Liljas, Ann Elizabeth Margaretha; (2017) The relationship of sensory impairments with cardiovascular disease and mortality, disability and frailty in older age: longitudinal cohort studies using the British Regional Heart Study and the English Longitudinal Study of Ageing. Doctoral thesis (Ph.D), UCL (University College London).

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Abstract

BACKGROUND AND AIM: Impairments in hearing and vision (sensory impairments) are common in older age and associated with increased risks of important adverse health outcomes such as chronic diseases and poor physical functioning. However the majority of previous studies are of cross-sectional design and little research has focused on older adults. The overarching aim of this thesis is therefore to prospectively investigate the influence of sensory impairments on the subsequent risks of adverse cardiovascular disease (CVD) incidence and mortality, disability and frailty. METHODS: This thesis uses data from two population-based cohorts: the British Regional Heart Study (BRHS) (3981 men aged 63-85 years) and the English Longitudinal Study of Ageing (ELSA) (2836 men and women aged ≥ 60 years). Data from the BRHS were used to examine the prospective relationships between self-reported sensory impairments and the risk of non-fatal and fatal CVD (MI or stroke) (data obtained from medical records), all-cause mortality, and self-reported disability defined as mobility limitation, activities of daily living (ADL) and instrumental ADL (IADL). ELSA data were used to examine the prospective relationship between self-reported sensory impairments and incident frailty defined as the Fried phenotype. RESULTS: In the BRHS, hearing impairment was associated with greater risks of incident CVD, in particular incident stroke, and CVD mortality. Vision impairment was not associated with incident CVD outcomes but with increased risks of all-cause mortality. Hearing impairment, but not vision impairment, was associated with increased risks of incident disability in the form of IADL. In ELSA, hearing impairment was associated with increased risks of incident frailty in individuals who were pre-frail. Vision impairment was associated with greater risks of incidence of pre-frailty and frailty in non-frail participants. The findings of this thesis emphasise the potentially important contribution of sensory impairments in older age particularly to risk of stroke, disability and frailty.

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