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west - Is Vision Function Related to Physical Functional...

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JAGS 50:136–145, 2002 © 2002 by the American Geriatrics Society 0002-8614/02/$15.00 Is Vision Function Related to Physical Functional Ability in Older Adults? Catherine G. West, MD,* Ginny Gildengorin, PhD,* Gunilla Haegerstrom-Portnoy, OD, PhD, Marilyn E. Schneck, PhD,* Lori Lott, PhD,* and John A. Brabyn, PhD* OBJECTIVES: To assess the relationship between a broad range of vision functions and measures of physical perfor- mance in older adults. DESIGN: Cross-sectional study. SETTING: Population-based cohort of community-dwell- ing older adults, subset of an on-going longitudinal study. PARTICIPANTS: Seven hundred eighty-two adults aged 55 and older (65% of living eligible subjects) had subjec- tive health measures and objective physical performance evaluated in 1989/91 and again in 1993/95 and a battery of vision functions tested in 1993/95. MEASUREMENTS: Comprehensive battery of vision tests (visual acuity, contrast sensitivity, effects of illumination level, contrast and glare on acuity, visual fields with and without attentional load, color vision, temporal sensitivity, and the impact of dimming light on walking ability) and physical function measures (self-reported mobility limita- tions and observed measures of walking, rising from a chair and tandem balance). RESULTS: The failure rate for all vision functions and physical performance measures increased exponentially with age. Standard high-contrast visual acuity and stan- dard visual fields showed the lowest failure rates. Non- standard vision tests showed much higher failure rates. Poor performance on many individual vision functions was significantly associated with particular individual measures of physical performance. Using constructed combination vision variables, significant associations were found between spatial vision, field integrity, binocularity and/or adapta- tion, and each of the functional outcomes. CONCLUSIONS: Vision functions other than standard visual acuity may affect day-to-day functioning of older adults. Additional studies of these other aspects of vision and how they can be treated or rehabilitated are needed to determine whether these aspects play a role in strategies for reducing disability in older adults. J Am Geriatr Soc 50:136–145, 2002. Key words: vision function; physical performance; mobility A dequate vision function has long been recognized as an important factor for independence in older adults. Cross-sectional studies have demonstrated that visual im- pairment (defined as reduced visual acuity), either self- reported or performance-based, is a correlate of physical disability and falls. 1–6 In longitudinal analyses, poor visual acuity was also associated with the later development of self-reported limitations in both mobility and activities of daily living (ADLs). 2 Distance visual acuity is commonly tested in clinical practice using wall charts with black letters on a white background under high light levels. Because these types of charts are known to participants and easy to administer, they have frequently been used to define visual impairment in epidemiological studies of older adults.
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