IMPORTANCE Vision impairment (VI) and mental health conditions are highly prevalent among older adults and are major causes of morbidity and health care expenditures. However, there are few nationally representative data from the United States on the longitudinal association between VI and depressive symptoms, and no such data on anxiety symptoms.OBJECTIVE To evaluate the longitudinal association and directionality of the association between self-reported VI and clinically significant symptoms of depression and anxiety in older US adults. DESIGN, SETTING, AND PARTICIPANTSThe National Health and Aging Trends Study, a nationally representative US survey administered annually from 2011 to 2016 to a cohort of Medicare beneficiaries 65 years and older. A total of 7584 participants with complete data on self-reported VI status at baseline were included. Data analysis was performed from February to October 2018. MAIN OUTCOMES AND MEASURESMultivariable Cox proportional hazards regression models were used to evaluate the longitudinal associations between self-reported VI and depression and anxiety symptoms, adjusting for sociodemographics and medical comorbidities and accounting for the complex survey design.RESULTS There were 7584 participants included in this study. At baseline, the survey-weighted proportion of participants who were women was 56.6%; 53.0% were aged 65 to 74 years, and 8.9% (95% CI, 8.1%-9.8%) had self-reported VI. Symptoms of depression were significantly more common in participants with self-reported VI than those without self-reported VI (31.2%; 95% CI, 27.0%-35.6% vs 12.9%; 95% CI, 11.9%-14.0%; P < .001), as were symptoms of anxiety (27.2%; 95% CI, 23.7%-30.9% vs 11.1%; 95% CI,10.2%-12.0%, P < .001). Baseline self-reported vision status was significantly associated with future report of depression (hazard ratio [HR], 1.33; 95% CI, 1.15-1.55) but not anxiety (HR, 1.06; 95% CI, 0.85-1.31) symptoms. Baseline depression (HR, 1.37; 95% CI, 1.08-1.75) and anxiety (HR, 1.55; 95% CI, 1.19-2.02) symptoms were both significantly associated with future reports of self-reported VI. In a sensitivity analysis excluding data provided by proxy respondents, statistical significance was unchanged and the effect size was similar for all statistical models. CONCLUSIONS AND RELEVANCEOlder US adults with self-reported VI were more likely to report symptoms of depression in the future, while those who had symptoms of either depression or anxiety were more likely to report VI in the future. This investigation suggests that there is a significant bidirectional and longitudinal association between self-reported VI and mental health symptoms. Furthermore, the study suggests the need for effective strategies to screen for and address depression and anxiety among older US adults with VI.

Objectives To determine the prevalence of falls, fear of falling (FoF), and activity limitation due to FoF in a nationally representative study of older adults with self‐reported vision impairment (VI). Design Cross‐sectional analysis of panel survey data. Setting National Health and Aging Trends Study, a nationally representative survey administered annually from 2011 to 2016 to U.S. Medicare beneficiaries aged 65 and older. Participants Respondents (N=11,558) who contributed 36,229 participant observations. Measurements We performed logistic regression to calculate the unadjusted and adjusted prevalence of self‐reported history of more than 1 fall in the past year, any fall in the past month, FoF, and activity limitation due to FoF in participants with and without self‐reported VI. Results The weighted proportion of participants reporting VI was 8.6% (95% confidence interval (CI)=8.0–9.2%). The unadjusted prevalence of more than 1 fall in the past year was 27.6% (95% CI=25.5–29.7%) in participants with self‐reported VI and 13.2% (95% CI=12.7–13.7%) in those without self‐reported VI. In respondents with self‐reported VI, the prevalence of FoF was 48.3% (95% CI=46.1–50.6%) and of FoF limiting activity was 50.8% (95%CI 47.3–54.2%), and in those without self‐reported VI, the prevalence of FoF was 26.7% (95% CI=25.9–27.5%) and of FoF limiting activity was 33.9% (95% CI=32.4–35.4%). The prevalence of all fall and fall‐related outcomes remained significantly higher among those with self‐reported VI after adjusting for sociodemographics and potential confounders. Conclusion The prevalence of falls, FoF, and activity limitation due to FoF is high in older adults with self‐reported VI. This is the first study to provide nationally representative data on the prevalence of fall‐related outcomes in older Americans with self‐reported VI. These findings demonstrate the need to treat avoidable VI and to develop interventions to prevent falls and fall‐related outcomes in this population. J Am Geriatr Soc 67:239–245, 2019.