Severe Vision and Hearing Impairment and Successful Aging
Purpose: Previous research on psychosocial adaptation of sensory-impaired older adults has focused mainly on only one sensory modality and on a limited number of successful aging outcomes. We considered a broad range of successful aging indicators and compared older adults with vision impairment, hearing impairment, and dual sensory impairments and without sensory impairment.
Design and Methods: Data came from samples of severely visually impaired (VI; N = 121), severely hearing-impaired (HI; N = 116), dual sensory-impaired (DI; N = 43), and sensory-unimpaired older adults (UI; N = 150). Participants underwent a wide-ranging assessment, covering everyday competence, cognitive functioning, social resources, self-regulation strategies, cognitive and affective well-being, and 4-year survival status (except the DI group).
Results: The most pronounced difference among groups was in the area of everyday competence (lowest in VI and DI). Multigroup comparisons in latent space revealed both similar and differing relationship strengths among health, everyday competence, social resources, self-regulation, and overall well-being, depending on sensory status. After 4 years, mortality in VI (29%) and HI (30%) was significantly higher than in UI (20%) at the bivariate level, but not after controlling for confounders in a multivariate analysis.
Implications: A multidimensional approach to the understanding of sensory impairment and psychosocial adaptation in old age reveals a complex picture of loss and maintenance.
Baltes and Baltes (1990), Rowe and Kahn (1998), and Ryff (1989) have argued that successful aging requires a multidimensional view, which should include health and longevity, everyday competence, cognitive performance, social engagement, coping, and well-being-oriented indicators. Baltes, Lindenberger, and Staudinger (2006) emphasized that human development contains elements of loss and gain across the life span, although loss increases as people age. This paper examines whether and how chronic conditions, such as severe vision and hearing impairment (Heyl & Wahl, 2012; Horowitz, Brennan, & Reinhardt, 2005; Li-Korotky, 2012), are threats to successful aging.
Evidence that both hearing and vision impairments are accompanied by heightened multimorbidity and an increased rate of mortality is inconsistent. For example, although Anstey, Luscz, Giles, and Andrews (2001) and Appollonio, Carabellese, Magini, Frattola, and Trabucchi (1995) have found that visual and hearing declines over time predict death in very old age, other studies have detected no significant relationship after adjusting for confounders such as age, sex, and education (Ostbye, Steenhuis, Wolfson, Walton, & Hill, 1999).
Age-related vision impairment has been found to be closely associated with significantly lower everyday competence, as visual capacity is a critical prerequisite for such behaviors (Burmedi, Becker, Heyl, Wahl, & Himmelsbach, 2002a; Heyl & Wahl, 2001). Hearing loss has not been found to have a major affect on behavioral functioning (Rudberg, Furner, Dunn, & Cassel, 1993), although some have observed its negative long-term consequences on everyday functioning (Dalton et al., 2003).
Reduced sensory function is accompanied by a decrease in cognitive performance in older adults, according to Wahl and Heyl (2003). Differences in the relationship of vision and hearing impairments with cognitive performance have not been identified, although there is some evidence of a stronger link with vision loss (Anstey, Luszcz, & Sanchez, 2001).
Existing evidence supports the view that social relations of older adults with severe vision and hearing loss are not fundamentally different from those of sensory-unimpaired (UI) individuals. Reinhardt (1996) found that visually impaired (VI) older adults named an average of 5.4 persons with whom they had intimate relationships within their family network and 3.5 persons within their friendship network, similar to UI older adults (Wagner, Schütze, & Lang, 1999). Socioemotional selectivity theory (Carstensen, 2006) posits that older adults—including sensory-impaired individuals—invest a great deal in maintaining close relationships because of a more limited future-time perspective in old age. Neither vision nor hearing impairment are thought to affect the experience of loneliness dramatically (Burmedi, Becker, Heyl, Wahl, & Himmelsbach, 2002b; Wahl & Tesch-Römer, 2001), although a recent study found an increased risk of loneliness (Nachtegaal et al., 2009). Hearing impairment negatively impacts social communication and carries a strong stigma, however (Dalton et al., 2003; Wahl & Tesch-Römer, 2001; Wallhagen, 2010).
Successful aging also includes self-regulation skills, such as the ability to work toward life goals tenaciously and adjust and adapt goals flexibly (e.g., Brandtstädter, 2009; Brandtstädter & Renner, 1990). Evidence is emerging of flexible goal adjustment for mental health outcomes in those with vision impairment (Boerner, 2004; Wahl, Becker, Schilling, Burmedi, & Himmelsbach, 2005). However, the combination of tenacity and flexibility in pursuing life goals has never been examined in comparisons among those with vision impairment, hearing impairment, and no sensory impairment.
VI older adults have shown evidence of diminished well-being compared with UI older adults (Horowitz & Reinhardt, 2000; Nachtegaal et al., 2009; Wahl, Schilling, Oswald, & Heyl, 1999), although a related meta-analysis found only small effect sizes (Pinquart & Pfeiffer, 2011). Differences in well-being between hearing-impaired (HI) and unimpaired older adults appear to be small or non-existent (Tesch-Römer, 2001). The "well-being paradox" in old age, assuming that adaptive resources to maintain well-being are pronounced and efficient even under adverse conditions (Kunzmann, Little, & Smith, 2000), may also apply to sensory-impaired older adults (Schilling & Wahl, 2006; Schilling, Wahl, Horowitz, Reinhardt, & Boerner, 2011).
Finally, the overall psychosocial situation of those with dual sensory impairment, which affects about 20% of those 70 years and older, has been found to be worse than for those with single impairments, particularly in everyday functioning (Brennan, Horowitz, & Su, 2005).
We examine the impact of severe vision and hearing impairments, as well as dual sensory impairment, on a range of successful aging indicators, covering health and everyday functioning, cognitive performance, social integration, self-regulation, and well-being. Given Baltes and coworkers (2006) view that development in old age always contains elements of loss and gain, we expect sensory impairment to be accompanied by both losses and maintenance. Regarding loss, we predict that sensory-impaired older adults will rate low in health-related and everyday competence indicators, and that vision impairment may have even greater negative impact than hearing impairment. In terms of cognitive functioning, we expect lower performance in severely sensory-impaired older adults as compared with UI older adults. Regarding self-regulation, we predict lower tenacious goal pursuit in those with vision impairment, assuming that deficient everyday functioning blocks goal attainment. In terms of maintenance, socioemotional selectivity theory suggests that sensory-impaired older adults will demonstrate social relationships and loneliness similarly to UI older adults. With respect to well-being, the well-being paradox and the potential for late-life adaptation may limit differences. We also test major predictors of an overall index of well-being in latent data space, influenced by classic work of Campbell (1976) and Smith et al. (1999), and we examine possible differences among those with vision impairment, hearing impairment, and no sensory impairment. We exclude cognitive function, not generally regarded as an important predictor of well-being (Kotter-Grühn et al., 2010; Smith et al., 1999). Finally, we examine survival status 4 years after baseline.
Abstract and Introduction
Abstract
Purpose: Previous research on psychosocial adaptation of sensory-impaired older adults has focused mainly on only one sensory modality and on a limited number of successful aging outcomes. We considered a broad range of successful aging indicators and compared older adults with vision impairment, hearing impairment, and dual sensory impairments and without sensory impairment.
Design and Methods: Data came from samples of severely visually impaired (VI; N = 121), severely hearing-impaired (HI; N = 116), dual sensory-impaired (DI; N = 43), and sensory-unimpaired older adults (UI; N = 150). Participants underwent a wide-ranging assessment, covering everyday competence, cognitive functioning, social resources, self-regulation strategies, cognitive and affective well-being, and 4-year survival status (except the DI group).
Results: The most pronounced difference among groups was in the area of everyday competence (lowest in VI and DI). Multigroup comparisons in latent space revealed both similar and differing relationship strengths among health, everyday competence, social resources, self-regulation, and overall well-being, depending on sensory status. After 4 years, mortality in VI (29%) and HI (30%) was significantly higher than in UI (20%) at the bivariate level, but not after controlling for confounders in a multivariate analysis.
Implications: A multidimensional approach to the understanding of sensory impairment and psychosocial adaptation in old age reveals a complex picture of loss and maintenance.
Introduction
Baltes and Baltes (1990), Rowe and Kahn (1998), and Ryff (1989) have argued that successful aging requires a multidimensional view, which should include health and longevity, everyday competence, cognitive performance, social engagement, coping, and well-being-oriented indicators. Baltes, Lindenberger, and Staudinger (2006) emphasized that human development contains elements of loss and gain across the life span, although loss increases as people age. This paper examines whether and how chronic conditions, such as severe vision and hearing impairment (Heyl & Wahl, 2012; Horowitz, Brennan, & Reinhardt, 2005; Li-Korotky, 2012), are threats to successful aging.
Previous Research
Evidence that both hearing and vision impairments are accompanied by heightened multimorbidity and an increased rate of mortality is inconsistent. For example, although Anstey, Luscz, Giles, and Andrews (2001) and Appollonio, Carabellese, Magini, Frattola, and Trabucchi (1995) have found that visual and hearing declines over time predict death in very old age, other studies have detected no significant relationship after adjusting for confounders such as age, sex, and education (Ostbye, Steenhuis, Wolfson, Walton, & Hill, 1999).
Age-related vision impairment has been found to be closely associated with significantly lower everyday competence, as visual capacity is a critical prerequisite for such behaviors (Burmedi, Becker, Heyl, Wahl, & Himmelsbach, 2002a; Heyl & Wahl, 2001). Hearing loss has not been found to have a major affect on behavioral functioning (Rudberg, Furner, Dunn, & Cassel, 1993), although some have observed its negative long-term consequences on everyday functioning (Dalton et al., 2003).
Reduced sensory function is accompanied by a decrease in cognitive performance in older adults, according to Wahl and Heyl (2003). Differences in the relationship of vision and hearing impairments with cognitive performance have not been identified, although there is some evidence of a stronger link with vision loss (Anstey, Luszcz, & Sanchez, 2001).
Existing evidence supports the view that social relations of older adults with severe vision and hearing loss are not fundamentally different from those of sensory-unimpaired (UI) individuals. Reinhardt (1996) found that visually impaired (VI) older adults named an average of 5.4 persons with whom they had intimate relationships within their family network and 3.5 persons within their friendship network, similar to UI older adults (Wagner, Schütze, & Lang, 1999). Socioemotional selectivity theory (Carstensen, 2006) posits that older adults—including sensory-impaired individuals—invest a great deal in maintaining close relationships because of a more limited future-time perspective in old age. Neither vision nor hearing impairment are thought to affect the experience of loneliness dramatically (Burmedi, Becker, Heyl, Wahl, & Himmelsbach, 2002b; Wahl & Tesch-Römer, 2001), although a recent study found an increased risk of loneliness (Nachtegaal et al., 2009). Hearing impairment negatively impacts social communication and carries a strong stigma, however (Dalton et al., 2003; Wahl & Tesch-Römer, 2001; Wallhagen, 2010).
Successful aging also includes self-regulation skills, such as the ability to work toward life goals tenaciously and adjust and adapt goals flexibly (e.g., Brandtstädter, 2009; Brandtstädter & Renner, 1990). Evidence is emerging of flexible goal adjustment for mental health outcomes in those with vision impairment (Boerner, 2004; Wahl, Becker, Schilling, Burmedi, & Himmelsbach, 2005). However, the combination of tenacity and flexibility in pursuing life goals has never been examined in comparisons among those with vision impairment, hearing impairment, and no sensory impairment.
VI older adults have shown evidence of diminished well-being compared with UI older adults (Horowitz & Reinhardt, 2000; Nachtegaal et al., 2009; Wahl, Schilling, Oswald, & Heyl, 1999), although a related meta-analysis found only small effect sizes (Pinquart & Pfeiffer, 2011). Differences in well-being between hearing-impaired (HI) and unimpaired older adults appear to be small or non-existent (Tesch-Römer, 2001). The "well-being paradox" in old age, assuming that adaptive resources to maintain well-being are pronounced and efficient even under adverse conditions (Kunzmann, Little, & Smith, 2000), may also apply to sensory-impaired older adults (Schilling & Wahl, 2006; Schilling, Wahl, Horowitz, Reinhardt, & Boerner, 2011).
Finally, the overall psychosocial situation of those with dual sensory impairment, which affects about 20% of those 70 years and older, has been found to be worse than for those with single impairments, particularly in everyday functioning (Brennan, Horowitz, & Su, 2005).
Research Questions and Expectations
We examine the impact of severe vision and hearing impairments, as well as dual sensory impairment, on a range of successful aging indicators, covering health and everyday functioning, cognitive performance, social integration, self-regulation, and well-being. Given Baltes and coworkers (2006) view that development in old age always contains elements of loss and gain, we expect sensory impairment to be accompanied by both losses and maintenance. Regarding loss, we predict that sensory-impaired older adults will rate low in health-related and everyday competence indicators, and that vision impairment may have even greater negative impact than hearing impairment. In terms of cognitive functioning, we expect lower performance in severely sensory-impaired older adults as compared with UI older adults. Regarding self-regulation, we predict lower tenacious goal pursuit in those with vision impairment, assuming that deficient everyday functioning blocks goal attainment. In terms of maintenance, socioemotional selectivity theory suggests that sensory-impaired older adults will demonstrate social relationships and loneliness similarly to UI older adults. With respect to well-being, the well-being paradox and the potential for late-life adaptation may limit differences. We also test major predictors of an overall index of well-being in latent data space, influenced by classic work of Campbell (1976) and Smith et al. (1999), and we examine possible differences among those with vision impairment, hearing impairment, and no sensory impairment. We exclude cognitive function, not generally regarded as an important predictor of well-being (Kotter-Grühn et al., 2010; Smith et al., 1999). Finally, we examine survival status 4 years after baseline.
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