The Relationship of Self-rated Vision and Hearing to Functional Status and Well-being Among Seniors 70 Years and Older PAUL LEE, MD, JD, JAMES P. SMITH, PHD, AND RAYNARD KINGTON, MD, PHD ● PURPOSE: To describe the relationship between self- reported visual and hearing impairment and an index of global functional status among seniors age 70 years or older. ● METHODS: A total of 7,320 United States community- dwelling persons aged 70 years or older participating in the 1993 Assets and Health Dynamics of the Oldest Old Survey (AHEAD) completed detailed questionnaires about their demographic, socioeconomic, and health sta- tus. Multivariate analyses of functional status (using a global index of functional status based on self-reported limitations in 11 activities) were conducted, controlling for demographic and socioeconomic status and common medical conditions, as well as independently for hearing and vision. ● RESULTS: Of the respondents, 27% rated their vision as fair or poor, whereas 25% rated their hearing as fair or poor. Controlling for demographic factors, socioeco- nomic status, medical conditions, and general health status, limitations in both vision and hearing correlated independently with worsened functional status. Control- ling for income, wealth, and education did not greatly reduce the strength of the association between visual and hearing impairment and function. ● CONCLUSIONS: Visual and hearing impairment appear to have a significant relationship to overall functioning in the oldest old, regardless of income or wealth. By con- firming these findings across income and household wealth groups, adjusted for medical conditions and gen- eral health status, in a nationally representative popula- tion of Americans age 70 years or older, this study provides a powerful added impetus to efforts for improv- ing vision and hearing for all other Americans, including the oldest old. (Am J Ophthalmol 1999;127:447– 452. © 1999 by Elsevier Science Inc. All rights reserved.) T HE LOSS OF VISION AND HEARING HAS BEEN ASSOCI- ated with important health decrements among older Americans. 1–4 Whether measured by visual acuity, “trouble seeing,” “blurred vision,” or by other terms, diminished vision has been associated with a greater rate of hip fractures, 1 loss of general functional status, well- being, 2–4 and vision-related functioning. 5–8 Similarly, loss of aural acuity has been associated with important decre- ments in health-related functioning and well-being. 6,9 –11 Furthermore, poor hearing has been shown to correlate with a higher subsequent risk for nursing home placement and cognitive decline. 12,13 However, only one previous study has been able to address the relationship between visual difficulties (“trou- ble seeing”) and functioning, while explicitly adjusting for socioeconomic status, including detailed household in- come and wealth in a nationally representative popula- tion. 3 This study extends previous research in addressing the relationship of both self-rated vision and hearing to functioning and also explicitly adjusts for both as well as for personal and household income, wealth, and the educational disparities that may play a causal role in differences in the risk of poor functioning. This study also uses a large and detailed data set to provide more precise adjustments for general health status, comorbid medical status, and demographic factors for the fastest growing portion of our population—seniors age 70 years or older. As a result, this study provides a more complete assessment of the impact of difficulties with hearing and vision in this population than has been described previously. METHODS THIS STUDY IS BASED ON DATA FROM THE FIRST WAVE OF the Asset and Health Dynamics of the Oldest Old Survey Accepted for publication Oct 27, 1998. From RAND, Santa Monica, California (Drs Lee, Smith and Kington); Duke University School of Medicine, Durham, North Carolina (Dr Lee); and the National Center for Health Statistics, Baltimore, Maryland (Dr Kington). Supported by a grant from the National Institute on Aging (5PO- AG08291) and Research to Prevent Blindness, Inc, New York, New York. Reprint requests to Paul Lee, MD, JD, RAND, 1700 Main Street, P.O. Box 2138, Santa Monica, CA 90407-2138; fax: (310) 451-6917; e-mail: Paul_Lee@rand.org © 1999 BY ELSEVIER SCIENCE INC.ALL RIGHTS RESERVED. 0002-9394/99/$20.00 447 PII S0002-9394(98)00418-8