Wilmer Eye Institute, The Johns Hopkins University School of Medicine, Baltimore, Maryland.
Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
J Gerontol A Biol Sci Med Sci. 2020 Feb 14;75(3):596-602. doi: 10.1093/gerona/glz182.
Older adults with visual impairments are at increased risk of negative health outcomes. Here, we investigate the association between visual impairment and frailty.
Cross-sectional and longitudinal relationships between visual impairment (distance visual acuity) and frailty (frailty phenotype criteria) were examined using data from the National Health and Nutrition Examination Survey (NHANES, 1999-2002, ≥60 years) and the Women's Health and Aging Studies (WHAS III). Imbalance of potential confounders, particularly age, was addressed using propensity score-based adjustment. Multinomial logistic regression determined the odds of prefrailty and frailty at baseline in NHANES and ordinal logistic regression examined the odds of baseline and incident frailty over 3 years in WHAS III after adjustment for confounders and probability weighting (survey weights × inverse propensity scores).
In NHANES (n = 2,639, 9% vision impairment), participants with visual impairment were more likely to be prefrail (odds ratio [OR] = 3.2; 95% confidence interval [CI]: 1.9-5.3) and frail (OR = 3.7; 95% CI: 1.5-9.2) than those without visual impairment. In WHAS III (n = 796, 26% mild, 37% moderate/severe vision impairment), participants with mild and moderate/severe vision impairment were more likely to be frail (OR = 2.0; 95% CI: 1.5-2.5; OR = 5.5; 95% CI: 4.2-7.2, respectively). A one-line worse visual acuity (0.1 logMAR increase) was associated with greater odds of frailty (OR = 1.5; 95% CI: 1.4-1.7). Of those non-frail at baseline (n = 549), moderate/severe visual impairment and one-line worse visual acuity was associated with greater odds of incident frailty (OR = 3.5; 95% CI: 1.4-8.4; OR = 1.3; 95% CI: 1.1-1.5, respectively) over 3 years.
Visual impairment may be an important, yet understudied risk factor for frailty.
视力受损的老年人发生负面健康结局的风险增加。在这里，我们研究了视力损害与虚弱之间的关系。
使用来自国家健康和营养检查调查（NHANES，1999-2002 年，≥60 岁）和妇女健康与老龄化研究（WHAS III）的数据，分别通过横断面和纵向关系来检验视力损害（距离视力）和虚弱（虚弱表型标准）之间的关联。使用倾向评分调整来解决潜在混杂因素的不平衡问题，特别是年龄。多分类逻辑回归确定了 NHANES 中基线时预虚弱和虚弱的可能性，有序逻辑回归则在调整混杂因素和概率加权（调查权重×逆倾向评分）后，检验了 WHAS III 中 3 年内基线和新发虚弱的可能性。
在 NHANES（n=2639，9%视力障碍）中，与无视力障碍的参与者相比，有视力障碍的参与者更有可能处于虚弱前期（优势比[OR]=3.2；95%置信区间[CI]：1.9-5.3）和虚弱（OR=3.7；95%CI：1.5-9.2）。在 WHAS III（n=796，26%轻度，37%中度/重度视力障碍）中，轻度和中度/重度视力障碍的参与者更有可能虚弱（OR=2.0；95%CI：1.5-2.5；OR=5.5；95%CI：4.2-7.2）。视力每下降一行（0.1 对数视力损害增加），虚弱的可能性就会增加 1.5 倍（OR=1.5；95%CI：1.4-1.7）。在基线时非虚弱的参与者中（n=549），中度/重度视力障碍和视力下降一行与较高的新发虚弱可能性相关（OR=3.5；95%CI：1.4-8.4；OR=1.3；95%CI：1.1-1.5），为期 3 年。
视力损害可能是虚弱的一个重要但研究不足的危险因素。
