Visual trajectories and risk of physical and cognitive impairment among older Chinese adults

Abstract

Background/Objectives: To identify visual trajectories and examine their relationships with physical and cognitive function in older Chinese adults. Design: Population-based longitudinal study. Setting: The Chinese Longitudinal Healthy Longevity Survey. Participants: A total of 16,151 participants aged ≥65 years. Measurements: Visual, physical (including activities of daily living [ADL] and instrumental ADL [IADL]), and cognitive function were assessed at baseline and subsequently every 3 years. ADI disability and IADL disability were defined as needing any help in any item of the Katz scale and a modified Lawton's scale, respectively. Cognitive impairment was defined as a Chinese version of the Mini-Mental State Examination score below 24. A group-based trajectory model was used to determine visual trajectories adjusted for age, sex, and education. Associations of visual trajectories with ADL disability, IADL disability, and cognitive impairment were evaluated using generalized estimating equation models adjusted for potential confounders. Results: This study identified three distinct visual trajectories, including no decline (32.4%), moderate decline (48.3%), and progressive decline (19.3%) during the follow-up period. Compared with the no decline trajectory, both the moderate decline (ADL disability: OR = 2.75, 95% CI: 2.30–3.28; IADL disability: OR = 3.01, 95% CI: 2.74–3.31; cognitive impairment: OR = 3.37, 95% CI: 3.02–3.76) and the progressive decline (ADL disability: OR = 8.50, 95% CI: 6.55–11.02; IADL disability: OR = 12.96, 95% CI: 9.95–16.87; cognitive impairment: OR = 10.84, 95% CI: 8.89–13.23) trajectories were significantly associated with an increased risk of functional impairment. Compared with the moderate decline trajectory, the progressive decline trajectory was significantly associated with an increased risk of ADL disability (OR = 3.09, 95% CI: 2.46–3.89), IADL disability (OR = 4.30, 95% CI: 3.29–5.61), and cognitive impairment (OR = 3.22, 95% CI:2.63–3.93). Conclusion: Older Chinese adults exhibit three distinct visual trajectories and those with decline trajectories in vision have an increased risk of functional impairment than those with a trajectory of no decline in vision.