Dual Sensory Impairment as a Predictor of Loneliness and Isolation in Older Adults: National Cohort Study

Abstract

Background Loneliness and social isolation are global public health challenges. Sensory impairments (SIs) are highly prevalent among older adults but are often ignored as a part of normal aging. Identifying the role of SIs in loneliness and social isolation could provide insight into strategies for improving public health among older adults. Objective This study aims to analyze the effects of SIs on loneliness and social isolation among older adults in rural and urban China. Methods This cohort study of 3069 older adults (aged 60+) used data from 4 waves (2011, 2013, 2015, and 2018) of the China Health and Retirement Longitudinal Study (CHARLS), a nationally representative survey of adults aged 45 years or older. SIs include hearing impairment (HI), vision impairment (VI), and dual sensory impairment (DSI). DSI is defined as the co-occurrence of VI and HI. Participants with complete data on hearing, vision, social isolation, and loneliness were included in the analysis. Generalized estimating equation models adjusted for covariates were used to examine the relationships of DSI with loneliness and social isolation among older adults. Results Older adults in rural areas have higher prevalence of DSI, loneliness, and social isolation than their urban counterparts. In rural areas, participants with VI only (odds ratio [OR] 1.34, 95% CI 1.12-1.62; P=.002), HI only (OR 1.32, 95% CI 1.02-1.71; P=.03), and DSI (OR 1.84, 95% CI 1.56-2.18; P<.001) were more likely to experience loneliness compared with participants without SIs. DSI showed a statistically significant association with loneliness compared with VI only (OR 1.37, 95% CI 1.22-1.54; P<.001) and HI only (OR 1.39, 95% CI 1.13-1.72; P=.002). In urban areas, participants with VI only (OR 2.44, 95% CI 1.57-3.80; P<.001), HI only (OR 2.47, 95% CI 1.41-4.32; P=.002), and DSI (OR 1.88, 95% CI 1.24-2.85; P=.003) were more likely to experience loneliness compared with participants without SIs. DSI was not associated with the increased likelihood of loneliness compared with HI only or VI only. SIs were not associated with social isolation among older adults in urban and rural areas. Until 2018, 86.97% (2669/3069) reported VI, but only 27.11% (832/3069) and 9.45% (290/3069) were treated with glasses and cataract surgery, respectively; besides, 75 individuals received both glasses and cataract surgery treatment. The prevalence of HI was 74.39% (2283/3069) in 2018, but only 0.72% (22/3069) were treated with a hearing aid. Conclusions SIs are associated with an increased risk of loneliness rather than social isolation. A compounded risk of DSI on loneliness exists in rural areas rather than in urban areas. These findings expand our knowledge about the effects of SIs on loneliness and social isolation in non-Western populations. Interventions targeting HI only and DSI might be particularly effective for mitigating loneliness of older adults in urban and rural areas, respectively. Considering the high prevalence and low treatment rate of SIs, measures should be taken to make treatment more accessible.

Associations of visual, hearing, and dual sensory impairment with motoric cognitive risk syndrome: Observational and Mendelian randomization analyses

“…Participants were considered to have DSI when both VI and HI were present. The evaluation and classification of sensory impairments were consistent with previous studies in CHARLS 24–26 …”

“…Firstly, sensory impairments were selfreported by participants, and there may be selection bias. Although this method has been extensively used in similar studies [24][25][26] and there is evidence to suggest that self-evaluation of vision and hearing status may be more intuitive than clinical measurements. 50 Secondly, some unmeasured potential confounding factors were not included…”

“…The evaluation and classification of sensory impairments were consistent with previous studies in CHARLS. [24][25][26]…”

Social participation and tooth loss, vision, and hearing impairments among older Brazilian adults

“…The experience of multiple impairments is more than the sum of each impairment alone 8 . In that regard, combined vision and hearing loss, also known as dual sensory impairment, is associated with reduced social participation 17 and predicts social isolation and loneliness 18 …”

“…8 In that regard, combined vision and hearing loss, also known as dual sensory impairment, is associated with reduced social participation 17 and predicts social isolation and loneliness. 18 To date, only two cross-sectional studies have investigated the associations of tooth loss, vision, and hearing impairments with social participation among community-dwelling older adults. A study in Japan found that self-reported vision, hearing and tooth loss were associated with fewer social interactions with friends, after adjustment for sex, age, education, residence area, chronic conditions, and depressive symptoms.…”