Association between visual impairment and recurrent hospitalizations in older US adults

Abstract

Background

Visual impairment (VI) is common in older adults and is associated with adverse health outcomes. However, the association between objectively assessed VI and recurrent hospitalization remains unclear.

Objective

To investigate the association of different domains of visual function with recurrent hospitalization in older adults in the United States.

Methods

We used data from Round 11 of the National Health and Aging Trends Study (NHATS), a nationally representative survey of Medicare beneficiaries, which included objective measures of distance and near visual acuity and contrast sensitivity. Using multivariable logistic regression models, we analyzed the association between VI (distance and near acuity <20/40, contrast sensitivity <1 SD below the sample mean) and prior year hospitalization and estimated marginal predicted probabilities of any (≥1) and recurrent (>1) hospitalization. Models were adjusted for demographic factors and comorbid medical conditions and accounted for NHATS complex survey design.

Results

The sample included 2960 respondents aged 71 and older (median age 81 years; 45% male, 82% non‐Hispanic White). The predicted probability of hospitalization for those with any type of VI was 19.2% (15.9–22.6) versus 16.7% (14.9–18.6) for those without VI. The predicted probability of recurrent hospitalization for those with any type of VI was 7.2% (4.8–9.7) versus 4.1% (3.1–5.2) for those without VI. Near VI was significantly associated with recurrent hospitalization (OR = 2.04 [1.6, 3.61], p = 0.02), independent of other visual function measures, while other types of VI were not.

Conclusion

Near VI is significantly associated with recurrent hospitalization in older US adults. Future studies should determine whether improving near vision affects the likelihood of recurrent hospitalization.

Key points

• Vision impairment is linked to adverse late‐life health outcomes among older adults.

• Using objective vision measures from a nationally representative sample of older adults in the United States, we sought to understand the relationship between vision impairment and hospitalizations.

• Near vision impairment, but not distance visual acuity or contrast sensitivity impairment, was associated with increased odds of recurrent hospitalizations.

Why does this paper matter?

Vision impairment (VI) is common among older adults in the United States, and is expected to increase in incidence and prevalence as the population ages. It has been associated with cognitive decline, functional limitations, and reduced quality of life. Hospitalization, a major driver of healthcare costs and a significant burden for both individuals and the healthcare system, can exacerbate these issues. Prior research has shown a link between self‐reported visual difficulties and hospitalization but has not thoroughly explored objective measures of visual function or differentiated between various visual functions. This study seeks to fill that gap by assessing whether specific types of visual impairments—near and distance visual acuity, as well as contrast sensitivity—are associated with increased odds of recurrent hospitalizations. By identifying modifiable associations like visual impairment, these findings could inform future interventions aimed at improving vision and reducing hospitalizations, ultimately contributing to healthier aging and better public health outcomes.

INTRODUCTION

Visual impairment (VI) is common among older US adults, affecting 27.8% of those aged 71 years and older. ¹ Visual and other sensory impairments are associated with functional limitations, an increased risk of cognitive decline, loss of independence, and lower quality of life. ² Prior work has also suggested an association between vision problems and hospitalization in older US adults. ³ Since some hospitalizations and their sequelae may be preventable, identification of factors associated with recurrent hospitalizations may contribute to well‐being and optimal aging.

Among older adults, hospitalization can represent a sentinel event and may transiently increase the risk of conditions such as delirium, dehydration, accelerated deconditioning, malnutrition, and nosocomial infection, predisposing individuals to dependency, falls, and fractures.^{4, 5, 6} Hospitalization may also confer a large financial burden on individuals and the healthcare system. Hospital care accounts for 31% of all healthcare spending in the United States, ⁷ and total hospital expenditures by Medicare exceeded $350 billion in 2021. ⁸ Identifying modifiable factors that influence recurrent hospitalizations is therefore an important fiscal and public health consideration.

A study by Deardorff et al. established an association between self‐reported visual difficulty and increased odds of hospitalization, which was also correlated with higher healthcare expenditures in a panel of Medicare beneficiaries. ⁹ Another study using Medicare Current Beneficiary Survey data from 2001 to 2017 found that respondents who self‐reported visual difficulty were more likely to be hospitalized in a three‐year follow‐up period, independent of medical comorbidities. ³ Indeed, while there is evidence that vision problems are associated with a higher likelihood of hospitalization, prior studies have largely relied on self‐reports of visual difficulty^{3, 9, 10} or administrative claims^{11, 12} and have not assessed the association of hospitalization with different objective measures of visual function.

Recent studies have demonstrated that discordance between self‐reported visual difficulty and objectively assessed VI is common.^{13, 14} Furthermore, vision is a multidimensional construct; though visual acuity is often the only measure of visual function in population‐based studies, different visual functions may have varied impacts on gerontological outcomes. ¹⁵ Thus, characterizing associations between various objective measures of visual function and hospitalization may inform future work to understand the mechanisms by which VI influences recurrent hospitalization and could aid in designing and testing vision‐improving interventions to keep older adults out of the hospital. Accordingly, the purpose of this study was to determine whether near visual acuity, distance visual acuity, and contrast sensitivity are associated with recurrent hospitalization in a nationally representative sample of older US adults.

METHODS

Study population

The National Health and Aging Trends Study (NHATS) is a nationally representative panel survey of Medicare beneficiaries aged 65 and older. NHATS conducts annual interviews with participants, including survey and performance measures. The first round of NHATS was conducted in 2011 and the NHATS panel has been periodically replenished. The current analysis used data from Round 11, collected from June to November 2021; since the prior sample replenishment was in 2015, participants in Round 11 were aged 71 years and older. This was the first year in which NHATS integrated objective assessments of visual function into its annual data collection protocol.

Hospitalizations

While our primary interest was in studying recurrent hospitalization we assessed two outcomes: (1) whether the respondent had been hospitalized at any time during the prior year (“any hospitalization”) and (2) whether respondent had been hospitalized more than once during the past year (“recurrent hospitalization”). Hospitalizations were defined as an overnight stay in the hospital lasting through one midnight or longer since completing the last NHATS interview; this was reported by the NHATS respondent or their proxy.

Visual impairment

Visual function was assessed in NHATS using tablet‐based measures (Ridgevue Vision). The NHATS vision testing protocol is described in detail elsewhere. ¹⁶ All tests were administered binocularly and interviewers asked participants to wear their usual refractive correction (glasses or contacts) for each test. The vision tests in NHATS were validated against clinical gold standard measures ¹⁷ and were pilot tested ¹⁸ in 2019 before integration into the NHATS annual protocol. By conducting vision tests with participants using their usual glasses or contact lenses, these tests represent free‐living rather than idealized measures of visual function.

Near and distance visual acuity impairments were defined using World Health Organization impairment categories. ¹⁹ Near visual acuity impairment was defined as reading print size larger than N6 at 40 cm, which is approximately equivalent to logarithm of the minimum angle of resolution (logMAR) >0.30 or Snellen equivalent <20/40. Distance visual acuity impairment categories include mild impairment (>0.30 to 0.48 logMAR; <20/40 to 20/60), moderate impairment (>0.48 to 1.0 logMAR, <20/60 to 20/200), severe impairment (>1.0 to 1.3 logMAR, <20/200 to 20/400), and blindness (>1.3 logMAR, <20/400). Due to small counts in the higher impairment categories, moderate and severe impairment and blindness were collapsed into a single category. There are no standard metrics for reporting contrast sensitivity (CS) impairment and we defined this as binocular contrast sensitivity >1 standard deviation below the NHATS sample mean (sample mean – 1 SD equivalent to 1.65–0.28 = 1.37 logCS) as in prior published studies.^{1, 20} Of note, higher logMAR and lower logCS values correspond to worse visual function.

Covariates

Covariates were included in the analysis based on their conceptual relevance to each regression model. We used a theoretical approach to identify variables that may confound the relationship between vision impairment and hospitalizations. Sociodemographic factors included age (in 5‐year increments), gender (male or female), race and ethnicity (non‐Hispanic White, non‐Hispanic Black, Hispanic, other), education (less than high school diploma, high school diploma, some college, college degree or more), and annual household income by quartile. Indicators of health status included number of health conditions (myocardial infarction, heart disease, hypertension, diabetes, lung disease, stroke, cancer), smoking status, dementia status (none, possible, or probable based on NHATS algorithm), ²¹ and body mass index. All covariates were self‐ or proxy‐reported, except for BMI, which was based on measurement of height and weight, and dementia status, which was based on the results of cognitive tests or a self/proxy‐reported diagnosis. Second‐Order Rao–Scott Chi‐Square Test was used to test the association between covariates and VI status.

Data analysis

Two sets of multiple logistic regression models were used to investigate the relationship between visual impairments and (i) the odds of any (≥1) and (ii) recurrent (>1) hospitalization over the year prior to the NHATS interview. We also estimated the marginal predicted probability of any hospitalization and recurrent hospitalization, adjusted for covariates, using the “margins” command in STATA. We first analyzed the association of each measure of visual function with the hospitalization outcomes. Based on the results of those models, our primary analyses included all three visual functions in a single model in order to estimate the association of each vision measure with the outcome independent of other visual functions. Separate models were estimated with visual function operationalized on a continuous log scale (effect estimates scaled to 0.1 log units), as well as with binary variables representing VI. Analyses were conducted using SAS version 9.4 (SAS Institute, Cary, NC, USA) and STATA version 16 (StataCorp, College Station, TX) and accounted for the NHATS complex survey design in order to make nationally representative parameter estimates. All statistical tests were two‐tailed, and a p‐value of < 0.05 was considered statistically significant.

Ethical considerations

NHATS was approved by the Johns Hopkins Bloomberg School of Public Health Institutional Review Board (IRB) and all participants provided informed consent. The current analysis was approved by the University of Michigan IRB and all data were de‐identified and publicly available (https://nhats.org/researcher/data-access).

RESULTS

Overall, 3388 NHATS respondents completed the Round 11 sample person interview. Among those participants, 3026 had complete vision data. After excluding an additional 66 individuals with missing outcomes or covariates, the final analytical cohort included 2960 participants. The weighted median age of the study sample was 76.9 years, 44.7% were male, 81.8% were non‐Hispanic White, and 27.8% had any type VI (Table 1). Approximately 17.4% of the study sample was hospitalized one or more times and 5.1% had recurrent hospitalizations over the year prior to the interview. The weighted baseline sample characteristics by type of VI status (near, distance, CS impairment, and any VI) can be found in Supplement Table 1.

TABLE 1.

Survey weighted baseline characteristics by visual impairment status, 2021 National Health and Aging Trends Study, Round 11, n = 2960.

		Weighted % (95% CI)
Characteristics	Total, No.	Total	Normal vision	Any VI a	p‐value b
N	2960		72.2 (70.0, 74.5)	27.8 (25.5, 30.0)
Age (years)					<0.0001
71–74	412	29.7 (27.4, 32.0)	33.1 (30.2, 36.0)	20.7 (16.9, 24.6)
75–79	885	32.7 (30.3, 35.0)	34.5 (31.8, 37.3)	27.8 (23.7, 31.9)
80–84	755	20.1 (18.5, 21.7)	19.3 (17.7, 21.0)	22.1 (19.1, 25.1)
85–89	546	11.6 (10.7, 12.6)	9.5 (8.4, 10.6)	17.2 (14.8, 19.7)
90+	362	5.9 (5.2, 6.6)	3.5 (2.8, 4.2)	12.2 (10.2, 14.2)
Gender					0.75
Male	1256	44.7 (42.2, 47.1)	44.4 (41.7, 47.2)	45.3 (40.6, 50.0)
Female	1074	55.3 (52.9, 57.8)	55.6 (52.8, 58.3)	54.7 (50.0, 59.4)
Race					<0.0001
Non‐Hispanic White	2167	81.8 (79.2, 84.4)	85.0 (82.6, 87.4)	73.5 (68.7, 78.3)
Non‐Hispanic Black	591	7.9 (6.8, 9.1)	6.4 (5.4, 7.5)	11.9 (9.4, 14.4)
Hispanic	136	6.9 (5.0, 8.9)	5.6 (4.1, 7.0)	10.5 (6.4, 14.6)
Other	66	3.3 (2.1, 4.5)	3.0 (1.8, 4.3)	4.2 (2.4, 5.9)
Education					<0.0001
Less than high school diploma	453	12.6 (10.9, 14.4)	9.4 (7.7, 11.1)	21.1 (17.5, 24.7)
High school diploma	756	24.3 (21.8, 26.9)	24.1 (21.1, 27.0)	25.0 (21.3, 28.7)
Some college	650	23.0 (20.8, 25.1)	23.8 (21.2, 26.4)	20.8 (17.0, 24.6)
College degree or more	1101	40.0 (36.5, 43.6)	42.7 (38.8, 46.7)	33.1 (28.2, 37.9)
Annual family income					<0.0001
<$21,000	718	19.7 (17.6, 21.8)	15.5 (13.4, 17.7)	30.6 (26.4, 34.8)
$21,000 to <40,000	698	22.1 (19.8, 24.4)	21.3 (18.7, 23.8)	24.3 (20.4, 28.2)
$40,000–75,000	749	27.0 (24.6, 29.4)	28.8 (25.9, 31.6)	22.5 (19.0, 26.1)
$75,000+	795	31.2 (27.4, 34.9)	34.5 (30.4, 38.5)	22.6 (17.8, 27.3)
Number of health conditions					0.01
0	401	16.0 (14.4, 17.5)	16.7 (14.8, 18.6)	14.1 (10.4, 17.8)
1	978	34.8 (32.6, 37.0)	35.8 (33.0, 38.6)	32.3 (28.1, 36.4)
2	927	28.8 (26.7, 30.9)	29.3 (26.8, 31.9)	27.4 (22.9, 31.8)
3	480	15.2 (13.7, 16.7)	13.5 (11.8, 15.2)	19.7 (16.4, 23.0)
≥ 4	174	5.2 (4.4, 6.0)	4.7 (3.6, 5.7)	6.6 (4.9, 8.4)
Ever smoked	1440	49.7 (47.6, 51.8)	49.6 (47.3, 51.9)	50.0 (46.3, 53.7)	0.84
Possible or probable dementia	495	12.2 (10.9, 13.6)	9.1 (7.7, 10.5)	20.4 (17.3, 23.6)	<0.0001
BMI category					0.02
Underweight	77	2.2 (1.5, 2.9)	1.4 (0.8, 2.1)	4.2 (2.5, 5.8)
Healthy weight	1003	31.7 (29.5, 34.0)	31.5 (28.5, 34.5)	32.4 (28.8, 36.0)
Overweight	1002	34.4 (32.1, 36.8)	35.7 (32.8, 38.6)	31.1 (27.3, 34.8)
Obese	780	27.6 (25.5, 29.7)	27.4 (24.7, 30.0)	28.1 (24.1, 32.2)
Unknown	98	4.1 (3.1, 5.1)	4.0 (2.9, 5.1)	4.3 (2.2, 6.3)
Any hospitalization (≥1 vs. 0)	557	17.4 (15.7, 19.2)	16.0 (14.1, 18.0)	21.1 (18.0, 24.2)	<0.01
Recurrent hospitalization (>1 vs. ≤1)	173	5.1 (4.1, 6.0)	4.0 (3.0, 4.9)	7.8 (5.5, 10.2)	<0.01

^a Near or distance visual acuity <20/40 or contrast sensitivity <1SD below sample mean (1.37 logCS).

^b Second‐Order Rao–Scott Chi‐Square Test.

The adjusted odds of any hospitalization were not statistically different between those with any type of VI and those without a VI (OR = 1.20, 95% CI 0.93–1.55). In separate models for each visual function test, similar results were seen, including for near visual acuity impairment (OR = 1.26, 95% CI 0.96–1.65), distance visual acuity impairment (OR = 1.08, 95% CI 0.78–1.49), and CS impairment (OR = 1.07, 95% CI 0.78–1.48) (Supplement Table 2). The predicted probability of any hospitalization for those with any VI was 19.2% (15.9–22.6), compared to 16.7% (14.9–18.6) for those with no VI (Figure 1).

FIGURE 1.

Predicted probability of any (≥1 vs. 0) and recurrent (>1 vs. ≤1) hospitalization by visual impairment type. Alt text: graph comparing predicted probabilities of any hospitalization (more than 1 vs. none) and recurrent hospitalization (more than 1 vs. less than 1) across different types of visual impairments. Model adjusted for age (in 5‐year increments), gender (male or female), race and ethnicity (non‐Hispanic White, non‐Hispanic Black, Hispanic, other), education (less than high school diploma, high school diploma, some college, college degree, or more), annual household income by quartile, number of health conditions (myocardial infarction, heart disease, hypertension, diabetes, lung disease, stroke, cancer), smoking status, dementia status (none, possible, or probable based on NHATS algorithm), and body mass index. *p < 0.05.

The adjusted odds of recurrent hospitalization (Supplement Table 3) were significantly greater in those with any type of VI compared to those with normal vision (OR = 1.87; 95% CI 1.16–3.03). In separate models for each visual function test, the odds of recurrent hospitalization were significantly higher among those with near VI (OR = 1.88, 95% CI 1.14–3.12) compared to no near VI. However, distance visual acuity impairment (OR = 1.05, 95% CI 0.58–1.90) and CS impairment (OR = 1.21, 95% CI 0.70–2.07) were not significantly associated with the odds of recurrent hospitalization. The predicted probability of recurrent hospitalization for those with any VI was 7.2% (4.8–9.7), compared to 4.1% (3.1–5.2) for those with no VI (Figure 1).

Next, we included all visual function tests in a single model. No type of VI was significantly associated with the odds of any hospitalization. Likewise, log‐scaled measures of visual function were not associated with the odds of any hospitalization (Table 2). Near VI was significantly associated with increased odds of recurrent hospitalization (OR = 2.04, 95% CI 1.16–3.61) and for each 0.1 logMAR worsening of near visual acuity the odds of recurrent hospitalization were 16% greater (OR = 1.16, 95% CI 1.02–1.33). There was no significant association between distance visual acuity or CS and recurrent hospitalization in models containing all three visual function tests (Table 3).

TABLE 2.

Adjusted association between visual impairment (VI) and any hospitalization (≥1 vs. 0).

	Weighted hospitalization prevalence (95% CI) a	Odds ratio (95% CI)	p‐value
Continuous measure (per 0.1 log‐unit)
Near VI		1.06 (0.97, 1.15)	0.173
Distance VI		0.97 (0.86, 1.10)	0.652
CS impairment		0.99 (0.92, 1.07)	0.804
Binary measure
Near VI	20.1 (16.0, 24.1)	1.27 (0.93, 1.75)	0.131
Distance VI	16.9 (11.9, 22.0)	0.96 (0.64, 1.44)	0.829
CS impairment	17.3 (12.5, 22.2)	0.99 (0.68, 1.43)	0.947

Note: Model adjusted for age (in 5‐year increments), gender (male or female), race and ethnicity (non‐Hispanic White, non‐Hispanic Black, Hispanic, other), education (less than high school diploma, high school diploma, some college, college degree, or more), annual household income by quartile, number of health conditions (myocardial infarction, heart disease, hypertension, diabetes, lung disease, stroke, cancer), smoking status, dementia status (none, possible, or probable based on NHATS algorithm), and body mass index.

^a Marginal predicted probability of outcome.

TABLE 3.

Adjusted association between visual impairment (VI) and recurrent hospitalization (>1 vs. ≤1).

	Weighted hospitalization prevalence (95% CI) a	Odds ratio (95% CI)	p‐value
Continuous measure (per 0.1 log‐unit)
Near VI		1.16 (1.02, 1.33)	0.026
Distance VI		0.93 (0.76, 1.14)	0.494
CS impairment		1.00 (0.90, 1.11)	0.987
Binary VI
Near VI	7.9 (4.8, 11.1)	2.04 (1.16, 3.61)	0.015
Distance VI	3.9 (1.6, 6.2)	0.71 (0.32, 1.55)	0.382
CS impairment	5.3 (2.3, 8.3)	1.06 (0.55, 2.04)	0.857

Note: Model adjusted for age (in 5‐year increments), gender (male or female), race and ethnicity (non‐Hispanic White, non‐Hispanic Black, Hispanic, other), education (less than high school diploma, high school diploma, some college, college degree, or more), annual household income by quartile, number of health conditions (myocardial infarction, heart disease, hypertension, diabetes, lung disease, stroke, cancer), smoking status, dementia status (none, possible, or probable based on NHATS algorithm), and body mass index.

^a Marginal predicted probability of outcome.

DISCUSSION

Using cross‐sectional data from NHATS Round 11, a nationally representative sample of older US adults who were aged 71 and older in 2021, we found that presenting near VI was significantly associated with recurrent hospitalization, however, there was no significant association between other measures of visual function and hospitalization or recurrent hospitalization. While prior studies have noted an association between self‐reported visual difficulty and hospitalization,^{3, 11} to our knowledge this study is the first to specifically pinpoint which visual functions are most relevant to this important outcome. These findings underscore the potential for future research aimed at addressing near VI to decrease the likelihood of recurrent hospitalization among older US adults.

Few previous studies have drawn on objective assessments of visual function to study the relationship between vision and hospitalizations. One prospective observational study from 2016 tested near visual acuity at bedside in hospitalized older adults and found an increased incidence of falls, but not hospital readmissions, in the post‐discharge period among those with impaired vision. ²² However, in that study participants were only followed for 30 days and some recurrent hospitalizations may have happened after the follow‐up period; the study sample was also not population representative and may therefore lack generalizability. The majority of other studies on this topic have assessed the association between self‐reported visual difficulty and hospitalization using survey responses, while several have also relied on diagnoses derived from administrative claims. For example, in a study using claims data, Morse et al. found that among older US adults, those with severe vision loss had longer lengths of stay, higher readmission rates, and higher hospitalization and post‐discharge costs compared to those with no vision loss. ¹¹ Another study, by Ratakonda et al., found an increase in potentially preventable hospitalizations among Medicare beneficiaries in whom vision loss was also ascertained using administrative claims. ²³ The use of administrative claims to identify VI has a relatively high specificity but low sensitivity, which may limit the generalizability of its conclusions since this approach biases toward including only those with the most severe degree of VI.^{24, 25} In contrast, our use of objective measures of visual function may be a more sensitive indicator of VI, including those with milder degrees of vision loss, as well as differentiating between different types of vision loss. Additionally, self‐reported and objective assessments of vision are often discordant and are influenced by question wording, survey response options, and participant characteristics.^{13, 26, 27, 28} Reliance only on administrative claims or self‐reported vision could therefore have a considerable impact on the estimated association of vision problems with hospitalization, particularly for vulnerable groups who may be less likely to report visual difficulty or receive eyecare.^{13, 27}

In our analysis, we found that near visual acuity was associated with recurrent hospitalization even independent of distance visual acuity and CS. Further research is needed to determine the degree to which this association is driven by uncorrected presbyopia versus the effect of non‐refractive causes of VI (e.g., cataract, age‐related macular degeneration, etc.) on near visual acuity. However, prior epidemiologic studies suggest that a large fraction of near VI may be addressed with reading glasses. ²⁹ Moreover, there is evidence that correction of near VI with affordable over‐the‐counter reading glasses can improve productivity and vision‐related quality of life.^{30, 31}

The specific mechanism(s) through which poor near vision is associated with recurrent hospitalization is not clear. One possibility is that those with near VI may be less able to read medication labels, discharge instructions, and other health informational materials that are important to optimizing health after discharge from the hospital. Prescribed diet or therapy regimens may also be more difficult to adhere to for those with near VI when accessible materials are not provided. Bedside near visual acuity testing could be performed in hospitals to identify those with impaired near vision prior to discharge. Along these lines, future clinical studies could be undertaken to examine challenges that those with near VI face upon discharge, as well as the impact of interventions like provision of reading glasses, use of large‐print instructions and medication labels, or home modifications to promote safety and success in instrumental activities of daily living following hospitalization.

Strengths of this study include that, to our knowledge, this is the first study to elucidate the specific type of VI associated with increased hospitalizations among older adults and the first to use nationally representative objective visual function assessment data to do so. Limitations of this study include its observational nature and the possibility of associated residual confounding. Also, there may be recall bias in report of hospitalization over the year since the previous NHATS interview. Inclusion of only individuals aged 71 and older may limit generalizability of these results to younger older adults. Additionally, we acknowledge that the NHATS vision protocol tests presenting visual function, as opposed to best‐corrected vision, which may reflect uncorrected refractive and accommodative errors. However, since many older adults lack appropriate refractive correction, ³² presenting visual function may better represent individuals' lived experience. These issues are present in the daily lives of many older adults and are often readily correctable with glasses and could thus represent a future intervention target. Finally, while our study highlights the association of near VI and recurrent hospitalization, NHATS does not include data on the cause of VI, so we cannot discern the contribution of correctable (e.g., refractive and accommodative errors) and non‐correctable causes.

In conclusion, near VI was independently associated with increased odds of recurrent hospitalization in older US adults. As recurrent hospitalization may adversely impact well‐being, and carries a high financial cost, future work should focus on elucidating the mechanisms by which near VI is associated with recurrent hospitalization, as well as on developing targeted interventions aimed at identifying and supporting at‐risk, hospitalized older adults with poor near vision.

AUTHOR CONTRIBUTIONS

KL – Study design, preparation of manuscript. NN – Preparation of manuscript, interpretation of data. YZ – Data analysis, critical revisions of manuscript. RM – Preparation of manuscript. MH – Study design, interpretation of data, critical revisions of manuscript. LdL – Study design, interpretation of data, critical revisions of manuscript. DR – Study design, interpretation of data, critical revisions of manuscript. JRE – Study conception and design, interpretation of data, preparation of manuscript.

CONFLICT OF INTEREST STATEMENT

None of the authors have conflicts of interest related to this submission.

SPONSOR'S ROLE

Sponsors played no role in the design, execution, analysis, and interpretation of data, or writing of the study.

FINANCIAL DISCLOSURE

NHATS is supported by a grant from the National Institutes of Health/National Institute on Aging. The current study was supported by the National Eye Institute [grant number: R01EY034479] and was supported in part by the SENSE Network through a grant from the National Institute on Aging [grant number: R61AG089063]. This work was also supported by an unrestricted grant from Research to Prevent Blindness to the Department of Ophthalmology and Visual Sciences at the University of Michigan.

Supporting information

Data S1. Supporting Information.

Nagarajan N, Leziak K, Zhou Y, et al. Association between visual impairment and recurrent hospitalizations in older US adults. J Am Geriatr Soc. 2025;73(3):782‐790. doi: 10.1111/jgs.19308