Research Article: Combined impairments in vision, hearing and cognition are associated with greater levels of functional and communication difficulties than cognitive impairment alone: Analysis of interRAI data for home care and long-term care recipients in Ontario

Date Published: February 15, 2018

Publisher: Public Library of Science

Author(s): Dawn M. Guthrie, Jacob G. S. Davidson, Nicole Williams, Jennifer Campos, Kathleen Hunter, Paul Mick, Joseph B. Orange, M. Kathleen Pichora-Fuller, Natalie A. Phillips, Marie Y. Savundranayagam, Walter Wittich, Mary Bowen.


The objective of the current study was to understand the added effects of having a sensory impairment (vision and/or hearing impairment) in combination with cognitive impairment with respect to health-related outcomes among older adults (65+ years old) receiving home care or residing in a long-term care (LTC) facility in Ontario, Canada.

Cross-sectional analyses were conducted using existing data collected with one of two interRAI assessments, one for home care (n = 291,824) and one for LTC (n = 110,578). Items in the assessments were used to identify clients with single sensory impairments (e.g., vision only [VI], hearing only [HI]), dual sensory impairment (DSI; i.e., vision and hearing) and those with cognitive impairment (CI). We defined seven mutually exclusive groups based on the presence of single or combined impairments.

The rate of people having all three impairments (i.e., CI+DSI) was 21.3% in home care and 29.2% in LTC. Across the seven groups, individuals with all three impairments were the most likely to report loneliness, to have a reduction in social engagement, and to experience reduced independence in their activities of daily living (ADLs) and instrumental ADLs (IADLs). Communication challenges were highly prevalent in this group, at 38.0% in home care and 49.2% in LTC. In both care settings, communication difficulties were more common in the CI+DSI group versus the CI-alone group.

The presence of combined sensory and cognitive impairments is high among older adults in these two care settings and having all three impairments is associated with higher rates of negative outcomes than the rates for those having CI alone. There is a rising imperative for all health care professionals to recognize the potential presence of hearing, vision and cognitive impairments in those for whom they provide care, to ensure that basic screening occurs and to use those results to inform care plans.

Partial Text

Sensory (vision and hearing) and cognitive impairments are highly prevalent among older adults (65+ years old) and are associated with difficulties in multiple domains including communication, mood, functional ability, and social engagement. The literature has focused on the influence of a single impairment (e.g., hearing impairment, vision impairment, or cognitive impairment) and has infrequently considered their combined influence on health and well-being in older adults. Researchers have even less frequently investigated these combined effects among older adults receiving continuing care services (e.g., home care or long-term care).

The results are presented in four main sections. We first describe the outcomes for each of the two cohorts separately, then compare the two groups, and end with the results from the age-stratified analysis.

To our knowledge, this is the first study on the relationships among combined sensory and cognitive impairments and the associations with several important health outcomes in older adults living in LTC or receiving home care. We found high rates of combined vision, hearing, and cognitive impairments representing one-fifth and just under one-third of home care clients and LTC residents, respectively. Those with multiple impairments are a particularly vulnerable group with unique needs and challenges. Across several important outcomes known to be associated with older adults’ health (e.g., functional independence, skills for daily decision-making and communication), the rates were higher among individuals with CI+DSI versus those with CI-alone. Although not surprising, this is an important new finding that demonstrates of the extent of the effect of combined sensory and cognitive impairments.




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