Aging does not occur in silos

Healthy Aging Involves the Combination of Sensory, Motor and Cognitive Health

Healthy aging and integrated care

The World Health Organization (WHO), refers to healthy aging as developing and maintaining functioning in everyday life so that people can be and do what they value (1). Population health experts have defined health as the capacity of people to adapt to, respond to, or control life’s challenges and changes (2). According to this view, despite age-related changes, health may be less about biological changes and more about how people maintain everyday functioning by adjusting to those changes. As people grow older, they may experience changes in sensory, motor and/or cognitive abilities that make it more challenging to functioning optimally in everyday life. It becomes increasingly common to experience changes in multiple abilities. It is important to understand that there are links between these changes and that their combinations can have important effects on functioning. In particular, the WHO report Integrated Care for Older People identifies hearing, vision, mobility and cognition as four key abilities that are likely to decline with age and it recommends an integrated approach to address the combined effects of these declines on functioning (3). Prevention, treatment and supportive environments can help aging adults to maintain functioning in everyday life as they learn to live optimally with one or more changes in sensory, motor and/or cognitive abilities. Ultimately, this integrated approach will support older adults’ participation and engagement in valued physical, mental, and social activities.

Our four upcoming blogs will explore the links between changes in hearing, vision, mobility and cognition, how their combinations can affect functioning in everyday life, and what can be done to prevent, check, and help people to adjust to these changes. Here’s what to expect in each blog.

1. Linking Sensory Loss to Cognitive Decline

The research shows us that sensory losses (i.e., hearing and/or vision) are linked to changes in cognition including dementia (4-6). The reasons for these links are not yet known, although several possible explanations have been proposed (7-10). Read more about how to take preventative measures to protect your sensory health to preserve your cognitive function and reduce risk for dementia.

2. Linking Cognition and Mobility

There is research linking dementia with poor balance, unsteady or slow walking, and falls (11). Physical exercise can improve both cognitive performance and mobility and reduce falls for everyone, whether or not they already have cognitive impairments (12-18). Read more about this research and what the recommended physical activity guidelines are for older adults.

3. Linking Sensory Loss and Mobility

Good hearing and vision are important for safe mobility in everyday life (e.g., when walking or driving), especially when a person does another task (e.g., listening) at the same time. Sensory losses have been linked to increased falls risk and poor driving performance (19-25). Read more about how to optimize mobility within and beyond the home.

4. Implementing Hearing and Vision Health Strategies

There are several effective strategies that can improve hearing and vision (26-32). Prevention, checking for sensory loss yourself using online applications, and seeking professional help are key. Help may include specialized technologies (e.g., hearing aids, glasses) and/or more common technologies (e.g., smartphone apps). People with sensory problems and their family or friends can benefit from learning how to use new communication strategies and how to improve daily environments (e.g., reducing noise, increasing lighting). Read more about this research and recommendations. 

References

1. World Health Organization. Healthy ageing and functional ability. [Internet] 2020. [cited November 2024]. Available from: https://www.who.int/news-room/questions-and-answers/item/healthy-ageing-and-functional-ability 

2. Frankish CJ, Green LW, Ratner PA, et al. Impact assessment as a tool for population health promotion and public policy. [Internet] 1996. [cited November 2024] Available from: https://www.canada.ca/en/public-health/services/health-promotion/population-health/population-health-approach.html#def_health 

3. World Health Organization. Integrated care for older people (‎ICOPE)‎: Guidance for person-centred assessment and pathways in primary care. [Internet] 2019. [cited November 2024]. Available from: https://www.who.int/publications/i/item/WHO-FWC-ALC-19.1 

4. Lin FR, Yaffe K, Xia J, et al. Hearing loss and cognitive decline in older adults. JAMA Internal Medicine. 2013; 173(4): 293-299. doi:10.1001/jamainternmed.2013.1868  

5. Loughrey DG, Kelly ME, Kelley GA, et al. Association of age-related hearing loss with cognitive function, cognitive impairment, and dementia: A systematic review and meta-analysis. JAMA Otolaryngol Head Neck Surg. 2018; 144(2):115-126. doi: 10.1001/jamaoto.2017.2513.   

6. Ehrlich, JR, Goldstein J, Swenor B, et al. Addition of vision impairment to a life-course model of potentially modifiable dementia risk factors in the US. JAMA Neurology. 2022; 79(6): 623-626. doi: 10.1001/jamaneurol.2022.0723 

7. Uchida Y, Sugiura S. Nishita Y, et al. Age-related hearing loss and cognitive decline—The potential mechanisms linking the two. Auris Nasus Larynx. 2019; 46(1): 1-9. doi:10.1016/j.anl.2018.08.010 

8. Evans IE, Martyr A, Collins R, et al. Social isolation and cognitive function in later life: A systematic review and meta-analysis. Journal of Alzheimer’s disease. 2019 70(s1):S119-44. doi: 10.3233/JAD-180501 

9. Blondell SJ, Hammersley-Mather R, Veerman JL. Does physical activity prevent cognitive decline and dementia?: A systematic review and meta-analysis of longitudinal studies. BMC Public Health. 2014; 14:1-2. doi:10.1186/1471-2458-14-510 

10. Fortunato S, Forli F, Guglielmi V, et al. A review of new insights on the association between hearing loss and cognitive decline in ageing. Acta Otorhinolaryngologica Italica. 2016; 36(3):155. doi: 10.14639/0392-100X-993 

11. Chiaramonte R, Cioni M. Critical spatiotemporal gait parameters for individuals with dementia: A systematic review and meta-analysis. Hong Kong Physiotherapy Journal. 2021; 41(01):1-4. doi:10.1142/S101370252130001X 

12. Lam FM, Huang MZ, Liao LR, et al. Physical exercise improves strength, balance, mobility, and endurance in people with cognitive impairment and dementia: A systematic review. Journal of Physiotherapy. 2018; 64(1):4-15. doi:10.1016/j.jphys.2017.12.001 

13. Falck RS, Davis JC, Best JR, et al. Impact of exercise training on physical and cognitive function among older adults: A systematic review and meta-analysis. Neurobiology of Aging. 2019; 79:119-30. doi:10.1016/j.neurobiolaging.2019.03.007                                                                                        

14. Papalia GF, Papalia R, Diaz Balzani LA, et al. The effects of physical exercise on balance and prevention of falls in older people: A systematic review and meta-analysis. Journal of Clinical Medicine. 2020; 9(8):2595. doi:10.3390/jcm9082595 

15. Sherrington C, Michaleff ZA, Fairhall N, et al. Exercise to prevent falls in older adults: An updated systematic review and meta-analysis. British Journal of Sports Medicine. 2017; 51(24):1750-8. doi:10.1136/bjsports-2016-096547 

16. Sherrington C, Fairhall NJ, Wallbank GK, et al. Exercise for preventing falls in older people living in the community. Cochrane Database of Systematic Reviews. 2019 (1). doi:10.1002/14651858.CD012424.pub2. 

17. Tricco AC, Thomas SM, Veroniki AA, et al. Comparisons of interventions for preventing falls in older adults: A systematic review and meta-analysis. Jama. 2017; 318(17):1687-99. doi:10.1001/jama.2017.15006   

18. Chen FT, Etnier JL, Chan KH, et al. Effects of exercise training interventions on executive function in older adults: A systematic review and meta-analysis. Sports Medicine. 2020; 50(8):1451-67. doi:10.1007/s40279-020-01292-x  

19. Foster JI, Williams KL, Timmer BH, et al. The association between hearing impairment and postural stability in older adults: A systematic review and meta-analysis. Trends in Hearing. 2022; 26. doi:10.1177/23312165221144155 

20. Kahiel Z, Grant A, Aubin MJ, et al. Vision, eye disease, and the onset of balance problems: The Canadian longitudinal study on aging. American Journal of Ophthalmology. 2021; 231:170-178. doi:10.1016/j.ajo.2021.06.008 

21. Lin FR, Ferrucci L. Hearing loss and falls among older adults in the United States. Archives of Internal Medicine. 2012; 172(4):369-71. doi:10.1001/archinternmed.2011.728  

22. Dhital A, Pey T, Stanford MR. Visual loss and falls: A review. Eye. 2010; 24(9):1437-46. doi:10.1038/eye.2010.60

23. Freeman EE, Munoz B, Turano KA, et al. Measures of visual function and time to driving cessation in older adults. Optometry and Vision Science. 2005; 82(8):765-773. doi:10.1097/01.opx.0000175008.88427.05

24. Owsley C, Wood JM, McGwin Jr G. A roadmap for interpreting the literature on vision and driving. Survey of Ophthalmology. 2015; 60(3):250-262.doi:10.1016/j.survophthal.2015.01.005  

25. Green KA, McGwin Jr G, Owsley C. Associations between visual, hearing, and dual sensory impairments and history of motor vehicle collision involvement of older drivers. Journal of the American Geriatrics Society. 2013; 61(2):252-257. doi:10.1111/jgs.12091 

26. Government of Canada. Seniors and Aging – Vision Care. [Internet] 2006. [cited November 2024]. Available from: https://www.canada.ca/en/health-canada/services/healthy-living/your-health/lifestyles/seniors-aging-vision-care.html    

27. National Institute on Deafness and Other Communication Disorder. Age-Related Hearing Loss (Presbycusis). [Internet] 2023. [cited November 2024]. Available from: https://www.nidcd.nih.gov/health/age-related-hearing-loss 

28. World Health Organization. hearWHO. [Internet] ND. [cited November 2024]. Available from: https://www.who.int/teams/noncommunicable-diseases/sensory-functions-disability-and-rehabilitation/hearwho  

29. World Health Organization. Check your vision with WHOeyes. [Internet] 2023. [cited November 2024]. Available from: https://www.who.int/teams/noncommunicable-diseases/sensory-functions-disability-and-rehabilitation/whoeyes 

30. Borre ED, Kaalund K, Frisco N, et al. The impact of hearing loss and its treatment on health-related quality of life utility: A systematic review with meta-analysis. Journal of General Internal Medicine. 2023; 38(2):456-79. doi:10.1007/s11606-022-07795-9 

31. Ferguson MA, Kitterick PT, Chong LY, et al. Hearing aids for mild to moderate hearing loss in adults. Cochrane Database of Systematic Reviews. 2017; (9). doi:10.1002/14651858.CD012023.pub2 

32. Health Hearing. Communication tips for talking to people with hearing loss. [Internet] 2023. [cited November 2024]. Available from: https://www.healthyhearing.com/report/51744-Communication-strategies-when-talking-to-individuals-with-hearing-loss  

McMaster Optimal Aging Blog Posts are written by faculty, staff, PhD students, and external collaborators, and are assessed for accuracy by members of the Portal scientific leadership team.

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