Duke-NUS Medical School, Singapore, Singapore.
Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore.
Gerontology. 2024;70(1):37-47. doi: 10.1159/000533636. Epub 2023 Oct 30.
The concomitant impact of visual impairment (VI) and cognitive impairment (CI) on health-related quality of life (HRQoL) in older adults is unclear. We aimed to determine the synergistic effect of baseline VI and CI on HRQoL decline at 6 years in multiethnic Asians.
We included Chinese, Malay, and Indian adults aged ≥60 years who participated in baseline (2004-2011) and 6-year (2011-2017) follow-up visits of the Singapore Epidemiology of Eye Diseases Study, a population-based cohort study in Singapore. Visual acuity (VA) was objectively measured at both visits, with VI defined as presenting VA >0.3 LogMAR in the better eye. CI was defined as Abbreviated Mental Test scores of ≤6 and ≤8 for individuals with ≤6 and >6 years of formal education, respectively. HRQoL was measured using the European Quality of Life-5 Dimensions (EQ-5D) questionnaire. HRQoL decline was defined as the difference in the composite EQ-5D scores at baseline and 6-year follow-up and deemed clinically meaningful if the reduction was equal to or larger than the minimal clinically important difference. Multivariable linear regression assessed the independent associations and synergism (β interaction) between baseline VI and CI on EQ-5D decline.
Of the 2,433 participants (mean [SD] age: 67.6 [5.5]) at baseline, 559, 120, and 151 had VI only, CI only, and both impairments, respectively. HRQoL decline in individuals with baseline comorbid VI-CI was clinically meaningful and was 2.0 times (β = -0.044, 95% confidence interval: -0.077 to -0.010) and 3.7 times (β = -0.065, 95% confidence interval: -0.11 to -0.022) larger than those with VI only and CI only, respectively. Importantly, there was a significant synergism (β interaction = -0.048, 95% confidence interval: -0.095 to -0.001) between baseline VI and CI as predictors of HRQoL decline, suggesting that individuals having both conditions concurrently had a greater HRQoL reduction than the sum in those with VI alone and CI alone. The affected HRQoL domains included mobility and usual activities.
Concomitant VI-CI potentiated HRQoL decline to a greater extent than the sum of individual contributions of VI and CI, suggesting synergism. Our results suggest that rehabilitative interventions such as the use of mobility aids and occupational therapy are needed to maintain HRQoL in older adults with concomitant VI-CI. Moreover, preventive interventions targeting at early detection and management of both VI and CI may also be beneficial.
视力障碍（VI）和认知障碍（CI）对老年人健康相关生活质量（HRQoL）的共同影响尚不清楚。我们旨在确定基线 VI 和 CI 对多民族亚洲人 6 年内 HRQoL 下降的协同作用。
我们纳入了参加新加坡流行病学眼病研究基线（2004-2011 年）和 6 年（2011-2017 年）随访的年龄≥60 岁的中国、马来和印度成年人，这是一项在新加坡进行的基于人群的队列研究。在两次就诊时均客观测量视力（VA），以更好眼的视力>0.3 LogMAR 定义 VI。CI 定义为 Abbreviated Mental Test 得分分别为≤6 和≤8，对于接受≤6 年和>6 年正规教育的个体。使用欧洲生活质量-5 维度（EQ-5D）问卷测量 HRQoL。如果减少量等于或大于最小临床重要差异，则定义 HRQoL 下降为基线和 6 年随访时的综合 EQ-5D 评分之间的差异，并认为具有临床意义。多变量线性回归评估了基线 VI 和 CI 对 EQ-5D 下降的独立关联和协同作用（β 交互作用）。
在基线时的 2433 名参与者（平均[标准差]年龄：67.6[5.5]）中，分别有 559、120 和 151 人仅有 VI、CI 或两者兼有。基线合并 VI-CI 的个体的 HRQoL 下降具有临床意义，其程度分别为仅 VI 个体和仅 CI 个体的 2.0 倍（β=-0.044，95%置信区间：-0.077 至-0.010）和 3.7 倍（β=-0.065，95%置信区间：-0.11 至-0.022）。重要的是，基线 VI 和 CI 作为 HRQoL 下降的预测因素之间存在显著的协同作用（β 交互作用=-0.048，95%置信区间：-0.095 至-0.001），这表明同时存在两种情况的个体的 HRQoL 下降幅度大于仅存在 VI 和 CI 的个体的总和。受影响的 HRQoL 领域包括移动性和日常活动。
VI-CI 同时存在会比 VI 和 CI 单独存在的个体的 HRQoL 下降总和更能增强 HRQoL 下降，表明存在协同作用。我们的结果表明，需要进行康复干预，例如使用助行器和职业治疗，以维持合并 VI-CI 的老年人的 HRQoL。此外，针对 VI 和 CI 的早期发现和管理的预防性干预也可能是有益的。
