AS669 - The Women’s Health Initiative Vision Impairment Project (WHI-VIP)

Investigator Names and Contact Information

Emily Gower (egower@unc.edu)

Introduction/Intent

Approximately 55% of older Americans have hearing and/or vision impairment, making these sensory impairments important chronic conditions of late life. Prior data suggest that older adults with vision and hearing impairments are more vulnerable to a multitude of negative health outcomes, including increased disability, comorbidity, and mortality; however, the impact of these sensory impairments on health outcomes in late life is not fully understood. This 5-year grant proposal “The Women’s Health Initiative Sensory Impairment Project (WHI SIP)” aims to fill these knowledge gaps by integrating objective measures of vision, hearing, and a global measure of cognitive functioning into the second visit of the Long Life Study cohort (LLS2) embedded in the WHI. We aim to enroll all 4200 women participating in the LLS2 home visit. We will test distance visual acuity, contrast sensitivity and hearing during the LLS2 visit. We will follow these women longitudinally to assess the impact of sensory impairment on major health outcomes that are adjudicated as part of WHI. We also will utilize the CMS-WHI link to assess a series of questions related to health care utilization.

SPECIFIC AIMS

The overarching goal of this 5-year grant proposal “The Women’s Health Initiative Sensory Impairment Project (WHI SIP)” is to determine the longitudinal impact of age-related sensory impairments on health outcomes among older adults. This application is timely because it allows for integration with a planned inperson study, and highly important because it fills a current knowledge gap by using validated in-person vision and hearing assessments to identify sensory impairment. The proposed research will leverage data and resources from the Women’s Health Initiative (WHI), which includes a well-established infrastructure and repository of multiple measures collected from a well-characterized cohort of older women sampled from across the US.

Approximately 55% of older Americans have hearing and/or vision impairment, making these sensory impairments important chronic conditions of late life. Prior work has indicated that the negative impact of these sensory impairments goes far beyond visual and hearing function. Older adults with vision and/or hearing impairments have worse physical and cognitive functioning and poorer quality of life, as well as increased disability, comorbidity, and mortality. These data suggest that older adults with sensory impairments are more vulnerable to negative health outcomes; however, the impact of sensory impairment on health outcomes is not fully understood. First, while other studies have shown that vision and hearing impairments are associated with a greater number of comorbidities, longitudinal data examining the risk of specific chronic diseases, including cancer, stroke, and cardiovascular disease by sensory impairments are limited. These comorbidities are three of the top four causes of death among Americans 65 years and older, making understanding factors contributing to their prevalence or exacerbating their severity of high public health importance. Second, previous research has found that older adults with sensory impairments have increased risk of cognitive impairment. However, there is limited work examining dual sensory impairment – defined as concurrent vision and hearing impairments. Additionally, not all older adults with sensory impairments develop cognitive decline, suggesting there may be factors bolstering cognitive functioning in these cognitively-resilient individuals. There is limited research identifying characteristics of individuals that do not go to cognitive impairment, such as levels of physical functioning and social engagement. Therefore, investigating the relationship between both dual sensory impaired, and cognitive impairment “escapees” with sensory impairments, would enhance our understanding of the sensory-cognitive relationship and help to identify interventions. Third, while prior work indicates that older adults with sensory impairments have higher rates of hospitalizations and higher healthcare costs, prospective data using objective sensory impairment assessments are lacking. But, full examination of the utilization and cost of care the diseases that are the primary causes of death in the US are limited for populations with vision and/or hearing impairments, leaving an important gap in the disability health disparity literature. Fourth, dual sensory impairment, defined as concurrent vision and hearing impairments, is hypothesized to have a greater impact on health outcomes over vision or hearing impairment alone. While dual sensory impairment is common among the oldest old, there is limited research examining the health outcomes associated with having combined impairments. Our project will address each of these gaps, through the following specific aims.

Aim 1: To determine the impact of vision, hearing, and dual sensory impairment on three adjudicated health outcomes: cancer, stroke, and cardiovascular disease in a well-characterized population of older women. We hypothesize that women with vision or hearing impairments will be at increased risk of cancer, stroke, and cardiovascular disease, and that those with dual sensory impairments will be at greatest risk.

Aim 2: To characterize the relationship between vision, hearing, and dual sensory impairment and cognitive functioning. Using data from the Montreal Cognitive Assessment (MOCA) and cognitive change index (CCI), we will test our hypotheses that women with dual sensory impairments are at greatest risk of cognitive decline then those with vision or hearing impairments alone, and that older women with sensory impairments who are cognitive decline “escapees” will have unique risk factor profiles as determined using latent class regression modeling approaches.

Aim 3: To determine differences in healthcare utilization between older women with and without sensory impairments. We will create a novel dataset linking healthcare utilization data from the Centers of Medicare and Medicaid (CMS) to the WHI cohort to test our hypothesis that women with vision or hearing impairments will have less health utilization than those without these impairments, particularly for care related to primary prevention (osteoporosis screening, mammography, etc.).

By creating a novel data resource that includes objective measures of vision and hearing added to the Women’s Health Initiative (WHI) Long Life Study 2 (LLS2) cohort, this proposed research addresses a National Institute on Aging (NIA) strategic mission (Goal A-4) to “understand the sensory and motor changes associated with aging and how they lead to decreased function and increased incidence of disease”.