Sensory impairment and cognitive impairment among older adults in rural China: personal responsibility for health as a possible moderator?

BACKGROUND: Sensory impairment (SI) is often overlooked as a part of normal aging. In the unique context of rural China, there is a dearth of studies exploring the association between SI and cognitive impairment. Personal responsibility for health has been promoted as a positive concept aimed at maintaining and improving health by taking proactive actions, but whether it can modify the association between SI and cognitive impairment remains unclear. Here, we explored the association between SI and cognitive impairment and investigated whether personal responsibility for health is a moderator in this association among Chinese rural older adults.

METHODS: A total of 3,208 Chinese rural older adults (60+) were included in this study. The primary outcome, cognitive impairment, was accessed using the Mini-Mental State Examination (MMSE). Self-reported SI was categorized as hearing impairment (HI), vision impairment (VI), and dual sensory impairment (DSI). Personal responsibility for health was accessed using self-reported questions and categorized into high personal health responsibility and low personal health responsibility. Binary logistic regression models and marginal effect analysis were used to explore the association of SI with cognitive impairment and the moderating effect of personal responsibility for health.

RESULTS: The prevalence of cognitive impairment and self-reported DSI were 19.5% and 21.6%, respectively, among Chinese rural older adults. In fully adjusted models, older adults with HI only (OR = 1.61, 95%CI: 1.22-2.12) or DSI (OR = 1.74, 95%CI: 1.35-2.24) were about twice likely to experience cognitive impairment than those without SI. We found that personal responsibility for health moderated the association between DSI and cognitive impairment (DSI × low personal responsibility for health: OR = 1.82, 95% CI: 1.10-3.02, p = 0.019). Marginal effect analysis showed that under the condition that other variables remain unchanged, for older adults with low personal responsibility for health, the probability of them with DSI experiencing cognitive impairment was 12.8% higher than those without SI (95% CI: 0.071-0.185, p < 0.001).

CONCLUSIONS: This observational study highlights that the relationship between DSI and cognitive impairment varied by personal responsibility for health. It is crucial to focus on the cognitive function of older adults with DSI and low personal health responsibility in rural China.