Assessing the Burden of Worsening Self-reported Vision in Older Americans Using the Health and Retirement Study
Assessing the Burden of Worsening Self-reported Vision in Older Americans Using the Health and Retirement Study

Author: Vanessa Shih

Publisher:

Published: 2015

Total Pages: 38

ISBN-13:

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Background Visual disorders are estimated to affect about 3.6% of Americans by 2020. Vision impairment has a substantial impact on individuals functionally. Vision impairment is associated with many comorbidities, functional limitations, as well as higher caregiving needs. This study aims to assess the transition to self-reported vision impairment and the effect on an individual's functionality and ability to live independently. Methods The Health and Retirement Study is an ongoing, biennial survey of older Americans that collects an abundance of data on an individual's family, health, and financial circumstances. The explanatory variable of interest was a dichotomous variable of vision impaired or not vision impaired as defined by their self-reported vision status. Outcomes studied were functional limitations defined as difficulty performing activities of daily living (ADLs) and instrumental activities of daily living (IADLs), likelihood of move to nursing home, and both informal and formal caregiving needs. Descriptive univariate and bivariate statistics were performed to describe the demographics of the sample over the ten waves of data used, from 1995-2012. Multivariable logistic regressions controlling for sociodemographic characteristics, were performed to test the association between vision status and outcomes of interest for specific representative waves. Panel data methods of logistic regression were used to measure the association between a transition to impaired vision and the effect on functional limitations and nursing home residence while controlling for potential confounders and within-patient correlation. Specifically, mixed-effects logistic regressions with subject-level random-effects were conducted for the binary outcomes of nursing home residence, difficulty in performing at least one ADL, and difficulty in performing at least one IADL. Results The prevalence of overall vision impairment was, on average, about 6%. On average, about 5% and 7% of respondents had near and distal vision impairment, respectively. The overall prevalence of nursing home residence in our sample was approximately 2%. Prevalence of ADL and IADL limitations was stable across waves but ranged from 1%-20% for each of the six ADL and five IADL limitations. More respondents reported receiving informal caregiving versus formal caregiving; however the hours of caregiving received was similar for both formal and informal caregiving recipients. Multivariable logistic regression for three representative waves found numerically higher odds of a nursing home residence for vision impaired individuals compared to individuals with no vision impairment, though the difference was not significant. The odds ratios for 1998, 2006, and 2012 were 1.08 (95% CI: 0.64, 1.84), 1.09 (95% CI: 0.64, 1.86), and 1.22 (95% CI: 0.76, 1.97), respectively. Significant associations were found between vision impairment and functional limitations. Using a similar approach, the odds ratio for difficulty performing at least one ADL was 2.57 (95% CI: 2.16, 3.05), 2.37 (95% CI: 1.97, 2.84), and 2.31 (95% CI: 1.92, 2.77) in 1998, 2006, and 2012, respectively. The odds ratios for difficulty performing at least one IADL was 3.78 (95% CI: 3.15, 4.53), 3.94 (95% CI: 3.26, 4.76), and 3.49 (95% CI: 2.89, 4.22) in 1998, 2006, and 2012, respectively. In the mixed-effects logistic regression of the total study panel, a transition from no vision impairment to vision impairment was significantly associated with 1.37 times higher odds of a nursing home residence (95% CI: 1.05, 1.78), a 2.96 times higher odds of difficulty performing at least one ADL (95% CI: 2.71, 3.24), and a 4.02 times higher odds of difficulty performing at least one IADL (95% CI: 3.70, 4.37), after controlling for confounders. Discussion We found the estimated prevalence of visual impairment and functional limitations within our sample, and the association between the two, to remain relatively stable over time. Additionally, we found an age-adjusted transition to self-reported vision impairment within an individual to have significant detrimental effects on the ability to live independently and perform ADLs and IADLs without difficulty. Thus, prevention of this transition can substantially impact an individual???s quality of life, and benefits derived from early detection and improved treatment of medical conditions that contribute to vision loss can have extensive value beyond simply improving vision.

Families Caring for an Aging America
Families Caring for an Aging America

Author: National Academies of Sciences, Engineering, and Medicine

Publisher: National Academies Press

Published: 2016-11-08

Total Pages: 367

ISBN-13: 0309448093

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Family caregiving affects millions of Americans every day, in all walks of life. At least 17.7 million individuals in the United States are caregivers of an older adult with a health or functional limitation. The nation's family caregivers provide the lion's share of long-term care for our older adult population. They are also central to older adults' access to and receipt of health care and community-based social services. Yet the need to recognize and support caregivers is among the least appreciated challenges facing the aging U.S. population. Families Caring for an Aging America examines the prevalence and nature of family caregiving of older adults and the available evidence on the effectiveness of programs, supports, and other interventions designed to support family caregivers. This report also assesses and recommends policies to address the needs of family caregivers and to minimize the barriers that they encounter in trying to meet the needs of older adults.

Social Isolation and Loneliness in Older Adults
Social Isolation and Loneliness in Older Adults

Author: National Academies of Sciences, Engineering, and Medicine

Publisher: National Academies Press

Published: 2020-05-14

Total Pages: 317

ISBN-13: 0309671035

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Social isolation and loneliness are serious yet underappreciated public health risks that affect a significant portion of the older adult population. Approximately one-quarter of community-dwelling Americans aged 65 and older are considered to be socially isolated, and a significant proportion of adults in the United States report feeling lonely. People who are 50 years of age or older are more likely to experience many of the risk factors that can cause or exacerbate social isolation or loneliness, such as living alone, the loss of family or friends, chronic illness, and sensory impairments. Over a life course, social isolation and loneliness may be episodic or chronic, depending upon an individual's circumstances and perceptions. A substantial body of evidence demonstrates that social isolation presents a major risk for premature mortality, comparable to other risk factors such as high blood pressure, smoking, or obesity. As older adults are particularly high-volume and high-frequency users of the health care system, there is an opportunity for health care professionals to identify, prevent, and mitigate the adverse health impacts of social isolation and loneliness in older adults. Social Isolation and Loneliness in Older Adults summarizes the evidence base and explores how social isolation and loneliness affect health and quality of life in adults aged 50 and older, particularly among low income, underserved, and vulnerable populations. This report makes recommendations specifically for clinical settings of health care to identify those who suffer the resultant negative health impacts of social isolation and loneliness and target interventions to improve their social conditions. Social Isolation and Loneliness in Older Adults considers clinical tools and methodologies, better education and training for the health care workforce, and dissemination and implementation that will be important for translating research into practice, especially as the evidence base for effective interventions continues to flourish.

Visual Impairment and Eye Care Among Older Americans
Visual Impairment and Eye Care Among Older Americans

Author: Amy L. Freeland

Publisher:

Published: 2009

Total Pages: 244

ISBN-13:

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The aim of this three-paper format dissertation is to explore three topics relevant to public health and vision loss. The three papers are independent studies, yet build upon each other by first describing the population of people aged 40 years and older in the United States in terms of visual impairment, diagnosed eye disease/ injury, and their use of eye care, and then next exploring the factors that influence eye care use for both the general population and the subpopulation of people with diagnosed diabetes. The first paper provides a state-level examination of the characteristics of people aged 40 years and older with vision loss, self-reported eye diseases associated with aging, eye health care access, and eye health behaviors for four states that utilized the Behavioral Risk Factor Surveillance System (BRFSS), Visual Impairment and Access to Eye Care Module and Diabetes Module in 2007. The second and third papers examined three years of BRFSS data from the 11 states that implemented both modules in order to predict non-use of eye care based upon vision loss, diagnosed eye disease, and social demographic characteristics including possession of eye health insurance; however, the third paper focused on the subpopulation of people with diabetes by including diabetes management habits as an additional predictor of eye-care use. Results from the first paper indicate variations in prevalence of eye disease and visual impairment and use of eye care by age and race with rates of eye disease increasing with age; glaucoma and diabetic retinopathy most prevalent in blacks and Hispanics; macular degeneration most prevalent in whites; and use of eye care increasing with diagnosis of eye disease, possession of eye-care insurance, and increasing income. Results from the second study indicate that the strongest predictor of non-use was having no history of diagnosed eye disease, followed closely by not having insurance, and then by having a mid-range household income ($25,000-$35,000). Similar results were revealed for the subpopulation of people with diabetes, with certain positive diabetes management behaviors aiding the prediction of non-use. Implications for public health practice, health policy reform, public policy development, and educational programs are discussed.

Communities in Action
Communities in Action

Author: National Academies of Sciences, Engineering, and Medicine

Publisher: National Academies Press

Published: 2017-04-27

Total Pages: 583

ISBN-13: 0309452961

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In the United States, some populations suffer from far greater disparities in health than others. Those disparities are caused not only by fundamental differences in health status across segments of the population, but also because of inequities in factors that impact health status, so-called determinants of health. Only part of an individual's health status depends on his or her behavior and choice; community-wide problems like poverty, unemployment, poor education, inadequate housing, poor public transportation, interpersonal violence, and decaying neighborhoods also contribute to health inequities, as well as the historic and ongoing interplay of structures, policies, and norms that shape lives. When these factors are not optimal in a community, it does not mean they are intractable: such inequities can be mitigated by social policies that can shape health in powerful ways. Communities in Action: Pathways to Health Equity seeks to delineate the causes of and the solutions to health inequities in the United States. This report focuses on what communities can do to promote health equity, what actions are needed by the many and varied stakeholders that are part of communities or support them, as well as the root causes and structural barriers that need to be overcome.

Making Eye Health a Population Health Imperative
Making Eye Health a Population Health Imperative

Author: National Academies of Sciences, Engineering, and Medicine

Publisher: National Academies Press

Published: 2017-01-15

Total Pages: 587

ISBN-13: 0309439981

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The ability to see deeply affects how human beings perceive and interpret the world around them. For most people, eyesight is part of everyday communication, social activities, educational and professional pursuits, the care of others, and the maintenance of personal health, independence, and mobility. Functioning eyes and vision system can reduce an adult's risk of chronic health conditions, death, falls and injuries, social isolation, depression, and other psychological problems. In children, properly maintained eye and vision health contributes to a child's social development, academic achievement, and better health across the lifespan. The public generally recognizes its reliance on sight and fears its loss, but emphasis on eye and vision health, in general, has not been integrated into daily life to the same extent as other health promotion activities, such as teeth brushing; hand washing; physical and mental exercise; and various injury prevention behaviors. A larger population health approach is needed to engage a wide range of stakeholders in coordinated efforts that can sustain the scope of behavior change. The shaping of socioeconomic environments can eventually lead to new social norms that promote eye and vision health. Making Eye Health a Population Health Imperative: Vision for Tomorrow proposes a new population-centered framework to guide action and coordination among various, and sometimes competing, stakeholders in pursuit of improved eye and vision health and health equity in the United States. Building on the momentum of previous public health efforts, this report also introduces a model for action that highlights different levels of prevention activities across a range of stakeholders and provides specific examples of how population health strategies can be translated into cohesive areas for action at federal, state, and local levels.

Health and Safety Needs of Older Workers
Health and Safety Needs of Older Workers

Author: Institute of Medicine

Publisher: National Academies Press

Published: 2004-03-26

Total Pages: 319

ISBN-13: 030909111X

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Mirroring a worldwide phenomenon in industrialized nations, the U.S. is experiencing a change in its demographic structure known as population aging. Concern about the aging population tends to focus on the adequacy of Medicare and Social Security, retirement of older Americans, and the need to identify policies, programs, and strategies that address the health and safety needs of older workers. Older workers differ from their younger counterparts in a variety of physical, psychological, and social factors. Evaluating the extent, causes, and effects of these factors and improving the research and data systems necessary to address the health and safety needs of older workers may significantly impact both their ability to remain in the workforce and their well being in retirement. Health and Safety Needs of Older Workers provides an image of what is currently known about the health and safety needs of older workers and the research needed to encourage social polices that guarantee older workers a meaningful share of the nation's work opportunities.

Demography of Aging
Demography of Aging

Author: National Research Council

Publisher: National Academies Press

Published: 1994-02-01

Total Pages: 424

ISBN-13: 0309050855

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As the United States and the rest of the world face the unprecedented challenge of aging populations, this volume draws together for the first time state-of-the-art work from the emerging field of the demography of aging. The nine chapters, written by experts from a variety of disciplines, highlight data sources and research approaches, results, and proposed strategies on a topic with major policy implications for labor forces, economic well-being, health care, and the need for social and family supports.