(Aging 16: 382-388, 2004), © 2004, Editrice Kurtis 382 Aging Clin Exp Res, Vol. 16, No. 5 ABSTRACT. Background and aims: We investigated the prevalence of visual impairment (VI), its determi- nants and its association with Activities of Daily Living (ADL), Instrumental Activities of Daily Living (IADL), Gross Mobility (GM) and 6-year mortality in elderly sub- jects. A cross-sectional survey in a large population ran- domly selected in 1992 with a 6-year mortality evalu- ation in Campania, a region in southern Italy. Meth- ods: A random sample of 1332 elderly subjects aged 65 to 95 years (mean age 74.2±6.4), selected from the electoral rolls, was interviewed by trained physicians. Self-reported visual function, socio-demographic and clinical characteristics were recorded. Disability was as- sessed by measuring ability in ADL, IADL and GM. Re- sults: VI was found to affect 34% of this population, with an age-related increase of mild and severe VI. VI affects ADL, IADL and GM disability. Age, diabetes and low educational level, but not comorbidity or hy- pertension, proved to be predictors of VI. Mortality in- creased with severity of VI in 38.1% of subjects with se- vere functional impairment (p<0.001). The presence of VI was seen to increase the risk of mortality by 1.40 (95% CI 1.07-1.84), independently of age, sex, co- morbidity, diabetes, hypertension or disability. Con- clusions: This study demonstrates an association be- tween visual impairment and disability in an elderly population, and the predictive effect of visual impair- ment on mortality independently of comorbidity. These results illustrate the need to eradicate avoidable blindness, in order to improve the quality of life and to prolong survival of the elderly. (Aging Clin Exp Res 2004; 16: 382-388) © 2004, Editrice Kurtis Disability and 6-year mortality in elderly population. Role of visual impairment Francesco Cacciatore 1,2 , Pasquale Abete 2 , Stefania Maggi 3 , Guido Luchetti 2 , Claudio Calabrese 1 , Luisa Viati 2 , Dario Leosco 2 , Nicola Ferrara 1,4 , Dino Franco Vitale 1 , and Franco Rengo 1,2 1 Department of Rehabilitation, Salvatore Maugeri Foundation, Telese/Campoli (Bn), 2 Chair of Geriatrics, Department of Clinical Medicine, Cardiovascular and Immunological Science, “Federico II” University, Napoli, 3 CNR - Aging Branch - Institute of Neuroscience, Padova, 4 Chair of Internal Medicine, Department of Animal, Vegetal and Environmental Sciences, University of Molise, Italy INTRODUCTION Visual impairment (VI) and blindness are the func- tional end-stage of many eye, metabolic and systemic dis- eases (1-4). The increased life expectancy and preva- lence of age-related diseases have led to an increase in the frequency of VI in the elderly (1-4). This trend has been demonstrated in many recent population-based eye surveys. A Finnish epidemiological cross-sectional study reported that about 65% of the elderly are affected by cataract, aphakia, or pseudiphakia in one or both eyes, with a prevalence increase from 44.6% in the 70- to 74-year-old age group to 97.6% in the 85- to 89-year-old group (1). The Baltimore Eye Sur- vey (2), a population-based prevalence survey of ocular disease among multiracial non-institutionalized people 40 years of age and older, showed an age-related increase in the prevalence of VI and blindness, with a sharp in- crease in the group over 75 years and in subjects with lower socio-economic status (3). The prevalence of VI is also high among nursing-home residents, especially in the oldest group (4). Several studies have indicated VI as a predictor of poor survival in the elderly, independently of age and sex (5). VI was also predictive of all-cause and cause-specific mortality (ischemic heart disease and stroke) in a dia- betic population (6). In a longitudinal study, the mortality rate after 5 years was double in subjects with mild VI (7). VI and cataract at baseline were predictive of mortality af- ter multivariate adjustment for age, male sex, low self-rat- ed health, low socio-economic status, and systemic med- ical conditions (8). VI affects disability in elderly adults, although the rea- son for this phenomenon is still unclear (9-11). The Aging Clinical and Experimental Research Key words: Disability, elderly, mortality, visual impairment. Correspondence: F. Cacciatore, MD, PhD, Dipartimento di Medicina Clinica e Scienze Cardiovascolari ed Immunologiche, Cattedra di Geriatria, Università degli Studi di Napoli “Federico II”, Via S. Pansini 5, 80131 Napoli, Italy. E-mail: fcacciatore@fsm.it Received December 20, 2002; accepted in revised form December 9, 2003.