Self-Reported Visual Difficulty and Mortality Risk Among Older Adults: The Mediating Role of Recurrent Falls.

Background and objectives: Visual difficulty is associated with an increased risk of mortality, however the mechanisms accounting for the link between visual difficulty and mortality have not been described. This study examined the association between visual difficulty, recurrent falls, and mortality risk among Americans aged 65 and older.

Research design and methods: This longitudinal study employed data from the 2015-2020 waves of the National Health and Aging Trends Study (N = 7,039). Visual difficulty was assessed by questions regarding self-reported near and distance vision and the use of visual aids. Recurrent falls were defined as experiencing a fall more than one time within the last year. Discrete-time survival models with a structural equation modeling-based approach were estimated for the associations between visual difficulty, recurrent falls, and all-cause mortality.

Results: Among the respondents, 8.1% reported visual difficulty at baseline. Compared to those without visual difficulty, older adults with visual difficulty were more likely to experience recurrent falls. Having visual difficulty at baseline was associated with experiencing recurrent falls in the following wave (β (log-hazard odds) = 0.12, p < .001) and with mortality in subsequent waves (β = 0.39, p < .001). The association of visual difficulty with mortality was mediated by recurrent falls (β = 0.05, p < .001).

Discussion and implications: Compared to those with normal vision, older adults with visual difficulty are more likely to experience recurrent falls, which may in turn increase the risk of mortality. Future research should investigate other potential pathways to gain a more complete understanding of the relationship between visual difficulty and mortality risk.