Sensory impairment among older US workers

Associations of dual sensory impairment with long-term depressive and anxiety symptoms in the United States

OBJECTIVE

We explored the associations of dual sensory impairment (DSI) with long-term depressive and anxiety symptoms as well as low perceived social support (LPSS) as a modifier of these associations.

METHODS

Multinomial logistic regression models were used to examine the associations of DSI and single sensory impairment (hearing [pure-tone average > 25 dB] and vision [impaired visual acuity and/or contrast sensitivity]) with long-term depressive symptom (≥8 on the 10-item Center for Epidemiologic Studies-Depression Scale) and anxiety symptom (present on the Hopkins Symptom Checklist) latent classes from group-based trajectory models (rare/never; mild/moderate increasing; chronically high) among 2102 Health, Aging and Body Composition Study participants (mean age:74.0 ± 2.8 years; 51.9 % female) over 10 years. Models were adjusted by demographic characteristics and cardiovascular risk factors, and LPSS. An additional model evaluated the two-way interaction between DSI and LPSS.

RESULTS

DSI was associated with increased risk of being chronically depressed (Risk Ratio, RR = 1.99, 95 % Confidence Interval, CI: 1.25, 3.17), not mild/moderate increasingly depressed (RR = 1.25, 95 % CI: 0.91, 1.71). DSI had increased risk of being mild/moderate increasingly anxious (RR = 1.60, 95 % CI: 1.16, 2.19) and chronically anxious (RR = 1.86, 95 % CI: 1.05, 3.27) groups, as compared to no impairments. Hearing impairment was associated with being mild/moderate increasingly anxious (RR = 1.34, 95 % CI: 1.01, 1.79). No other associations were found for single sensory impairments. LPSS did not modify associations.

LIMITATIONS

Sensory measures were time-fixed, and LPSS, depression and anxiety measures were self-reported.

CONCLUSIONS

Future research is warranted to determine if DSI therapies may lessen long-term chronically high depressive and anxiety symptoms.

The longitudinal effect of sensory loss on depression among Chinese older adults

BACKGROUND

Previous studies have suggested that sensory loss is linked to depression. However, most of these studies have been conducted in developed countries and the results are mixed.

OBJECTIVES

The current study aims to examine the longitudinal relationship between hearing loss, vision loss, dual sensory loss, and depression among Chinese older adults over four years.

METHODS

The data were obtained from the China Health and Retirement Longitudinal Survey (CHARLS). In total, 6353 Chinese older adults aged 60 years and over were included at baseline in this study. Self-reported hearing and vision status was used, and dual sensory loss was a combined variable of hearing loss and vision loss. Depressive symptoms were assessed by The Center for Epidemiologic Studies Depression Scale (CESD-10). The baseline relationship between sensory loss and depression was explored by logistic regression analyses. A logistic mixed model was used to assess whether baseline sensory loss was associated with incident depression for older adults with no depressive symptoms at baseline over four years.

RESULTS

At baseline, vision loss (OR=1.46, 95%CI: 1.19-1.79) and dual sensory loss (OR=2.14, 95%CI: 1.77-2.58) were associated with depression, while hearing loss was not. After four years, vision loss (OR=1.60, 95%CI: 1.16-2.22) and dual sensory loss (OR=1.78, 95%CI: 1.32-2.41) were associated with incident depression.

LIMITATIONS

Not all potential confounding factors are measured and adjusted in the analysis. Apart from that, all measurements of interest are self-reported scales.

CONCLUSION

Vision loss and dual sensory loss are significantly associated with both onset and increased depressive symptoms over time, while hearing loss is not associated with depression. Interactions between all types of sensory loss and social activities are not significant. Our results suggest that target mental health intervention programs should be delivered to vision loss or dual sensory loss populations.

Differential associations between sensory loss and neuropsychiatric symptoms in adults with and without a neurocognitive disorder

BACKGROUND

To investigate the differential associations between sensory loss and neuropsychiatric symptoms among older adults with and without diagnosed neurocognitive disorder.

METHODS

The sample comprised 1,393 adults (52.3% men) aged between 72 and 79 years from a community-based cohort study. There were 213 cases of mild and 64 cases of major neurocognitive disorders. The main outcome was number of informant reported symptoms on the Neuropsychiatric Inventory (NPI). Sensory loss was defined by visual acuity worse the 0.3 logMAR (6/12 or 20/40) and self-reported hearing problems.

RESULTS

Clinically relevant NPI symptoms were reported in 182 (13.1%) participants, but no individual symptom occurred in more than 5% of the total sample. Among participants diagnosed with a major neurocognitive disorder, those with any sensory loss had over three times (95%CI: 1.72-11.78) greater rates of NPI symptoms than those with unimpaired levels of sensory functioning. There were no differences in the number of neuropsychiatric symptoms by type of sensory loss, and no additional risk associated with a dual sensory loss compared to a single sensory loss. There was no evidence of an association between sensory loss and number of neuropsychiatric symptoms among cognitively healthy adults.

CONCLUSIONS

The extent to which this association is the result of underlying neuropathology, unmet need, or interpersonal factors is unclear. These findings have significant implications for dementia care settings, including hospitals and respite care, as patients with sensory loss are at increased risk of neuropsychiatric symptoms and may require additional psychosocial support. Interventions to manage sensory loss and reduce the impact of sensory limitations on neuropsychiatric symptoms are needed.

Prevalence and Causes of Visual Impairment and Blindness among Cocoa Farmers in Ghana

PURPOSE

To determine the prevalence and causes of visual impairment and blindness among cocoa farmers in Ghana in order to formulate early intervention strategies.

METHODS

A cross-sectional study using multistage random sampling from four cocoa growing districts in Ghana was conducted from November 2013 to April 2014. A total of 512 cocoa farmers aged 40 years and older were interviewed and examined. The brief interview questionnaire was administered to elicit information on the demographics and socioeconomic details of participants. The examination included assessment of visual acuity (VA), retinoscopy, subjective refraction, direct ophthalmoscopy, slit-lamp biomicroscopy and intraocular pressure (IOP). For quality assurance, a random sample of cocoa farmers were selected and re-examined independently.

RESULTS

Moderate to severe visual impairment (VA <6/18 to 3/60 in the better-seeing eye) was present in 89 participants (17.4%) and 27 (5.3%) were blind (presenting VA <3/60 in the better eye) defined using presenting VA. The main causes of visual impairment were cataract (45, 38.8%), uncorrected refractive error (42, 36.2%), posterior segment disorders (15, 12.9%), and corneal opacity (11, 9.5%).

CONCLUSION

The prevalence of visual impairment and blindness among cocoa farmers in Ghana is relatively high. The major causes of visual impairment and blindness are largely preventable or treatable, indicating the need for early eye care service interventions.

Hearing impairment and retirement

BACKGROUND

Many factors influence the decision to retire including age, insurance, and pension availability along with physical and mental health. Hearing impairment may be one such factor.

PURPOSE

The purpose of this study was to compare the 15 yr retirement rate among subjects with and without hearing impairment.

RESEARCH DESIGN

Prospective, population-based study.

STUDY SAMPLE

Subjects were participants in the Epidemiology of Hearing Loss Study (EHLS), a longitudinal investigation of age-related hearing loss. Participants who were working full- or part-time in 1993-1995 were included (n = 1410, mean age = 57.8 yr).

DATA COLLECTION AND ANALYSIS

Data from four EHLS phases (1993-1995, 1998-2000, 2003-2005, and 2009-2010) were analyzed in 2010-2012. Hearing impairment was defined as a pure tone threshold average (at 0.5, 1, 2, and 4 kHz) greater than 25 dB HL in the worse ear. Employment status was determined at each of the four phases. Kaplan-Meier estimates of the cumulative incidence of retirement were calculated, and Cox discrete-time modeling was used to determine the effect of hearing impairment on the rate of retirement.

RESULTS

The cumulative incidence of retirement was significantly (p < 0.02) higher in those with a hearing impairment (77%) compared to those without a hearing impairment (74%). After adjustment for age, gender, self-reported health, and history of chronic disease, there was no significant difference in the rate of retirement between those with and without a hearing impairment (hazard ratio [HR] = 0.9, 95% confidence interval (CI) = 0.7, 1.1). Similar results were observed when hearing aid users were excluded, when hearing impairment was based on the better ear thresholds, and when analyses were restricted to those under 65 yr of age and working full-time at baseline. Participants with a hearing impairment were less likely to state that the main reason for retirement was that the time seemed right.

CONCLUSIONS

Hearing impairment was found to be associated with a higher rate of retirement, but the association was not independent of the effects of age, gender, and health.

Mental health and dual sensory loss in older adults: a systematic review

Mental health is a core component of quality of life in old age. Dual Sensory Loss (DSL; combined vision and hearing loss) is prevalent in older adults and has been correlated with decreased levels of well-being. This systematic review aimed to critically review and summarize the evidence from studies that examined the mental health of older adults with DSL. In accordance with the Preferred Reporting Items for Systematic Reviews (PRISMA) statement, specific databases were searched and eight articles were selected for final review. Seven studies investigated the association between DSL and depression or depressive symptoms, whilst one study explored the relationship between DSL and quality of life. No studies investigated the impact of DSL on anxiety. Overall, results of this review suggested that there is a significant relationship between DSL and decreased mental health with those with DSL either displaying depressive symptoms or being at risk for developing depression. Future research should focus on comparative studies of older people with and without sensory loss, as well as targeted studies of older people with dual sensory loss, that incorporate well-defined and valid measures of sensory loss and mental health.

Workplace Accommodations, Job Performance and Job Satisfaction Among Individuals with Sensory Disabilities

This study examined differences between requesters and non-requesters of workplace accommodations in their self-reported job performance and job satisfaction. Participants were 194 individuals with visual and hearing disabilities (females = 67.5%, visual = 53.2%) receiving rehabilitation and related services in the US. They completed a survey on their self-reported accommodation requests, job satisfaction and work performance. Chi square and ANOVA tests were used to compare and contrast the differences. Findings suggest participants with requested accommodations have higher levels on job performance and job satisfaction than non-requesters. Individuals who were more likely to request accommodations were associated with higher educational background, moderate disability severity and higher levels of workplace supports from employers and coworkers. They reported higher knowledge levels on Americans with Disabilities Act and accommodation procedures, and higher outcome expectations and self-efficacies in requesting accommodations. Requesting workplace accommodations is an interactive and multifaceted process that involves various biopsychosocial factors. Rehabilitation professionals should help individuals with sensory disabilities from biopsychosoical perspectives to enhance job accommodation and job satisfaction.

Self-reported hearing difficulty versus audiometric screening in younger and older smokers and nonsmokers

Background

The high incidence of age-related hearing loss demands accessible, low cost hearing screenings for prevention and hearing health promotion. This study assessed performance of self report (SR) against audiometry, and prevalence of hearing difficulty when screening hearing in middle-aged and younger adults, including smokers and nonsmokers.

Methods

Prospective participants (N = 219) completed a questionnaire providing biographical, health, and smoking information. Their Yes/No responses about hearing or communication difficulty provided data for self-reported hearing loss. Eligible (N = 170) participants received a hearing test including immittance, pure-tone, and speech audiometry. The binaural pure-tone average (PTA) hearing threshold was determined; PTA decibel (dB) level indicated degree (e.g., mild) of hearing loss. All hearing screening data were coded and initially analyzed in an Access database. Statistical analyses based on conditional probability included measures of prevalence, sensitivity, specificity, and predictive value of the SR versus audiometric measures. Participants provided a urine sample for biochemical analysis to confirm smoker/nonsmoker status.

Results

Among all participants (N = 170), overall prevalence of self-reported hearing difficulty (15.9%) was in excellent agreement with measured, mild hearing loss (16.5%). However, factoring in age and smoking revealed that SR was incongruent with audiometry because hearing loss was overestimated by smokers and younger participants and underestimated by middle-aged individuals. The SR question yielded high specificity (80-90%) overall. Specificity was highest in nonsmokers (89-94%) and younger (90-91%) individuals with lower performance in smokers and middle-aged participants. SR sensitivity was high (86-100%) only when the hearing impairment cutoff was > 40 dB (moderate loss) and > 60 dB (severe loss). Sensitivity was highest in smokers (100%), supporting SR for screenings. High negative and low positive predictive value (PPV) occurred in smokers, younger, and middle-aged persons. This study reports new sensitivity and specificity data on self-reported hearing difficulty in smokers (N = 98), younger (N = 80), and middle-aged (N = 90) adults, indicating efficacy of SR as an adult hearing screening measure.

Conclusions

SR was effective as few normal-hearing persons were labeled “hearing-impaired”. However, audiometry should supplement SR to optimize detection of mild hearing loss for at-risk adults. Results may guide community health initiatives for hearing screenings, prevention, and health promotion.

Keywords

Aging; Smoking; Self Report; Health Promotion; Hearing Screening

Occupational injuries, illnesses, and fatalities among workers in the services sector industries: 2003 to 2007

OBJECTIVE

Provide descriptive statistics and discuss priorities for injury and fatality risks among services sector workers.

METHODS

Bureau of Labor Statistics Survey of Occupational Injuries and Illnesses and Census of Fatal Occupational Injuries data for 2003 to 2007 were analyzed to identify occupational injury and fatality risks for services sector industry groups.

RESULTS

Many services sector industry groups experienced, on average, greater than one occupational fatality per week, and survey of occupational injuries and illnesses days-away-from-work rates in excess of those for all US workers. Overall, transportation incidents and homicides are leading factors contributing to fatalities.

CONCLUSIONS

These results indicate the need for adoption of safety and health prevention practices in numerous industry groups. For groups that experience elevated injury and fatality rates, priorities for research and intervention can be identified through these data.

Health status and risk indicator trends of the aging US health care workforce

OBJECTIVES

To describe the health status and risk indicator trends in a representative sample of US health care workers aged 45 years and older.

METHODS

Using pooled data from the 1997 to 2009 National Health Interview Survey, logistic regression analyses were performed to determine whether age-group specific morbidity risks differed within occupational subgroups of the health care workforce (N = 6509). Health and morbidity trends were examined via complex survey adjusted and weighted chi-squared tests.

RESULTS

Rates of functional limitation and hypertension increased among diagnosing/assessing health care workers. The prevalence of hearing impairment, cancer, and hypertension was two to three times greater in health-diagnosing/assessing workers aged 60 years and older than in younger workers. Health care service workers were up to 19 times more likely to be obese than workers who diagnose/assess health.

CONCLUSIONS

Healthier workplaces and targeted interventions are needed to optimize the ability to meet health care demands of this aging workforce.

Recent trends in chronic disease, impairment and disability among older adults in the United States

Background

To examine concurrent prevalence trends of chronic disease, impairment and disability among older adults.

Methods

We analyzed the 1998, 2004 and 2008 waves of the Health and Retirement Study, a nationally representative survey of older adults in the United States, and included 31,568 community dwelling adults aged 65 and over. Measurements include: prevalence of chronic diseases including hypertension, heart disease, stroke, diabetes, cancer, chronic lung disease and arthritis; prevalence of impairments, including impairments of cognition, vision, hearing, mobility, and urinary incontinence; prevalence of disability, including activities of daily living (ADLs) and instrumental activities of daily living (IADLs).

Results

The proportion of older adults reporting no chronic disease decreased from 13.1% (95% Confidence Interval [CI], 12.4%-13.8%) in 1998 to 7.8% (95% CI, 7.2%-8.4%) in 2008, whereas the proportion reporting 1 or more chronic diseases increased from 86.9% (95% CI, 86.2%-89.6%) in 1998 to 92.2% (95% CI, 91.6%-92.8%) in 2008. In addition, the proportion reporting 4 or more diseases increased from 11.7% (95% CI, 11.0%-12.4%) in 1998 to 17.4% (95% CI, 16.6%-18.2%) in 2008. The proportion of older adults reporting no impairments was 47.3% (95% CI, 46.3%-48.4%) in 1998 and 44.4% (95% CI, 43.3%-45.5%) in 2008, whereas the proportion of respondents reporting 3 or more was 7.2% (95% CI, 6.7%-7.7%) in 1998 and 7.3% (95% CI, 6.8%-7.9%) in 2008. The proportion of older adults reporting any ADL or IADL disability was 26.3% (95% CI, 25.4%-27.2%) in 1998 and 25.4% (95% CI, 24.5%-26.3%) in 2008.

Conclusions

Multiple chronic disease is increasingly prevalent among older U.S. adults, whereas the prevalence of impairment and disability, while substantial, remain stable.