Article Title

Defining Care Needs in Older Adults With a Particular Set of Multiple Chronic Conditions: Coexisting Visual, Auditory and Cognitive Impairments

Publication Date



aging, multiple chronic conditions


Background/Aims: Patients who have multiple chronic conditions (MCCs) represent a majority of older adults and have high health care needs. Considering the heterogeneity of MCC, one approach to identifying specific need gaps is to focus on common pairs or clusters of MCCs. Visual, auditory and cognitive impairments are common in old age, frequently coexist, and impact function. However, little is known about their combined association with patient-centered outcomes in older adults. Our objective was to assess the relationship of disability and self-reported health with various combinations of coexisting visual, auditory and/or cognitive impairments.

Methods: We analyzed sample data from the North Carolina EPESE study (N=3,871; age 65–105 years), a population-based epidemiological study of community-dwelling seniors. Cognition was assessed by the Short Portable Mental Status Questionnaire, and visual and auditory status determined from self-reported information. Logistic regression characterized the cross-sectional associations of all combinations of visual, auditory and cognitive impairment with disability in activities of daily living (ADL), instrumental ADL (IADL) and poor self-reported health (SRH).

Results: The prevalence of ADL disability was 9.9% (384 of 3,871), IADL disability 29.6% (1,146 of 3,871), and fair/poor SRH 46.6% (1,805 of 3,871). In adjusted analyses, compared to persons with no impairments, persons with all three impairments had increased odds of ADL disability (odds ratio [OR]: 4.99, 95% confidence interval [CI]: 2.95–8.44), IADL disability (OR: 10.39, 95% CI: 5.67–19.05) and low SRH (OR: 2.81, 95% CI: 1.64–4.82). The relationship between impairments and ADL disability exhibited a “step-wise” pattern (odds of disability increased as number of impairments increased), but IADL disability was particularly common in those with vision impairment, cognitive impairment, or the combination. While sensory impairments were associated with poor SRH, cognitive impairment was not unless both sensory impairments were present.

Discussion: Older adults with coexistent sensory and cognitive impairments have high functional needs. People with combined vision and hearing loss are likely to perceive their health as poor, whereas cognitive impairment may confer some protection against illness perceptions. Persons with coexisting visual and cognitive impairments are especially likely to require assistance with IADLs (e.g. medication management, handling finances) and may benefit from targeted clinical services that help overcome those impairments.