Pinto, J.M., Kern, D.W., Wroblewski, K.E., Chen, R.C., Schumm, L.P., & McClintock, M.K. (2014). Sensory function: insights from wave 2 of the national social life, health, and aging project. Journals of
Gerontology, Series B: Psychological Sciences and Social Sciences, 69(8), S144–S153, doi:10.1093/geronb/gbu102
Sensory Function: Insights From Wave 2 of the National
Social Life, Health, and Aging Project
Jayant M. Pinto,1 David W. Kern,2 Kristen E. Wroblewski,3 Rachel C. Chen,4 L. Philip Schumm,3
and Martha K. McClintock2
1
Department of Surgery/Otolaryngology-Head and Neck Surgery,
Institute for Mind and Biology and Department of Comparative Human Development,
3
Department of Health Studies, and
4
Pritzker School of Medicine, The University of Chicago, Illinois.
2
Objectives. Sensory function, a critical component of quality of life, generally declines with age and influences
health, physical activity, and social function. Sensory measures collected in Wave 2 of the National Social Life, Health,
and Aging Project (NSHAP) survey focused on the personal impact of sensory function in the home environment and
included: subjective assessment of vision, hearing, and touch, information on relevant home conditions and social sequelae as well as an improved objective assessment of odor detection.
Method. Summary data were generated for each sensory category, stratified by age (62–90 years of age) and gender,
with a focus on function in the home setting and the social consequences of sensory decrements in each modality.
Results. Among both men and women, older age was associated with self-reported impairment of vision, hearing, and
pleasantness of light touch. Compared with women, men reported significantly worse hearing and found light touch less
appealing. There were no gender differences for vision. Overall, hearing loss seemed to have a greater impact on social
function than did visual impairment.
Discussion. Sensory function declines across age groups, with notable gender differences for hearing and light touch.
Further analysis of sensory measures from NSHAP Wave 2 may provide important information on how sensory declines
are related to health, social function, quality of life, morbidity, and mortality in this nationally representative sample of
older adults.
Key Words: Aging—Demography—Geriatrics—Hearing—Older adults—Olfaction—Sensation—Sensory function—
Social consequences—Vision.
S
ensory function in older adults plays a critical
role in health (Kiely, Gopinath, Mitchell, Luszcz, &
Anstey, 2012), disease (Babizhayev, Deyev, & Yegorov,
2011; Lafreniere & Mann, 2009), and quality of life
(Ciorba, Bianchini, Pelucchi, & Pastore, 2012; Lam
et al., 2013; Viljanen et al., 2012). Though clinicians see
the sequelae of both aging and disease on sensory function in their patients over time, these changes are typically gradual. Nonetheless, they impose important and
heavy burdens for older people and may significantly
affect public health, with consequences for a range of
geriatric problems, from falls (Babizhayev et al., 2011)
and injuries (Whiteside, Wallhagen, & Pettengill, 2006)
to nutrition (Murphy, 1993). Importantly, compromise of
sensory function is directly related to an older person’s
ability to carry out routine daily activities (Hochberg
et al., 2012) and to participate in important physiologic
and social functions such as personal interaction (hearing and vision), nutrition (smell and taste), and mobility (vision, touch, and balance) (Albertsen, Temprado, &
Berton, 2012). Major human functions such as sexuality,
physical exercise, and intellectual stimulation are also
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affected. Thus, understanding the decline of sensory abilities is likely to help understand their role in social life,
and, assuming they can be treated or mitigated, relieve
these major burdens, thereby improving health and quality of life in older adults.
Although other studies have included sensory measures
(e.g., the National Health and Nutrition Examination Survey
[NHANES]), Wave 1 of the National Social Life, Health, and
Aging Project (NSHAP) focused exclusively on older adults
with an emphasis on social function and in-home assessment of these modalities (Schumm et al., 2009). Analysis
of the Wave 1 data improved our understanding of factors
associated with decreased olfaction and taste (Boesveldt,
Lindau, McClintock, Hummel, & Lundstrom, 2011) and
vision (Bookwala, 2011; Bookwala & Lawson, 2011), along
with information on health disparities in sensation (Pinto,
Schumm, Wroblewski, Kern, & McClintock, 2014).
The purpose of NSHAP is to examine the effects of health
burden on social function. With respect to sensory function,
NSHAP focuses not only on objective measures, but also
on subjective measures that help capture self-perception of
impairment. In addition, NSHAP captures external ratings
© The Author 2014. Published by Oxford University Press on behalf of The Gerontological Society of America.
All rights reserved. For permissions, please e-mail: [email protected].
Received November 8, 2013; Accepted July 14, 2014
Decision Editor: Robert B. Wallace, MD
Sensory Measures
of function and the relevant characteristics of the home
environment via interviewer ratings.
Ratings of sensory function can be a more broadly integrated assessment of a complex system than a single objective
test targeted at only one component, for example, distance
vision. Although cultural differences or personality (degree
of stoicism) may skew these ratings, they also are referential
to the respondent’s functioning when they were younger. By
their nature, objective measures are restricted to the domains
tested and do not necessarily reflect all perceived aspects of
sensory loss, especially on an integrated framework of overall function in the real life environment of older adults. For
example, clinically measured sensory function (e.g., distance
vision using a Snellen chart under optimal high-contrast
lighting) may not reflect conditions in the home (where lighting is often dimmer than in the clinic) and therefore underestimate the burden felt by older adults. Nor does it measure
the impairment of near or peripheral vision, which may contribute to an overall sense of vision impairment. However,
objective measures are by definition carefully defined and
can be compared across studies; thus, objective and subjective measures provide different and complementary perspectives on sensory function in field research.
Representative data on longitudinal changes in sensory
function are sparse. Other studies have included older adults
(Lam et al., 2013) in addition to younger individuals (Kiely
et al., 2012; Pedroso et al., 2012; Schubert, Cruickshanks,
Klein, Klein, & Nondahl, 2011). Wave 2 of NSHAP provides an opportunity to study self-reported (and for olfaction objective) sensory decline with aging in an older cohort
after a 5-year interval in a social context. Wave 2 is focused
on respondents’ global self-assessments of their sensory
experience and how those assessments are associated with
their physical health, mental health, and social function in
the home environment.
We summarize the available information on sensory
measures in Wave 2 of NSHAP for potential researchers.
We also provide an analysis comparing subjective and
objective assessment of vision from Wave 1 as an example of the types of analyses possible in this data set. Our
goals are to illustrate the differences in measures collected
in Waves 1 and 2 and to describe the range of sensory measures included in Wave 2 in an effort to provide a roadmap
toward utilizing this data set for research on sensory decline
in older adults.
Method
Brief Description of the NSHAP Cohort
In 2005–2006 interviewers from the National Opinion
Research Center (NORC) conducted in-home interviews
with 3,005 community-dwelling older adults (1,454
men and 1,551 women), a representative sample of the
U.S. community-dwelling population 57–85 years of age
(NSHAP Wave 1) (O’Muircheartaigh, Eckman, & Smith,
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2009; Suzman, 2009). Five years later, data were collected
again (2010–2011, Wave 2) in the same respondents and
their cohabiting partners, plus a few Wave 1 respondents
who had refused the Wave 1 interview but completed Wave
2. Interviews collected demographic, social, psychological,
and biological measures, including sensory function, which
are detailed subsequently. Further details regarding design,
data collection, and baseline characteristics of NSHAP
respondents are available elsewhere (Lindau et al., 2007;
O’Muircheartaigh et al., 2009; Suzman, 2009) [Jaszczak
et al. and O’Doherty et al., in this special issue]. The
Institutional Review Boards of The University of Chicago
and NORC approved the study; all respondents provided
written, informed consent.
Sensory Measures: Differences Between Waves 1 and 2
In constructing the sensory items in Wave 2, the NSHAP
investigator team reviewed data generated from Wave
1 with a goal of streamlining the survey protocol. It was
decided to remove the objective measures of gustation,
vision, and touch due to time constraints to improve the
objective measure of olfactory function (Kern et al., in
this issue), and to focus in this wave on respondents’ perceptions of sensory losses and their social consequences.
Gustation, vision, hearing, and touch may be (re)measured
objectively in the next wave of data collection (Wave 3),
potentially providing interval follow-up. Notably, interviewer ratings of vision and hearing were included in Wave
2 as external measures of the respondent’s sensory function
during a social interaction (objective perspective) in addition to the respondent’s own rating (subjective perspective).
The same subjective questions from Wave 1 on vision
and hearing were included in Wave 2, with some minor
modifications (see Table 1). Overall vision and hearing were
self-rated from “poor” to “excellent” as well as degree of
specific difficulty driving during the day or night. Modified
questions included the use of hearing aids (or not), a common treatment for sensorineural hearing loss (LaplanteLevesque, Hickson, & Worrall, 2010), and specific social
consequences of difficulty with hearing (e.g., frustration
with communication, difficulty hearing whispers, and compromise to personal or social life) (reviewed in Vesterager
& Salomon, 1990). In Wave 2, perceived sensation of touch
was measured by ranking the appeal or pleasantness of a
light touch (not at all to very appealing), a stimulus associated both with allodynia and social interaction (see Galisky
et al., in this issue). Because self-rated olfactory function
does not correlate with objective measures (20), this question was dropped from the subjective items on olfaction,
but assessment of factors that may influence assessment of
olfactory function was enhanced in Wave 2 (e.g., presence
of a cold, history of facial trauma, or nasal surgery; see
Kern et al., in this issue).
As in Wave 1, field interviewers in Wave 2 provided
an external (albeit their own subjective) assessment of
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PINTO ET AL.
Table 1. A Summary of Subjective Sensory Function Measures Collected in NSHAP Waves 1 and 2. *Prompted in Wave 1— “If you wear a
hearing aid, please answer this based on your hearing when you are wearing your hearing aid”
Self-reported sensory measures
Senses
Olfaction
Gustation
Vision
Hearing
Touch
Wave 1
• “How is your sense of smell? Is it… EXCELLENT, VERY
GOOD, GOOD, FAIR, POOR”
Randomized subset (50%)
• “Have you ever had surgery on your nose? YES, NO”
Full sample
• “How is your sense of taste? Is it… EXCELLENT, VERY
GOOD, GOOD, FAIR, POOR”
Randomized subset (50%)
• “With your glasses or contact lenses if you wear them, is your
eyesight EXCELLENT, VERY GOOD, GOOD, FAIR, OR
POOR?”
• “Driving a car during the day? NO DIFFICULTY, SOME
DIFFICULTY, MUCH DIFFICULTY, UNABLE TO DO,
HAVE NEVER DONE (if volunteered), DOES NOT DRIVE
ANYMORE (if volunteered)”
• “Driving a car during the night? NO DIFFICULTY, SOME
DIFFICULTY, MUCH DIFFICULTY, UNABLE TO DO,
HAVE NEVER DONE (if volunteered), DOES NOT DRIVE
ANYMORE (if volunteered)”
Full sample
• “Have you ever had a severe head injury requiring
hospitalization overnight? Do not include an overnight stay in
the emergency room. YES, NO”
• “How old were you when you had this injury?”
• “Is your hearing EXCELLENT, VERY GOOD, GOOD, FAIR,
OR POOR?”*
• “Do you feel you have a hearing loss? YES, NO”
Full sample
• “How is your sense of touch? Is it, EXCELLENT, VERY
GOOD, GOOD, FAIR, POOR”
Randomized subset (50%)
respondents’ vision and hearing as well as relevant characteristics of the home environment (Table 2). These measures
included metrics of room lighting for vision, assessment
of room noise for auditory function, and the odor of the
respondent’s home (Table 2). A reference table of objective
measures is provided in Table 3.
We performed linear regression to determine the effects
of gender and age (62–69, 70–79, and 80–90 years of age,
Wave 2
• “Today, do you have a head cold or chest cold? YES, NO”
• “Broken nose in the past 5 years? YES, NO”
• “Have you ever had surgery on your nose? YES, NO”
Full sample
• None
• “With your glasses or contact lenses if you wear them, is your
eyesight”
EXCELLENT, VERY GOOD, GOOD, FAIR, OR POOR?
• “Driving a car during the day?”
NO DIFFICULTY, SOME DIFFICULTY, MUCH DIFFICULTY,
UNABLE TO DO, HAVE NEVER DONE (if volunteered)
• “Driving a car during the night?”
NO DIFFICULTY, SOME DIFFICULTY, MUCH DIFFICULTY,
UNABLE TO DO, HAVE NEVER DONE (if volunteered)
Full sample
• “Is your hearing, with a hearing aid if you wear one,”
EXCELLENT, VERY GOOD, GOOD, FAIR, OR POOR?
• “How often do you wear a hearing aid?”
NEVER/DON’T HAVE ONE, SOMETIMES, MOST OF THE TIME,
ALWAYS
• “Does a hearing problem cause you to feel frustrated when talking to
members of your family?”
YES, NO
• “Do you have difficulty hearing when someone speaks in a whisper?”
YES, NO
• “Does a hearing problem cause you difficulty when visiting friends,
relatives, or neighbors?”
YES, NO
• “Do you feel that any difficulty with your hearing limits or hampers
your personal or social life?”
YES, NO
Full sample
• “Some people like being physically touched by people they are close
to, whereas others do not.
How appealing or pleasant do you find the following ways of being
touched?
1. Being touched lightly, such as someone putting a hand on your arm?
2. Hugging?
3. Cuddling?
4. Sexual Touching?
VERY APPEALING, SOMEWHAT APPEALING, NOT APPEALING,
NOT AT ALL APPEALING”
Full sample
including two participants who were 91 as an artifact of
interview scheduling) on self-rating of audition and vision.
Similarly, we examined the effects of age group and gender on the 5-year change in self-rating of these two senses
between Waves 1 and 2. We used ordinal logistic regression to assess the effects of gender and age on ratings of the
appeal of being lightly touched. Correlations between Wave
1 and Wave 2 responses were assessed by the method of
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Sensory Measures
Table 2. Field Interviewer Ratings of the Respondents’ Sensory Perception of the Environment in Waves 1 and 2 of NSHAP
Waves 1 and 2 field interviewer ratings
Sensory measure
Olfaction
Gustation
Vision
Hearing
Touch
• Room smell intensity using a 5-point scale ranging from “NO SMELL” to “STRONG SMELL”
• Room smell hedonics using a 5-point scale ranging from “PLEASANT SMELL” to “UNPLEASANT
SMELL”
Full sample
• None
• Respondent vision using a 5-point scale ranging from “PRACTICALLY BLIND” to “NORMAL VISION”
Room lighting using a 5-point scale ranging from “DARK” to “LIGHT”
Full sample
• Respondent hearing using a 5-point scale ranging from “PRACTICALLY DEAF” to “NORMAL HEARING”
• Room sound using a 5-point scale ranging from “QUIET” to “NOISY”
Full sample
• None
Table 3. Objective Evaluation of Sensory Function Collected in NSHAP Waves 1 and 2
Objective sensory tests
Senses
Wave 1
Wave 2
Olfaction
• Olfactory Identification Test (Five-Item Sniffin’-Sticks Test)
• Sensitivity: n-butanol Sniffin’-Sticks (with Visual Analog Scale (VAS))
Full sample
Gustation
• Four taste strips (sour, bitter, sweet, salty)
• R’s were asked to rate their certainty of each response using a 10-point
scale
Full sample
• Binocular distance acuity at 3 m using a Sloan letters chart (with glasses if
aided)
Randomized subset (50%)
• None
• Two-point discrimination at the tip of the index finger on the dominant
hand at 12 mm, 8 mm, and 4 mm
Randomized subset (50%)
Vision
Hearing
Touch
Spearman. For comparison of factors associated with subjective versus objective vision, multivariate ordinal logistic
regression was employed to determine the effects of age,
sex, race, education level, social, and health factors. A p
value ≤ .05 was considered statistically significant. All analyses were performed using Stata 12 (StataCorp, College
Station, TX).
Results/Analysis
Here we highlight the Wave 2 estimates of sensory decrements in the U.S. population, 62–90 years of age, and
report differences between age groups and gender. The
distributions for each sensory modality are available in the
Supplementary Tables A–G.
Vision
Sixteen percent of home-dwelling older adults rated
their current vision as poor or fair (Supplementary Table
A). Likewise, of all respondents, 14% reported some difficulty driving during the day, although 40% had difficulty
at night; 8% were unable to drive during the day. Severity
of impaired vision was greater in the middle and oldest
age groups than the youngest age group (p = .001 and p <
• Olfactory Identification Test (Five-Item Sniffin’-Sticks Test)
• Detection: n-butanol and androstadienone Sniffin’-Sticks
triads
Randomized subset (66%)
• None
• None
• None
• None
.001, respectively) but similar for men and women (p = .64;
Figure 1). Comparable results were found using ordinal
logistic regression. The same effects of age and gender were
detected 5 years earlier in Wave 1 (data not shown here).
Thus, preliminary analysis of Wave 2 data confirmed that
vision impairment in community-dwelling older adults is
prevalent in both men and women and increases across age
groups.
Among respondents assessed 5-years apart in Waves 1
and 2 (n = 2,254), the degree of impairment was significantly
correlated (r = 0.40), indicating stable individual differences
in visual function within the population. Of these respondents, approximately 40% reported no change in vision,
23.6% reported a decline of one functional category, 7.6% a
decline of two functional categories, and only 1.4% a decline
of three functional categories. Although the remaining 27%
reported an improvement by at least one functional category,
significantly more respondents showed a decline versus
improvement (p < .001). These data suggest that a large
number of older adults have stable vision, perhaps related to
the healthier condition of NSHAP respondents who live at
home compared with their counterparts who reside in nursing or retirement homes or hospitals. Nevertheless, ~30% of
respondents reported declines in vision.
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PINTO ET AL.
Age Group
0
1
Mean Rating in Wave 2
2
3
4
Gender
Men
Women
Hearing
Men
Women
Vision
62-69 70-79 80-90
62-69 70-79 80-90
Hearing
Vision
Figure 1. Effects of gender and age on self-rated hearing and vision. Y axis: Self-rated scores (1 = poor, 5 = excellent).
Men and women reported a similar decline in vision between
Waves 1 and 2 (average drop ± SEM: 0.06 ± 0.04 in men versus
0.11 ± 0.04 in women, p = .21). This 5-year decline in vision
was greater for the oldest and second oldest age groups compared with the youngest respondents (average drop: 0.19 ± 0.05,
0.12 ± 0.05, and 0.01 ± 0.05, in the oldest, middle, and youngest
age groups, respectively; p = .04). This is consistent with the
cross-sectional analysis described earlier and may support the
hypothesis that aging of the visual system does not appear to
be affected by hormonal or other physiologic differences or by
differential environmental exposures between genders.
Interviewers rated 55% of respondents as having normal
vision (Supplementary Table B). However, only 23% of
homes were rated as well lit, reflecting a major environmental challenge in the home that might compromise the
function of the other 45% with decreased vision. Increasing
light levels might be a simple way to mitigate poor vision.
Vision as an Example of Concordance Between
Subjective Experience and Objective Assessment
Prevalence of Vision Impairment in Wave 1.—Of the
1,506 Wave 1 respondents randomized to receive the vision
assessment, 93.9% (n = 1,414) completed the Sloan chart
test for distance visual acuity and rated the quality of their
vision overall. Reasons for exclusion included (n = 92):
refusal to participate (n = 64), glasses were not worn
(n = 20), incomplete interview or equipment problems
(n = 5), and self-reported vision was not reported (n = 3).
Almost a quarter of older adults in Wave 1 (23%) had
an objectively-measured vision impairment (defined as less
than 20/40 best-corrected bilateral visual acuity, the minimum acuity required for obtaining a driver’s license). This
included respondents who were unable to read the largest line on the chart and categorized as having worse than
20/200 vision (n = 23).
Similarly, 18% of respondents had self-reported vision
impairment (poor or fair vs. good, very good, or excellent).
Fully 75% of respondents were concordant for objective
visual acuity and overall subjective assessment. Rooms
rated as more brightly lit were associated with better objective (p < .001), but not subjective, vision.
Covariates of Subjectively and Objectively Assessed
Vision in Wave 1.—Increased age, more medications, and
more depressive symptoms were associated with decrements
in both subjective and objective vision (Table 4; n = 1,377
respondents with relevant covariates and both subjective
and objective vision). We also found that social, demographic, and health factors have different effects on objective and subjective vision, indicating that each may have
an impact on perception of sensory function in the home
environment. Interestingly, gender (women) and decreases
in cognition were associated with worse objective visual
acuity, but not self-reported subjective vision. In contrast,
impaired subjective vision was more prevalent among nonwhites, those with less education, and those with increased
problems with activities of daily living, whereas decreased
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Sensory Measures
Table 4. Multivariate Ordinal Logistic Regression of Objectively Assessed and Subjectively Assessed Vision in NSHAP Wave 1
Objective (n = 1,377)
Age (year)
Gender (Women vs. Men)
Race/ethnicity (vs. White)
Black
Hispanic
Other
Education (vs. <High School)
High School or equivalent
Some college
≥Bachelor’s
Depression
(vs. not depressed–CES-Da <9)
Cognitionb
Comorbidityc
Medicationsd
ADL probleme
Brightness of room lightingf
Subjective (n = 1,377)
Odds ratio
95% CI
Odds ratio
95% CI
0.93***
0.77**
0.92, 0.95
0.64, 0.93
0.98*
1.11
0.97, 0.99
0.91, 1.35
0.83
0.99
1.46
0.63, 1.10
0.70, 1.40
0.79, 2.69
0.57***
0.45***
0.69
0.43, 0.76
0.32, 0.65
0.37, 1.27
1.17
1.63***
1.24
0.75*
0.88, 1.56
1.22, 2.17
0.91, 1.69
0.59, 0.97
1.66***
1.93***
2.31***
0.39***
1.23, 2.23
1.43, 2.59
1.67, 3.20
0.30, 0.51
1.23***
0.95
0.97*
1.00
1.35***
1.12, 1.35
0.89, 1.01
0.94, 0.99
0.92, 1.08
1.22, 1.50
1.04
1.01
0.97*
0.85***
1.03
0.95, 1.14
0.94, 1.08
0.94, 0.99
0.78, 0.92
0.93, 1.15
Notes. Objectively assessed vision was categorized such that higher categories indicated better vision based on Sloan chart test performance. Subjectively
assessed vision was rated on a 5-point scale from poor to excellent. a
Center for Epidemiologic Studies Depression Scale.
b
Cognition based on performance on Short Portable Mental Status Questionnaire (range 0–10).
c
Modified Charlson comorbidity index (range 0–10).
d
Number of medications (range 0–20).
e
Number of Activities of Daily Living problems (range 0–6).
f
Interviewer rated brightness of room lighting (range 1 = dark to 5 = light).
*p < .05. **p < .01. ***p < .001.
objectively-measured visual acuity was not. Additionally,
brighter home lighting was strongly associated with better
objective visual acuity.
Most respondents’ visual assessments were concordant
(objective and subjective vision measures). Assessing factors that predict vision concordance would improve future
survey studies of sensory function and provide insight
into how older people view their sensory health. Indeed,
Chen and colleagues employed Wave 1 data to examine
concordance of objective vision assessment and self-report
of vision to determine pessimism and optimism about this
sensory function (Chen, McClintock, Kern, Pinto, & Dale,
2013).
Hearing
Among NSHAP respondents, 22% reported poor or
fair corrected hearing (Table C; 13% used a hearing aid).
Interestingly, although only 12% of respondents reported
that hearing difficulties limited personal or social life, fully
42% had trouble hearing whispered words and a significant
number experienced frustration when talking with family
members (20%) or when visiting with friends, relatives, and
neighbors (18%). These results support the fact that hearing loss is a major sensory burden in older adults, but hint
that perception of this burden is context specific, affecting
concrete problems of everyday living rather than broad concepts of burden in the mind of respondents.
Men reported more hearing loss than did women (p < .001;
Figure 1). As with vision, hearing loss was more severe in the
middle and oldest age groups compared with the youngest
age group for both genders (p = .001, p < .001, respectively).
Similar gender differences and age effects were found using
data collected 5 years earlier in Wave 1 and by using ordinal logistic regression (data not shown here). Thus, hearing
impairment in community-dwelling older adults is a frequent
outcome and prevalence increases in older age groups. These
gender differences in cross sectional analyses of self-reported
hearing are consistent with well-known gender differences in
age-related hearing loss. Hearing loss was also more severe
in older respondents as is typical of this generation where
work-related noise exposure (e.g., in factories, industrial settings) was much higher for men.
The correlation between self-reported auditory function
in Wave 1 and Wave 2 was r = 0.57, higher than that found
for vision. More respondents experienced a decline in best
hearing (i.e., potentially corrected with hearing aids) rather
than an improvement (n = 2,248, p < .001). A quarter (23%)
reported a decline of one functional category, 5.1% a drop of
two functional categories and only 0.89% a drop of three or
four functional categories. Almost half (46%) did not report
a change and the remaining 25% reported an improvement
by at least one functional category. Age groups did not
differ in magnitude of the decline (average drop ± SEM:
0.01 ± 0.05, 0.11 ± 0.04, and 0.05 ± 0.06 in youngest, middle, and oldest age groups, respectively; p = .25). This may
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reflect that the aging of the auditory system may begin earlier in life, prior to the age of 57 years. Men and women
had similar declines between Waves 1 and 2 (average drop
of 0.07 ± 0.04 for men and 0.04 ± 0.04 for women, p = .66).
Interestingly, this lack of a significant difference in hearing
across waves between the genders may indicate that once
the injury to auditory function has occurred, both groups
decline at the same rate. We speculate that there may be a
window of time earlier in life where people are most sensitive to this environmental insult. Indeed, noise exposure is
a known risk factor for hearing loss, but its role in affecting
hearing specifically in older adults is not well known nor is
it known when in life the auditory system is most susceptible to injury. Hobbies such as gun use or prior history of
gun use (e.g., in veterans) may affect hearing loss.
Those using hearing aids (either sometimes, most of the
time, or always) nonetheless reported significantly lower
corrected hearing function (2.78 ± 0.08, n = 397) compared
with those who did not (3.45 ± 0.03, n = 2,978; p < .001).
This is an important internal control, as hearing aid use
would be expected to be associated with worse audition.
Interviewers rated 54% of respondents as having normal
hearing, and a large majority of homes were rated as quiet
during the interview (75%; Supplementary Table D).
Touch
A majority of respondents reported that being touched
lightly was somewhat or very appealing/pleasant (87%;
Supplementary Table E). Men found it less appealing than
did women (p = .011; for example, 36% of men vs. 41% of
women rated it very appealing). The appeal of light touch
was lowest in the oldest age group (p < .001; for example,
41% (62–69), 40% (70–79), and 30% (80–90) considered
it very appealing). These results indicate that there are gender differences in the perception of touch, a finding that
may affect the relationships between partners including
both sexual and non-sexual activity as well as interpersonal
communication. Furthermore, such differences could have
health implications on activities such as exercise, physical or
occupational therapy, or delivery of social services. Further
information on pleasure derived from light and intimate
touch is provided in this issue (Galinsky et al., in this special
issue). We note that this measure is different than traditional
objective physiological measures of touch (e.g., as included
in Wave 1 [two-point discrimination] or assessment of sensitivity to vibration or pressure; Bruce, 1980; Thornbury &
Mistretta, 1981; Gescheider, Bolanowski, Hall, Hoffman, &
Verrillo, 1994; Goble, Collins, Cholewiak, 1996; Verrillo,
Bolanowski, & Gescheider, 2002).
Olfaction
On the day of the survey, few respondents reported having a cold (8%), which might have altered objective olfactory assessment (Supplementary Table F). There was also
a low prevalence of a history of nasal surgery or of trauma
(8% and <1%, respectively), other factors that affect olfaction. Thus, these potential confounds should not greatly
affect estimates of objective olfactory function (reported
by Kern et al., in this issue), although some researchers
may wish to consider not including these respondents in
certain analyses. In this way, relevant parameters present
at the time of olfactory assessment can be used as internal
controls in analyses, for example by comparing those with
colds or surgery to those without.
Interviewers rated the strength and pleasantness of odors present in the home, which might affect olfactory function. Fully
76% of homes were rated as having no smell, whereas 3% had
a strong odor (Supplementary Table G). Of homes with odors,
65% were rated somewhat unpleasant (a rating of 3–4 out of
5) and an additional 14% smelled the most unpleasant (5 on
a 5-point scale; Supplementary Table G). Conversely, environmental odors in the home may reflect inability to detect malodors and also yield insights into other aspects of health (social
disorganization, poor cognition, lack of social supports, etc.).
Discussion
These data provide nationally representative information on sensory function in older adults who live at home
in the United States. Preliminary analysis revealed that
vision and hearing impairments in these older adults are
prevalent in both men and women and are greater in older
age groups. We found expected gender differences in crosssectional analysis of self-reported hearing, consistent with
well-known gender differences in age-related hearing loss.
These data demonstrate the kind of questions that can be
addressed in NSHAP that can be used to complement and
contrast with other major studies that contain information
on sensory function (e.g., the National Health and Nutrition
Examination, among others). We note that NSHAP’s sampling design (though similar to the Health and Retirement
Study from which it is derived) is distinctive and its focus
on social context and function remains a relative strength.
The sensory impairments shown here have important functional consequences in terms of personal interactions with
both friends and family, but also on critical activities such as
driving (Ramulu, West, Munoz, Jampel, & Friedman, 2009).
For example, these deficits could affect access to health care,
healthy foods, personal safety, with major impacts on health,
quality of life, and social function. Inability to communicate
(e.g., hearing other people or reading correspondence) could
affect pleasure in daily life and lead to social isolation, with
concomitant depression, anxiety, or stress. With the rich data
available in NSHAP Wave 2, these questions can be directly
addressed. For each modality, important questions of the
relationship to disease, medication use, co-morbidity, and
social function can be answered with this data set.
A number of types of additional analyses are possible with these data. Vision is the most straightforward as
Sensory Measures
the subjective assessments of overall vision are exactly
the same in Waves 1 and 2 and thus interval change with
time can be addressed in the same individuals, or cohort
effects can be assessed in analyses adjusted for birth year.
Similarly, because self-rated hearing was measured in both
waves, longitudinal analyses are possible here.
Distinction between subjective and objective evaluation
of sensory function receives much attention in studies with
a clinical perspective. However, for analysis of personal
impact of sensory function on social functions, it is illustrative to consider which factors are associated with each
assessment and how they differ. This is possible for vision,
touch, olfaction, and gustation in Wave 1, where both objective and subjective measures were collected. Similarly,
assessment of the home environment as provided by field
interviewer rating of relevant parameters for these senses (as
well as their ratings of subject sensory function) is available in both Wave 1 and Wave 2, allowing for analyses that
account for home context, for example in our examination of
vision concordance. Lastly, one might use subjective measures and/or field interviewer ratings to impute missing data.
Field interviewer ratings of respondent sensory function
and the home environment can be incorporated into such
analyses and enable users of this data set to assess if the
self-reported information is consistent with the trained
interviewer’s determination. We acknowledge the limitations of such ratings, but they can provide important information in studies of the social setting of older adults and
their health. For example, ratings of the noise present in the
home could be used as covariates when analyzing respondent hearing. Nevertheless, these ratings compromise a small
subset of interviewer provided ratings across a large standard battery of items common in these types of surveys. As
with all survey items, such data come with some degree of
associated error. Interviewers (n = 124) were highly trained
professionals with longstanding experience in survey studies, and the study was designed to increase inter-rater reliability across all measures. Lastly, we did not measure
interviewer sensory function, though they were largely
young and mostly women with likely normal sensory function allowing reasonable estimates for these ratings. We are
not aware of assessments of interviewer sensory function
in survey studies for use as a scale anchor or covariate in
analyses; such assessment was not feasible in NSHAP.
The variables concerning subjective assessment of home
environment and relevant history similarly provide useful
context. For hearing and smell, the environmental information can be used as a check or control when analyzing other
aspects of the data (self-report or objective function, respectively) and provide important contexts. For example, use of
hearing aids is an indicator of worse hearing and respondents with colds may show worse olfaction.
Analyses of these data are limited by the granularity of
available health information; for example, without detailed
data on prior treatments, earlier life history, or environmental
S151
exposures on sensory function, such studies are not possible. Other limitations would include specific details related
to the sensory measures. For example, we did not include
assessment of near vision, presence of cataracts or history
of cataract surgery, laterality of hearing, vision, or olfactory
loss, nor variability in the assessment of touch at multiple
anatomic sites. Objective measures are limited to interviewer observations without audiometry, which constrains
conclusions that can be drawn regarding experienced and
objective hearing loss. These limitations were necessary
for logistical reasons related to survey length and cost (e.g.,
portable audiometers, need for trained technicians, etc.).
A potential limitation to the subjective measures is variation in temperament and standardization of self-rating
scales. Though open to challenge, it is our opinion that
inclusion of such measures provides for a more personal
reflection of disease burden in the case of respondents and
provides a more holistic assessment of health by allowing
analysis of how respondents perceive their sensory function and contrast their actual level of function for measures
where that is available. These data may also be used as an
external check on perception of these burdens and environmental contexts in the case of interviewers. Our example
of vision concordance supports this argument. However,
we acknowledge that other confounders not measured
in NSHAP could lead to reporting better or worse function via self-report than by objective measurement (e.g.,
known generational and cultural differences in stoicism,
personality or psychological or religious proclivities). In
this context, one may consider the subjective measures in
Wave 2 as perceived sensory function. One critical finding in this study, which is generalizable to other studies
of sensory function that employ NSHAP data, is that as
assessments were made in the home, they reflect these
perceived conditions in the home environment and thus
are directly translational in terms of personal and societal
impact, as has been suggested by others (Ball, 2003). In
summary, despite these limitations, NSHAP provides an
excellent opportunity to examine the relationship between
sensory loss, aging, and health in a social context.
Most importantly, the relationship between sensory function and other health measures can be addressed using these
data. For example, what is the association between sensory
function and comorbidities, mental health, social networks?
Does this vary by race, gender, age, or modality? Data from
NSHAP show a substantial prevalence of olfactory loss in
older adults and significant health disparities, with African
Americans showing worse olfactory function compared with
whites despite adjustment for relevant confounders (Pinto
et al., 2014) (see also Kern et al., in this issue). Are some
senses more “frail” than others? Is there a concept of sensory
frailty that incorporates these measures? In summary, a host
of studies are possible with these data that will inform the
factors that affect sensory loss and also consequences that
these losses have on health and social function.
S152
PINTO ET AL.
Key Points
•• Sensory measures collected in Wave 2 of the National
Social Life, Health, and Aging Project (NSHAP)
included information on olfaction, vision, hearing,
and touch.
•• Significant differences between men and women
existed for hearing and touch, and age was associated
with decreased sensory function across modalities.
•• These deficits were associated with detrimental
impact on social function.
•• These data, along with associated measures related
to social and physical function and health may prove
useful for the investigation of sensory function in
older people.
Supplementary Material
Supplementary material can be found at: http://psychsocgerontology.
oxfordjournals.org/
Funding
NSHAP was funded by the National Institute on Aging (grant numbers
AG033903-01, AG030481-37, AG021487-01), and by NORC which was
responsible for the data collection. These awards also supported the work of
KEW, LPS, DWK, and MKM. DWK was also supported by The Center on
Aging Specialized Training Program in the Demography and Economics of
Aging (NIA T32000243). JMP was supported by the McHugh Otolaryngology
Research Fund, an American Geriatrics Society/Dennis W. Jahnigen Scholar
Award, the National Institute of Aging (AG12857, K23 AG036762), the
Institute for Translational Medicine (KL2RR025000, UL1RR024999),
and the National Institute on Aging (K23 AG036762) at The University of
Chicago. The content is solely the responsibility of the authors and does not
necessarily represent the official views of the National Institutes of Health.
Acknowledgments
Data from NSHAP Wave 1 (Waite, Linda J., Edward O. Laumann, Wendy
Levinson, Stacy Tessler Lindau, and Colm A. O’Muircheartaigh. National
Social Life, Health, and Aging Project (NSHAP): Wave 1. ICPSR20541-v6.
Ann Arbor, MI: Inter-university Consortium for Political and Social
Research [distributor], 2014-04-30. doi:10.3886/ICPSR20541.v6) and Wave
2 (Waite, Linda J., Kathleen Cagney, William Dale, Elbert Huang, Edward
O. Laumann, Martha McClintock, Colm A. O’Muircheartaigh, L. Phillip
Schumm, and Benjamin Cornwell. National Social Life, Health, and Aging
Project (NSHAP): Wave 2 and Partner Data Collection. ICPSR34921-v1.
Ann Arbor, MI: Inter-university Consortium for Political and Social
Research [distributor], 2014-04-29. doi:10.3886/ICPSR34921.v1) are available for public use at http://www.icpsr.umich.edu/icpsrweb/landing.jsp
Conflict of Interest
The authors declare no conflicts of interest.
Correspondence
Correspondence should be addressed to Jayant M. Pinto, MD,
Department of Surgery/Otolaryngology-Head and Neck Surgery,
University of Chicago, 5841 S. Maryland Avenue, Chicago, IL 60647.
E-mail: [email protected].
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