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

评估中年女性视力与认知功能、平衡和跌倒的相互作用

• 批准号: 9892014
• 负责人: DAVID C MUSCH
• 金额: $ 23.4万
• 依托单位: UNIVERSITY OF MICHIGAN AT ANN ARBOR
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-04-01 至 2022-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9892014
• 关键词: Abbreviations; Address; Adult; Affect; Age; Aging; American; Arthritis; Behavioral Risk Factor Surveillance System; Biological; Biological Factors; Biological Markers; Body mass index; C-reactive protein; Caring; Cessation of life; Cognition; Cognitive; Contrast Sensitivity; Cross-Sectional Studies; Data; Data Set; Dizziness; Elderly; Emergency Situation; Environmental Risk Factor; Equilibrium; Goals; Health; Health Promotion; Hospitalization; Hypotension; Impaired cognition; Inflammatory; Injury; Knowledge; Linear Regressions; Link; Logistic Regressions; Longitudinal Studies; Measures; Mediation; Mediator of activation protein; Menopause; Michigan; Modeling; National Health and Nutrition Examination Survey; Ophthalmic examination and evaluation; Outcome; Pharmaceutical Preparations; Physical Function; Play; Preventive; Probability; Provider; Public Health; Reporting; Role; Social Network; Study of Women' s Health Across the Nation; Surveys; Testing; Vision; Visit; Visual Acuity; Visual impairment; Woman; age related; cognitive function; cohort; cost effective; fall risk; falls; healthy aging; middle age; side effect; translational impact; trend

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.

抽象的 证据正在赶上常识，即视力障碍（VI）在平衡、跌倒和 认知障碍。这些情况是严重的公共卫生问题，因为它们影响 独立性、致命和非致命伤害，以及对社交网络和社会的二次后果 经济。 2014 年行为风险因素监测系统中 65 岁以上的美国成年人 调查显示，29% 的人报告在过去一年中跌倒过，估计有 2,900 万次跌倒导致 700 万人受伤，2.8 100 万人次紧急就诊、80 万人次住院、27,000 人死亡。 2017 年两项横断面研究 数据集（国家健康和营养检查调查和国家健康和老龄化趋势研究） 近 33,000 名美国老年人表明，视力不佳与认知能力较差有关。有一个 在理解视力、身体机能、平衡、跌倒和运动之间的关系方面存在知识差距 认知功能。由于这一差距，对于护理老年人的临床医生来说存在一个关键障碍 认识与认知能力下降和跌倒相关的预防和可治疗因素，以确保健康 老化。我们的目标是了解 VI 对跌倒结果与身体功能中介因素的因果作用， 平衡和认知功能。我们的假设是视觉功能的具体测量（例如对比度 敏感性）与年龄相关的身体功能、平衡、跌倒和认知结果相关 功能。我们将在密歇根队列中检验这一假设（N=543；基线平均年龄为 51 ± 4.2 岁， 全国妇女健康研究 (SWAN) 的 60% 黑人，40% 白人）。这是一个持续的、20- 年，对中年和老年妇女的纵向研究。纵向数据可用于视觉、物理 功能、平衡、跌倒、环境和生物因素以及认知功能。最近一段时间里 在访问 (V16) 期间，我们的团队对 255 名女性（年龄 66 ± 2.7 岁；62% 是黑人）进行了广泛的眼部检查和测试 和 38% 白色）。该数据集提供了一个独特的、具有成本效益的机会来解决知识差距 分析视力、身体功能、平衡、跌倒和认知功能之间的关系。我们将测试 假设有两个目标。目标 1：检验视觉障碍 (VI) 与以下因素相关的假设： 身体功能、平衡和跌倒，并评估身体功能和平衡的作用： VI 对跌倒影响的中介变量。目标 2：检验与视觉障碍相关的假设 与认知功能，并评估认知功能作为视觉效果的中介作用 跌倒损伤。通过实现这些目标，我们将增进对视觉相互作用的理解， 身体功能、平衡、跌倒和认知功能。通过这样做，所有照顾老年人的临床医生将 有能力识别与跌倒和认知能力下降相关的可治疗和预防因素，以及 从而促进老年人的健康。识别和治疗这些因素的综合方法 可以减轻与年龄相关的认知功能下降和跌倒风险。