Thompson Atalie C, Rigdon Joseph, Miller Michael E, Kritchevsky Stephen B
Department of Surgical Ophthalmology, Wake Forest University School of Medicine, Winston Salem, North Carolina, USA.
Division of Gerontology and Geriatric Medicine, Wake Forest University School of Medicine, Winston Salem, North Carolina, USA.
J Am Geriatr Soc. 2025 Jun 18. doi: 10.1111/jgs.19584.
Older adults with visual impairment (VI) have a greater risk of mortality, but the reasons are poorly understood. We have shown that older adults with VI are more likely to have poor mobility performance on the short physical performance battery (SPPB). In this analysis, we examined whether VI predicted mortality over 10 years and if this was related to poor baseline mobility (SPPB < 9).
We analyzed 2457 older adults (mean age 75.6 (±2.8) years, 38.5% black, 51.9% female) who completed vision testing at the year 3 visit in the Health, Aging and Body Composition study. Cox proportional hazards models for mortality were right-censored at 10 years and adjusted for demographic and clinical comorbidities. VI (visual acuity < 20/40 or log contrast sensitivity < 1.55 or stereoacuity > 85) and SPPB < 9 were tested as main predictors and their interaction was tested.
In separate multivariable models, VI (HR 1.511, 95% CI [1.335-1.709], p < 0.0001) and SPPB < 9 (HR 1.442, 95% CI [1.210-1.717], p < 0.0001) each predicted mortality. When including both poor mobility and vision variables as main effects, both poor mobility and impaired vision remained significant predictors of mortality in all models (all p < 0.001). When adding poor mobility (as a main effect and interaction with VI) and using unimpaired vision and mobility as the reference, those with only VI (HR 1.467, 95% CI [1.287-1.672], p < 0.0001) or only poor mobility (HR 1.380, 95% CI [0.963-1.979], p = 0.0792) had similar HRs, while those with both VI and poor mobility had an increased mortality risk (HR 2.035, 95% CI [1.643-2.522], p < 0.0001), but the interaction was not significant (p = 0.981).
Older adults with both VI and poor mobility are at an additive increased risk of mortality. Future interventions may want to target older adults with both VI and poor mobility to improve survival.
视力障碍（VI）的老年人死亡风险更高，但原因尚不清楚。我们已经表明，患有视力障碍的老年人在简短身体功能测试（SPPB）中更有可能身体活动能力较差。在本分析中，我们研究了视力障碍是否能预测10年以上的死亡率，以及这是否与基线身体活动能力差（SPPB<9）有关。
我们分析了2457名老年人（平均年龄75.6（±2.8）岁，38.5%为黑人，51.9%为女性），他们在健康、衰老和身体成分研究的第3年随访时完成了视力测试。死亡率的Cox比例风险模型在10年时进行右删失，并对人口统计学和临床合并症进行了调整。将视力障碍（视力<20/40或对数对比敏感度<1.55或立体视锐度>85）和SPPB<9作为主要预测因素进行测试，并测试它们的相互作用。
在单独的多变量模型中，视力障碍（风险比[HR]1.511，95%置信区间[CI][1.335-1.709]，p<0.0001）和SPPB<9（HR 1.442，95%CI[1.210-1.717]，p<0.0001）均能预测死亡率。当将身体活动能力差和视力变量都作为主要效应纳入时，身体活动能力差和视力受损在所有模型中仍然是死亡率的显著预测因素（所有p<0.001）。当加入身体活动能力差（作为主要效应以及与视力障碍的相互作用）并以视力和身体活动能力正常作为参照时，仅患有视力障碍者（HR 1.467，95%CI[1.287-1.672]，p<0.0001）或仅身体活动能力差者（HR 1.380，95%CI[0.963-1.979]，p=0.0792）的风险比相似，而同时患有视力障碍和身体活动能力差者的死亡风险增加（HR 2.035，95%CI[1.643-2.522]，p<0.0001），但相互作用不显著（p=0.981）。
同时患有视力障碍和身体活动能力差的老年人死亡风险额外增加。未来的干预措施可能需要针对同时患有视力障碍和身体活动能力差的老年人，以提高生存率。
