults and with greater odds of falling over time.

The influence of multiple sensory impairments on functional balance and difficulty with falls among U.S. adults

OBJECTIVE

Studies have looked at the individual associations of sensory impairment on balance, but no population-based studies have examined their combined association on balance and difficulty with falls. Thus, the purpose of this study was to examine both the independent associations and combined associations of visual impairment, peripheral neuropathy, and self-reported hearing loss with the odds of reporting difficulty with falls and functional balance.

METHODS

Data from the 2003-2004 National Health and Nutrition Examination Survey were used. Vision and peripheral neuropathy were objectively measured, and hearing was self-reported. Balance testing consisted of a modified Romberg test. After exclusions, 1662 (40-85years of age) participants provided complete data on the study variables.

RESULTS

Sensory impairment was associated with perceived difficulty of falls and functional balance. Participants who presented a single sensory impairment had 29% reduced odds of having functional balance (95% CI=0.54-0.93, p=0.01) and increased odds of reporting difficulty with falls by 61% (95% CI=0.99-2.60, p=0.05). Moreover, our multisensory models showed some evidence of a dose-response relationship, in that sensory impairment of multiple sensory systems was associated with worse balance (OR =0.59, CI=0.35-1.00, p=0.05) and perceived difficulty of falls (OR =5.02, 95% CI=1.99-12.66, p=0.002) when compared to those with less sensory impairment.

CONCLUSION

Multiple sensory impairment is associated with significantly higher odds of both reporting difficulty with falls and balance dysfunction, which may lead to a subsequent fall, ultimately compromising the individual's health.

The effects of aging on the perception of depth from motion parallax

Successful navigation in the world requires effective visuospatial processing. Unfortunately, older adults have many visuospatial deficits, which can have severe real-world consequences. Although some of these age effects are well documented, some others, such as the perception of depth from motion parallax, are poorly understood. Depth perception from motion parallax requires intact retinal image motion and pursuit eye movement processing. Decades of research have shown that both motion processing and pursuit eye movements are affected by age; it follows that older adults may also be less sensitive to depth from motion parallax. The goals of the present study were to characterize motion parallax depth thresholds in older adults, and to explain older adults' sensitivity to depth from motion parallax in terms of motion and pursuit deficits. Younger and older adults' motion thresholds and pursuit accuracy were measured. Observers' depth thresholds across several different stimulus conditions were measured, as well. Older adults had higher motion thresholds and less accurate pursuit than younger adults. They were also less sensitive to depth from motion parallax at slow and moderate pursuit speeds. Although older adults had higher motion thresholds than younger adults, they used the available motion signals optimally, and age differences in motion processing could not account for the older adults' increased depth thresholds. Rather, these age effects can be explained by changes in older adults' pursuit signals.

Hearing and vision impairment and the 5-year incidence of falls in older adults

BACKGROUND

concurrent vision and hearing loss are common in older adults; however, epidemiological data on their relationship with the incidence of falls are lacking.

OBJECTIVE

we assessed the association between dual sensory impairment (DSI) and incidence of falls. We examined the influence of self-perceived hearing handicap and hearing aid use and risk of falls.

DESIGN

a population-based, cohort study of participants followed over 5 years.

SETTING

Blue Mountains, west of Sydney, Australia.

SUBJECTS

one thousand four hundred and seventy-eight participants aged 55 and older at baseline were included in longitudinal analyses.

METHODS

visual impairment was defined as presenting or best-corrected visual acuity less than 20/40 (better eye), and hearing impairment as average pure-tone air conduction threshold >25 dB HL (500-4,000 Hz, better ear). The shortened version of the hearing handicap inventory for the elderly was administered. Incident falls were assessed over the 12 months before each visit. Cognitive impairment was determined using the Mini-Mental State Examination.

RESULTS

five-year incidence of falls was 10.4%. Participants with severe self-perceived hearing handicap versus no hearing handicap had increased risk of incident falls, multivariable-adjusted OR 1.93 (95% confidence intervals, CI, 1.02-3.64). Hearing aid users versus non-users had 75% increased likelihood of incident falls. Participants with co-existing best-corrected visual impairment and mild hearing loss (>25 to ≤40 dB HL) had higher odds of incident falls, OR 2.19 (95% CI 1.03-4.67). After excluding persons with cognitive impairment, this association did not persist.

CONCLUSION

these epidemiological data show that DSI in older adults could significantly increase their risk of falling.

Effects of high intensity noise on the vestibular system in rats

Some individuals with noise-induced hearing loss (NIHL) also report balance problems. These accompanying vestibular complaints are not well understood. The present study used a rat model to examine the effects of noise exposure on the vestibular system. Rats were exposed to continuous broadband white noise (0-24 kHz) at an intensity of 116 dB sound pressure level (SPL) via insert ear phones in one ear for three hours under isoflurane anesthesia. Seven days after the exposure, a significant increase in ABR threshold (43.3 ± 1.9 dB) was observed in the noise-exposed ears, indicating hearing loss. Effects of noise exposure on vestibular function were assessed by three approaches. First, fluorescein-conjugated phalloidin staining was used to assess vestibular stereocilia following noise exposure. This analysis revealed substantial sensory stereocilia bundle loss in the saccular and utricular maculae as well as in the anterior and horizontal semicircular canal cristae, but not in the posterior semicircular canal cristae. Second, single unit recording of vestibular afferent activity was performed under pentobarbital anesthesia. A total of 548 afferents were recorded from 10 noise-treated rats and 12 control rats. Noise exposure produced a moderate reduction in baseline firing rates of regular otolith afferents and anterior semicircular canal afferents. Also a moderate change was noted in the gain and phase of the horizontal and anterior semicircular canal afferent's response to sinusoidal head rotation (1 and 2 Hz, 45°/s peak velocity). Third, noise exposure did not result in significant changes in gain or phase of the horizontal rotational and translational vestibulo-ocular reflex (VOR). These results suggest that noise exposure not only causes hearing loss, but also causes substantial damage in the peripheral vestibular system in the absence of immediate clinically measurable vestibular signs. These peripheral deficits, however, may lead to vestibular disorders over time.

Low Vision Rehabilitation, Age-Related Vision Loss, and Risk: A Critical Interpretive Synthesis

PURPOSE

Given the centrality of risk in geriatric rehabilitation, it is critically important to attend to how conceptualizations of risk shape research, policies, and rehabilitation practices. This paper presents a critical interpretive synthesis (CIS) of literature addressing risk and low vision rehabilitation for older adults with age-related vision loss (ARVL) to identify key guiding assumptions regarding risk and discuss implications for what gets attended to, and not attended to, within research and rehabilitation.

DESIGN AND METHODS

This CIS combined guidelines proposed by Dixon-Woods and colleagues (2006-Conducting a critical interpretive synthesis of the literature on access to healthcare by vulnerable groups. BMC Medical Research Methodology, 6, 35) and Alvesson and Sandberg (2011-Generating research questions through problematization. Academy of Management Review, 36, 247-271; 2013-Constructing research questions: Doing interesting research. London: Sage). The iterative review process involved 3 steps: literature search and selection, data extraction, and syntheses to identify boundary assumptions. The dataset included 83 research and practice description articles.

RESULTS

Older adults with ARVL were constructed as "at risk" for various adverse outcomes, particularly dependency and self-harm, and as posing risks to others. An epidemiological approach to risk based in assumptions aligned with a technico-scientific perspective was dominant, with risk conceptualized as an embodied, individual-level phenomenon that is to be determined and managed through objective screening and expert monitoring.

IMPLICATIONS

Key concerns include a lack of: attention to the tensions created when rehabilitation research and practice attempt to promote independence while simultaneously reducing risk, incorporation of aging adults' perspectives on risk, and analysis of environmental factors that shape risks. Research that starts by valuing older adults' experiences and attends to context can inform rehabilitation practices that support health-promoting, risk-taking, and facilitate collaborative approaches to risk management.

Assessing the quality of a non-randomized pragmatic trial for primary prevention of falls among older adults

Current approaches to falls prevention mostly rely on secondary and tertiary prevention and target individuals at high risk of falls. An alternative is primary prevention, in which all seniors are screened, referred as appropriate, and educated regarding falls risk. Little information is available on research designs that allow investigation of this approach in the setting of aging services delivery, where randomization may not be possible. Healthy Steps for Older Adults, a statewide program of the Pennsylvania (PA) Department of Aging, involves a combination of education about falls and screening for balance problems, with referral to personal physicians and home safety assessments. We developed a non-randomized statewide trial, Falls Free PA, to assess its effectiveness in reducing falls incidence over 12 months. We recruited 814 seniors who completed the program (503 first-time participants, 311 people repeating the program) and 1,020 who did not participate in the program, from the same sites. We assessed the quality of this non-randomized design by examining recruitment, follow-up across study groups, and comparability at baseline. Of older adults approached in senior centers, 90.5 % (n = 2,219) signed informed consent, and 1,834 (82.4 %) completed baseline assessments and were eligible for follow-up. Attrition in the three groups over 12 months was low and non-differential (<10 % for withdrawal and <2 % for other loss to follow-up). Median follow-up, which involved standardized monthly assessment of falls, was 10 months in all study groups. At baseline, the groups did not differ in measures of health or falls risk factors. Comparable status at baseline, recruitment from common sites, and similar experience with retention suggest that the non-randomized design will be effective for assessment of this approach to primary prevention of falls.

Screening for sensory impairment in older adults: Training and practice of occupational therapists in Quebec

BACKGROUND

The goal of occupational therapy education is to train generalists who can refine their knowledge after graduation according to the requirements of the professional environment. However, it is currently unclear to what extent sensory screening should be included in the educational curricula.

PURPOSE

The purpose of this study was to examine the sensory screening education for and practice by occupational therapists working with older adults.

METHOD

A cross-sectional survey was used to collect data from members of the Quebec Order of Occupational Therapists. Descriptive statistics were used in the analysis.

FINDINGS

Data from 102 respondents indicated that training on sensory impairment-related topics was minimal and in stark contrast to the proportion who reported serving clients with a visual (92%), hearing (84%), or combined impairment (53%).

IMPLICATIONS

Occupational therapy considers numerous aspects of physical, cognitive, and emotional well-being. The question remains as to what extent vision and hearing health should take their place among these priorities.

Socio-demographic characteristics, lifestyle factors and burden of morbidity associated with self-reported hearing and vision impairments in older British community-dwelling men: a cross-sectional study

BACKGROUND

Hearing and vision problems are common in older adults. We investigated the association of self-reported sensory impairment with lifestyle factors, chronic conditions, physical functioning, quality of life and social interaction.

METHODS

A population-based cross-sectional study of participants of the British Regional Heart Study aged 63-85 years.

RESULTS

A total of 3981 men (82% response rate) provided data. Twenty-seven per cent (n = 1074) reported hearing impairment including being able to hear with aid (n = 482), being unable to hear (no aid) (n = 424) and being unable to hear despite aid (n = 168). Three per cent (n = 124) reported vision impairment. Not being able to hear, irrespective of use of hearing aid, was associated with poor quality of life, poor social interaction and poor physical functioning. Men who could not hear despite hearing aid were more likely to report coronary heart disease (CHD) [age-adjusted odds ratios (ORs) 1.89 (95% confidence interval 1.36-2.63)]. Vision impairment was associated with symptoms of CHD including breathlessness [OR 2.06 (1.38-3.06)] and chest pain [OR 1.58 (1.07-2.35)]. Vision impairment was also associated with poor quality of life, poor social interaction and poor physical functioning.

CONCLUSIONS

Sensory impairment is associated with poor physical functioning, poor health and poor social interaction in older men. Further research is warranted on pathways underlying these associations.

Visual impairment and multimorbidity in a representative sample of the Spanish population

BACKGROUND

In the context of population aging, visual impairment has emerged as a growing concern in public health. However, there is a need for further research into the relationship between visual impairment and chronic medical conditions in the elderly. The aim of our study was to examine the relationship between visual impairment and three main types of co-morbidity: chronic physical conditions (both at an independent and additive level), mental health and cognitive functioning.

METHODS

Data were collected from the COURAGE in Europe project, a cross-sectional study. A total of 4,583 participants from Spain were included. Diagnosis of chronic medical conditions included self-reported medical diagnosis and symptomatic algorithms. Depression and anxiety were assessed using CIDI algorithms. Visual assessment included objective distance/near visual acuity and subjective visual performance. Descriptive analyses included the whole sample (n = 4,583). Statistical analyses included participants aged over 50 years (n = 3,625; mean age = 66.45 years) since they have a significant prevalence of chronic conditions and visual impairment. Crude and adjusted binary logistic regressions were performed to identify independent associations between visual impairment and chronic medical conditions, physical multimorbidity and mental conditions. Covariates included age, gender, marital status, education level, employment status and urbanicity.

RESULTS

The number of chronic physical conditions was found to be associated with poorer results in both distance and near visual acuity [OR 1.75 (CI 1.38-2.23); OR 1.69 (CI 1.27-2.24)]. At an independent level, arthritis, stroke and diabetes were associated with poorer distance visual acuity results after adjusting for covariates [OR 1.79 (CI 1.46-2.21); OR 1.59 (CI 1.05-2.42); OR 1.27 (1.01-1.60)]. Only stroke was associated with near visual impairment [OR 3.01 (CI 1.86-4.87)]. With regard to mental health, poor subjective visual acuity was associated with depression [OR 1.61 (CI 1.14-2.27); OR 1.48 (CI 1.03-2.13)]. Both objective and subjective poor distance and near visual acuity were associated with worse cognitive functioning.

CONCLUSIONS

Arthritis, stroke and the co-occurrence of various chronic physical diseases are associated with higher prevalence of visual impairment. Visual impairment is associated with higher prevalence of depression and poorer cognitive function results. There is a need to implement patient-centered care involving special visual assessment in these cases.

Comorbidity in adults with hearing difficulties: which chronic medical conditions are related to hearing impairment?

OBJECTIVES

To investigate the occurrence of 27 chronic medical conditions in a cohort of adults with and without hearing impairment, and to examine the association between these conditions and hearing ability.

DESIGN

The National Longitudinal Study on Hearing (NL-SH study) is a large prospective study among adults aged 18 to 70 years, conducted via the internet in the Netherlands. Hearing ability was measured with a digits-in-noise test and comorbidity was assessed through self-report.

STUDY SAMPLE

Cross-sectional data of 890 hearing-impaired and 975 normally-hearing adults were analyzed. Both descriptive statistics and multinomial logistic regression analyses were conducted.

RESULTS

Of the NL-SH participants with insufficient or poor hearing ability, 78.5% reported to suffer from at least one additional chronic condition. This proportion was larger than in the normally-hearing group (68.6% with one or more chronic conditions and 37.7% with two or more). After adjustment for age and gender, 'dizziness causing falling', 'diabetes' and 'arthritis types other than osteoarthritis and rheumatic arthritis' were significantly associated with poor hearing ability.

CONCLUSIONS

Our results show that some previously reported associations do not only occur in older age groups, but also in younger cohorts. Comorbidity is relevant in the rehabilitation (multi-disciplinary care) and the clinical encounter.

Dual sensory loss and depressive symptoms: the importance of hearing, daily functioning, and activity engagement

Background: The association between dual sensory loss (DSL) and mental health has been well established. However, most studies have relied on self-report data and lacked measures that would enable researchers to examine causal pathways between DSL and depression. This study seeks to extend this research by examining the effects of DSL on mental health, and identify factors that explain the longitudinal associations between sensory loss and depressive symptoms.

Methods: Piecewise linear-mixed models were used to analyze 16-years of longitudinal data collected on up to five occasions from 1611 adults (51% men) aged between 65 and 103 years. Depressive symptoms were assessed by the Centre for Epidemiological Studies Depression (CES-D). Vision loss (VL) was defined by corrected visual acuity >0.3 logMAR in the better eye, blindness, or glaucoma. Hearing loss (HL) was defined by pure-tone average (PTA) >25 dB in the better hearing ear. Analyses were adjusted for socio-demographics, medical conditions, lifestyle behaviors, activities of daily living (ADLs), cognitive function, and social engagement.

Results: Unadjusted models indicated that higher levels of depressive symptoms were associated with HL (B = 1.16, SE = 0.33) and DSL (B = 2.15, SE = 0.39) but not VL. Greater rates of change in depressive symptoms were also evident after the onset of HL (B = 0.16, SE = 0.06, p < 0.01) and DSL (B = 0.30, SE = 0.09, p < 0.01). The associations between depressive symptoms and sensory loss were explained by difficulties with ADLs, and social engagement.

Conclusion: Vision and HL are highly prevalent among older adults and their co-occurrence may compound their respective impacts on health, functioning, and activity engagement, thereby exerting strong effects on the mental health and wellbeing of those affected. There is therefore a need for rehabilitation programs to be sensitive to the combined effects of sensory loss on individuals.

[Elderly victims of trauma: analysis of the risk factors]

The objective of this study was to identify the risk factors for trauma among the elderly, using a quantitative, cross-sectional approach, as well as logistical regression analysis. This study was performed at the emergency rooms of two hospitals in Curitiba. Interviews were performed with 261 elderly individuals, 56.7% of whom were women, and 43.3% men. Their ages ranged between 60 and 103 years, with most being younger than 70 years (44.8%). The most frequent trauma mechanisms were: falls (75.9%), being run over (9.6%), direct trauma (5.4%) and motor vehicle accident (3.8%). The multivariate analysis permitted the authors to affirm that the female gender, the presence of a caregiver, the utilization of continuous-use medication, and the presence of hearing impairment significantly increased the risk of trauma due to falls. Individuals having vision problems (without the use of glasses) and aged individuals with a monthly income of less than three minimum salaries tend to have a higher risk of suffering trauma due to falls. If the factors that greatly influence trauma among the elderly are evaluated during nursing appointments, it is possible to promote health interventions that favor their prevention.

Dual sensory loss and depressive symptoms: the importance of hearing, daily functioning, and activity engagement

BACKGROUND

The association between dual sensory loss (DSL) and mental health has been well established. However, most studies have relied on self-report data and lacked measures that would enable researchers to examine causal pathways between DSL and depression. This study seeks to extend this research by examining the effects of DSL on mental health, and identify factors that explain the longitudinal associations between sensory loss and depressive symptoms.

METHODS

Piecewise linear-mixed models were used to analyze 16-years of longitudinal data collected on up to five occasions from 1611 adults (51% men) aged between 65 and 103 years. Depressive symptoms were assessed by the Centre for Epidemiological Studies Depression (CES-D). Vision loss (VL) was defined by corrected visual acuity >0.3 logMAR in the better eye, blindness, or glaucoma. Hearing loss (HL) was defined by pure-tone average (PTA) >25 dB in the better hearing ear. Analyses were adjusted for socio-demographics, medical conditions, lifestyle behaviors, activities of daily living (ADLs), cognitive function, and social engagement.

RESULTS

Unadjusted models indicated that higher levels of depressive symptoms were associated with HL (B = 1.16, SE = 0.33) and DSL (B = 2.15, SE = 0.39) but not VL. Greater rates of change in depressive symptoms were also evident after the onset of HL (B = 0.16, SE = 0.06, p < 0.01) and DSL (B = 0.30, SE = 0.09, p < 0.01). The associations between depressive symptoms and sensory loss were explained by difficulties with ADLs, and social engagement.

CONCLUSION

Vision and HL are highly prevalent among older adults and their co-occurrence may compound their respective impacts on health, functioning, and activity engagement, thereby exerting strong effects on the mental health and wellbeing of those affected. There is therefore a need for rehabilitation programs to be sensitive to the combined effects of sensory loss on individuals.

Association between hearing loss and saccular dysfunction in older individuals

OBJECTIVE

1) Describe the association between hearing loss and dysfunction of each of the 5 vestibular end-organs--the horizontal, superior, and posterior semicircular canals; saccule; and utricle--in older individuals. 2) Evaluate whether hearing loss and vestibular end-organ deficits share any risk factors.

STUDY DESIGN

Cross-sectional study.

SETTING

Academic medical center.

PATIENTS

Fifty-one individuals age 70 years or older.

INTERVENTIONS

Audiometry, head-thrust dynamic visual acuity (htDVA), sound-evoked cervical vestibular-evoked myogenic potential (cVEMP), and tap-evoked ocular VEMP (oVEMP).

MAIN OUTCOME MEASURES

Audiometric pure-tone averages (PTA), htDVA LogMAR scores as a measure of semicircular canal function in each canal plane, and cVEMP and oVEMP amplitudes as a measure of saccular and utricular function, respectively.

RESULTS

We observed a significant correlation between hearing loss at high frequencies and reduced cVEMP amplitudes (or reduced saccular function; r = -0.37, p < 0.0001) in subjects age 70 years or older. In contrast, hearing loss was not associated with oVEMP amplitudes (or utricular function), or htDVA LogMAR scores (or semicircular canal function) in any of the canal planes. Age and noise exposure were significantly associated with measures of both cochlear and saccular dysfunction.

CONCLUSION

The concomitant decline in the cochlear and saccular function associated with aging may reflect their common embryologic origin in the pars inferior of the labyrinth. Noise exposure seems to be related to both saccular and cochlear dysfunction. These findings suggest a potential benefit of screening individuals with presbycusis-particularly those with significant noise exposure history-for saccular dysfunction, which may contribute to fall risk in the elderly.

Evaluation of postural balance in postmenopausal women and its relationship with bone mineral density--a cross sectional study

BACKGROUND

Low bone mineral density (BMD) and falls are common problems encountered in the postmenopausal women. The purpose was to evaluate the association between postural balance and BMD in postmenopausal women and its relation to risk for falls.

METHODS

In this cross-sectional study, 225 women in amenorrhea > 12 months and age ≥ 45 years were included and divided, according to BMD, in T-score values > -2.0 SD (n = 140) and ≤ -2 SD (n = 85). Those with neurological or musculoskeletal disorders, history of vestibulopathies, uncorrected visual deficit or drug use that could affect balance were excluded. History of falls (last 24 months), clinical and anthropometric characteristics were evaluated. Postural balance was assessed by stabilometry (force platform). For statistical analysis were used Wilcoxon's Test, Chi-Square Test and logistic regression method for fall risk (Odds Ratio-OR).

RESULTS

Patients with BMD > -2.0 SD were younger, with shorter time since menopause, and showed higher BMI as compared to those with low BMD (≤ -2 SD) (p < 0.05). It was observed that 57.8% of the participants reported fall episodes without significant difference distribution between the groups (p = 0.055). No differences were found from the comparison between the groups (p > 0.05) for stabilometric parameters. Risk for falls increased with age (OR 1.07; CI 95% 1.01-1.13), current smoking (OR 2.19; CI 95% 1.22-3.21) and corrected visual deficit (OR 9.06; CI 95% 1.14-4.09). In contrast, hormone therapy (HT) use was significantly associated with reduced risk for falls (OR 0.48; CI 95% 0.26-0.88).

CONCLUSIONS

In postmenopausal women, BMD did not show association with postural balance or risk for falls. Age, smoking and corrected visual deficit were clinical indicators of risk for falls whereas HT use showed to be a protective factor.