School of Social Work, University of Michigan, Ann Arbor.
Institute for Social Research, University of Michigan, Ann Arbor.
J Gerontol A Biol Sci Med Sci. 2020 Feb 14;75(3):589-595. doi: 10.1093/gerona/glz148.
Vision impairment (VI) in older adults is associated with declines in well-being. However, the pathways through which poor vision leads to declines in well-being have not been well-described. The purpose of this study was to determine whether activity limitations and social participation restrictions mediate the impact of self-reported VI on subjective well-being.
The National Health and Aging Trends Study (NHATS) is a nationally representative longitudinal study of Medicare beneficiaries 65 and older that includes detailed measures of the disablement process. A longitudinal mediation model was conceptualized linking self-reported VI and subjective well-being. Structural equation modeling was used to test the mediating effects of activity limitations and social participation restrictions while adjusting for relevant covariates.
The final sample included 5,431 respondents. At baseline, 8.0% of Medicare beneficiaries had self-reported VI. Subjective well-being scores were significantly lower among respondents with self-reported VI (15.7; 95% confidence interval [CI]: 15.2, 16.2) compared with those without VI (17.6; 95% CI: 17.5, 17.7). Self-reported VI had a significant indirect effect on subjective well-being through limiting mobility (β = -0.04; 95% CI: -0.07, -0.03) and household activities (β = -0.05; 95% CI: -0.08, -0.03), but not self-care limitations (β = 0.0; 95% CI = 0.0, 0.0) or participation restrictions (β = 0.0; 95% CI = -0.01, 0.00). Total indirect effects from all mediation paths accounted for 42% of the effect of VI on well-being.
Mobility and household activity limitations are significant mediators that explain a considerable portion of the impact of poor vision on well-being. Interventions to promote successful accommodation may result in greater overall well-being for older adults with poor vision.
老年人视力障碍（VI）与幸福感下降有关。然而，视力不佳导致幸福感下降的途径尚未得到很好的描述。本研究的目的是确定自我报告的 VI 是否通过活动受限和社会参与受限来影响主观幸福感。
国家健康老龄化趋势研究（NHATS）是一项针对 65 岁及以上医疗保险受益人的全国代表性纵向研究，包括对失能过程的详细测量。概念化了一个纵向中介模型，将自我报告的 VI 与主观幸福感联系起来。结构方程模型用于测试活动受限和社会参与受限对主观幸福感的中介作用，同时调整了相关协变量。
最终样本包括 5431 名受访者。在基线时，8.0%的医疗保险受益人自我报告 VI。与没有 VI 的受访者相比（17.6；95%置信区间[CI]：17.5，17.7），有 VI 的受访者的主观幸福感得分明显较低（15.7；95%CI：15.2，16.2）。自我报告的 VI 通过限制行动能力（β=-0.04；95%CI：-0.07，-0.03）和家务活动（β=-0.05；95%CI：-0.08，-0.03）对主观幸福感有显著的间接影响，但对自我护理的限制没有影响（β=0.0；95%CI=0.0，0.0）或参与限制（β=0.0；95%CI=-0.01，0.00）。所有中介途径的总间接效应占 VI 对幸福感影响的 42%。
行动能力和家务活动受限是重要的中介因素，解释了视力不佳对幸福感影响的相当一部分。促进成功适应的干预措施可能会使视力不佳的老年人整体幸福感得到提高。
