Assessing the Interplay of Vision with Cognitive Functioning, Balance, and Falls in Middle-aged Women

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Abstract Evidence is catching up with common knowledge that vision impairment (VI) plays a role in balance, falls and cognitive impairment. These conditions are serious public health issues because of their impact on independence, both fatal and nonfatal injuries, and secondary consequences on social networks and the economy. Among US adults older than 65 years in the 2014 Behavioral Risk Factor Surveillance System survey, 29% reported a fall in the past year with estimates of 29 million falls resulting in 7 million injuries, 2.8 million emergency visits, 800,000 hospitalizations, and 27,000 deaths. A 2017 cross-sectional study of two datasets (National Health and Nutrition Examination Survey and National Health and Aging Trends Study) of nearly 33,000 older Americans showed that poor vision was associated with poor cognition. There is a knowledge gap in understanding the relationships among vision, physical function, balance, falls, and cognitive function. Because of this gap, a critical barrier exists for clinicians who care for older adults in recognizing preventive and treatable factors that are linked to cognitive decline and falls to assure healthy aging. Our goal is to understand the causal role of VI on fall outcomes with mediators of physical function, balance, and cognitive function. Our hypothesis is that specific measures of visual function (e.g., contrast sensitivity) are associated with age-related outcomes of physical function, balance, falls, and cognitive function. We will test this hypothesis in the Michigan cohort (N=543; baseline mean age of 51 ± 4.2 years, 60% Black, 40% White) of the Study of Women's Health Across the Nation (SWAN). This is an ongoing, 20- year, longitudinal study of women during mid-life and aging. Longitudinal data are available for vision, physical function, balance, falls, environmental and biological factors, and cognitive function. During the most recent visit (V16), our team conducted extensive eye exams and tests on 255 women (age 66 ± 2.7 years; 62% black and 38% white). This dataset provides a unique, cost-effective opportunity to address the knowledge gap by analyzing relationships among vision, physical function, balance, falls, and cognitive function. We will test the hypothesis in two aims. Aim 1: Test the hypothesis that visual impairment (VI) is associated with physical function, balance and falls, and evaluate the role of physical function and balance as mediators of the effect of VI on falls. Aim 2: Test the hypothesis that visual impairment is associated with cognitive function, and evaluate the role of cognitive function as a mediator of the effect of visual impairment on falls. By addressing these aims, we will advance understanding of the interplay of vision, physical function, balance, falls, and cognitive function. By doing so, all clinicians who care for older adults will be equipped to identify treatable and preventive factors that are linked to falls and cognitive decline, and thereby promote health among aging adults. An integrated approach of recognizing and treating these factors may mitigate the age-related decline in cognitive function and risk of falls.