Vision impairment and risk of frailty: the English Longitudinal Study of Ageing

Abstract

Background

Age-related vision impairment has been associated with comorbidities, current disability, and poor quality of life. However, it is unclear whether vision impairment is associated with increasing future frailty, further affecting ability to live independently. We investigated the association of poor vision with incident pre-frailty and frailty.

Methods

2836 men and women aged 60 years or more with data on vision (self-reported vision problems) and frailty status (Fried phenotype) from the nationally representative English Longitudinal Study of Ageing were followed up for 4 years for pre-frailty and frailty between 2004 and 2008. Frailty was defined according to number of Fried phenotype components present (slow walking, weak grip, self-reported exhaustion, weight loss, low physical activity) as non-frail (0 components), pre-frail (1–2), and frail (≥3). Participants non-frail at baseline were followed up for incident pre-frailty and frailty. Participants pre-frail at baseline were followed up for incident frailty.

Findings

At baseline, 1396 participants (49%) were non-frail, 1178 (42%) pre-frail, and 262 (9%) frail. At follow-up, there were 367 new cases of pre-frailty and frailty among those non-frail at baseline, and 133 new cases of frailty among those pre-frail at baseline. Cross-sectional analysis showed an association between vision impairment and frailty (age-adjusted and sex-adjusted odds ratio 2·53, 95% CI 1·95–3·30; p<0·0001) which remained after further adjustment for wealth, education, cardiovascular disease, diabetes, falls, cognition, and depression. In longitudinal analysis, compared with non-frail participants with no vision impairment, non-frail participants with vision impairment had double the risk of becoming pre-frail or frail at follow-up (2·07, 1·32–3·24; p=0·002) and the association remained after further adjustment for covariates (1·86, 1·17–2·95; p=0·009). Pre-frail participants with vision impairment did not have greater risks of becoming frail at follow-up (1·34, 0·82–2·19).

Interpretation

Older adults who experience poor vision and are not frail have double the risk of becoming pre-frail or frail over 4 years. Public health interventions aiming to identify and actively manage vision impairment might prevent frailty.

Funding

AEML is funded by the National Institute for Health Research School for Public Health Research (509546). LAC is funded by the British Heart Foundation (RG/10/001/28296) and the Medical Research Council (RG71546). SER is funded by a UK Medical Research Council fellowship (G1002391).