Skip to main content
NCBI home page
NIHPA Author Manuscripts logoLink to NIHPA Author Manuscripts
. Author manuscript; available in PMC: 2026 Feb 18.
Published in final edited form as: J Aging Health. 2025 Aug 1;38(9):491–503. doi: 10.1177/08982643251364364

SENSORY DIFFICULTY, SOCIAL AND PHYSICAL ACTIVITY, AND DEMENTIA RISK AMONG OLDER ADULTS

Shu Xu 1, Jeffrey A Burr 2, Qian Song 3, Joshua R Ehrlich 4
PMCID: PMC12911503  NIHMSID: NIHMS2137701  PMID: 40747808

Abstract

Objectives:

Sensory loss is associated with increased dementia risk, yet the underlying mechanisms remain unclear. This longitudinal study examined the association between self-reported sensory difficulty (vision, hearing, dual), social and physical activity, and dementia risk among older U.S. adults.

Methods:

Data were drawn from the 2015–2020 National Health and Aging Trends Study (N=6,295). Discrete-time survival mediation models with a structural equation modeling-based approach were estimated to examine the associations.

Results:

Dementia incidence was highest among those with dual sensory difficulty (21.8%), followed by visual (18.8%) and hearing (13.2%) difficulties. Visual difficulty and dual sensory difficulty were associated with decreased social activities and incident dementia in subsequent waves. Social activity, but not physical activity, significantly mediated the visual difficulty-dementia link and the dual sensory difficulty-dementia link.

Discussion:

Older adults with sensory difficulty were at a higher risk of incident dementia. Future research should investigate other factors underlying the sensory loss-dementia link.

Keywords: sensory loss, dementia, discrete-time survival models, social activity, physical activity

1. Introduction

Cognitive health is a major factor conditioning the quality of life of older adults, including preserving their independence. Sensory loss (vision loss, hearing loss) has been shown to have a significant impact on cognitive wellbeing (Ehrlich et al., 2021; Fischer et al., 2016; Lin et al., 2013; Swenor et al. 2019). While both vision loss and hearing loss are recognized as modifiable risk factors for dementia (Livingston et al., 2024), the mechanisms underlying these associations among older adults are still unclear. Thus, there is a need to have a better understanding of the association between sensory loss and dementia and the underlying mechanisms. This study extends previous research by prospectively examining (1) the association between self-reported sensory difficulty (termed “sensory difficulty” hereafter) and incident dementia among U.S. older adults and (2) the mediating roles of social and physical activities in this association.

1.1. Dementia and Sensory Loss

Over 55 million individuals are living with dementia worldwide, with nearly 10 million new cases each year (WHO, 2023). Dementia has a large and growing impact on older adults, their families, and societies across the world. In 2015, the worldwide economic impact of dementia was estimated to be $818 billion annually (Prince et al., 2015). Approximately 11% of older Americans have Alzheimer’s disease or a related dementia (Hudomiet et al., 2018), with an estimated 7.2 million aged 65 and older living with Alzheimer’s dementia in 2025 (Rajan et al., 2021). This number is projected to reach 13.8 million persons by 2060 (Alzheimer’s Association, 2024). Further, due to the large proportion of the population comprised of aging baby boomers, the total number of people affected by dementia is expected to increase substantially (Julie et al., 2018; Robert et al., 2018).

Prior studies have demonstrated a consistent relationship between vision loss and dementia (Ehrlich et al., 2021; Nagarajan et al., 2022). A meta-analysis (Vu et al., 2020) found that across diverse populations and using longitudinal research designs, older adults with vision loss were twice as likely to have dementia compared to those without vision loss. Hearing loss has also been linked to an increased risk of dementia (Huang et al., 2023; Pichora-Fuller 2020). Meta-analyses and systematic reviews found that individuals with hearing loss had a higher risk of cognitive decline and dementia, with a stronger association observed for individuals with severe hearing loss (Loughrey et al., 2018; Zheng et al., 2017). Dual sensory loss, the loss of both vision and hearing, is also a significant risk factor for dementia risk in older adults (Kuo et al., 2021). A recent longitudinal cohort study (Hwang et al., 2022) demonstrated that dual sensory loss was associated with a 2.6 times higher risk of incident all-cause dementia and 3.7 times higher risk for incident Alzheimer’s disease over an eight-year follow-up period. In the most recent report of the highly influential Lancet Commission on dementia prevention, intervention, and care, both vision loss and hearing loss are included in the model as important modifiable dementia risk factors (Livingston et al., 2024).

1.2. Mechanisms Linking Sensory Loss and Dementia

Several mechanisms have been hypothesized to explain the association between sensory loss and cognitive function (Pronk et al., 2019; Swenor et al., 2020; Whitson et al., 2018). These mechanisms can be understood through four major pathways outlined in the literature (Pronk et al., 2019). The common cause hypothesis suggests that sensory health and cognitive health may share common pathological processes, such as neurodegeneration or vasculopathy; these may simultaneously drive the underlying relationship between vision loss and cognitive function (Salthouse et al., 1996; Wayne & Johnsrude, 2015). The sensory deprivation hypothesis indicated that prolonged sensory loss may result in reduced stimulation of related brain regions, leading to neural atrophy and eventually cognitive decline (Pronk et al., 2019; Swenor et al., 2020). The information degradation hypothesis proposes that degraded sensory input increases cognitive effort required to process information, diverting resources away from higher-order tasks, ultimately impairing performance on cognitive tasks (Varadaraj et al., 2021; Valentijn et al., 2005; Pronk et al., 2019). The cognitive load on perception hypothesis suggests that reduced cognitive capacity may itself impair sensory processing, particularly in demanding environments where more cognitive resources are needed to interpret sensory stimuli (Wayne & Johnsrude, 2015; Pronk et al., 2019). Additionally, sensory loss may indirectly affect cognitive function through risk factors, such as reduced engagement in cognitively stimulating social activities and lack of physical inactivity (Maharani et al., 2019; Powell et al., 2022; Whitson et al., 2018). This multifaceted framework underscores the importance of considering both direct and indirect pathways in understanding how sensory loss contributes to dementia risk and supports our focus on social and physical activity as potential mediators.

Older adults who experience vision loss or hearing loss are at significantly increased risk of becoming socially isolated (Shah et al., 2020; Shukla et al., 2020) and less physically active (Bookwala et al., 2011). Older adults may withdraw from social activities they previously enjoyed due to the inability to engage and communicate with others, decreased awareness of surroundings, and increased anxiety (Chen et al., 2015; Choi et al., 2016; Martinez-Amezcua et al., 2021). Studies have shown that, compared to their counterparts without sensory impairments, older adults with sensory loss engaged in lower levels of physical activity, engaged in fewer activities generally, spent less time in activities (Cai et al., 2021), had smaller social networks, and overall had reduced social participation (Palmer et al., 2016).

According to motivational theory of life-span development, individuals use both optimal and nonoptimal strategies to navigate action cycles of goal selection, pursuit, and disengagement when facing challenges (Heckhausen et al., 2010). For older adults with sensory loss, distancing themselves from social activities by devaluating their importance can be a self-protective strategy to avoid the negative effects of potential failure in social engagement. However, the inability to participate in activities may contribute to additional negative consequences beyond sensory loss itself. Social isolation has been linked to worse cognitive functioning (Evans et al., 2019) and a higher risk of Alzheimer’s disease and related dementias (Maharani et al., 2019; Rafnsson et al., 2020; Shukla et al., 2020). Conversely, physical activity, including walking, is believed to promote cognitive health (Rebecca et al., 2009; Thomas et al., 2009).

Taken together, activity participation may serve as a pathway from sensory loss to dementia, aligning with the sensory deprivation and information degradation hypotheses. Individuals with sensory loss may be less likely to participate in cognitively stimulating social or physical activities, which in turn can negatively impact cognitive health and increase dementia risk. Guided by the motivational theory of life-span development, this study also considers that older adults may disengage from social and physical activities as a self-protective strategy when faced with sensory limitations; however, this withdrawal may inadvertently increase social isolation and reduce cognitive stimulation, worsening cognitive wellbeing. Despite the theoretical relevance, few studies examined the mediating effect of social activity and physical activity for the association between sensory loss and dementia. More research is needed to investigate these pathways.

Thus, the current study employed longitudinal data from the National Health & Aging Trends Study (NHATS) to examine the relationship between sensory difficulty and dementia among older adults, and the mediating roles of social activity and physical activity. We hypothesized that (H1) older adults with sensory difficulty had a higher risk of dementia over a 6-year follow-up period, (H2) sensory difficulty is associated with reduced social activity, which in turn increases the risk of dementia, and (H3) sensory difficulty is associated with reduced physical activity, which in turn increases the risk of dementia.

2. Methods

2.1. Data source and study sample

The data for this study were taken from the NHATS, an ongoing nationally representative sample of U.S. Medicare beneficiaries ages 65 and older (Freedman et al., 2024). NHATS is a longitudinal study with annual follow-up. The sample is drawn from the Medicare enrollment file and the NHATS used a stratified three-stage sample design. The initial sample was interviewed in 2011, with a sample size of 8,500 participants, and replenishment of the sample was undertaken in 2015 and 2022.

The current longitudinal study included participants from the 2015 NHATS cohort. Participants in the analytic sample were followed annually from 2015 through 2020 (six waves total). The baseline sample of this cohort included 8,334 participants. Over the six-year interval, 4,064 participants survived until 2020, 2,038 participants died, and 2,232 participants were lost to follow-up for other reasons. We excluded participants who (1) were nursing homes residents, (2) had missing values on dementia status, (3) had no valid values on both vision and hearing status, (4) had missing values on other key baseline variables, or (5) had dementia at baseline, leaving a study sample of 6,295 participants. All included participants contributed data until they died, were lost to follow-up, or remained under observation through 2020. A detailed flow chart of the sample selection process is presented in Supplementary Figure 1, and annual participant status (attrition, mortality, and dementia onset) is summarized in Supplementary Table 1.

2.2. Measures

Dependent variable.

The dementia status of participants was evaluated using a combination of (1) self-reported physician diagnosis of dementia, (2) the Alzheimer’s Disease-8 Screening interview (AD-8), which is an 8-item instrument that assesses memory, temporal orientation, judgment, and function, and only administered to proxy respondents who participated in the NHATS interview for the sample person, and (3) a cognitive test battery that evaluated participants’ memory (immediate and delayed 10-word recall), orientation (date, month, year, and day of the week; naming the current President and Vice President), and executive function (clock drawing test). NHATS defined cognitive impairment as scores at or below 1.5 standard deviations (SD) from the mean for self-respondents (Kasper et al., 2013). The cut-points for the specific domains of cognitive impairment were defined by the following criteria: orientation (range = 0–8), memory (range = 0–20) and executive function (range = 0–5).

The NHATS dementia classification algorithm (Kasper et al., 2013) was created by combining these three domains and categorizing participants into three groups: (1) probable dementia (i.e., respondents with diagnosis of dementia reported or met AD-8 criteria if no diagnosis reported (criteria: a score of two or higher of AD-8) or had impairment (< 1.5 SD below the mean) in two or more cognitive domains); (2) possible dementia (impairment < 1.5 SD below the mean) in one cognitive domain); and (3) no dementia (all others). For this study, dementia status was measured as: 1=probable dementia, 0 = no dementia or possible dementia.

Independent variables.

Consistent with previous research (Kuo et al., 2021; Yorgason et al., 2022), participants were considered to have visual difficulty if they reported blindness or were not able to see well enough to recognize someone across the street and/or were unable to read newspaper print when using glasses or contacts (if applicable). Participants were considered to have hearing difficulty if they reported deafness, use of a hearing aid or other hearing devices, or not being able to hear well enough to use the telephone or to carry on a conversation in a room with a radio or TV playing when using a hearing device (if applicable). Older adults with both visual difficulty and hearing difficulty were classified as having dual sensory difficulty.

Mediators.

Self-reported participation in social and physical activities served as mediators for the relationship between sensory difficulty and dementia status. Specifically, social activities were assessed based on the following four items: (1) visiting friends and family who lived separately, (2) attending religious services, (3) participating in clubs, classes, or other organized activities, and (4) going out for enjoyment. Participants were also asked to rate the importance of participating in these four activities on a three-point scale: 1 = very important, 2 = somewhat important, and 3 = not so important. Activities rated as “somewhat” or “very important” were considered to be of personal value to the individual (Szanton et al., 2016). If participants rated one of the four activities important, whether they participated in this activity within the last month was assessed using a yes/no format (Latham & Clarke, 2018). The reliability of the measurement of valued social activity in NHATS has been confirmed (Freedman et al., 2011). In line with previous research (Parisi et al., 2019), valued social activity was rated from “0” (not engaging in any of the valued activities within the past month) to “4” (engaging in all the valued activities within the past month).

Physical activity was evaluated based on the following two questions: (1) “In the last month, did you ever go walking for exercise?” and (2) “In the last month, did you ever spend time on vigorous activities that increased your heart rate and made you breathe harder (like working out, swimming, running or biking, or playing a sport)?” (Zhou & Larson, 2023). Participants were asked whether they had participated in each activity using a yes/no format. Physical activity was measured as follows: “0” indicated not doing any such activities within the past month, “1” represented engaging in either regular moderate exercise (walking) or vigorous activities within the past month, and “2” represented engaging in both regular moderate exercise and vigorous activities within the past month.

Covariates included participants’ age in years, gender (1 = female, 0 = male), racial/ethnic status (non-Hispanic White [reference group], Hispanic, non-Hispanic black, non-Hispanic other), and education (less than high school [reference group], high school degree, some college, college and above), and marital status (1=married/living with partner, 0=divorced/separated/widowed/never married). We also included a series of dichotomous indicators for having ever been diagnosed with heart disease, high blood pressure, lung disease, stroke, and cancer. Body mass index (BMI) was calculated with participants’ self-reported height and weight and categorized as 1) underweight, (<23 kg/m2) [reference group], 2) healthy weight (23–33 kg/m2), and 3) overweight (>33 kg/m2) using standards for older adults (Winter et al., 2014). Current smoking status was coded as 1 = current smoker and 0 = never smoked or former smoker.

2.3. Analytic strategy

Descriptive characteristics of the study sample at baseline were analyzed. Bivariate analyses (t-tests or chi-square tests) were used to compare participants with or without sensory difficulties for all variables in the analyses. The data were adjusted using NHATS sample weights to account for non-response bias and the probability of selection into the NHATS sample.

A structural equation modeling (SEM), with a discrete-time survival model (DTSM), was used to test the hypotheses. The DTSM is useful for longitudinal studies when the data are collected at discrete time periods and avoids the methodological issue of ties in the timing of the occurrence of events – death (Singer & Willett, 2003). In this study, a participant contributed an observation for each wave up to the incidence of probable dementia or censoring (i.e., loss to follow-up or death). Because the analytic sample was restricted to those who had no dementia at baseline, the estimates reflected the effects of the independent variables on new cases of dementia. The DTSM was estimated using a full-information maximum likelihood approach (Muthén and Masyn, 2005; Singer and Willett, 1993), which allowed for missing data in the form of non-informative right censoring, incorporating partial information that was available about the event times for right-censored individuals into the likelihood function for the sample.

Models integrating both mediation analysis and DTSM were conducted in a SEM framework. The direct effect in the DTSM model captured the influence of a predictor on the hazard probability of event occurrence controlling for the mediator, and the indirect effect captured the influence of the predictor on the hazard probability of event occurrence through the mediator (Fairchild et al., 2019). This study estimated the DTSM with a time-variant mediation effect in a mixture modeling (Muthen & Masyn, 2005) to understand how sensory difficulties impact the incident dementia directly and indirectly through social and physical activities.

Sensory difficulties and social and physical activities were assessed at baseline, and dementia was assessed from wave 2 (year 2016) to wave 6 (year 2020) (Figure 1). All covariates were treated as time-invariant in the models. To investigate mediation, social activity and physical activity were examined simultaneously and were regressed on sensory difficulties to produce path estimates. The incidence of dementia was regressed on the mediators, social activity and physical activity, to yield each of the b path estimates. Multiple mediated effects were identified, with one for each binary onset indicator (i.e., incident dementia from wave 2 (year 2016) to wave 6 (year 2020)) included in the model. A latent variable representing the latent propensity for the incidence of dementia was created. This latent construct of dementia was regressed on sensory difficulties to yield the c’ parameter estimate. Since the impact of sensory difficulties on dementia while controlling for mediators used a traditional proportional hazard approach with a time-invariant effect, there was only one direct effect identified. The indirect effect at each time interval was reflected by the a path parameter multiplied by the b path parameter for each time interval. The significance of the indirect effects was determined by examining bias-corrected bootstrapped confidence intervals, in line with currently recommended techniques in the literature (MacKinnon et al., 2004; Preacher & Hayes, 2008). The model was estimated using MPlus Version 8. A sensitivity analysis was conducted for all research questions using social and physical activities assessed at wave 2 (year 2016).

Figure 1.

Figure 1.

Open in a new tab

Discrete-Time Survival Mediation Model for Sensory Difficulty and Dementia Risk with Social and Physical Activity.

3. Results

3.1. Descriptive results

Descriptive characteristics of the weighted study sample at baseline are presented in Table 1. Among the participants, 8.00% had visual difficulty, 23.08% had hearing difficulty, and overlaps between these groups resulted in 2.67% having dual sensory difficulty. Additionally, 60.52% were aged between 65 and 74, 54.75% were female, 59.85% were married, 80.50% were non-Hispanic white, 39.88% had no degree or high school degree, 65.03% had healthy weight, and 8.89% were smokers. The most commonly reported social activity was visiting in-person with friends and family (83.34%), followed by going out for enjoyment (75.48%), attending religious services (53.09%), and participating in clubs, classes, or other organized activities (35.86%). Sixty-four percent of participants engaged in regular moderate exercise (walking), and 45.38% engaged in vigorous activities within the past month. Moreover, 9.17% developed dementia across the observation period (wave 2-wave 6 (year 2016–2020)).

Table 1.

Descriptive Statistics of the Study Sample by Sensory Difficulty, NHATS 2015

Characteristics Full sample
(N=6,295)		 No sensory difficulty
(n=4,505)		 Visual difficulty
(n=505)		 Hearing difficulty
(n=1453)		 Dual sensory difficulty
(n=168)
Dementiaa 9.17 7.49 18.83 13.21 21.78
Age groups, % *** *** ***
65–74 60.52 65.16 51.39 45.00 43.90
75–84 30.41 28.75 30.72 35.90 25.41
85+ 9.07 6.09 17.89 19.21 30.69
Female, % 54.75 57.13 63.06 43.06 *** 60.63
Married, % 59.85 60.08 47.80 ** 61.95 46.83 *
Race, % *** *** ***
non-Hispanic white 80.50 80.43 67.29 83.21 60.11
non-Hispanic black 8.07 9.11 10.74 3.03 6.78
Hispanic 4.15 4.29 4.00 4.09 7.84
non-Hispanic other 7.28 6.18 17.97 9.67 25.27
Education, % *** ***
no degree 14.67 13.45 30.92 16.03 39.11
high school 25.21 24.22 30.61 27.94 31.84
some college 25.10 25.84 18.90 23.47 17.23
college or above 35.01 36.50 19.57 32.55 11.83
Comorbidities, %
heart disease 14.07 13.10 17.50 * 17.23 ** 22.65 **
high blood pressure 62.12 60.71 72.56 ** 65.84 ** 82.16 **
stroke 6.71
lung disease 15.26 14.11 19.13 19.00 * 20.69
cancer 23.70 23.21 22.20 26.89 30.52
BMI *
Underweight 15.45 15.87 15.25 13.95 15.01
Healthy weight 65.03 65.21 59.02 65.88 59.68
overweight 19.52 18.92 25.74 20.17 25.31
Current smoking, % 8.89 9.75 10.62 5.25 ** 1.09 **
Social activities, %
visit friends or family 83.34 85.01 71.15 *** 79.44 ** 68.10 **
attend religious services 53.09 53.15 49.59 53.39 49.75
participate in clubs, classes, other organized activities 35.86 36.47 22.80 ** 36.43 19.31 *
go out for enjoyment 75.48 77.32 55.08 *** 72.99 * 46.85 ***
Physical activities
Walking 64.00 64.53 52.85 ** 64.24 48.33 **
Vigorous activities 45.38 46.30 34.25 ** 44.34 28.70 **
Open in a new tab

Notes: N=6,295. Estimates are based on weighted data. The 168 participants with dual sensory difficulty are included in both the visual difficulty (n=505) and hearing difficulty groups (n=1,453); they are not additional cases.

a

all dementia cases at baseline survey were excluded. The reported percentages of dementia reflecting dementia onset across subsequent survey waves (wave 2 (year 2016) - wave 4 (year 2020)).

P-values show statistically significant differences compared to the no sensory difficulty group, estimated with t-tests and χ2 tests.

*

p < .05.

**

p < .01.

***

p < .001

The bivariate results showed that participants with dual sensory difficulty had the highest proportion of incident dementia during the subsequent waves (21.78%), followed by those with visual difficulty (18.83%) and hearing difficulty (13.21%). Participants in these groups were significantly more likely to develop dementia than participants without sensory difficulty (7.49%). Compared to participants without sensory difficulty, those with visual difficulty or dual sensory difficulty were less likely to visit friends or family, participate in clubs, classes, or other organized activities, go out for enjoyment, and engage in moderate or vigorous physical activities, those with hearing difficulty were less likely to visit friends or family and to go out for enjoyment. No significant differences were found in terms of physical activities between the hearing difficulty group and the no sensory difficulty group.

3.2. Discrete-time survival model results

The results for the association between sensory difficulty and incident dementia risk from the discrete-time survival models are presented in Table 2. Considering direct effects only, having visual difficulty was significantly associated with decreased social activities (hazard ratio (HR)=0.68; 95% confidence interval (CI)=0.58, 0.78) and an increased likelihood of incident dementia (HR=2.34; 95% CI=1.55, 3.33) during the following observation period (wave 2-wave 6 (year 2016–2020)). No significant results were found in terms of the associations between hearing difficulty, social and physical activities, and dementia. Dual sensory difficulty was significantly associated with decreased social activities (HR=0.63; 95% CI=0.51, 0.80) and an increased likelihood of incident dementia (HR=2.75; 95% CI=1.28, 4.77) during the observation period (wave 2-wave 6 (year 2016–2020)).

Table 2.

Direct Effects on Dementia, Social Activity, and Physical Activity

Visual difficulty
(N=5,010)		 Hearing difficulty
(N=5,958)		 Dual sensory difficulty
(N=4,673)
Variable Hazard ratio 95% Confidence Intervals Hazard ratio 95% Confidence Intervals Hazard ratio 95% Confidence Intervals
Dementia
Sensory difficultya 2.34 (1.55, 3.33) 1.28 (0.88, 1.71) 2.75 (1.28, 4.77)
Ageb 1.09 (1.07, 1.11) 1.11 (1.08, 1.13) 1.10 (1.07, 1.12)
Femalec 0.85 (0.64, 1.19) 0.89 (0.65, 1.21) 0.77 (0.54, 1.09)
Educationd 0.83 (0.71, 0.98) 0.87 (0.75, 1.01) 0.80 (0.66, 0.93)
Non-Hispanic blacke 1.43 (0.98, 1.99) 1.37 (0.94, 1.87) 1.34 (0.92, 1.94)
Hispanice 0.93 (1.09, 3.23) 1.39 (0.73, 2.25) 1.63 (0.72, 2.90)
Non-Hispanic other racee 1.97 (0.21, 2.07) 1.14 (0.37, 2.37) 1.12 (0.36, 2.42)
Marriedf 1.09 (0.81, 1.55) 0.99 (0.72, 1.31) 1.14 (0.76, 1.51)
Healthy weightg 1.08 (0.95, 2.54) 1.80 (1.13, 2.81) 1.06 (1.04, 2.95)
Current smokingh 1.66 (0.78, 1.49) 1.11 (0.83, 1.53) 1.80 (0.79, 1.60)
Heart disease 0.87 (0.66, 1.27) 0.89 (0.67, 1.20) 0.94 (0.57, 1.48)
High blood pressure 0.90 (0.53, 1.32) 0.88 (0.59, 1.23) 0.89 (0.60, 1.59)
Stroke 1.49 (0.88, 2.31) 1.65 (1.08, 2.37) 1.54 (0.91, 2.40)
Lung disease 0.96 (0.61, 1.36) 1.24 (0.85, 1.72) 0.98 (0.64, 1.54)
Cancer 1.01 (0.69, 1.42) 1.07 (0.78, 1.41) 1.08 (0.72, 1.56)
Social activity
Sensory difficulty 0.68 (0.58, 0.78) 0.96 (0.87, 1.06) 0.63 (0.51, 0.80)
Physical activity
Sensory difficulty 0.95 (0.87, 1.04) 1.02 (0.96, 1.08) 0.93 (0.80, 1.08)
Open in a new tab

Notes: Values in bold denote statistically significant values. For each sensory difficulty group, N includes individuals with the specified sensory difficulty and those with no sensory difficulty (reference group).

a

ref: no sensory difficulty

b

age in years

c

ref: male

d

ref: high school degree/some college/undergraduate and graduate degree

e

ref: non-Hispanic white

f

ref: divorced/separated/widowed/never married

g

ref: underweight/overweight

h

ref: never smoked/former smoker

Statistically significant paths of the DTSM model with indirect effects of social and physical activities in the relationship between visual difficulty and dementia are presented in Figure 2. Regressing social activity onto visual difficulty at baseline yielded an a path of −0.381 (0.68), p<.001, indicating that having visual difficulty at baseline was significantly associated with a 0.381 unit decrease in social activity. Regressing the latent construct of dementia onto visual difficulty yielded a parameter estimate of c’=0.85 (2.34), p<.001, suggesting a significant effect of visual difficulty on the latent propensity for incident dementia. In terms of the association between social activity and incident dementia, there was a significant effect of social activity on incident dementia at wave 2 (year 2016; b1=−0.323(0.091), p<.001) and a marginally significant effect of social activity on incident dementia at wave 3 (year 2017; b2=−0.210(0.114), p=0.066). However, there were no significant effects of social activity on incident dementia at wave 4–wave 6 (year 2018–2020). A statistically significant indirect effect of visual difficulty on incident dementia through social activity was found when examined with a 95% bias-corrected, bootstrapped confidence interval. The indirect effect of visual difficulty on the risk of incident dementia through social activity was significant at wave 2 (ab1=0.123, 95% CI=0.055, 0.233) and marginally significant at wave 3 (ab2=0.080, 95% CI=−0.003, 0.177). There was no significant indirect effect of visual difficulty on the risk of incident dementia through physical activity.

Figure 2.

Figure 2.

Open in a new tab

Results for Discrete-Time Survival Mediation Model for Visual Difficulty and Dementia Risk with Social and Physical Activity.

Notes: All covariances were adjusted for the model and are omitted from the diagram.

The direct and indirect pathways are highlighted by arrows in the figure; observed variables are represented by rectangles, latent variables by circles.

Statistically significant paths from the DTSM model with indirect effects of social and physical activities in the relationship between dual sensory difficulty and dementia are presented in Figure 3. Regressing social activity onto dual sensory difficulty at baseline yielded a path of a = −0.456 (0.63), p< .001, such that having dual sensory difficulty at baseline was significantly associated with a 0.456 unit decrease in social activity. Regressing the latent construct of dementia onto dual sensory difficulty yielded a parameter estimate of c’=1.01 (2.75), p<.001, indicating a significant effect of dual sensory difficulty on the latent propensity for incident dementia risk. In terms of the association between social activity and incident dementia, there was a significant effect of social activity on incident dementia at wave 2 (year 2016; b1=−0.315(0.095), p<.01) and a marginally significant effect of social activity on incident dementia at wave 3 (year 2017; b2=−0.226(0.130), p=0.081) and wave 4 (year 2018; b3=−0.234(0.139), p=0.093). However, there were no significant effects of social activity on incident dementia at wave 5–wave 6 (year 2019 – 2020). A statistically significant indirect effect of dual sensory difficulty on incident dementia through social activity was found. The indirect effect of dual sensory difficulty on incident dementia risk through social activity was significant at wave 2 (ab1=0.144, 95% CI=0.053, 0.274) and marginally significant at wave 3 (ab2=0.103, 95% CI=−0.001, 0.242). There was no significant indirect effect of dual sensory difficulty on incident dementia through physical activity.

Figure 3.

Figure 3.

Open in a new tab

Results for Discrete-Time Survival Mediation Model for Dual Sensory Difficulty and Dementia Risk with Social and Physical Activity.

Notes: All covariances were adjusted for the model and are omitted from the diagram.

The direct and indirect pathways are highlighted by arrows in the figure; observed variables are represented by rectangles, latent variables by circles.

Since no direct effects were identified for the relationship between hearing difficulty, social and physical activities, and incident dementia, the figure of the DTSM model depicting the indirect effects of social and physical activities for the association between hearing difficulty and dementia is not included.

Sensitivity analyses showed similar results when social and physical activities were assessed at wave 2 (year 2016). No significant effects were identified for the relationship between hearing difficulty, social and physical activities, and incident dementia. Visual difficulty and dual sensory difficulty at baseline were significantly associated with incident dementia risk (c’=0.61 (0.17), p<.001; c’=0.60 (0.17), p<.05, respectively) and social activity (a=−0.341 (0.08), p<.001; a=−0.402 (0.12), p<.001, respectively). The indirect effect of visual difficulty on incident dementia risk at wave 2 and wave 3 through social activity at wave 2 was significant (ab1=0.129, p<.001; ab2=0.102, p<.05). The indirect effect of dual sensory difficulty on incident dementia risk at wave 2 through social activity at wave 2 was significant (ab1=0.152, p<.05). No significant mediation effects of physical activity were found in the sensitivity analyses.

4. Discussion

Using data from the 2015–2020 NHATS, this study investigated the association between sensory difficulty, social and physical activities, and the risk of incident dementia among a national sample of community-dwelling older adults. The results showed partial support for the study hypotheses, including the main effects of sensory difficulty and social activity on incident dementia, as well as for the mediation effects of social activity.

These results align with results from prior studies (Ehrlich et al., 2021; Hwang et al., 2022; Kuo et al., 2021) that showed older adults with visual difficulty or dual sensory difficulty experience an increased risk of dementia compared to those without sensory difficulties. Those with dual sensory difficulty exhibited the highest risk of incident dementia. It was expected that older adults with hearing difficulty would have a higher risk of incident dementia in the following years. An earlier study reported that the hazard of developing dementia was 9% higher for those with hearing difficulty alone compared to those with no impairment (Kuo et al., 2021). Although our study also observed an increased risk of dementia when comparing participants with hearing difficulty to those without any sensory difficulty, the results were not statistically significant. It is also possible that hearing difficulty may have been underreported in the current sample, as older adults may tend to overestimate their hearing ability, or they may not report this condition due stigmatization associated with hearing loss (Bainbridge & Wallhagen, 2014). Previous studies using the same NHATS 2015 cohort found no significant association between hearing difficulty and a decline in cognitive function over time (Yorgason et al., 2022).

Compared to older adults without sensory difficulty, those with visual difficulty or dual sensory difficulty were less likely to participate in valued social activities. The results from this study are consistent with others showing the association between sensory difficulty and reduced social network diversity and social participation (Mick et al., 2018; Palmer et al., 2016). The findings also reflect the motivational theory of life-span development, which posits that individuals evaluate their values and behaviors in order to optimally pursue their intended goals (Heckhausen et al., 2010). With increased age, many people tend to participate in socially oriented activities that bring them pleasure (Bryant et al., 2001; Pressman et al., 2009). It is possible that individuals with sensory difficulty choose to participate in less demanding and more sedentary activities in later life. They may reduce or cease engagement in social activities to avoid discomfort or downgrade the importance of some activities that are no longer performed as a means of maintaining congruence between their activity values and behaviors (Heckhausen et al., 2010; Parisi et al., 2019; Wrosch et al., 2007). Study findings also showed that social activity was associated with a reduced risk of dementia among older people, supporting previous studies that participation in social activities may offer protective benefits in reducing the risk of dementia (Kuiper et al., 2015; Sörman et al., 2014).

By incorporating both discrete-time survival analysis and mediation analysis, this study contributed to a more comprehensive understanding of how sensory impairment is associated with dementia risk through social and physical activities. These results provided evidence partially supporting research based on other study designs that sensory loss may affect cognitive function indirectly through risk factors, such as activity participation (Maharani et al., 2019; Powell et al., 2022; Whitson et al., 2018). The present study also found that social activity mediated the visual difficulty-dementia link and the dual sensory difficulty-dementia link. According to the sensory deprivation and information degradation hypotheses, two major pathways in the framework outlined by Pronk et al. (2019), reduced sensory input likely leads to lower cognitive stimulation and greater cognitive demands of social interaction. Although activity disengagement may be a necessary means of adaptation to avoid further losses (Heckhausen et al., 2010), the inability to participate in valued activities may contribute to additional negative consequences other than sensory loss itself, including cognitive decline. Prolonged reduction in sensory input and stimulation, exacerbated by social disconnection and activity, may further lead to reduced cognitively stimulating experiences, increased cognitive load, and subsequent cognitive deterioration (Valentijn et al., 2005; Whitson et al., 2018). Additionally, a lack of social connection and inactivity can have negative effects on health, such as emotional distress, which can speed up cognitive decline and worsen the effects of sensory loss on dementia. Other proposed pathways in the framework, such as the common cause and cognitive load on perception hypotheses, were not directly empirically examined in this study.

Significant indirect effects were observed in the first two waves but not in later waves. Once a participant experiences probable dementia, the participant’s onset indicators at subsequent time points are coded as missing so that they are no longer included in the risk set. Thus, it is possible that, given the sample size for incident dementia decreases over the observation period, statistical power for detecting mediation effects may have declined during the later observation points (McDaniel, 2018). Future research with larger samples is needed.

The analyses did not uncover significant mediation effects for physical activity for the relationship between sensory difficulty and dementia risk. One explanation is that the measures of physical activity in the study, which were based on two single-item questions, limited our ability to uncover statistically significant relationships. The measures used in this study may not be adequate for capturing the diverse range of physical activities that could potentially benefit older adults at risk of developing dementia. Other studies assessing physical activity frequency included intensity, time (duration), and type of activity (Sallis, 2010); these measures were not available in the NHATS. Future research should extend our study by examining physical activity using different measures to better understand the association with dementia risk. Moreover, it is possible that physical activity may influence cognitive health through pathways not directly captured in our model, such as vascular health (Anlskog et al., 2011). Additionally, the timing and consistency of physical activity engagement across the life course, rather than frequency alone, may be more critical in influencing dementia risk (Anlskog et al., 2011). Future research should consider more nuanced and comprehensive assessments of physical activity to clarify its role in the sensory-cognition relationship.

Beyond measurement issues, theoretical frameworks in cognitive aging may provide further insight. According to the cognitive reserve hypothesis, engagement in cognitively and socially stimulating activities can build resilience against cognitive decline (Stern, 2009). Social activity may contribute more directly to cognitive reserve than physical activity alone, especially in later life. In addition, the socioemotional selectivity theory suggests that older adults increasingly prioritize emotionally meaningful social interactions over time, which may amplify the cognitive benefits of social activity, rather than physical activity (Carstensen et al., 1999). These theoretical perspectives may help explain why social activity emerged as a more salient mediator in the sensory loss–dementia relationship in the current study. Future research should build on this work by incorporating more comprehensive activity measures and considering the role of motivational and cognitive frameworks in activity engagement among older adults with sensory loss.

Implications

This study had public health implications. Helping older adults with sensory loss stay engaged in valued social activities may be a modifiable factor for dementia risk. Intervention strategies, such as helping older adults with sensory loss tailor activities to their functional level and creating environments adapted for their abilities, can minimize the effects of sensory loss. It is also important to have a better understanding of the specific barriers limiting activity engagement as well as the use of compensatory strategies to overcome such challenges. For some older adults with visual difficulties, participation in activities outside the home may be difficult; thus, providing a range of transportation options may help them remain actively engaged. However, for some individuals with dual sensory difficulty, it may be necessary to bring certain activities and services into the home. Providing additional support and assistance, such as the use of remote technology, may also help these older adults participate in social activities and maintain their social networks.

Limitations

This study had limitations. First, the measures of activity participation were limited to the items available in the NHATS. Only four activities were covered in the NHATS to assess social activity, which may not adequately reflect the diverse range of activities in which older adults may engage. To partially address this issue, the measurement of activities took into account the level of importance attributed to each activity in order to determine if it was deemed a “valued social activity” by the participants. Second, older adults who experienced sensory loss over a longer period of the life course may differ from those who have recently developed such limitations. Further research is necessary to unravel the complex relationship between the duration of sensory loss, activity participation, and health outcomes over time. Third, high participation in social and physical activities could be a sign of less severe sensory difficulty. Future studies should investigate the relationship by considering the severity of sensory loss. Future research is also needed to explore the role of social and physical activities in the relationship between sensory loss and dementia among long-term care residents and other populations. Fourth, although self-reported sensory difficulty provides valuable insight into perceived sensory function, it may be subject to under- or overreporting, potentially attenuating or inflating the observed associations with dementia risk. Future research using objective sensory assessments would strengthen the validity of findings.

Conclusion

This study contributed to the scientific literature by demonstrating with a national sample of older adults that those with sensory difficulty were at a higher risk of incident dementia, and social activity plays a crucial pathway for this association. The findings highlighted the importance of promoting interventions for social activity among aging populations and those who experience vision loss. Further research is necessary to examine other factors that modify and mediate the relationship between sensory loss and dementia, especially important is to identify modifiable risk factors for dementia.

Supplementary Material

supplementary material

Acknowledgments:

Author contributions: Shu Xu: Writing – review & editing, Writing – original draft, Methodology, Investigation, Formal analysis, Conceptualization. Jeffrey A. Burr: Supervision, Writing – review & editing, Conceptualization. Qian Song: Writing – review & editing, Methodology, Conceptualization. Joshua R. Ehrlich: Writing – review & editing, Methodology, Conceptualization.

Funding:

This study is supported by a grant from the National Eye Institute (R01EY034479) and The SENSE Network, which is funded by the National Institute on Aging (R61AG089063).

Footnotes

Conflict of Interest: None.

Contributor Information

Shu Xu, Institute for Social Research, University of Michigan, 426 Thompson Street, Ann Arbor, MI 48104; Department of Gerontology, University of Massachusetts Boston, 100 Morrissey Blvd, Boston, MA 02125-3393.

Jeffrey A. Burr, Department of Gerontology, University of Massachusetts Boston, 100 Morrissey Blvd, Boston, MA 02125-3393.

Qian Song, Department of Gerontology, University of Massachusetts Boston, 100 Morrissey Blvd, Boston, MA 02125-3393.

Joshua R. Ehrlich, Institute for Social Research and Department of Ophthalmology and Visual Sciences, University of Michigan, 426 Thompson Street, Ann Arbor, MI 48104.

Data Availability:

The data used in this study are from the National Health and Aging Trends Study (NHATS), which is publicly available through the NHATS website (https://www.nhats.org/researcher/nhats).

References

  1. Ahlskog JE, Geda YE, Graff-Radford NR, & Petersen RC (2011). Physical exercise as a preventive or disease-modifying treatment of dementia and brain aging. Mayo Clinic Proceedings, 86(9), 876–884. 10.4065/mcp.2011.0252 [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Alzheimer’s Association. (2024). 2024 Alzheimer’s disease facts and figures. Alzheimer’s & Dementia, 20(5), 3708–3821. 10.1002/alz.13809 [DOI] [Google Scholar]
  3. Amieva H, Ouvrard C, Giulioli C, Meillon C, Rullier L, & Dartigues JF (2015). Self-reported hearing loss, hearing aids, and cognitive decline in elderly adults: A 25-year study. Journal of the American Geriatrics Society, 63(10), 2099–2104. doi: 10.1111/jgs.13649 [DOI] [PubMed] [Google Scholar]
  4. Bryant LL, Corbett KK, & Kutner JS (2001). In their own words: a model of healthy aging. Social Science & Medicine (1982), 53(7), 927–941. doi: 10.1016/s0277-9536(00)00392-0 [DOI] [PubMed] [Google Scholar]
  5. Bookwala J, & Lawson B (2011). Poor vision, functioning, and depressive symptoms: A test of the activity restriction model. The Gerontologist, 51(6), 798–808. doi: 10.1093/geront/gnr051 [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Cai Y, Schrack JA, Wang H, E JY, Wanigatunga AA, Agrawal Y, Urbanek JK, Simonsick EM, Ferrucci L, & Swenor BK. (2021). Visual impairment and objectively measured physical activity in middle-aged and older adults. The Journals of Gerontology. Series A, Biological Sciences and Medical Sciences, 76(12), 2194–2203. doi: 10.1093/gerona/glab103 [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Carstensen LL, Isaacowitz DM, & Charles ST (1999). Taking time seriously. A theory of socioemotional selectivity. The American Psychologist, 54(3), 165–181. 10.1037//0003-066x.54.3.165 [DOI] [PubMed] [Google Scholar]
  8. Chen DS, Betz J, Yaffe K, Ayonayon HN, Kritchevsky S, Martin KR, … & Health ABC Study. (2015). Association of hearing impairment with declines in physical functioning and the risk of disability in older adults. Journals of Gerontology Series A: Biomedical Sciences and Medical Sciences, 70(5), 654–661. doi: 10.1093/gerona/glu207 [DOI] [Google Scholar]
  9. Choi JS, Betz J, Deal J, Contrera KJ, Genther DJ, Chen DS, Gispen FE, & Lin FR (2016). A comparison of self-report and audiometric measures of hearing and their associations with functional outcomes in older adults. Journal of Aging and Health, 28(5), 890–910. doi: 10.1177/0898264315614006 [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Ehrlich JR, Swenor BK, Zhou Y, & Langa KM (2021). The longitudinal association of vision impairment with transitions to cognitive impairment and dementia: findings from the Aging, Demographics and Memory Study. The Journals of Gerontology. Series A, Biological Sciences and Medical Sciences, 76(12), 2187–2193. doi: 10.1093/gerona/glab157 [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Evans IEM, Martyr A, Collins R, Brayne C, & Clare L (2019). Social isolation and cognitive function in later life: a systematic review and meta-analysis. Journal of Alzheimer’s Disease, 70(s1), S119–S144. doi: 10.3233/JAD-180501 [DOI] [Google Scholar]
  12. Fischer ME, Cruickshanks KJ, Schubert CR, Pinto AA, Carlsson CM, Klein BE, Klein R, & Tweed TS (2016). Age-related sensory impairments and risk of cognitive impairment. Journal of the American Geriatrics Society, 64(10), 1981–1987. doi: 10.1111/jgs.14308 [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Freedman VA, Kasper JD, Cornman JC, Agree EM, Bandeen-Roche K, Mor V, Spillman BC, Wallace R, & Wolf DA (2011). Validation of new measures of disability and functioning in the National Health and Aging Trends Study. The Journals of Gerontology. Series A, Biological Sciences and Medical Sciences, 66(9), 1013–1021. 10.1093/gerona/glr087 [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Freedman VA, Schrack JA & Skehan ME (2024). National Health and Aging Trends Study User Guide: Rounds 1–13 Beta Release. Baltimore: Johns Hopkins Bloomberg School of Public Health. Available at www.NHATS.org. [Google Scholar]
  15. Heckhausen J, Wrosch C, & Schulz R (2010). A motivational theory of life-span development. Psychological Review, 117(1), 32–60. doi: 10.1037/a0017668 [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. Hu LT, & Bentler PM (1999). Cutoff criteria for fit indexes in covariance structure analysis: conventional criteria versus new alternatives. Structural Equation Modeling, 6, 1–55. doi: 10.1080/10705519909540118 [DOI] [Google Scholar]
  17. Hudomiet P, Hurd MD, & Rohwedder S (2018). Dementia prevalence in the United States in 2000 and 2012: estimates based on a nationally representative study. The Journals of Gerontology. Series B, Psychological Sciences and Social Sciences, 73(suppl_1), S10–S19. doi: 10.1093/geronb/gbx169 [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Hwang PH, Longstreth WT Jr, Thielke SM, Francis CE, Carone M, Kuller LH, & Fitzpatrick AL. (2022). Longitudinal changes in hearing and visual impairments and risk of dementia in older adults in the United States. JAMA Network Open, 5(5), e2210734. doi: 10.1001/jamanetworkopen.2022.10734 [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. Kasper JD, Freedman VA, & Spillman BC (2013). Classification of persons by dementia status in the National Health and Aging Trends Study. Technical Paper, 5, 1–4. [Google Scholar]
  20. Kuiper JS, Zuidersma M, Oude Voshaar RC, Zuidema SU, van den Heuvel ER, Stolk RP, & Smidt N (2015). Social relationships and risk of dementia: A systematic review and meta-analysis of longitudinal cohort studies. Ageing Research Reviews, 22, 39–57. doi: 10.1016/j.arr.2015.04.006 [DOI] [PubMed] [Google Scholar]
  21. Kuo PL, Huang AR, Ehrlich JR, Kasper J, Lin FR, McKee MM, Reed NS, Swenor BK, & Deal JA (2021). Prevalence of concurrent functional vision and hearing impairment and association with dementia in community-dwelling Medicare beneficiaries. JAMA Network Open, 4(3), e211558. doi: 10.1001/jamanetworkopen.2021.1558 [DOI] [PMC free article] [PubMed] [Google Scholar]
  22. Latham K, & Clarke PJ (2018). Neighborhood disorder, perceived social cohesion, and social participation among older Americans: Findings from the National Health & Aging Trends Study. Journal of Aging and Health, 30(1), 3–26.doi: 10.1177/0898264316665933 [DOI] [PubMed] [Google Scholar]
  23. Lin FR, Yaffe K, Xia J, Xue QL, Harris TB, Purchase-Helzner E, Satterfield S, Ayonayon HN, Ferrucci L, Simonsick EM, & Health ABC Study Group. (2013). Hearing loss and cognitive decline in older adults. JAMA Internal Medicine, 173(4), 293–299. doi: 10.1001/jamainternmed.2013.1868 [DOI] [PMC free article] [PubMed] [Google Scholar]
  24. Livingston G, Huntley J, Liu KY, Costafreda SG, Selbæk G, Alladi S, … & Mukadam N. (2024). Dementia prevention, intervention, and care: 2024 report of the Lancet standing Commission. The Lancet, 404(10452), 572–628. doi: 10.1016/S0140-6736(24)01296-0 [DOI] [Google Scholar]
  25. Loughrey DG, Kelly ME, Kelley GA, Brennan S, & Lawlor BA (2018). Association of age-related hearing loss with cognitive function, cognitive impairment, and dementia: a systematic review and meta-analysis. JAMA Otolaryngology--Head & Neck Surgery, 144(2), 115–126. doi: 10.1001/jamaoto.2017.2513 [DOI] [PMC free article] [PubMed] [Google Scholar]
  26. Logsdon R, McCurry S, Pike K, & Teri L (2009). Making physical activity accessible to older adults with memory loss: a feasibility study, The Gerontologist, 49(S1), S94–S99. doi: 10.1093/geront/gnp082 [DOI] [PMC free article] [PubMed] [Google Scholar]
  27. Maharani A, Pendleton N, & Leroi I (2019). Hearing impairment, loneliness, social isolation, and cognitive function: longitudinal analysis using English Longitudinal Study on Ageing. The American Journal of Geriatric Psychiatry, 27(12), 1348–1356. doi: 10.1016/j.jagp.2019.07.010 [DOI] [PubMed] [Google Scholar]
  28. Martinez-Amezcua P, Powell D, Kuo PL, Reed NS, Sullivan KJ, Palta P, Szklo M, Sharrett R, Schrack JA, Lin FR, & Deal JA (2021). Association of age-related hearing impairment with physical functioning among community-dwelling older adults in the US. JAMA Network Open, 4(6), e2113742. doi: 10.1001/jamanetworkopen.2021.13742 [DOI] [PMC free article] [PubMed] [Google Scholar]
  29. McDaniel HL (2018). Advancing Understanding Of Dynamic Mechanisms In Onset To Event Models: Discrete Time Survival Mediation With A Time Variant Mediator (Doctoral dissertation, University of South Carolina). [Google Scholar]
  30. Muthén B, & Masyn K (2005). Discrete-time survival mixture analysis. Journal of Educational and Behavioral Statistics, 30(1), 27–58. 10.3102/10769986030001027 [DOI] [Google Scholar]
  31. Palmer AD, Newsom JT, & Rook KS (2016). How does difficulty communicating affect the social relationships of older adults? An exploration using data from a national survey. Journal of Communication Disorders, 62, 131–146. doi: 10.1016/j.jcomdis.2016.06.002 [DOI] [PMC free article] [PubMed] [Google Scholar]
  32. Parisi JM, Roberts L, Szanton SL, Hodgson NA, & Gitlin LN (2019). Valued activities among individuals with and without functional impairments: Findings from the National Health and Aging Trends study (NHATS). Activities, Adaptation & Aging, 43(4), 259–275. 10.1080/01924788.2018.1521254 [DOI] [Google Scholar]
  33. Pressman SD, Matthews KA, Cohen S, Martire LM, Scheier M, Baum A, & Schulz R (2009). Association of enjoyable leisure activities with psychological and physical well-being. Psychosomatic Medicine, 71(7), 725–732. doi: 10.1097/PSY.0b013e3181ad7978 [DOI] [PMC free article] [PubMed] [Google Scholar]
  34. Pronk M, Lissenberg-Witte BI, van der Aa HPA, Comijs HC, Smits C, Lemke U, Zekveld AA, & Kramer SE (2019). Longitudinal Relationships Between Decline in Speech-in-Noise Recognition Ability and Cognitive Functioning: The Longitudinal Aging Study Amsterdam. Journal of Speech, Language, and Hearing Research, 62(4s), 1167–1187. 10.1044/2018_jslhr-h-ascc7-18-0120 [DOI] [Google Scholar]
  35. Pichora-Fuller MK (2020). Hearing and cognitive aging. In Oxford Research Encyclopedia of Psychology. doi: 10.1093/acrefore/9780190236557.013.367 [DOI] [Google Scholar]
  36. Powell DS, Oh ES, Reed NS, Lin FR, & Deal JA (2022). Hearing loss and cognition: what we know and where we need to go. Frontiers in Aging Neuroscience, 13, 769405. doi: 10.3389/fnagi.2021.769405 [DOI] [PMC free article] [PubMed] [Google Scholar]
  37. Prince M, Wimo A, Guerchet M, Ali G, Wu Y, & Prina M (2015). World Alzheimer Report 2015. The global impact of dementia: An analysis of prevalence, incidence, cost and trends. London: Alzheimer’s Disease International; https://www.alz.co.uk/research/WorldAlzheimerReport2015.pdf [Google Scholar]
  38. Rafnsson SB, Orrell M, d’Orsi E, Hogervorst E, & Steptoe A (2020). Loneliness, social integration, and incident dementia over 6 years: prospective findings from the English Longitudinal Study of Ageing. The Journals of Gerontology. Series B, Psychological Sciences and Social sciences, 75(1), 114–124. doi: 10.1093/geronb/gbx087 [DOI] [PMC free article] [PubMed] [Google Scholar]
  39. Rajan KB, Weuve J, Barnes LL, McAninch EA, Wilson RS, & Evans DA (2021). Population estimate of people with clinical Alzheimer’s disease and mild cognitive impairment in the United States (2020–2060). Alzheimer’s & Dementia, 17(12), 1966–1975. doi: 10.1002/alz.12362 [DOI] [Google Scholar]
  40. Roberts R, & Knopman DS (2013). Classification and epidemiology of MCI. Clinics in Geriatric Medicine, 29(4), 753–772. 10.1016/j.cger.2013.07.003 [DOI] [PMC free article] [PubMed] [Google Scholar]
  41. Sallis JF (2010). Measuring physical activity: practical approaches for program evaluation in Native American communities. Journal of Public Health Management and Practice: JPHMP, 16(5), 404–410. 10.1097/PHH.0b013e3181d52804 [DOI] [PMC free article] [PubMed] [Google Scholar]
  42. Shah K, Frank CR, & Ehrlich JR (2020). The association between vision impairment and social participation in community-dwelling adults: A systematic review. Eye, 34(2), 290–298. [DOI] [PMC free article] [PubMed] [Google Scholar]
  43. Shukla A, Harper M, Pedersen E, Goman A, Suen JJ, Price C, Applebaum J, Hoyer M, Lin FR, & Reed NS (2020). Hearing loss, loneliness, and social isolation: A systematic review. Otolaryngology--Head and Neck Surgery, 162(5), 622–633. 10.1177/0194599820910377 [DOI] [PMC free article] [PubMed] [Google Scholar]
  44. Singer JD, & Willett JB (2003). Applied longitudinal data analysis: Modeling change and event occurrence. Oxford university press. [Google Scholar]
  45. Stern Y (2009). Cognitive reserve. Neuropsychologia, 47(10), 2015–2028. 10.1016/j.neuropsychologia.2009.03.004 [DOI] [PMC free article] [PubMed] [Google Scholar]
  46. Sörman DE, Sundström A, Rönnlund M, Adolfsson R, & Nilsson LG (2014). Leisure activity in old age and risk of dementia: A 15-year prospective study. The Journals of Gerontology. Series B, Psychological Sciences and Social Sciences, 69(4), 493–501. 10.1093/geronb/gbt056 [DOI] [PubMed] [Google Scholar]
  47. Swenor BK, Wang J, Varadaraj V, Rosano C, Yaffe K, Albert M, & Simonsick EM (2019). Vision impairment and cognitive outcomes in older adults: The Health ABC Study. The Journals of Gerontology. Series A, Biological Sciences and Medical Sciences, 74(9), 1454–1460. 10.1093/gerona/gly244 [DOI] [PMC free article] [PubMed] [Google Scholar]
  48. Valentijn SA, van Boxtel MP, van Hooren SA, Bosma H, Beckers HJ, Ponds RW, & Jolles J (2005). Change in sensory functioning predicts change in cognitive functioning: results from a 6-year follow-up in the Maastricht Aging Study. Journal of the American Geriatrics Society, 53(3), 374–380. doi: 10.1111/j.1532-5415.2005.53152.x [DOI] [PubMed] [Google Scholar]
  49. Wayne RV, & Johnsrude IS (2015). A review of causal mechanisms underlying the link between age-related hearing loss and cognitive decline. Ageing Research Reviews, 23(Pt B), 154–166. 10.1016/j.arr.2015.06.002 [DOI] [PubMed] [Google Scholar]
  50. Winter JE, MacInnis RJ, Wattanapenpaiboon N, & Nowson CA (2014). BMI and all-cause mortality in older adults: A meta-analysis. The American Journal of Clinical Nutrition, 99(4), 875–890. 10.3945/ajcn.113.068122 [DOI] [PubMed] [Google Scholar]
  51. World Health Organization. (2023). Dementia. https://www.who.int/news-room/fact-sheets/detail/dementia
  52. Yorgason JB, Tanner CT, Richardson S, Hill MMYS, Stagg B, Wettstein M, & Ehrlich JR (2022). The Longitudinal Association of Late-Life Visual and Hearing Difficulty and Cognitive Function: The Role of Social Isolation. Journal of Aging and Health, 34(6–8), 765–774. 10.1177/08982643211063338 [DOI] [PMC free article] [PubMed] [Google Scholar]
  53. Zheng Y, Fan S, Liao W, Fang W, Xiao S, & Liu J (2017). Hearing impairment and risk of Alzheimer’s disease: A meta-analysis of prospective cohort studies. Neurological Sciences, 38, 233–239. [DOI] [PubMed] [Google Scholar]
  54. Zhou W, & Larson JL (2023). Associations of living in residential care facilities with participation in physical activities among older adults in the United States. Interdisciplinary Nursing Research, 2(1), 27–31. doi: 10.1097/NR9.0000000000000018 [DOI] [Google Scholar]

Associated Data

This section collects any data citations, data availability statements, or supplementary materials included in this article.

Supplementary Materials

supplementary material
NIHMS2137701-supplement-supplementary_material.docx (28.8KB, docx)

Data Availability Statement

The data used in this study are from the National Health and Aging Trends Study (NHATS), which is publicly available through the NHATS website (https://www.nhats.org/researcher/nhats).

RESOURCES