DUAL SENSORY IMPAIRMENT AND CHANGE IN ADL ABILITY AMONG ELDERLY OVER TIME: A SEM LATENT GROWTH CURVE APPROACH Ya-ping Su, PhD, The Peer Review Organization of New Jersey Mark Brennan, PhD and Amy Horowitz, DSW Arlene R. Gordon Research Institute Research funded by the AARP Andrus Foundation

Dual Sensory Loss (Vision + Hearing) Age-related vision and hearing impairments are two of the most prevalent chronic conditions affecting quality of life and medical service use among older Americans (NCHS, 1999). In 1995, 18% of noninstitutionalized adults aged 70 and older were vision impaired, one-third were hearing impaired and 9% were dual impaired. The prevalence of vision and hearing impairment increases sharply with age (e.g., among adults aged 85 and older, 31% were vision impaired, 50% were hearing impaired and 24% were dual impaired).

Vision Loss and ADL Functioning Consistent Finding functional disabilityA growing body of research highlighting the relationship between vision loss and functional disability among community-based elderly. More severeMore severe impact on everyday functioning than other physical impairments. declineRisk for decline in functional ability over time.

Hearing Loss and ADL Functioning Mixed Evidence GreaterGreater functional disability compared to the non- imparied not as strongRelationship not as strong as vision impairment No notNo relationship & not an independent predictor of ADL disability over time

Dual Sensory and Functional Ability Limited and Contradictory Evidence notDid not lead to additional deterioration of PADL and IADL over a single sensory deficit in either vision or hearing 40% greater40% greater risk of functional decline over a single vision loss greaterA greater impact on functional disability than that seen with a single impairment

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

Method Data: the Longitudinal Study of Aging (LSOA) which was based on the 1984 National Health Interview Survey (NHIS), a continuous survey of the US population. Sample: the 4-wave sample (N=2,211) Design/Analysis: SEM Latent Growth Curve Only the slope function, or rate of change, latent variable was estimated Unweighted Least Square estimation (ULS)

Sample: Age and Sex

Sample: Race and Health

Sensory Impairment Status Measurement: Sensory impairment status was obtained with the following items: “Which statement best describes your (vision or hearing) even when wearing (glasses/contact lenses or hearing aid): no trouble, a little trouble, or a lot of trouble?” Respondents were classified as non-impaired, singly vision or hearing impaired, or dual impaired based on these items.

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

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

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

Discussion additiveThe effects of dual sensory impairment on changes in PADL and IADL function over time were both additive. Similar patterns were found for both PADL and IADL domains. Mean vector of change for both domains of -.07 indicating a gradual, linear increase in ADL disability over the six years of study. Vision impairmentcomorbid physical healthVision impairment and comorbid physical health measures were the strongest predictors.

Conclusions Vision impairmentVision impairment appears largely responsible for functional limitations, regardless of the level of hearing loss and when controlling for the effects of comorbid physical health and cognitive functions. Future research should continue to address the issue of dual sensory impairment and functional ability over time, using repeated assessments of vision and hearing to examine how change in sensory abilities are related to change in ADL functioning over time.

Implications independentFindings reveal the far-reaching impact of sensory impairment on the quality of life among older adults, and thus underscore the need for expanded educational, rehabilitation and outreach programs for elders with concurrent vision and hearing impairment to support them in their efforts to remain independent. Education of both public and professional audiences is also needed to specifically address the effects of sensory loss, and emphasize that sensory loss should neither be ignored nor considered to be a normal part of aging.

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

For further information, please contact: Ya-ping Su, PhD The Peer Review Organization of New Jersey 557 Cranbury Road, Suite 21 East Brunswick, NJ TEL: (732) ext. 2111/FAX: (732) Mark Brennan, PhD Lighthouse International 111 East 59th Street New York, NY TEL: (212) /FAX: (212)