Accelerometer-assessed physical activity and objectively determined dual sensory impairment in US adults

Dual sensory impairment: Global prevalence, future projections, and its association with cognitive decline

There is rising public health concern surrounding dual sensory impairment (DSI), or comorbid hearing and vision impairments. Its global prevalence and the magnitude of its association with cognitive decline (CD) is unclear. Three databases were searched for epidemiological studies examining DSI prevalence or its association with CD. Independent reviewers selected studies, extracted data, and evaluated bias. Random-effects meta-analyses were performed. Projections were estimated using United Nations data. The population attributable fraction of DSI-associated CD was calculated. Among 43 studies with 5,246,796 participants, clinically assessed DSI prevalence was 5.50% (95% confidence interval [CI] = 2.88%-10.26%), with regional/ethnic/age variations. DSI prevalence is projected to increase by 27.2% from 2025 to 2050. Approximately 59.83% (95%CI = 41.03-76.12) of DSI patients had cognitive impairment. Baseline DSI was associated with incident CD (odds ratio [OR] = 1.72, 95%CI = 1.37-2.15). Globally, 3.81% (95%CI = 1.05-10.55) of incident CD may be attributed to DSI. DSI is globally prevalent, growing, and associated with CD, highlighting the need for better health policy and resource allocation. HIGHLIGHTS: The global prevalence of DSI is 5.50%, with geographical, ethnical and age variations. The prevalence of DSI rises with age and is projected to increase by 27.2% by 2050. Approximately 60% of individuals with DSI may have measurable cognitive impairment. DSI was associated with a 72% greater longitudinal risk of incident CD. Globally, 3.81% of CD cases may be attributable to DSI.

Data Analytics in Physical Activity Studies With Accelerometers: Scoping Review

BACKGROUND

Monitoring free-living physical activity (PA) through wearable devices enables the real-time assessment of activity features associated with health outcomes and provision of treatment recommendations and adjustments. The conclusions of studies on PA and health depend crucially on reliable statistical analyses of digital data. Data analytics, however, are challenging due to the various metrics adopted for measuring PA, different aims of studies, and complex temporal variations within variables. The application, interpretation, and appropriateness of these analytical tools have yet to be summarized.

OBJECTIVE

This research aimed to review studies that used analytical methods for analyzing PA monitored by accelerometers. Specifically, this review addressed three questions: (1) What metrics are used to describe an individual's free-living daily PA? (2) What are the current analytical tools for analyzing PA data, particularly under the aims of classification, association with health outcomes, and prediction of health events? and (3) What challenges exist in the analyses, and what recommendations for future research are suggested regarding the use of statistical methods in various research tasks?

METHODS

This scoping review was conducted following an existing framework to map research studies by exploring the information about PA. Three databases, PubMed, IEEE Xplore, and the ACM Digital Library, were searched in February 2024 to identify related publications. Eligible articles were classification, association, or prediction studies involving human PA monitored through wearable accelerometers.

RESULTS

After screening 1312 articles, 428 (32.62%) eligible studies were identified and categorized into at least 1 of the following 3 thematic categories: classification (75/428, 17.5%), association (342/428, 79.9%), and prediction (32/428, 7.5%). Most articles (414/428, 96.7%) derived PA variables from 3D acceleration, rather than 1D acceleration. All eligible articles (428/428, 100%) considered PA metrics represented in the time domain, while a small fraction (16/428, 3.7%) also considered PA metrics in the frequency domain. The number of studies evaluating the influence of PA on health conditions has increased greatly. Among the studies in our review, regression-type models were the most prevalent (373/428, 87.1%). The machine learning approach for classification research is also gaining popularity (32/75, 43%). In addition to summary statistics of PA, several recent studies used tools to incorporate PA trajectories and account for temporal patterns, including longitudinal data analysis with repeated PA measurements and functional data analysis with PA as a continuum for time-varying association (68/428, 15.9%).

CONCLUSIONS

Summary metrics can quickly provide descriptions of the strength, frequency, and duration of individuals' overall PA. When the distribution and profile of PA need to be evaluated or detected, considering PA metrics as longitudinal or functional data can provide detailed information and improve the understanding of the role PA plays in health. Depending on the research goal, appropriate analytical tools can ensure the reliability of the scientific findings.

Cross-sectional associations between multisensory impairment and brain volumes in older adults: Baltimore Longitudinal Study of Aging

Sensory impairment and brain atrophy is common among older adults, increasing the risk of dementia. Yet, the degree to which multiple co-occurring sensory impairments (MSI across vision, proprioception, vestibular function, olfactory, and hearing) are associated with brain morphometry remain unexplored. Data were from 208 cognitively unimpaired participants (mean age 72 ± 10 years; 59% women) enrolled in the Baltimore Longitudinal Study of Aging. Multiple linear regression models were used to estimate cross-sectional associations between MSI and regional brain imaging volumes. For each additional sensory impairment, there were associated lower orbitofrontal gyrus and entorhinal cortex volumes but higher caudate and putamen volumes. Participants with MSI had lower mean volumes in the superior frontal gyrus, orbitofrontal gyrus, superior parietal lobe, and precuneus compared to participants with < 2 impairments. While MSI was largely associated with lower brain volumes, our results suggest the possibility that MSI was associated with higher basal ganglia volumes. Longitudinal analyses are needed to evaluate the temporality and directionality of these associations.

A study on the relationship between recreational physical activity and audiovisual difficulty for older adults

Audiovisual difficulty are especially common in older adults. Audiovisual difficulty seriously affect the quality of life of older adults in their later years. It is a top priority to find out the related factors, and to intervene and prevent them. The purpose of this study was to explore the relationship between recreational physical activities and audiovisual difficulty in older adults. We hope that older adults can reduce the risk of hearing and visual difficulty through scientific physical activity. A total of 4,886 people were sampled from the National Health and Nutrition Examination Survey (NHANES) from 2013 to 2018. Recreational physical activity was assessed through the Global Physical Activity Questionnaire (GPAQ); Hearing and visual difficulty were assessed using the Disability Questionnaire (DLQ). Chi-square test was used for categorical variables and rank sum test was used for measurement variables. P < 0.05 was considered statistically significant (bilateral test). After univariate analysis, binary Logistic regression analysis was performed with recreational physical activity as the independent variable, statistically significant demographic variable as the covariate, and hearing and visual difficulty as the dependent variable, respectively. (1) After excluding all confounding variables, recreational physical activity was significantly associated with hearing difficulty (P < 0.001), odds ratio (OR) 0.657 (95% CI 0.5899-0.733); (2) Recreational physical activity was significantly associated with visual difficulty (P < 0.001), OR 0.731 (95% CI 0.630-0.849). (1) Recreational physical activity is the protective factor of hearing difficulty in older adults; (2) Recreational physical activity is a protective factor for visual difficulty in older adults.

Physical Function Trajectories and Mortality in Older Adults With Multisensory Impairment

Importance

Single sensory impairment is associated with reduced functional resilience and increased mortality, though the effects of multiple sensory deficits are not known.

Objective

To investigate longitudinal associations of the type, severity, and number of sensory impairments with physical function trajectories and mortality in older adults.

Design, Setting, and Participants

This retrospective analysis of a longitudinal cohort study, the Health, Aging, and Body Composition (Health ABC) study, incorporated data from April 1997 to July 2013, featuring a 16-year follow-up with annual examinations and questionnaires. The cohort comprised 3075 men and women, aged 70 to 79 years at baseline, residing in Memphis, Tennessee, and Pittsburgh, Pennsylvania. All participants with complete sensory testing and covariate data at analytical baseline (year 5, 2002) were included. The data were analyzed September 1, 2022.

Exposures

Visual, olfactory, auditory, and touch sensory functions were assessed between 2000 and 2002.

Main Outcomes

The main outcomes included physical functioning trajectories and mortality risk. Physical function was assessed longitudinally using the Health ABC physical performance battery (HABCPPB).

Results

A total of 1825 individuals (mean [SD] age, 77.4 [3.2] years; 957 [52%] female) were included in this study. Multivariable analysis of HABCPPB decline indicated that having 1 sensory impairment (β estimate, -0.01 [95% CI, -0.02 to -0.001]); 2 sensory impairments (β estimate, -0.01 [95% CI, -0.02 to -0.01]); 3 sensory impairments (β estimate, -0.03 [95% CI, -0.04 to -0.02]); or 4 sensory impairments (β estimate, -0.04 [95% CI, -0.05,-0.03]) was significantly associated with a steeper HABCPPB score decline in a dose-dependent manner. Adjusted Cox proportional hazards models indicated that having 1 sensory impairment (hazard ratio [HR], 1.35 [95% CI, 1.01-1.81]), 2 sensory impairments (HR, 1.58 [95% CI, 1.19-2.11]), 3 sensory impairments (HR, 1.79 [95% CI, 1.33-2.42]), or 4 sensory impairments (HR, 1.97 [95% CI, 1.39-2.79]) was significantly associated with increased mortality risk in a similarly dose-dependent manner.

Conclusion

In this retrospective cohort study, the degree and number of multiple sensory impairments were associated with worse physical functioning and increased mortality risk. These findings represent an opportunity for further investigation into the value of screening, prevention, and treatment of sensory impairments to reduce morbidity and mortality in older adults.

The Association of Multiple Sensory Impairment and Telomere Length: The Health ABC Study

OBJECTIVES

The objective of this study was to characterize the associations of sensory impairments, including olfaction (OI), vision (VI), hearing (HI), and touch (TI), with telomere length (TL) in a group of community-dwelling older adults who participated in the Health ABC study.

METHODS

Across 1603 participants, OI was classified with the Brief Smell Identification Test (<11), HI with pure-tone averages (<25 dB), VI with visual acuity (20/50 or worse), and TI with monofilament testing (inability to detect three of four touches). Shorter TL was defined as the lowest quartile of sample TLs. Adjusted multivariable regressions were used to examine the cross-sectional association between the modality, severity, and number of sensory impairments with TL.

RESULTS

Participants had an average age of 77.4 ± 2.84 years, and 89.7% (n = 1438) had at least one or more sensory impairments. Severe OI (odds ratio [OR] = 1.73, 95% confidence interval [CI] = [1.19, 2.6]) was independently associated with increased odds of shorter TL. Additionally, having one (OR = 2.79, 95% CI = [1.69, 4.70]), two (OR = 2.5, 95% CI = [1.51, 4.26]), three (OR = 3.04, 95% CI = [1.79, 5.36]), or four impairments (OR = 3.72, 95% CI = [1.52, 7.33]) was associated with increased odds of shorter TL in a dose-dependent manner.

CONCLUSION

Severe OI and TI appear to be particularly robust markers of shortened TL. Additionally, multiple sensory impairment is strongly associated with shortened TL, suggesting that sensory dysfunction may represent a unique biomarker of unhealthy aging.

LEVEL OF EVIDENCE

Level II Laryngoscope, 133:3132-3138, 2023.

Levels and patterns of physical activity and sedentary behavior in adults with and without visual impairment

BACKGROUND

Limited data are available on objectively measured physical activity (PA) and sedentary behavior (SB) among adults with and without visual impairment (VI).

OBJECTIVE

To compare PA and SB levels and patterns in adults with and without VI and to examine how these differ based on sex and day of the week.

METHODS

Thirty-two participants with VI and 32 participants without VI participated in this cross-sectional study. PA and SB were assessed using GT3X ActiGraph accelerometers during waking hours for 7 days, and variables were examined in terms of disability group, sex, and day of the week. Nonparametric Mann-Whitney U test and Wilcoxon signed-rank test were used, and significance was set at p < 0.05.

RESULTS

PA did not differ in terms of sex or day of the week in participants with VI. The PA of participants without VI was significantly higher for men than it was for women and was significantly higher during weekdays than on weekend days. Total sedentary time and the duration of SB breaks were significantly longer for female participants with VI than for those without VI. The number of sedentary bouts lasting ≥10 min during weekend days was significantly higher for participants with VI than for those without VI.

CONCLUSIONS

Most adults with and without VI did not meet the recommended levels of daily PA and spend a large portion of the day being sedentary. Interventions to enhance PA and reduce sedentary time in adults with and without VI are required.

Exploring Shared Effects of Multisensory Impairment, Physical Dysfunction, and Cognitive Impairment on Physical Activity: An Observational Study in a National Sample

Multisensory, physical, and cognitive dysfunction share age-related physiologic disturbances and may have common health effects. We determined whether the effect of multisensory impairment on physical activity (PA) is explained by physical (timed up and go) or cognitive (Short Portable Mental Status Questionnaire) dysfunction. A National Social Life, Health, and Aging Project participant subset (n = 507) underwent objective sensory testing in 2005-2006 and wrist accelerometry in 2010-2011. We related multisensory impairment to PA using multivariate mixed-effects linear regression and compared the effect magnitude after adjusting for physical then cognitive dysfunction. Worse multisensory impairment predicted lower PA across three scales (Global Sensory Impairment: β = -0.04, 95% confidence interval [-0.07, -0.02]; Total Sensory Burden: β = -0.01, 95% confidence interval [-0.03, -0.003]; and Number of Impaired Senses: β = -0.02, 95% confidence interval [-0.04, -0.004]). Effects were similar after accounting for physical and cognitive dysfunction. Findings suggest that sensory, physical, and cognitive dysfunction have unique mechanisms underlying their PA effects.

Associations of dual sensory impairment with incident mobility and ADL difficulty

BACKGROUND

There is a dearth of studies examining the associations of objectively measured dual sensory impairment (DSI) with incident mobility and activities of daily life (ADL) difficulty longitudinally.

METHODS

Cox proportional hazards models were used to examine the associations of DSI and single sensory impairment (hearing, vision) with incident mobility difficulty (many problems or inability to walk ¼ mile and/or climb 10 steps) and ADL difficulty up to six years of follow-up among 2020 participants of the Health, Aging, and Body Composition Study, a cohort of older adults aged 70-79 years from Pittsburgh, PA and Memphis, TN. Vision impairment (VI) was defined as impaired visual acuity (20/50 or worse on Bailey-Lovie distance test) and contrast sensitivity (<1.3 log units on Pelli-Robson test), and hearing impairment (HI) was defined as pure-tone average in better-hearing ear >25 decibels. Models were adjusted by age, race, sex, education, diabetes, depressive symptoms, hypertension, gait speed from 20-meter walk, global cognition score, prevalent cardiovascular disease, and body mass index.

RESULTS

There were 23% with DSI (n = 459). DSI was associated with increased risk of both incident report of mobility (hazard ratio [HR] = 2.25, 95% confidence interval [CI]: 1.47, 3.43), and ADL difficulty (HR = 2.26, 95% CI: 1.50, 3.40). Neither VI nor HI alone was associated with risk of either outcome.

CONCLUSIONS

DSI is associated with increased risk of incident mobility and ADL difficulty. Rehabilitation and adaptive environmental changes for individuals living with DSI may be important to maximize mobility and daily function.

Correlates of Physical Activity among Adults with Sight Loss in High-Income-Countries: A Systematic Review

Background: Physical activity (PA) is essential for almost all facets of health; however, research suggests that PA levels among populations with sight loss are critically low. The aim of this review was to identify the correlates of PA among people with sight loss in high income countries, to inform future interventions and policies. Methods: MEDLINE, Web of Science, PsycINFO, SPORTDiscus, The British Journal of Visual Impairment, The Journal of Visual Impairment and grey literature were searched for studies which reported correlates of PA among adults with sight loss. The protocol is available from PROSPERO (CRD42020215596). Results: A total of 29 articles were eligible for review. Evidence from multiple studies reported that the vision impairment category, worse visual acuity, bilateral visual field loss, worse contrast sensitivity, those of the female gender, low self-efficacy, and environmental barriers were associated with lower levels of PA among populations with sight loss. Conclusions: Overall, correlates of PA among people with sight loss in high income countries are complex and vary across different population groups. Health professionals, eye care, and sight loss services should work together to identify people at risk of low PA, and provide a range of services and interventions to influence the modifiable factors that are associated with low PA.

Leisure-time physical activity and incidence of objectively assessed hearing loss: The Niigata Wellness Study

Previous cohort study reported that high physical activity was associated with a low risk of self-reported hearing loss in women. However, no studies have examined the association between physical activity and the development of hearing loss as measured using an objective assessment of hearing loss in men and women. Here, we used cohort data to examine the association between leisure-time physical activity and incidence of objectively assessed hearing loss in men and women. Participants included 27 537 Japanese adults aged 20-80 years without hearing loss, who completed a self-administered physical activity questionnaire between April 2001 and March 2002. The participants were followed up for the development of hearing loss as measured by audiometry between April 2002 and March 2008. During follow-up, 3691 participants developed hearing loss. Compared with the none physical activity group, multivariable adjusted hazard ratios (HRs) for developing hearing loss were 0.93 (95% confidence interval (CI), 0.86-1.01) and 0.87 (0.81-0.95) for the medium (<525 MET-min/week) and high (≥525 MET-min/week) physical activity groups, respectively (p for trend = 0.001). The magnitude of risk reduction was slightly greater in vigorous-intensity activity than in moderate-intensity activity (p for interaction = 0.01). Analysis by sound frequency showed that the amount of physical activity was inversely associated with high frequency hearing loss development (p for trend <0.001), but not with low frequency hearing loss development (p for trend = 0.19). Higher level of leisure-time physical activity was associated with lower incidence of hearing loss, particularly for vigorous-intensity activities and high sound frequencies.

Gender differences in the association between physical activity and obesity in adults with vision and hearing losses

BACKGROUND

Physical inactivity is strongly associated with obesity, which in turn is a major risk factor for many non-communicable diseases. We examined associations between physical inactivity and obesity in Spanish adults with vision and hearing difficulties and explored differences between men and women.

METHODS

Data from the Spanish National Health Survey 2017 were analyzed [n = 23 089 adults (15-103 years, mean age 53.4 ± 18.9 years, 45.9% men)]. Participants self-reported difficulties in seeing and hearing. Physical inactivity (exposure) was evaluated with the International Physical Activity Questionnaire Short Form. Obesity (outcome) was defined as body mass index ≥30 kg m-2 based on self-reported weight and height. The association between physical inactivity and obesity was assessed with multivariable logistic regression in people with difficulties seeing and hearing, adjusting for significant covariates.

RESULTS

Multivariable logistic regression analyses showed that the association between physical inactivity and obesity was stronger in those with difficulty hearing (OR 1.778, 95% CI 1.215-2.602) compared with difficulty seeing (OR 1.375, 95% CI 1.076-1.756). Gender-stratified analyses showed significant association between physical inactivity and obesity in men who reported difficulty hearing (OR 2.319, 95% CI 1.441-3.735) and difficulty seeing (OR 1.556, 95% CI 1.079-2.244), but not in women.

CONCLUSIONS

A significant association between physical inactivity and obesity was observed in Spanish men with vision and hearing difficulties. Physical activity has an important role in the prevention of obesity in men with seeing and hearing difficulties. Active steps should be taken to encourage physical activity to reduce the risk of obesity in people with sensory impairments.

Can listening-related fatigue influence well-being? Examining associations between hearing loss, fatigue, activity levels and well-being

Objective

Well-being is influenced by the activities we undertake. Hearing loss may reduce well-being directly through increased listening-related fatigue due to cognitive and emotional strain in challenging situations. Hearing loss and hearing device use may also indirectly impact fatigue and well-being by altering the frequency and type of daily-life activities. This review examines the available literature to help understand the relationships.

Design

We provide (i) a summary of the extant literature regarding hearing loss, hearing device use and fatigue in adults, as well as regarding fatigue and daily-life activity (work, social and physical) and (ii) a systematic search and narrative review of the relationships between hearing loss, hearing device use and activity.

Study sample

The systematic search resulted in 66 eligible texts.

Results

Data examining well-being in persons with hearing loss are limited. Our literature review suggests that well-being can be related directly and indirectly to hearing loss, hearing device use, activity level and listening-related fatigue.

Conclusions

Variations and interactions between hearing loss, hearing device use, fatigue and activity levels can be expected to impact well-being in persons with hearing loss in direct and indirect ways. Future research linking hearing and daily-life fatigue should take account of activity levels.

Sensory impairment and all-cause mortality among the elderly adults in China: a population-based cohort study

With age-related functional deterioration, sensory impairment including vision impairment (VI), hearing impairment (HI), and dual sensory impairment (DSI) usually occurred among the elderly population, causing a decrease in functional capacity and quality of life. The study aimed to explore how sensory impairment is associated with the risk of all-cause mortality among the elderly adults in China. We prospectively investigated the association among 37,076 participants enrolled from 1998 to 2019 in the Chinese Longitudinal Healthy Longevity Survey. We also, as a sensitivity analysis, explored the association among 11,365 newly incident sensory impairment participants. Cox regression model with sensory impairment as a time-varying exposure was performed to calculate the hazard ratios (HRs) and 95% confidence intervals (CIs). Compared with participants without sensory impairment, those with VI (HR=1.20, 95% CI: 1.15-1.24), HI (HR=1.26, 95% CI: 1.21-1.31), and DSI (HR: 1.46, 95% CI=1.41-1.52) had significant higher risk of all-cause mortality after adjusting for potential confounders. These associations were robust among subgroup analyses stratified by sex and entry age, and sensitivity analyses performed among newly incident sensory impairment participants. In conclusion, sensory impairment was associated with higher mortality risk among the elderly adults in China.

Association between Exercise Intensity and Glaucoma in the National Health and Nutrition Examination Survey

PURPOSE

To examine the association between exercise intensity and glaucoma in the National Health and Nutrition Examination Survey (NHANES) population.

DESIGN

Retrospective, cross-sectional study.

PARTICIPANTS

Adult participants of the 2005-2006 NHANES aged 40 years and older.

METHODS

Objective exercise intensity was assessed based on measurements from accelerometers worn by participants over 1 week. Subjective exercise intensity was assessed with questionnaire responses. Glaucoma was defined with 2 definitions based on (1) the Rotterdam criteria and (2) ophthalmologist grading of optic disc photographs for characteristic features of glaucoma. Covariates included age, gender, ethnicity, blood pressure, body mass index, and spherical equivalent. Logistic regression was performed to assess associations between objective and subjective exercise intensity and glaucoma while controlling for all covariates. All data were weighted based on the NHANES multistage sampling design.

MAIN OUTCOME MEASURES

Prevalence of glaucoma based on the 2 definitions described.

RESULTS

The study included a sample of 1387 participants, of whom 68 (4.9%) had glaucoma based on Rotterdam criteria and 7 (0.5%) had glaucoma based on disc image grading. This translated to a weighted estimate of 70 246 160 individuals, with an estimated prevalence of glaucoma of 3.1% based on the Rotterdam criteria and 0.3% based on disc image grading. After adjusting for covariates, each 10-count increase in accelerometer intensity was associated with decreased odds of glaucoma using both criteria (odds ratio [OR], 0.97; 95% confidence interval [CI], 0.95-0.99 for Rotterdam; OR, 0.90; 95% CI, 0.85-0.95 using disc image grading). With Rotterdam criteria, participants who spent the day standing or walking versus sitting had 58% decreased odds of glaucoma (OR, 0.42; 95% CI, 0.25-0.70). With disc image grading, participants who performed moderate amounts of vigorous activity had 95% decreased odds of glaucoma compared with those who performed no vigorous activity (OR, 0.05; 95% CI, 0.01-0.56).

CONCLUSIONS

In the 2005-2006 NHANES adult population, increased exercise intensity is associated with decreased odds of glaucoma. Further population-based studies are needed to examine associations between additional aspects of exercise and glaucoma.

Subjective and Objective Measures of Daytime Activity and Sleep Disturbance in Retinitis Pigmentosa

SIGNIFICANCE

Objectively measured limitations in daytime activity levels appear to be inextricably linked with sleep disturbances in retinitis pigmentosa (RP) patients, as well as associated with unemployment status and central vision loss. Innovative interventional strategies should be developed to help improve these issues and overall quality of life for RP patients.

PURPOSE

Novel sensor devices are emerging as valuable tools to objectively assess behavior. We used validated measures of wrist accelerometry to determine relationships between sleep, vision, and physical activity in RP subjects.

METHODS

For one week, 33 RP adults wore a wrist Actiwatch to detect movement during the day (average total activity counts) and disturbed sleep at night. They completed Early Treatment Diabetic Retinopathy Study visual acuity testing, Pelli-Robson contrast sensitivity, Goldmann V4e visual fields, and sleep diaries and validated questionnaires to assess their sleep and general health.

RESULTS

Greater wake after sleep onset time measured with actigraphy (i.e., sleep disruption) (P = .01), loss of visual acuity (P = .009), and nonemployment/student status (P = .002) were all significant predictors of reduced daytime average total activity counts in a multiple linear regression model, after adjusting for contrast sensitivity as a cooperative suppressor variable (P = .01) (R = 0.54). Fragmentation measured with actigraphy (i.e., restlessness during sleep) (P = .07) and decreased sleep quality ratings reported upon awakening by the participants in a sleep diary (P = .06) were each marginally associated with reduced daytime average total activity counts, whereas nonemployment/student status, reduced visual acuity, and contrast sensitivity were still significant predictors. Objective and subjective measures of sleep or daytime activity were not statistically significantly correlated (P > .05).

CONCLUSIONS

We find nonemployment/student status and sleep disturbances appear to be related to reduced daytime activity levels in adults with central vision loss due to RP. These findings underscore the importance of developing and evaluating interventions to help RP patients maintain engagement in productive activities and improve their disturbed sleep.

Relationships between Hearing Loss and the Prevalences of Cataract, Glaucoma, Diabetic Retinopathy, and Age-Related Macular Degeneration in Korea

This study was conducted using the database of the Korea National Health and Nutrition Examination Survey to determine whether age-related eye diseases such as cataract, glaucoma, diabetic retinopathy (DR), and age-related macular degeneration (AMD), are related to hearing loss. 12,899 participants ≥ 40 years of age were included. The weighted prevalence of diabetic retinopathy was not significantly different between the normal hearing group and hearing-impaired group, but the weighted prevalences of cataract, glaucoma, early AMD, and late AMD were significantly different in the two groups. The odds ratio for cataract in the hearing-impaired group was 1.373 (1.118–1.687). The odds ratios of glaucoma, DR, early AMD, and late AMD were not significantly different in the hearing-impaired group. Age was significantly associated with the presence of concurrent cataract and hearing impairment by 6.574-fold per decade. Significant factors that increased the risk of concurrent glaucoma and hearing impairment were age, male gender, and triglyceride. Age, ex-smoker, systolic BP elevation, BMI decline, and fasting blood sugar significantly predicted the presence of concurrent DR and hearing loss. In early AMD, age and triglyceride, and in late AMD, age and systolic BP elevations increased the risk of concurrent AMD and hearing impairment.

Dual sensory impairment: The association between glaucomatous vision loss and hearing impairment and function

Background

Hearing impairment, vision impairment, and dual impairment (both hearing and vision impairment), have been independently associated with functional and cognitive decline. In prior studies of dual impairment, vision impairment is generally not defined or defined by visual acuity alone. Glaucoma is a leading cause of blindness and does not affect visual acuity until late in the disease; instead, visual field loss is used to measure vision impairment from glaucoma.

Objective

To examine the effect of glaucomatous visual field loss and hearing impairment on function.

Design

Cross-sectional.

Setting

Hospital-based clinic in Baltimore, Maryland.

Subjects

220 adults, ≥55 years presenting to the glaucoma clinic.

Methods

Vision impairment was defined as mean deviation on visual field testing worse than -5 decibels in the better eye, and hearing impairment was defined as pure tone average worse than 25 decibels on threshold audiometry testing in the better ear. Standardized questionnaires were used to assess functional status.

Results

Five participants were excluded for incomplete testing, leaving 32 with vision impairment only, 63 with hearing impairment only, 42 with dual impairment, and 78 controls with no hearing impairment or vision impairment. Participants with dual impairment were more likely to be older and non-White. Dual impairment was associated with significantly more severe driving limitation and more difficulty with communication compared to those without sensory impairment when adjusted for age, race, gender and number of comorbidities.

Conclusion

Older individuals with glaucoma and hearing loss seem to have generally poorer functioning than those with single sensory loss. Health professionals should consider visual field loss as a type of vision impairment when managing patients with dual impairment.

Global Sensory Impairment Predicts Morbidity and Mortality in Older U.S. Adults

OBJECTIVES

To evaluate global sensory impairment (GSI, an integrated measure of sensory dysfunction) as a predictor of physical function, cognition, overall health, and mortality.

DESIGN

Prospective study.

SETTING

The National Social Life, Health, and Aging Project.

PARTICIPANTS

A national probability sample of 3,005 home-dwelling older U.S. adults assessed at baseline (2005-06) and 5-year follow-up (2010-11).

MEASUREMENTS

Gait speed, activity, disability, cognition, overall health, 5-year mortality.

RESULTS

At baseline, older adults with worse GSI were slower (Timed Up and Go times: odds ratio (OR) = 1.32, 95% confidence interval (CI) = 1.17-1.50) and had more activity of daily living deficits (≥2: OR = 1.26, 95% CI = 1.10-1.46). Five years later, they were still slower (timed walk: OR = 1.22, 95% CI = 1.05-1.42), had more disabilities (≥2 instrumental activities of daily living; OR = 1.45, 95% CI = 1.23-1.70), were less active (daytime activity according to accelerometry: β = -2.7, 95% CI = -5.2 to -0.2), had worse cognitive function (Montreal Cognitive Assessment; β = -0.64, 95% CI = -0.84 to -0.44), more likely to have poorer overall health (OR = 1.16, 95% CI = 1.03-1.31) and lose weight (>10%: OR = 1.31, 95% CI = 1.04-1.64), and have died (OR = 1.45, 95% CI = 1.19-1.76). All analyses were adjusted for relevant confounders at baseline, including age, sex, race and ethnicity, education, smoking, problem drinking, body mass index, comorbidities, and cognitive function.

CONCLUSION

GSI predicts impaired physical function, cognitive dysfunction, significant weight loss, and mortality 5 years later in older U.S. adults. Multisensory evaluation may identify vulnerable individuals, offering the opportunity for early intervention to mitigate adverse outcomes.

Association between muscle strengthening physical activities and mortality among American adults with mobility limitations

Compared to aerobic-based physical activity, less research has evaluated the effects of muscle-strengthening physical activity (MSPA) on mortality. Additionally, limited research has evaluated this among adults with mobility limitations, which was this study's purpose. Data from the 2003-2006 NHANES, with follow-up through 2011, were used (analyzed in 2016). MSPA was assessed via self-report, with all-cause, CVD-specific, and cancer-specific mortality assessed as the outcome variables. Analyses were limited to adults with mobility limitations (N=1411), assessed via a validated questionnaire. After adjustments, those meeting MSPA guidelines (vs. not) had a 38% reduced hazard of all-cause death (HR=0.62; 95% CI: 0.41-0.95). Results were similar for CVD-specific mortality (HR=0.46; 95% CI: 0.23-0.97) and cancer-specific mortality (HR=0.27; 95% CI: 0.06-1.20). Meeting MSPA guidelines is associated with reduced all-cause and cause-specific mortality among adults with mobility limitations. This is an encouraging observation as adults with mobility limitations may be unable to engage in sufficient amounts of aerobic-based physical activity. Thus, promotion of MSPA among this population may be of critical importance.

Objectively measured physical activity in Brazilians with visual impairment: description and associated factors

BACKGROUND

Low level of physical activity is a serious health issue in individuals with visual impairment. Few studies have objectively measured physical activity in this population group, particularly outside high-income countries. The aim of this study was to describe physical activity measured by accelerometry and its associated factors in Brazilian adults with visual impairment.

METHODS

In a cross-sectional design, 90 adults (18-95 years old) answered a questionnaire and wore an accelerometer for at least 3 days (including one weekend day) to measure physical activity (min/day).

RESULTS

Sixty percent of the individuals practiced at least 30 min/day of moderate-to-vigorous physical activity. Individuals who were blind were less active, spent more time in sedentary activities and spent less time in moderate and vigorous activities than those with low vision. Individuals who walked mainly without any assistance were more active, spent less time in sedentary activities and spent more time in light and moderate activities than those who walked with a long cane or sighted guide.

CONCLUSION

Our data highlight factors associated with lower levels of physical activity in people with visual impairment. These factors, such as being blind and walking without assistance should be tackled in interventions to increase physical activity levels among visual impairment individuals. Implications for Rehabilitation Physical inactivity worldwide is a serious health issue in people with visual impairments and specialized institutions and public policies must work to increase physical activity level of this population. Those with lower visual acuity and walking with any aid are at a higher risk of having low levels of physical activity. The association between visual response profile, living for less than 11 years with visual impairment and PA levels deserves further investigations Findings of the present study provide reliable data to support rehabilitation programs, observing the need of taking special attention to the subgroups that are even more likely to be inactive.

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.

Accelerometer-determined physical activity and mortality in a national prospective cohort study: Considerations by visual acuity

BACKGROUND

Previous research demonstrates that visual impairment (VI) is associated with increased all-cause mortality risk and is also associated with reduced physical activity participation. Although physical activity is reduced among those with VI, no studies have examined the relationship between physical activity and all-cause mortality across different visual function statuses, which is noteworthy of investigation as physical activity is linked with greater survival.

METHODS

Data from the 2003-2006 NHANES were employed, with physical activity assessed via accelerometry and visual function assessed using the ARK-760 autorefractor.

RESULTS

For those with normal vision, and after adjustments, for every 60min increase in physical activity, normal-sighted adults had an 18% (HR=0.82; 95% CI: 0.72-0.93) reduced risk of all-cause mortality. Similarly, after adjustments and for every 60min increase in physical activity for those with uncorrected refractive error and VI, respectively, there was a 15% (HR=0.85; 95% CI: 0.72-1.00) and 35% (HR=0.65; 95% CI: 0.43-0.98) reduced risk of all-cause mortality. Among all three visual status groups, sedentary behavior was not associated with mortality status.

CONCLUSION

Among those with varying degrees of visual loss, sedentary behavior was not associated with mortality, but physical activity demonstrated survival benefits.

Healthy Lifestyle Characteristics and Their Joint Association With Cardiovascular Disease Biomarkers in US Adults

OBJECTIVE

To estimate the prevalence of healthy lifestyle characteristics and to examine the association between different combinations of healthy lifestyle characteristics and cardiovascular disease biomarkers.

PATIENTS AND METHODS

The prevalence of healthy lifestyle characteristics was estimated for the US adult population (N=4745) using 2003-2006 National Health and Nutrition Examination Survey data for the following parameters: being sufficiently active (accelerometer), eating a healthy diet (Healthy Eating Index based on 24-hour recalls), being a nonsmoker (serum cotinine level), and having a recommended body fat percentage (dual-energy X-ray absorptiometry). Cardiovascular biomarkers included mean arterial pressure, C-reactive protein, white blood cells (WBCs), total cholesterol, high-density lipoprotein cholesterol (HDL-C), total cholesterol to HDL-C ratio, fasting low-density lipoprotein cholesterol, fasting triglycerides, fasting glucose, fasting insulin, insulin resistance, hemoglobin A1c, and homocysteine. The study was conducted from August 15, 2013, through January 5, 2016.

RESULTS

Only 2.7% (95% CI, 1.9%-3.4%) of all adults had all 4 healthy lifestyle characteristics. Participants with 3 or 4 compared with 0 healthy lifestyle characteristics had more favorable biomarker levels except for mean arterial blood pressure, fasting glucose, and hemoglobin A1c. Having at least 1 or 2 compared with 0 healthy lifestyle characteristics was favorably associated with C-reactive protein, WBCs, HDL-C, total cholesterol, and homocysteine. For HDL-C and total cholesterol, the strongest correlate was body fat percentage. For homocysteine, a healthy diet and not smoking were strong correlates; for WBCs, diet was not a strong correlate.

CONCLUSION

Although multiple healthy lifestyle characteristics are important, specific health characteristics may be more important for particular cardiovascular disease risk factors.

Global Sensory Impairment in Older Adults in the United States

OBJECTIVES

To determine whether there may be a common mechanism resulting in global sensory impairment of the five classical senses (vision, smell, hearing, touch, and taste) in older adults.

DESIGN

Representative, population-based study.

SETTING

National Social Life, Health, and Aging Project.

PARTICIPANTS

Community-dwelling U.S. adults aged 57 to 85.

MEASUREMENTS

The frequency with which impairment co-occurred across the five senses was estimated as an integrated measure of sensory aging. It was hypothesized that multisensory deficits would be common and reflect global sensory impairment that would largely explain the effects of age, sex, and race on sensory dysfunction.

RESULTS

Two-thirds of subjects had two or more sensory deficits, 27% had just one, and 6% had none. Seventy-four percent had impairment in taste, 70% in touch, 22% in smell, 20% in corrected vision, and 18% in corrected hearing. Older adults, men, African Americans, and Hispanics had greater multisensory impairment (all P < .01). Global sensory impairment largely accounted for the effects of age, sex, and race on the likelihood of impairment in each of the five senses.

CONCLUSION

Multisensory impairment is prevalent in older U.S. adults. These data support the concept of a common process that underlies sensory aging across the five senses. Clinicians assessing individuals with a sensory deficit should consider further evaluation for additional co-occurring sensory deficits.

Apolipoprotein E Allele and Hearing Thresholds in Older Adults

BACKGROUND

Whether apolipoprotein E (APOE) E4 allele status which is associated with an increased risk of cognitive decline is also associated with hearing impairment is unknown.

METHODS

We studied 1833 men and women enrolled in the Health, Aging and Body Composition study. Regression models adjusted for demographic and cardiovascular risk factors were used to assess the cross-sectional association of APOE-E4 status with individual pure tone hearing thresholds and the 4-frequency pure tone average (0.5-4 kHz) in the better hearing ear.

RESULTS

Compared to participants with no APOE-E4 alleles, participants with 1 allele had better thresholds at 4.0 kHz (β = -2.72 dB, P = .013) and 8.0 kHz (β = -3.05 kHz, P = .006), and participants with 2 alleles had better hearing thresholds at 1.0 kHz (β = -8.56 dB, P = .021).

CONCLUSION

Our results suggest that APOE-E4 allele status may be marginally associated with better hearing thresholds in older adults.

Physical activity restriction in age-related eye disease: a cross-sectional study exploring fear of falling as a potential mediator

BACKGROUND

Fear of falling (FoF) is predictive of decreased physical activity. This study sought to determine if FoF mediates the relationship between decreased vision and physical activity restriction in individuals with glaucoma and age-related macular degeneration (AMD).

METHODS

Accelerometers were used to measure physical activity over 1 week in 59 control, 83 glaucoma, and 58 AMD subjects. Subjects completed the University of Illinois at Chicago Fear of Falling Questionnaire, and the extent of FoF was estimated using Rasch analysis. In negative binomial models adjusting for demographic, health, and social factors, FoF was investigated as a potential mediator between the severity of visual field (VF) loss (in glaucoma patients) or the severity of contrast sensitivity (CS) loss (in AMD patients) and decreased engagement in physical activity, defined as minutes spent in moderate-to-vigorous physical activity (MVPA) per day.

RESULTS

In multivariate negative binomial regression models, 5-decibels worse VF mean deviation was associated with 26 % less engagement in MVPA [rate ratio (RR) = 0.74, p < 0.01] amongst glaucoma subjects. When FoF was added to the model, the RR increased from 0.74 to 0.78, and VF loss severity remained associated with less MVPA at a statistically significant level (p < 0.01). Likewise, 0.1 log units worse CS was associated with 11 % less daily MVPA (RR = 0.89, p < 0.01) amongst AMD subjects. When FoF was added to the model, the RR increased from 0.89 to 1.02, and CS loss was no longer associated with MVPA at a statistically significant level (p = 0.53).

CONCLUSIONS

FoF may mediate the relationship between vision loss and physical activity restriction amongst patients with AMD. Future work should determine optimal strategies for reducing FoF in individuals with vision loss in order to prevent the deleterious effects of physical activity restriction.

Influence of visual acuity on anxiety, panic and depression disorders among young and middle age adults in the United States

BACKGROUND

Previous research, albeit limited, has demonstrated an association of visual acuity with depression and anxiety. However, these studies are limited in that they have focused on older adults, used a convenient sample, and/or used a subjective assessment of visual function. As a result, the purpose of this study was to examine the association of objectively-measured visual acuity with depression and anxiety (and panic disorder) among a national sample of young- and middle-age U.S. adults (20-39 years).

METHODS

Using data from the 2003-2004 NHANES (n=602), the presence of anxiety, depression, and panic disorders was assessed from a diagnostic interview. Visual acuity was assessed from a vision exam using the Nidek Auto Lensmeter Model (LM-990A) and expressed as LogMAR units.

RESULTS

After adjusting for age, gender, race-ethnicity, body mass index, mean arterial pressure, cotinine, diabetes, and physical activity, visual acuity was not associated with panic disorder (p=0.71) or depression disorder (p=0.20), but for every 0.1 LogMAR unit change in vision, participants had a 14% (OR=1.14; p=0.04) higher odds of having an anxiety disorder.

LIMITATIONS

The main limitation of this study was the cross-sectional design.

CONCLUSION

Young- and middle-age U.S. adults with worse visual function are at increased odds of having an anxiety disorder. Strategies to prevent and treat anxiety among those with worse visual function are needed.

Cardiorespiratory Fitness and Vision Loss among Young and Middle-Age U.S. Adults

Purpose.

To examine the association between vision loss and cardiorespiratory fitness among young and middle-age U.S. adults.

Design.

The study had a cross-sectional design.

Setting.

The National Health and Nutrition Examination Survey 1999–2004 served as the study setting.

Subjects.

Study subjects included 3135 adults ages 20 to 49 years.

Measures.

Cardiorespiratory fitness was assessed from cardiorespiratory extrapolation using heart rate response during submaximal treadmill testing, with inadequate cardiorespiratory fitness defined as below the 60th percentile for age and gender. Visual acuity was objectively assessed for each eye.

Analysis.

Multivariable regression (linear and logistic) models were computed to examine the association between cardiorespiratory fitness and vision.

Results.

Poorer cardiorespiratory fitness (β = −3.7 mL O2/kg per minute; 95% confidence interval: −5.3 to −2.2) was observed in subjects with visual impairment after adjusting for age, gender, race/ethnicity, and comorbid illness. Participants with vision impairment, as compared with those with normal sight, had 4.4-fold higher odds of having inadequate cardiorespiratory fitness (95% confidence interval: 1.04–18.97), whereas participants with uncorrected refractive error were not more likely to demonstrate poorer cardiorespiratory fitness.

Conclusion.

Adults with visual impairment, but not adults with uncorrected refractive error, demonstrate a significant reduction in cardiorespiratory fitness and are much more likely to have inadequate fitness compared with those with normal vision. Evaluation and implementation of strategies to increase cardiorespiratory fitness among those with vision impairment, in particular, are needed.

Association of diabetic peripheral arterial disease and objectively-measured physical activity: NHANES 2003-2004

Background

Although much is known about the management of peripheral arterial disease among adults in the general population, the management of this disease among those with diabetes, and the effects of diabetic-induced peripheral arterial disease on objectively-measured physical activity, is unclear. Here, we examined the association between accelerometer-assessed physical activity and peripheral arterial disease among a national sample of U.S. adults with diabetes.

Methods

Data from the 2003–2004 National Health and Nutrition Examination Survey were used. Physical activity was measured using an accelerometer in 254 adults with diabetes. Peripheral arterial disease was assessed via ankle brachial index. Negative binomial regression analysis was used to examine the association between physical activity and peripheral arterial disease.

Results

Results were adjusted for age, gender, race-ethnicity, comorbidity index, smoking, HgbA1C, C-reactive protein, homocysteine, glomerular filtration rate, microalbuminuria, peripheral neuropathy, physical functioning, and medication use. After adjustments, participants with peripheral arterial disease engaged in 23% less physical activity (RR = 0.77, 95% CI: 0.62-0.96) than those without peripheral arterial disease.

Conclusions

These findings demonstrate an inverse association between accelerometer-assessed physical activity and peripheral arterial disease in a national sample of U.S adults with diabetes.