Association of Sensory Impairments With Cognitive Decline and Depression Among Older Adults in China

IMPORTANCE: Sensory impairments may heighten the risk of premature brain aging. Little is known regarding the association of sensory impairments with cognitive function and depression in China. OBJECTIVE: To examine the association of visual and/or hearing impairments with cognitive decline and depression. DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study used the data from 18 038 respondents to the 2015 survey of the China Health and Retirement Longitudinal Study, a nationally representative survey of adults aged 45 years or older and their spouses. EXPOSURES: The presence of sensory impairments was identified by self-reported assessment of visual and/or hearing functions. MAIN OUTCOMES AND MEASURES: Overall, 3 composite measures were used to assess the respondents’ cognitive performance, including episodic memory, mental intactness, and global cognitive function. Depression was examined using the 10-item Center for Epidemiological Studies–Depression scale score. Multiple generalized linear regression models, adjusting for self-reported sociodemographic characteristics, health behaviors, chronic conditions, and participants’ overall health, were used. RESULTS: Of 18 038 respondents, 9244 (51.2%) were women. The mean (SD) age was 59.9 (9.7) years. Respondents with visual impairment had poorer episodic memory (β = –0.12; 95% CI, –0.19 to –0.05) and global cognition (β = –0.16; 95% CI, –0.31 to –0.02) and a greater risk of depression (odds ratio, 1.78; 95% CI, 1.59 to 1.99) than those without visual impairment. Respondents with hearing impairment had poorer episodic memory (β = –0.24; 95% CI, –0.30 to –0.18), mental intactness (β = –0.19; 95% CI, –0.28 to –0.10), and global cognition (β = –0.43; 95% CI, –0.55 to –0.31) as well as a greater risk of depression (odds ratio, 1.57; 95% CI, 1.44 to 1.70) than those without hearing impairment. People who reported dual sensory impairment performed worse on all of the aforementioned outcome measures (episodic memory: β = –0.23; 95% CI, –0.31 to –0.14; mental intactness: β = –0.13; 95% CI, –0.27 to –0.0003; global cognition: β = –0.37; 95% CI, –0.55 to –0.19; depression: odds ratio, 2.19; 95% CI, 1.90 to 2.52). CONCLUSIONS AND RELEVANCE: In this study, visual and hearing impairments were independently and together associated with poorer cognitive and depression outcomes. A more comprehensive and integrated system of care, covering vision, hearing, and cognition, is needed in China’s health care system to address age-related sensory impairments.