Study links visual impairment to physical and cognitive function declines in elderly

Maintaining healthy eyes and vision may play a role in postponing some aspects of aging, according to a study that appears in a recent issue of the Journal of the American Geriatrics Society.

In the study that appeared in the November issue of the society's journal, researchers undertook a longitudinal, population-based study of nearly 2,400 individuals ages 77 through 101. The study was designed to "identify how VI (visual impairment) affects physical and cognitive function in old age longitudinally. This knowledge is important to gain insights into the causal relationship between VI and physical and cognitive function," wrote researchers representing several institutions in Germany.

"This may be useful for developing strategies to maintain physical and cognitive function in old age," they added in the article. "This, in turn, may help to postpone the onset of cognitive and functional impairment."

Study participants were assessed on the basis of their physical activity including cycling, walking, swimming, gardening and taking care of others. Cognitive function was evaluated on the basis of reading, writing, social engagement, memory training and games—plus solving crossword puzzles. Participants were recruited through their general practitioner in Germany.

The study's conclusion? Researchers say they demonstrated a "causal" link between severe VI and declines in function. Seniors have undiagnosed and untreated eye or vision problems, leading to preventable falls.

"In view of the large effect of VI on cognitive function, these results especially highlight the importance of VI for decreases in cognitive function in old age," they wrote. "Consequently, interventional strategies to postpone VI might contribute to maintaining physical and cognitive function in old age.

"This should be emphasized because approximately three-quarters of vision loss is avoidable, and many eye care interventions are cost effective," they added.

Opportunity for doctors of optometry

About this time three years ago, Rebecca Wartman, O.D., was helping wrap up an update of the AOA manual Optometric Care of Nursing Home Residents. Dr. Wartman is national director of optometric services for Trident USA and has worked in nursing facilities for 20 years. She also presented on the topic for the AOA at a listening session sponsored by the National Council on Aging. 

The AOA report remains relevant, especially because the population is not getting any younger. According to an Administration on Aging study, the number of people 65 and older will jump from 46.2 million in 2014 to 98.2 million in 2060. They represented 14.5% of the population in 2014. By 2040, that percentage will be 21.7.  

Those kind of projections—and the new study—reinforce the importance of finding ways to keep Americans' eyes healthy as they age, and also serve as a reminder to doctors of optometry that they have their work cut out for them.  

"I agree with the findings that loss of visual function is connected to many of the 'ills' of aging,'" Dr. Wartman says. "The loss of ability and interest in activities, along with the fear of falling, and of course the reality of falls in the elderly, all create a population that is less active and has lost interest in many activities. "Because this loss of visual function can lead to falls with serious injury that can be life-threatening, and the loss of interest leads to more isolation, depression also can become a factor," she added.

"As well, the fear of finding out about a vision problem can cause a patient to not seek an exam in a timely manner, combined with the 'folk knowledge' that vision should decline with aging, create a waterfall into real and permanent loss of function."  

The solution? The researchers are vague. Dr. Wartman is not. She suggests a public service campaign to raise awareness "to help prevent the vision loss that can lead to isolation and fear."