Gender-specific associations of vision and hearing impairments with adverse health outcomes in older Japanese: a population-based cohort study

BACKGROUND: Several epidemiological studies have shown that self-reported vision and hearing impairments are associated with adverse health outcomes (AHOs) in older populations; however, few studies have used objective sensory measurements or investigated the role of gender in this association. Therefore, we examined the association of vision and hearing impairments (as measured by objective methods) with AHOs (dependence in activities of daily living or death), and whether this association differed by gender. METHODS: From 2005 to 2006, a total of 801 residents (337 men and 464 women) aged 65 years or older of Kurabuchi Town, Gunma, Japan, participated in a baseline examination that included vision and hearing assessments; they were followed up through September 2008. Vision impairment was defined as a corrected visual acuity of worse than 0.5 (logMAR = 0.3) in the better eye, and hearing impairment was defined as a failure to hear a 30 dB hearing level signal at 1 kHz in the better ear. Information on outcomes was obtained from the town hall and through face-to-face home visit interviews. We calculated the risk ratios (RRs) of AHOs for vision and hearing impairments according to gender. RESULTS: During a mean follow-up period of 3 years, 34 men (10.1%) and 52 women (11.3%) had AHOs. In both genders, vision impairment was related to an elevated risk of AHOs (multi-adjusted RR for men and women together = 1.60, 95% CI = 1.05-2.44), with no statistically significant interaction between the genders. In contrast, a significant association between hearing impairment and AHOs (multi-adjusted RR = 3.10, 95% CI = 1.43-6.72) was found only in the men. CONCLUSION: In this older Japanese population, sensory impairments were clearly associated with AHOs, and the association appeared to vary according to gender. Gender-specific associations between sensory impairments and AHOs warrant further investigation

Disparities in regular health care utilisation in Europe

Headlines: Regular care use as a public health issue Measuring healthcare utilisation habits Regular health care use at a glance Determinants of individual healthcare habits Exploring cross-country differences in healthcare habits Conclusion

Mobility, satisfaction with functional capacity and perceived quality of life (PQOL) in older persons with self-reported visual impairment: The pathway between ability to get around and PQOL

Research shows that ability to get around (AGA) is significantly associated with perceived quality of life (PQOL) among older persons with self-reported visual impairment. Much of this impact, however, is through satisfaction with one's functional capacity. Satisfaction with functional capacity is a construct composed of five items: satisfaction with (1) activities of daily living, (2) capacity to work, (3) self, (4) health and (5) sleep. At present, it is not known how AGA interacts individually with these items to influence PQOL. Purpose: The purpose of this study is to investigate the extent to which AGA interacts with each of these five items to affect PQOL. Methods: Structural equation modelling was employed in a secondary-analysis of data from 356 persons (aged 56-72) with self-reported visual impairment to identify the pathways by which AGA affects PQOL. Results: Satisfaction with self and health were the only items found to be both directly related to QOL and to provide a significant pathway between AGA and PQOL.Conclusion: AGA significantly affects PQOL both directly and indirectly through its impact on people's satisfaction with self and health. Lessons may be learnt from this to better focus mobility interventions to enhance PQOL in this population. Implications for Rehabilitation: The findings of this study indicate that ability to get around (AGA) has a significant impact on perceived quality of life (PQOL): the stated goal of many rehabilitation programs for older persons who are visually impaired. The study also found that the primary pathway by which AGA influenced PQOL was indirect through its association with both satisfaction with one's self and health rather than direct. Attempts to enhance PQOL by increasing AGA may be most effective if the focus of intervention was on restoring one's sense of self and health as opposed to focusing on meeting practical needs