Visual impairment predicts greater declines in physical performance over time: the Health, Aging and Body Composition Study

Background Poor vision has been associated with physical dysfunction and falls in older adults, but it is not known whether particular types of visual impairment (VI) may predict greater rates of decline in mobility over time in older adults. Methods Multi-center longitudinal cohort study of 2219 older adults (mean age = 75.5 years; 52.4% female; 37.4% black) who completed self-reported (visual function questions (VFQ)) or performance-based (visual acuity (VA); log contrast sensitivity (LCS); stereoacuity (SA)) vision testing at year 3 and the short physical performance battery (SPPB) at year 4. Analyses were performed including all 2219 participants (Cohort A) and 1795 of these participants with SPPB >= 9 (Cohort B) at year 4. Separate linear mixed models were constructed to evaluate the relationship of each vision measure with rate of change in performance on the SPPB and its components (gait speed, balance time, and chair pace) over 8 years. Results In cohort A, compared to the predicted decline at the mean vision level, a significantly faster rate of decline in SPPB was experienced by those with a 1 standard deviation worse year 3 logMAR VA (-0.044; 95% CI -0.065, -0.024), LCS (-0.062; 95% CI -0.082, -0.041), and VFQ (-0.045; 95% CI -0.065, -0.025) and those with a SA > 85 arcsec (-0.095; 95% CI -0.139, -0.052) versus those with SA <= 85 (all p < 0.001 for difference in slopes). Cohort B showed similar but stronger findings for SPPB, and demonstrated that worse logMAR VA, LCS and VFQ were significantly associated with a faster decline in gait speed, while worse logMAR VA, LCS, and SA were significantly associated with greater decline in balance times. Only poor SA > 85 arcsec was significantly associated with declines in chair pace. Conclusions All VI measures predicted faster declines in SPPB. Older adults with VI may benefit from targeted intervention to prevent declines in mobility.