Xiaoling Xiang1, Vicki A Freedman2, Khushali Shah3,4, Rita X Hu1, Brian C Stagg3,5, Joshua R Ehrlich3,6. 1. School of Social Work, University of Michigan, Ann Arbor. 2. Institute for Social Research, University of Michigan, Ann Arbor. 3. Department of Ophthalmology and Visual Sciences, Center for Eye Policy and Innovation, University of Michigan, Ann Arbor. 4. Miller School of Medicine, University of Miami, Florida. 5. Duke Eye Center, Durham, North Carolina, University of Michigan, Ann Arbor. 6. Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor.
Abstract
BACKGROUND: Vision impairment (VI) in older adults is associated with declines in well-being. However, the pathways through which poor vision leads to declines in well-being have not been well-described. The purpose of this study was to determine whether activity limitations and social participation restrictions mediate the impact of self-reported VI on subjective well-being. METHODS: The National Health and Aging Trends Study (NHATS) is a nationally representative longitudinal study of Medicare beneficiaries 65 and older that includes detailed measures of the disablement process. A longitudinal mediation model was conceptualized linking self-reported VI and subjective well-being. Structural equation modeling was used to test the mediating effects of activity limitations and social participation restrictions while adjusting for relevant covariates. RESULTS: The final sample included 5,431 respondents. At baseline, 8.0% of Medicare beneficiaries had self-reported VI. Subjective well-being scores were significantly lower among respondents with self-reported VI (15.7; 95% confidence interval [CI]: 15.2, 16.2) compared with those without VI (17.6; 95% CI: 17.5, 17.7). Self-reported VI had a significant indirect effect on subjective well-being through limiting mobility (β = -0.04; 95% CI: -0.07, -0.03) and household activities (β = -0.05; 95% CI: -0.08, -0.03), but not self-care limitations (β = 0.0; 95% CI = 0.0, 0.0) or participation restrictions (β = 0.0; 95% CI = -0.01, 0.00). Total indirect effects from all mediation paths accounted for 42% of the effect of VI on well-being. CONCLUSIONS: Mobility and household activity limitations are significant mediators that explain a considerable portion of the impact of poor vision on well-being. Interventions to promote successful accommodation may result in greater overall well-being for older adults with poor vision.
BACKGROUND:Vision impairment (VI) in older adults is associated with declines in well-being. However, the pathways through which poor vision leads to declines in well-being have not been well-described. The purpose of this study was to determine whether activity limitations and social participation restrictions mediate the impact of self-reported VI on subjective well-being. METHODS: The National Health and Aging Trends Study (NHATS) is a nationally representative longitudinal study of Medicare beneficiaries 65 and older that includes detailed measures of the disablement process. A longitudinal mediation model was conceptualized linking self-reported VI and subjective well-being. Structural equation modeling was used to test the mediating effects of activity limitations and social participation restrictions while adjusting for relevant covariates. RESULTS: The final sample included 5,431 respondents. At baseline, 8.0% of Medicare beneficiaries had self-reported VI. Subjective well-being scores were significantly lower among respondents with self-reported VI (15.7; 95% confidence interval [CI]: 15.2, 16.2) compared with those without VI (17.6; 95% CI: 17.5, 17.7). Self-reported VI had a significant indirect effect on subjective well-being through limiting mobility (β = -0.04; 95% CI: -0.07, -0.03) and household activities (β = -0.05; 95% CI: -0.08, -0.03), but not self-care limitations (β = 0.0; 95% CI = 0.0, 0.0) or participation restrictions (β = 0.0; 95% CI = -0.01, 0.00). Total indirect effects from all mediation paths accounted for 42% of the effect of VI on well-being. CONCLUSIONS: Mobility and household activity limitations are significant mediators that explain a considerable portion of the impact of poor vision on well-being. Interventions to promote successful accommodation may result in greater overall well-being for older adults with poor vision.
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