The Association between Frailty and Uncorrected Refractive Error in Older Adults

ABSTRACT

Purpose: Uncorrected refractive error (URE) is the leading cause of impaired vision in older adults and has been associated with adverse health outcomes. Here, we investigate the association between URE and frailty in older adults.

Methods: This is a cross-sectional analysis of National Health and Nutrition Examination Survey (NHANES) participants ≥60 years (1999–2006 cycles). URE was defined as visual acuity worse than 6/12 that can be improved with correction, and prefrailty and frailty were defined as meeting 1–2 and ≥3 of 4 components of a modified physical frailty phenotype. The 5-item phenotype (including slowness) was analyzed in a subset of participants with available data. Propensity score adjustment was used to address the imbalance of potential confounders (including age) between URE groups.

Results: In this sample (n = 5,265), 6% of participants had URE (n = 373). In fully adjusted propensity score-based models, individuals with URE were more likely to be prefrail (OR = 1.4; 95% CI: 1.0–2.0) and frail (OR = 3.2; 95% CI: 1.3–7.4) than those without URE using the 4-item phenotype. For the 2,486 participants with 5-item phenotype data, individuals with URE were more likely to be frail (OR = 3.0; 95% CI: 1.2–7.5); however, the association with prefrailty was not statistically significant (OR = 1.8; 95% CI: 0.9–3.6).

Conclusion: In this population-based sample, older adults with URE were more likely to be frail than those without URE, even after rigorous control for confounders, including age.

KEYWORDS:

• Frailty
• uncorrected refractive error
• vision

Acknowledgments

This submission has not been published elsewhere previously and is not simultaneously being considered for any other publication. It has been reviewed and rejected by Journal of American Geriatrics Society, and Age and Ageing. We did not receive any feedback from Journal of American Geriatrics Society. Criticism from Age and Ageing included the use of an “arbitrary” cutoff of 6/12 and the exclusion of non-refractive causes of visual impairment such as cataract and glaucoma. Ultimately, they felt that this manuscript was not suitable for their audience. Our cutoff of 6/12 was chosen in accordance with the American Academy of Ophthalmology criteria for visual impairment. Pertaining to causes of visual impairment that cannot be corrected with refraction, while we did analyze visual impairment not due to refractive error, the results were not included in this manuscript as we felt the public health implications of the results differed, and the impact of uncorrected refractive error (URE), commonly seen of as a trivial problem, warranted a separate manuscript. In addition, the NHANES data for ophthalmic diseases such as glaucoma or age-related macular degeneration were collected for certain years, but this data was not available for all of the cycle years analyzed in this study. Prior studies investigating the association between visual impairment and frailty have used subjective assessments of vision – known to be poorly correlated with objective vision measures. This study advances our understanding of the vision-frailty relationship by using objective assessments of vision, and specifically, focuses on URE, an easily correctable vision problem, that is currently the leading cause of impaired vision in older adults.

Data availability statement

The data described in this article are openly available in the Open Science Framework at DOI:10.17605/OSF.IO/TPA6U.

Supplementary material

Supplemental data for this article can be accessed publisher’s website.

Additional information

Funding

This work was supported by the Johns Hopkins University Older Americans Independence Center NIA at NIH under Grant P30 AG021334 and NIA at NIH under Grant K01 AG052640.