Multisensory impairment tied to higher mortality and physical function decline in older adults: JAMA

The retrospective cohort study of 1825 older adults showed that an increasing number of sensory impairments was associated with both a steeper decline in physical functioning and a significantly higher rate of mortality compared with individuals with no impairments.

Physical functioning is a critical aspect of older adults' health and quality of life. Age-related decline in physical functioning is a critical component of morbidity associated with frailty and sarcopenia, including disability, falls, and mortality.

Older adults also experience a high prevalence of sensory impairments in addition to declining physical function. In adults above 70 years, impaired olfaction (30%), touch (27%), vision (18%), and hearing (26%) are common. It is widely recognized that sensory function is significantly associated with quality of life and health, but a growing body of evidence indicates that sensory deficits may also be an understudied indicator of increased risk for functional decline and mortality.

Moreover, patients with dual impairment in vision and hearing experience an accumulation of adverse physical functioning and mortality outcomes. In studies of multiple sensory impairments, a similar accumulation of negative cognitive functioning and mortality outcomes is found.

Single sensory impairment is shown to be associated with increased mortality and reduced functional resilience, though the effects of multiple sensory deficits are unknown. To fill this knowledge gap, Varun Vohra, Johns Hopkins University, Baltimore, Maryland, and colleagues aimed to investigate longitudinal associations of the severity, type, and number of sensory impairments with physical function trajectories and mortality in older adults.

For this purpose, they conducted a retrospective analysis of a longitudinal cohort study, the Health, Aging, and Body Composition (Health ABC) study, incorporating data from 1997 to 2013, featuring a 16-year follow-up with annual examinations and questionnaires. The cohort included 3075 women and men aged 70 to 79 years at baseline. All participants with complete sensory testing and covariate data at the analytical baseline (year 5, 2002) were included.

Auditory, olfactory, visual, and touch sensory functions were assessed between 2000 and 2002. The main study outcomes were physical functioning trajectories and mortality risk. Physical function was evaluated longitudinally using the Health ABC physical performance battery (HABCPPB).

The study included 1825 individuals (mean age, 77.4 years; 52% female).

Based on the study, the researchers reported the following findings:

• Multivariable analysis of HABCPPB decline indicated that having 1 sensory impairment (β estimate, −0.01); 2 sensory impairments (β estimate, −0.01); 3 sensory impairments (β estimate, −0.03); or 4 sensory impairments (β estimate, −0.04) was significantly associated with a steeper HABCPPB score decline in a dose-dependent manner.
• Adjusted Cox proportional hazards models indicated that having 1 sensory impairment (hazard ratio [HR], 1.35), 2 sensory impairments (HR, 1.58), 3 sensory impairments (HR, 1.79), or 4 sensory impairments (HR, 1.97) was significantly associated with increased mortality risk in a similarly dose-dependent manner.

The retrospective cohort study showed that the number and degree of sensory impairments were associated with higher mortality and worse physical functional performance in older adults. As compared with other sensory functions, impairments in olfaction may represent a unique sensorineural harbinger of lifespan. Impairments in olfaction may represent a unique sensorineural harbinger of lifespan as compared with other sensory functions.

"These findings strongly support further mechanistic investigation and highlight the importance of treatment and prevention of sensory impairment in older adults," they concluded.

Reference:

Vohra V, Simonsick EM, Kamath V, Bandeen-Roche K, Agrawal Y, Rowan NR. Physical Function Trajectories and Mortality in Older Adults With Multisensory Impairment. JAMA Otolaryngol Head Neck Surg. Published online January 18, 2024. doi:10.1001/jamaoto.2023.4378