Self-rated near- and distance-vision patterns, vision change, and loss of functional independence in older adults: a longitudinal ELSA study.

BACKGROUND

Self-rated vision is often analysed as a single static measure, leaving the relevance of near versus distance difficulty and recent vision change less clear.

OBJECTIVE

To examine associations of near- and distance-vision patterns and vision change with next-wave loss of functional independence.

METHODS

We used waves 1-9 of the English Longitudinal Study of Ageing. Current-pattern analyses included 50,991 person-intervals from 12,811 participants; vision-change analyses included 39,143 intervals from 10,668 participants. Impairment was defined as self-rated fair, poor, or blind vision with usual correction. Discrete-time complementary log-log models used participant-clustered robust standard errors. The model adjusted for sociodemographic, behavioural, clinical, and hearing factors; an extended model adjusted for memory, orientation, and depressive symptoms.

RESULTS

Near-only, distance-only, and dual impairment were associated with functional-independence loss, with hazard ratios of 1.39 (95% CI, 1.23-1.58), 1.42 (1.22-1.66), and 1.59 (1.37-1.83), respectively. Dual impairment had the largest association with incident instrumental activities of daily living limitation (1.86, 1.53-2.24). Incident, improved/recovered, and persistent impairment were associated with functional-independence loss, with hazard ratios of 1.51 (1.34-1.70), 1.27 (1.11-1.46), and 1.63 (1.39-1.90).

CONCLUSIONS

Self-rated near- and distance-vision patterns and vision change were associated with next-wave functional loss. Distinguishing visual domain and change may add useful information to functional assessment.