Effects of changes in self-reported vision on cognitive, affective, and functional status and living arrangements among the elderly.

PURPOSE: To study effects of changes in self-reported vision on functional status, cognition, depressive symptoms, and living arrangements.
DESIGN: Longitudinal analysis of household survey data.
METHODS: A total of 6234 sample persons observed in the study of Assets and Health Dynamics Among the Oldest Old (AHEAD) 1995 were followed in 1998, 2000, and 2002 or until death or sample attrition. Effects of changes in self-reported vision and other factors were assessed by means of ordinary least-squares and logistic regression with panel data methods. Main outcome measures were limitations of instrumental activities of daily living (IADLs), activities of daily living (ADLs), and other, cognition, depressive symptoms, and living arrangements.
RESULTS: A decline from excellent/good vision to fair/poor near and distance vision had statistically significant effects on several IADL limitations, and some ADL and other limitations. Largest effects were for driving (OR for no limitation: 0.55, P = .003), managing money (OR: 0.61, P < .001), and preparing hot meals (OR: 0.61, P < .001). Onset of fair-poor near vision increased the likelihood of onset of at least one IADL (OR for no limitation: 0.71, P < .01) and ADL (OR: 0.74, P = .003) limitation. Onset of legal blindness resulted in a 78% increase in the likelihood of an IADL limitation (OR for no limitation: 0.22, P < .001). Effects of vision declines on cognition and depressive symptoms were statistically significant but small. Decline in vision increased the probability of nursing home residence.
CONCLUSIONS: Visual impairment has major impacts on functional status. Preventing vision loss is likely to appreciably improve the functioning of elderly persons.