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Coho compa ison o ision and hea ing in 75- and 80-yea -old men and women bo n
28 yea s apa
© 2024 The Au ho (s). Published by Else ie B.V.
Published e sion
Välimaa, Maija; Koi unen, Kaisa; Viljanen, Anne; Ran anen, Taina; on Bonsdo ,
Mikaela
Välimaa, M., Koi unen, K., Viljanen, A., Ran anen, T., & on Bonsdo , M. (2025). Coho
compa ison o ision and hea ing in 75- and 80-yea -old men and women bo n 28 yea s apa .
A chi es o Ge on ology and Ge ia ics, 129, A icle 105653.
h ps://doi.o g/10.1016/j.a chge .2024.105653
2025
Coho compa ison o ision and hea ing in 75- and 80-yea -old men and
women bo n 28 yea s apa
Maija V¨
alimaa
a,*
, Kaisa Koi unen
a
, Anne Viljanen
a
, Taina Ran anen
a
,
Mikaela on Bonsdo
a,b
a
Facul y o Spo and Heal h Sciences, and Ge on ology Resea ch Cen e , Uni e si y o Jy ¨
askyl¨
a, PL 35, Jy ¨
askyl¨
a 40014, Finland
b
Folkh¨
alsan Resea ch Cen e , Helsinki, Finland
HIGHLIGHTS
•Cu en ly olde people ha e be e isual acui y and a lowe p e alence o isual impai men compa ed o hei coun e pa s bo n 28 yea s ea lie .
•Coho di e ences in hea ing we e less p onounced, wi h only men o he la e -bo n coho showing imp o ed hea ing.
•The imp o emen s a e p obably a ibu able o he mo e ad an ageous li ing condi ions expe ienced by he la e -bo n coho .
ARTICLE INFO
Keywo ds:
Visual acui y
Hea ing acui y
In insic capaci y
Secula ends
Olde people
ABSTRACT
Pu pose: We compa ed he ision and hea ing o olde men and women bo n 28 yea s apa . In addi ion, we
explo ed ac o s explaining he possible coho di e ences.
Me hods: Two independen coho s o 75- and 80-yea -old men and women we e assessed as a pa o he
E e g een s udy in 1989–1990 (n =500) and he E e g een II s udy in 2017–2018 (n =726). S udies we e
conduc ed wi h simila p o ocols, and di e ences be ween coho s we e compa ed o dis ance isual acui y and
hea ing acui y. We also s udied whe he educa ional le el and heal h ac o s (i.e. o al choles e ol, blood
p essu e, BMI, and smoking s a us) unde lie he possible coho di e ences. Independen samples - es , Pea son
chi-squa ed es , and linea eg ession analyses we e used as s a is ical analyses.
Resul s: Ac oss age and sex g oups, he la e -bo n coho had be e isual acui y and a lowe p e alence o isual
impai men compa ed o he ea lie -bo n coho . In hea ing, 75-yea -old men in he la e -bo n coho had be e
hea ing acui y, wi h a e age hea ing le el a 32 dB compa ed o 36 dB in he ea lie -bo n coho , and 80-yea -old
men had a lowe p e alence o mode a e o wo se hea ing loss (74 % s. 54 %) han men in he ea lie -bo n
coho . Simila di e ences we e no obse ed o women. The coho di e ences in dis ance isual acui y and
hea ing acui y a enua ed when adjus ing o educa ion le el.
Conclusions: Today olde adul s e ain be e ision longe han be o e, bu coho di e ences in hea ing a e less
ob ious. Di e ences be ween coho s may be pa ly due o ad ances in educa ion.
1. In oduc ion
Vision and hea ing impai men s a e common in olde people (Killeen
e al., 2023; Reed e al., 2023), and a e among he mos signi ican
ac o s con ibu ing o yea s li ed wi h disabili y (GBD 2019 Ageing
Collabo a o s, 2022). Se e al s udies ha e shown ha olde people wi h
ision o hea ing impai men s a e mo e likely o ha e di icul ies in
ac i i ies o daily li ing (Chen e al., 2015; C ews & Campbell, 2004;
Mikkola e al., 2015; Taipale e al., 2019), which o en ely on isual and
audi o y cues. Mo eo e , poo ision and hea ing ha e a p o ound in-
luence on olde people’s e e yday li ing ha ex ends a beyond ac-
i i ies o daily li ing. Senso y impai men s ha e been linked o mobili y
limi a ions (Mikkola e al., 2015; Kulmala e al., 2012; Ta eque e al.,
2019; Viljanen e al., 2009b), and cogni i e di icul ies (Chen e al.,
2017; Lin e al., 2011; Lin e al., 2004), as well as inc eased isk o alls
(Viljanen e al., 2009a; Kulmala e al., 2008; Gopina h e al., 2016), and
mo ali y (Eh lich e al., 2021; Gen he e al., 2015; Feng e al., 2022).
Mo eo e , when bo h ision and hea ing impai men occu oge he he
* Co esponding au ho .
E-mail add ess: [email p o ec ed] (M. V¨
alimaa).
Con en s lis s a ailable a ScienceDi ec
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h ps://doi.o g/10.1016/j.a chge .2024.105653
Recei ed 8 Augus 2024; Recei ed in e ised o m 19 Sep embe 2024; Accep ed 1 Oc obe 2024
A chi es o Ge on ology and Ge ia ics 129 (2025) 105653
A ailable online 3 Oc obe 2024
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isk o unc ional decline migh be u he ele a ed (Bousca en e al.,
2019; A ms ong e al., 2022; Phillips e al., 2022). As such, losses in
ision and hea ing place a hea y bu den on socie ies and indi iduals.
Du ing he pas ew decades, se e al changes in educa ion, occupa-
ional sa e y, heal h ca e, and medicine ha e shaped people’s li e cou se
(D ewelies e al., 2019). These ad ances may also ha e educed expo-
su e o indi idual and en i onmen al isk ac o s o senso y impai -
men s, such as unheal hy li es yles, ch onic diseases, and en i onmen al
exposu es, like UV adia ion and noise exposu e (Yang e al., 2023;
Sacca e al., 2009). Acco ding o ecen coho compa isons, olde
people oday ha e be e physical, men al, and cogni i e unc ioning
han p e iously (Kek¨
al¨
ainen e al., 2023; Koi unen e al., 2021;
Munukka e al., 2021), sugges ing ha longe li e is accompanied by
be e age-speci ic unc ional abili y. Howe e , exis ing li e a u e p e-
sen s inconsis en indings ega ding he coho di e ences in ision and
hea ing among olde people. S udies om Eu ope indica e ha cu en
olde men and women ha e be e ision han p e iously (Delcou
e al., 2018; Pu ola e al., 2024), whe eas s udies om he US and China
did no ind signi ican coho di e ences o epo e en an inc eased
p e alence o isual impai men (Ko e al., 2012; Luo e al., 2022). In
e ms o hea ing, p e ious esea ch om he US and Eu ope indica es
ha he hea ing o cu en olde men is be e han p e iously (Ho
e al., 2018; Ho man e al., 2012), while he indings o women a e
con a y (G¨
o hbe g e al., 2020; Homans e al., 2017).
These inconsis en indings unde sco e he need o u u e esea ch
on coho di e ences in ision and hea ing in olde people. Mo eo e ,
he mechanisms unde lying he coho di e ences ha e been ha dly
s udied. To add ess his gap, his s udy aims o explo e he coho di -
e ences in ision and hea ing among olde adul s bo n almos h ee
decades apa , while also examining ac o s explaining he possible
coho di e ences.
2. Me hods
2.1. S udy popula ion and ec ui men
This s udy uses da a om wo popula ion-based esea ch p ojec s,
E e g een, and E e g een II, conduc ed a he Uni e si y o Jy ¨
askyl¨
a,
Finland. E e g een da a we e collec ed in 1989–1990 (Heikkinen,
1998), and E e g een II in 2017–2018 as pa o he Ac i e Aging –
Resilience and ex e nal suppo as modi ie s o disablemen ou come
(AGNES) s udy (Ran anen e al., 2018). Samples in bo h da ase s we e
d awn om he Finnish Popula ion egis e based on bi h yea and
place o esidence. All communi y-dwelling 75- and 80-yea -old men
and women li ing in he ci y o Jy ¨
askyl¨
a o med he a ge popula ion.
Pa icipan s o he E e g een coho we e bo n in 1910 and 1914 and o
he E e g een II coho in 1938–1939 and 1942–1943 (Heikkinen, 1998;
Ran anen e al., 2018).
The ec ui men p ocedu es o he E e g een and E e g een II
s udies we e compa able, and a e desc ibed in mo e de ail in he s udy
p o ocols (Heikkinen, 1998; Ran anen e al., 2018) and p io coho
compa isons (Kek¨
al¨
ainen e al., 2023; Koi unen e al., 2021; Munukka
e al., 2021). B ie ly, in he E e g een s udy, all communi y-li ing 75-
and 80-yea -old adul s ecei ed an in o ma ion le e abou he s udy
sugges ing a ime o he a -home in e iew and an examina ion a he
esea ch cen e . O he eligible (n =652) pa icipan s, 77 % (n =500)
pa icipa ed bo h in he a -home in e iew and he examina ion in he
labo a o y, and o whom 98 % had da a on ou come measu es, excep
o isual acui y (86 %). In he E e g een II p ojec , pa icipan s we e
sen an in o ma ion le e abou he s udy along wi h a scheduled phone
in e iew. Du ing he phone in e iew o hose willing o pa icipa e,
he a -home in e iew and physical examina ion we e scheduled. A
pos al ques ionnai e assessing li es yle, physical ac i i y, unc ional
s a us, and quali y o li e was sen wi h he in o ma ion le e . O he
eligible (n =1835) pa icipan s 40 % (n =726) pa icipa ed bo h in he
a -home in e iew and an examina ion a he labo a o y, wi h 99 % o
whom had da a a ailable on ou come measu es. Due o he di e ences
in he pa icipa ion a es, he non-pa icipan s we e compa ed be ween
he coho s o ensu e hei compa abili y. The non-pa icipan s in bo h
coho s we e simila in e ms o sel - a ed heal h and he easons o
non-pa icipa ion (Koi unen e al., 2021). Reasons o non-pa icipa ion
we e poo heal h (E e g een 23 % (n =35); E e g een II 17 % (n =
192)), lack o in e es (E e g een 40% (n =60); E e g een II 48 % (n =
527)) and o he unknown easons (E e g een 38 % (n =57); E e g een
II 35 % (n =390)). The esul s did no di e when analyses we e ca ied
ou sepa a ely o sex and age g oups (Koi unen e al., 2021).
2.2. Va iables
2.2.1. Vision
The ision es ing included a dis ance isual acui y measu emen a
he esea ch cen e assessed wi h he Illumina ed Landol ing decimal
cha (Oculus 4512) a a 5-m dis ance wi h cu en isual co ec ion.
Row-by- ow sco ing was used, and all alues we e p esen ed in Snellen
decimal equi alen s anging om 0.125 o 2.0 (Kulmala e al., 2008;
Ran anen e al., 2018), whe e a highe alue indica es be e isual
acui y. In he E e g een coho , isual acui y was measu ed sepa a ely
o he le and igh eye, and he be e eye isual acui y was used. In he
E e g een II coho , isual acui y was measu ed simul aneously o bo h
eyes. Fo he analyses, p esen ing isual acui y was classi ied acco ding
o WHO’s ecommenda ions as: No mal ision (VA ≥0.5), Mild ision
loss (VA <0.5 o ≥0.3), and Mode a e o wo se ision loss (VA <0.3)
(Wo ld Heal h O ganiza ion, 2019). Du ing he home in e iew, he
nea ision was assessed by a sel - a ed ques ion e alua ing whe he he
pa icipan could ead a no mal newspape wi h cu en isual co ec-
ion. The answe s we e ca ego ized as 1. Wi hou di icul y, 2. Wi h
some di icul y, and 3. Wi h a g ea deal o di icul y o no a all.
2.2.2. Hea ing
The hea ing p o ocol consis ed o pu e- one ai conduc ion es ing
o each ea sepa a ely a equencies o 0.125, 0.25, 0.5, 1, 2, 4, and 8
kHz. In he E e g een s udy, hea ing acui y was measu ed wi h a clinical
audiome e (Madsen OB 822 wi h TDH 39 headphones) wi h a
maximum in ensi y o 120 dB in he sound-p oo chambe by an audi-
ologis o ained esea ch assis an a he esea ch cen e . Be o e
es ing, he audiome e was calib a ed acco ding o he ISO 389 s an-
da d (Hie anen e al., 2004). In he E e g een II s udy, hea ing was
measu ed wi h a sc eening audiome e (Oscilla USB-330, Inmedico A/S,
Denma k wi h Pel o H7A headphones) wi h a maximum in ensi y o 95
dB in a quie o ice oom by a ained esea ch assis an (Ran anen e al.,
2018). The Hughson-Wes lake p o ocol was used in he measu emen s.
I he pu e- one h eshold could no be hea d a a gi en equency, a
alue o 130 dB was gi en, as ecommended by he B i ish Socie y o
Audiology (B i ish Socie y o Audiology, 2018). Since he maximum es
alues di e ed be ween coho s, all alues abo e 95 dB we e coded o
130 dB in bo h coho s o make da a compa able, esul ing in 13.5 % (n
=66) o he E e g een coho and 15.1 % (n =109) o he E e g een II
coho ha ing a leas one alue coded as 130 dB in he be e o wo se
ea .
Fo he coho compa isons, he be e ea (BE) and wo se ea (WE)
hea ing h esholds we e de e mined by he pu e- one a e age o e
equencies o 0.5–4 kHz (PTA
0.5–4 kHz
), whe e a highe alue indica es
wo se hea ing. Hea ing acui y was de ined as BE PTA
0.5–4 kHz
and used
o classi y hea ing impai men acco ding o he WHO’s ecommenda ion
as: No mal hea ing (<20 dB HL), Mild hea ing loss (≥20 o <35 dB
HL), and Mode a e o wo se hea ing loss (≥35 dB HL) (Wo ld Heal h
O ganiza ion, 2021). In he a -home in e iew, hea ing was assessed by
asking whe he he pa icipan could hea a no mal con e sa ion wi h
h ee o mo e pe sons wi h o wi hou hea ing aids. The esponses we e
ca ego ized as 1. Wi hou di icul y, 2. Wi h some di icul y, and 3. Wi h
a g ea deal o di icul y o no a all.
M. V¨
alimaa e al.
A chi es o Ge on ology and Ge ia ics 129 (2025) 105653
2
2.2.3. Dual senso y loss
Dual senso y loss was de ined based on he WHO’s ecommenda ions
o ision and hea ing impai men and he classi ica ion used p e iously
(Phillips e al., 2022). Fo analyses, he dual senso y a iable was
ca ego ized as h ee-le el: 1. No senso y loss, 2. Singel senso y loss, i
he pa icipan had ei he ision o hea ing loss, and 3. Dual senso y
loss, i he pa icipan had bo h ision and hea ing loss. Visual impai -
men was de ined as p esen ing VA <0.5 and hea ing impai men as
be e ea PTA
0.5–4 kHz
≥20 dB HL.
2.2.4. Co a ia es
To s udy he po en ial ac o s unde lying he coho di e ences, we
chose co a ia es ha heo e ically can be pa o he mechanism leading
o di e ences be ween he coho s. Educa ional le el is associa ed wi h
senso y unc ions (Killeen e al., 2023; Reed e al., 2023) and
sel - epo ed yea s o ull- ime educa ion assessed in he home in e iew
we e used as a co a ia e. Heal h ac o s such as high o al choles e ol,
blood p essu e, body mass index (BMI), and smoking s a us a e also
associa ed wi h ision and hea ing loss and we e used as co a ia es
(Yang e al., 2023; Sacca e al., 2009). Du ing he heal h examina ion in
he labo a o y o al choles e ol was d awn om blood samples, sys olic
and dias olic blood p essu e alues we e ob ained om he es ing phase
o an o hos a ic es , and BMI was calcula ed om pa icipan s’ weigh
and heigh (kg/m
2
) (Heikkinen, 1998; Ran anen e al., 2018). In he
analyses, o al choles e ol, blood p essu e, and BMI we e used as
con inuous a iables. Smoking s a us was assessed by sel - epo du ing
he home in e iew in he E e g een s udy and in he pos al ques ion-
nai e p io o he home in e iew in he E e g een II s udy. Fo analyses,
smoking s a us was ca ego ized as 0. Ne e smoked and, 1. Cu en o
o me smoke .
2.3. S a is ical analyses
To compa e he cu en and ea lie coho s, we used - es s o
con inuous and Pea son chi-squa ed es s o ca ego ical a iables. Di -
e ences in he median BE and WE hea ing h esholds we e es ima ed
wi h he Mann-Whi ney U es . We es ed whe he he coho di e ence
a ied acco ding o age and sex by examining coho -by-age and coho -
by-sex in e ac ion e ms in linea eg ession analysis comp ising all
pa icipan s.
We u he es ed ac o s explaining he po en ial coho di e ences
in a se o linea eg ession models. In he i s model, isual acui y was
placed as a dependen a iable and he bi h coho as an independen
a iable in he model. Then se e al models we e comple ed adding
co a ia es one a a ime, o s udy whe he hey a enua ed he po en ial
coho di e ences. The inal model included all co a ia es. The same
p ocedu e was pe o med o hea ing acui y. In all eg ession analyses,
he E e g een coho was used as a e e ence ca ego y. To inc ease he
powe , we also pe o med he hie a chical linea eg ession analysis in a
simila manne wi h age g oups combined and age included as a
Table 1
Desc ip i e s a is ics and coho di e ences o 75- and 80-yea -old men and women om he E e g een and he E e g een II coho s.
75-yea -old 80-yea -old
n E e g een
1989–1990
n E e g een II
2017–2018
p
a
n E e g een
1989–1990
n E e g een II
2017–2018
p
a
Men
Yea s o educa ion, m (sd) 102 6.2 (3.5) 182 12.2 (4.4) <0.001 59 5.9 (4.1) 130 11.9 (4.4) <0.001
To al choles e ol, m (sd) 104 6.0 (1.2) 183 4.9 (1.0) <0.001 60 5.6 (1.0) 132 4.5 (1.1) <0.001
Sys olic blood p essu e, m
(sd)
103 154.7 (18.3) 183 146.1 (18.3) <0.001 59 161.2 (28.6) 131 143 (17.3) <0.001
Dias olic blood p essu e, m
(sd)
103 85.7 (9.3) 183 78.4 (6.8) <0.001 59 82.2 (12.1) 131 76.2 (9.7) <0.001
Body mass index, m (sd) 104 25.8 (3.6) 183 27.0 (4.3) 0.021 60 26.3 (3.8) 131 27.0 (4.1) 0.268
Cu en o o me smoke ,
(%)
97 64 (66.0) 182 95 (52.2) 0.027 57 38 (66.7) 128 56 (43.8) 0.004
Use o spec acles, (%) 102 179 59 128
No spec acles 3 (2.9) 5 (2.8) <0.001 4 (6.8) 7 (5.5) <0.001
Spec acles o
nea sigh edness
15 (14.7) 11 (6.1) 11 (18.6) 1 (0.8)
Spec acles o
a sigh edness
0 (0.0) 51 (28.5) 2 (3.4) 38 (29.7)
Bo h 84 (82.4) 112 (62.6) 42 (71.2) 82 (64.1)
Uses hea ing aid,
(%)
102 9 (8.8) 181 28 (11.5) 0.111 60 9 (15.0) 127 31 (24.4) 0.143
Women
Yea s o educa ion, m (sd) 189 6.1 (3.3) 249 12.1 (4.1) <0.001 141 5.7 (3.2) 159 11.8 (6.2) <0.001
To al choles e ol, m (sd) 188 6.9 (1.4) 250 5.4 (1.1) <0.001 140 6.1 (1.0) 158 5.2 (1.1) <0.001
Sys olic blood p essu e, m
(sd)
191 160.1 (21.5) 249 151.0 (19.9) <0.001 144 169.7 (29.5) 159 153.8 (20.3) <0.001
Dias olic blood p essu e, m
(sd)
191 85.2 (9.8) 249 79.2 (8.8) <0.001 144 85.5 (13.0) 159 78.8(10.5) <0.001
Body mass index, m (sd) 191 27.8 (4.7) 251 28.0 (4.8) 0.757 145 26.7 (4.0) 159 27.9 (4.9) 0.018
Cu en o o me smoke ,
(%)
185 18 (9.7) 250 49 (19.6) 0.005 143 10 (7.0) 158 22 (13.9) 0.051
Use o spec acles,
(%)
183 246 145 157
No spec acles, 3 (1.6) 3 (1.2) <0.001 2 (1.4) 4 (2.5) <0.001
Spec acles o
nea sigh edness
29 (15.8) 8 (3.3) 21 (14.5) 1 (0.6)
Spec acles o
a sigh edness
6 (3.3) 45 (18.3) 7 (4.8) 35 (22.3)
Bo h 145 (79.2) 190 (77.2) 115 (79.3) 117 (74.5)
Uses hea ing aid, (%) 185 9 (4.9) 246 18 (7.3) 0.298 144 14 (9.7) 159 20 (12.6) 0.431
No es: m=Mean; sd=S anda d De ia ion; =F equency
a
= - es o con inuous a iables and Pea son chi-squa ed es o ca ego ical a iables; Bolded p- alue indica es s a is ically signi ican di e ence be ween coho s
M. V¨
alimaa e al.
A chi es o Ge on ology and Ge ia ics 129 (2025) 105653
3
co a ia e in he model. These esul s a e p esen ed in he supplemen a y
ma e ials. All analyses we e conduc ed wi h IBM SPSS S a is ic e sion
28.0.11.
3. Resul s
Desc ip i e s a is ics a e shown in Table 1. Men and women in he
la e -bo n coho had highe educa ional le els, lowe blood p essu e,
and lowe o al choles e ol le els compa ed o he ea lie -bo n coho . In
he la e -bo n coho , men we e less equen , and women we e mo e
equen ly cu en o o me smoke s han hei coun e pa s in he
ea lie -bo n coho . The inc eased use o spec acles in he la e -bo n
coho was mainly d i en by he mo e equen use o spec acles o
a sigh edness, e.g. eading glasses.
3.1. Vision
Coho compa isons o isual acui y, isual impai men , and di i-
cul ies in sel - epo ed nea ision a e shown in Table 2. In eg ession
analysis including all pa icipan s, he coho -by-age in e ac ion e m
o isual acui y was s a is ically signi ican (p <0.001) while he
coho -by-sex in e ac ion was no (p =0.084), sugges ing ha in he
la e -bo n coho , isual acui y imp o ed mo e in he 75-yea -olds han
in he olde age g oup, while he sex di e ences emained simila be-
ween coho s. In e ms o ela i e di e ences, he la e -bo n coho had
be e isual acui y ac oss sex and age g oups compa ed o he ea lie -
bo n coho , wi h mean di e ences anging om 0.2 o 0.5 decimals.
The la e -bo n coho also had a smalle p e alence o mild and mod-
e a e o wo se isual loss han he ea lie -bo n coho , excep o 80-
yea -old men. The p e alence o mode a e o wo se isual loss
dec eased in 75-yea -olds, om 19 % o 2 % in men and om 22 % o 2
% in women. Fo 80-yea -old women, he p e alence o mode a e o
wo se isual loss dec eased om 12 % o 3 %. Addi ionally, a smalle
p opo ion o he la e -bo n coho pe cei ed di icul ies in nea ision
compa ed o he ea lie -bo n coho .
In he linea eg ession models, none o he selec ed ac o s ully
explained he coho di e ences (Table 3). Howe e , highe educa ional
le els a enua ed coho di e ences he mos , educing he di e ence by
abou 15 %, excep o 80-yea -old men. The in luence o heal h ac o s
on he coho di e ences was smalle . When all a iables we e included
he coho di e ence a enua ed 15 % in 75-yea -old men, 13 % in 75-
yea -old women, and 12 % in 80-yea -old women. In Supplemen a y
Table S1 (Table S1) when age g oups we e combined, he esul s
emained simila . Visual acui y in he la e -bo n coho was 0.3 decimal
be e o men and 0.4 decimal o women. Highe educa ional le els
a enua ed he coho di e ences he mos , 10 % in men and 13 % in
women.
3.2. Hea ing
Fig. 1 illus a es he coho di e ences in he median hea ing
h esholds o bo h BE and WE ac oss measu ed equencies. In he la e -
bo n coho , 75-yea -old men showed 5 dB lowe (be e ) hea ing
h esholds a highe equencies in bo h BE and WE compa ed o he
ea lie -bo n coho . Fo 80-yea -old men, he la e -bo n coho had a 5
dB lowe hea ing h eshold in he BE only a 0.5 kHz. Con e sely, he
ea lie -bo n coho had median h esholds 5–10 dB lowe a 0.25 kHz
ac oss bo h age g oups. In women, he ea lie -bo n coho had app ox-
ima ely 5 dB lowe hea ing h esholds a 0.125, 0.25, and 2 kHz in BE in
bo h age g oups. A highe equencies and in he WE, he h esholds
o e lapped be ween he coho s. In 75-yea -old women, he dis ibu ion
o he hea ing h eshold a 0.125 kHz was sligh ly shi ed owa d lowe
decibels in he ea lie -bo n coho compa ed o he la e -bo n coho
(mean ank 195.0 s. 236.3, p <0.001) explaining he signi ican coho
di e ence, e en hough he medians a e same.
Fo hea ing acui y, he coho -by-age in e ac ion- e m was non-
signi ican (p =0.736), while he coho -by-sex in e ac ion showed
signi ican in e ac ion (p =0.005) indica ing ha hea ing imp o emen
was p onounced in men compa ed o women. In Table 2, when
analyzing he di e ences in hea ing acui y, hea ing impai men , and
sel - epo ed hea ing di icul ies, men in he la e -bo n coho had lowe
(be e ) hea ing acui ies compa ed o he ea lie -bo n coho . Howe e ,
he di e ence was signi ican only in 75-yea -old men, wi h mean di -
e ence o −3.9 dB. Addi ionally, 80-yea -old men in he la e -bo n
coho had a lowe p e alence o hea ing impai men han he ea lie -
bo n coho , wi h mode a e o wo se hea ing loss dec easing om 74
% o 54 %. Fu he mo e, a smalle p opo ion o he 80-yea -old men in
he la e -bo n coho epo ed hea ing di icul ies compa ed o he
ea lie -bo n coho . Simila di e ences we e no obse ed in women.
In he linea eg ession models o hea ing acui y, he coho di -
e ences became non-signi ican a e including highe educa ional le el
and all co a ia es in o he model (Table 4). Highe educa ional le el
explained 99 % and all co a ia es oge he explained 78 % o he
obse ed coho di e ence. When he age g oups we e combined, men
in he la e -bo n coho had −3.7 dB lowe hea ing acui y han he
ea lie -bo n coho , and simila ly, including educa ional le el and all
co a ia es in o he model he coho di e ences became non-signi ican ,
dec easing by 71 % and 68 % (Supplemen a y Table S2).
3.3. Dual senso y loss
The la e -bo n coho had a smalle p opo ion o dual senso y im-
pai men s compa ed o he ea lie -bo n coho , excep o 80-yea -old
men (Table 2). In 75-yea -olds, he p e alence o dual senso y impai -
men dec eased om 29 % o 6 % in men and om 40 % o 15 % in
women. Fo 80-yea -old women, he co esponding dec ease in p e a-
lence was om 32 % o 12 %. The majo i y o men and women in bo h
coho s s ill had a leas one senso y impai men .
4. Discussion
Based on ou esul s he ision o olde men and women is be e
compa ed o same-aged indi iduals bo n 28 yea s ea lie . The la e -bo n
coho had be e isual acui y and less isual impai men s compa ed o
he ea lie -bo n coho . In addi ion, a smalle p opo ion o he la e -
bo n coho epo ed di icul ies in nea ision han he ea lie -bo n
coho . Fo hea ing, he coho di e ences we e less p onounced, and
di e ences we e obse ed only in men. In addi ion, he la e -bo n coho
had ewe dual senso y impai men s han he ea lie -bo n coho , likely
due o imp o ed ision in he la e -bo n coho . These changes may ha e
impo an implica ions o o he aspec s o unc ioning, quali y o li e,
and heal hy aging.
Ou indings a e consis en wi h p e ious s udies conduc ed in
Eu ope (Pu ola e al., 2024; Delcou e al., 2018) showing ha besides
educed isual impai men s, o e all isual acui y has also imp o ed in
he la e -bo n coho s. Pu ola e al. (2024) measu ed dis ance and nea
isual acui ies wi h cu en co ec ion in Finland be ween 2000 and
2017, and while obse ing a dec ease in he p e alence o impai ed
ision (VA<0.25) om 30 % o 7 %, hey also epo ed ha he p e a-
lence o good ision (VA>1.0) inc eased om 6 % o 36 % among people
aged 85 and olde . Fu he mo e, ewe pa icipan s in he la e -bo n
coho had nea ision impai men s han in he ea lie -bo n coho
(Pu ola e al., 2024). In hei me a-analysis, Delcou e al. (2018)
concluded ha in people olde han 55 yea s he p e alence o
non- e ac i e isual impai men (VA<0.5) dec eased om 2 % in
1991–2006 o 1 % in 2007–2012 in Eu ope. Howe e , in he US he
p e alence o non e ac i e isual impai men (VA<0.5) in people olde
han 60 yea s emained s able be ween 1999–2002 o 2005–2008 (Ko
e al., 2012), and in China inc eased om 6 % in 1998 o 11 % in 2018
(Luo e al., 2022). The di e ences in indings ac oss s udies may s em
om he di e en ime in e als be ween coho s, age g oups s udied,
compa abili y o he coho s, and ways o measu ing isual acui y, bu
M. V¨
alimaa e al.
A chi es o Ge on ology and Ge ia ics 129 (2025) 105653
4
Table 2
Coho di e ence in ision and hea ing o 75- and 80-yea -old men and women om he E e g een coho and he E e g een II coho .
Men Women
75-yea -old 80-yea -old 75-yea -old 80-yea -old
E e g een
1989–1990
E e g een II
2017–2018
p
a
E e g een
1989–1990
E e g een II
2017–2018
p
a
E e g een
1989–1990
E e g een II
2017–2018
p
a
E e g een
1989–1990
E e g een II
2017–2018
p
a
Visual acui y, m (se) 0.6 (0.03) 1.0 (0.03) <0.001 0.8 (0.05) 1.0 (0.03) 0.003 0.5 (0.02) 1.0 (0.02) <0.001 0.6 (0.03) 0.9 (0.03) <0.001
Visual impai men ,
(%)
No mal ision 56 (70.0) 171 (94.5) <0.001 48 (85.7) 118 (89.4) 0.790 79 (55.2) 234 (93.2) <0.001 99 (73.3) 140 (88.1) 0.001
Mild ision loss 9 (11.3) 6 (3.3) 6 (10.7) 10 (7.6) 32 (22.4) 13 (5.2) 20 (14.8) 15 (9.4)
Mode a e o wo se
ision loss
15 (18.8) 4 (2.2) 2 (3.6) 4 (3.0) 32 (22.4) 4 (1.6) 16 (11.9) 4 (2.5)
Sel - a ed nea ision,
(%)
No di icul ies 78 (75.0) 163 (90.1) 0.002 41 (68.3) 110 (85.3) 0.016 137 (71.7) 219 (89.0) <0.001 93 (64.6) 137 (85.6) <0.001
Some di icul ies 17 (16.3) 14 (7.7) 16 (26.7) 18 (14.0) 43 (22.5) 25 (10.2) 29 (20.1) 18 (11.3)
Se e e di icul ies 9 (8.7) 4 (2.2) 3 (5.0) 1 (0.8) 11 (5.8) 2 (0.8) 22 (15.3) 5 (3.1)
Hea ing acui y, m (se) 35.9 (1.4) 32.0 (0.9) 0.007 42.4 (1.9) 38.9 (1.4) 0.159 28.9 (0.9) 30.5 (0.7) 0.155 34.8 (1.1) 36.0 (1.0) 0.436
Hea ing impai men ,
(%)
No mal hea ing 7 (7.1) 25 (13.8) 0.184 1 (1.8) 5 (3.8) 0.035 36 (19.1) 32 (12.9) 0.196 14 (9.7) 11 (7.0) 0.286
Mild hea ing loss 45 (45.9) 85 (47.0) 14 (24.6) 56 (42.2) 98 (52.1) 138 (55.4) 63 (43.4) 59 (37.3)
Mode a e o wo se
hea ing loss
46 (46.9) 71 (39.2) 42 (73.7) 71 (53.8) 54 (28.7) 79 (31.7) 68 (46.9) 88 (55.7)
Sel - a ed hea ing,
(%)
No di icul ies 61 (59.8) 119 (65.7) 0.314 25 (41.7) 59 (45.7) 0.028 121 (64.4) 179 (72.2) 0.198 76 (52.8) 104 (65.0) 0.059
Some di icul ies 39 (38.2) 55 (30.4) 23 (38.3) 61 (47.3) 59 (31.4) 59 (23.8) 58 (40.3) 51 (31.9)
Se e e di icul ies 2 (2.0) 9 (7.0) 12 (20.0) 9 (7.0) 8 (4.3) 10 (4.0) 10 (6.9) 5 (3.1)
Dual senso y
impai men , (%)
No senso y loss 5 (6.5) 25 (14.0) <0.001 1 (1.9) 4 (3.0) 0.731 16 (11.4) 30 (12.0) <0.001 10 (7.4) 11 (7.0) <0.001
Single senso y loss 50 (64.9) 144 (80.4) 46 (85.2) 115 (87.1) 68 (48.6) 204 (81.9) 93 (68.9) 127 (80.9)
Dual senso y loss 22 (28.6) 10 (5.6) 7 (13.0) 13 (9.8) 56 (40.0) 15 (6.0) 32 (23.7) 19 (12.1)
No es: m=Mean; se=S anda d E o ; =F equency; P esen ing isual acui y exp essed in Snellen decimal equi alen s whe e a highe alue indica es be e acui y; Visual impai men ca ego ized as No mal ision (VA ≥
0.5), Mild ision loss (VA <0.5 o ≥0.3), and Mode a e o wo se ision loss (VA <0.3) based on he p esen ing isual acui y; Hea ing acui y measu ed as he be e ea PTA
0.5–4 kHz
whe e a highe alue indica es wo se
hea ing; Hea ing impai men ca ego ized acco ding o he be e ea PTA
0.5–4 kHz
as No mal hea ing (<20 dB HL), Mild hea ing loss (≥20 o <35 dB HL), Mode a e o wo se hea ing loss (≥35 dB HL).
a
=S uden s’ - es o con inues a iables and Pea son chi-squa ed es o ca ego ical a iables; Bolded p- alue indica es s a is ically signi ican di e ence be ween coho s.
M. V¨
alimaa e al.
A chi es o Ge on ology and Ge ia ics 129 (2025) 105653
5
hey may also indica e ha ends in ision a y be ween coun ies.
In e ms o hea ing, ou esul s showed ha 75-yea -old men in he
la e -bo n coho had abou 5 dB lowe hea ing h esholds a highe
equencies and 3 dB lowe hea ing acui y, while 80-yea -old men had a
lowe p e alence o hea ing impai men . Al hough he olde age g oup
had simila di e ences in hea ing h esholds and hea ing acui y, he
obse ed coho di e ences did no each s a is ical signi icance, which
may be due o he small sample size. O e all ou esul s sugges ha
cu en olde men end o ha e be e hea ing han ea lie , and simila
esul s ha e been ob ained by G¨
o hbe g e al. (2020) and Homans e al.
(2017). Compa ing Swedish bi h coho s o 80-yea -old people,
G¨
o hbe g e al. (2020) ound ha men om he coho bo n in 1930 had
5–10 dB be e median h esholds compa ed o he coho bo n in
1901–1902, and he p e alence o disabling hea ing loss dec eased om
67 % o 43 %. Fo women, he hea ing h esholds, and he p e alence o
disabling hea ing loss (47 % s. 45 %) did no di e . Simila ly, Homans
e al. (2017) compa ed he hea ing h esholds a he equency o 4 kHz
in people olde han 55 yea s and epo ed ha only men had be e
hea ing h esholds in he la e -bo n coho compa ed o coho s bo n
wo o h ee decades ea lie . In con as , Ho e al. (2018) examined
Swedish bi h coho s o 70-yea -olds and epo ed ha men and women
in he coho bo n in 1930 had 5–20 dB be e median hea ing h esh-
olds in se e al equencies compa ed o he coho bo n in 1901–1907.
The p e alence o hea ing impai men (PTA>25 dB HL) also dec eased
om 53 % o 28 % in men and om 37 % o 22 % in women (Ho e al.,
2018). In addi ion, Engdahl e al. (2020) epo ha he adul popula ion
in No way in 2017 had be e hea ing h esholds a equencies 0.5–8
kHz compa ed o same-aged indi iduals in 1996. They also ound a
dec eased p e alence o disabling hea ing loss (>35 dB HL) in men (32
% s. 22 %) and women (19 % s. 14 %) in he la e -bo n coho .
O e all, s udies sugges ha men o he la e -bo n coho s ha e be e
hea ing compa ed o he ea lie -bo n coho s, bu in women he coho
di e ences a e less ob ious.
Se e al explana ions can unde lie he obse ed coho di e ences.
The E e g een coho was bo n when Finland was mainly an unde el-
oped and ag icul u al coun y. The ea lie -bo n coho li ed h ough he
Ci il Wa in 1918 and as young adul s, se ed in he Win e Wa
(1939–1940), he Con inua ion Wa (1941–1944), and he Lapland Wa
(1944–1945). The E e g een II coho p obably had less exposu e o
dele e ious isk ac o s as hey we e bo n owa ds he end o he wa s
and g ew up du ing he pe iod o econs uc ion when Finland apidly
mode nized.
Ou esul s indica e ha highe educa ional le el mainly a enua ed
he coho di e ences in ision and hea ing. A e he wa s, access o
educa ion imp o ed, especially in seconda y and e ia y educa ion
(B een e al., 2010), which is in line wi h he doubling o he yea s o
educa ion in ou indings. In gene al, highe educa ion is associa ed wi h
a highe s anda d o li ing and be e esou ces o ake ca e o onesel
coupled wi h heal hy li ing habi s. Highe educa ion is also associa ed
wi h whi e-colla jobs e lec ing changes in he occupa ional s uc u e,
which migh pa ly explain he coho di e ences in hea ing among
men. When he ea lie -bo n E e g een coho en e ed wo k li e he main
occupa ions in Finland we e ag icul u e and manu ac u ing, whe e
noise-induced hea ing loss is common (Na a ajan e al., 2023). Du ing
he pe iod o mode niza ion, he occupa ional s uc u e changed
ocusing mo e on se ice p o essions wi h less noise exposu e. In addi-
ion, he Occupa ional Heal h and Sa e y Ac was implemen ed in 1930
and upda ed in 1958, and he use o hea ing p o ec ion in noisy wo king
en i onmen s was widesp ead be ween 1970–1980 (Toppila e al.,
2005). Engdahl e al. (2021) also epo ed ha lowe noise exposu e
explained a g ea e p opo ion o he imp o ed hea ing among men han
in women. Since hea ing loss in men is mo e o en cha ac e ized as
noise-induced (Rea is e al., 2023; Dubno e al., 2013), he educed
occupa ional noise exposu e has mainly bene i ed men and po en ially
accoun s o he obse ed sex di e ences in hea ing. Fo women, he isk
o hea ing loss is emphasized by di e en ac o s, such as ca dio ascula
heal h (Rea is e al., 2023; Dubno e al., 2013), and changes in he isk
ac o s may ha e occu ed o a lesse ex en . Addi ionally, win and
amily s udies sugges ha he he i abili y o age- ela ed hea ing loss is
ela i ely high, a ound 35–75 % (Yang e al., 2023; Viljanen e al.,
2007), and gene ic suscep ibili y migh ha e a mo e signi ican ole in
he de e io a ion o women’s hea ing.
In addi ion, du ing he econs uc ion o Finland, mo e a en ion was
paid o he heal h o he popula ion. Heal h and heal hy li es yles we e
p omo ed h ough nu i ion ecommenda ions and na ional heal h
p omo ion in e en ions such as he No h Ka elia p ojec in he ea ly
1970-cen u y and he Public Heal h Ac in 1972 (P ¨
a ¨
al¨
a, 2003).
Enhanced heal h and heal hie li es yles migh ha e posi i ely in lu-
enced ision and hea ing in olde age as ew o he heal h ac o s sligh ly
a enua ed he coho di e ences. Some heal h ac o s, pa icula ly o al
choles e ol, ended o inc ease he coho di e ences, which may sug-
ges a nega i e con ounding (Mehio-Sibai e al., 2005). Fu he mo e,
du ing he pas decades, se e al e o ms we e also implemen ed in he
heal hca e sys em, enhancing access o ca e and ad ances in medical
ea men s, which may explain he obse ed coho di e ences in ision,
in pa icula . Fo ins ance, he Heal h Insu ance Ac o 1963 p o ided
medical co e age o ci izens, while he 2005 legisla ion o Na ional
Gua an eed Access o Heal hca e ensu ed ha medical p ocedu es, like
ca a ac su ge ies, we e ca ied ou wi hin six mon hs om diagnosis.
These changes may pa ly explain he inc eased numbe o ca a ac
su ge ies since he ea ly 2000s in Finland (Pu ola e al., 2022a). Besides,
he p e alence o se e al age- ela ed eye diseases, such as macula
degene a ion and glaucoma, has dec eased o a leas he age o onse
has pos poned du ing he las ou decades in Finland (Pu ola e al.,
2023; Pu ola e al., 2022b; Vaajanen e al., 2022). We also obse ed
mo e equen use o spec acles in he la e -bo n coho , which may
indica e be e awa eness o eye heal h and be e access o ision
se ices.
Table 3
Linea eg ession o he associa ion be ween bi h coho and isual acui y.
Men Women
75-yea -old 80-yea -old 75-yea -old 80-yea -old
β (SE) pAdj R
2
β (SE) pAdj R
2
β (SE) pAdj R
2
β (SE) pAdj R
2
Bi h Coho 0.432 (0.047) <0.001 0.240 0.181 (0.061) 0.003 0.041 0.522 (0.034) <0.001 0.375 0.261 (0.038) <0.001 0.136
þEduca ion 0.364 (0.057) <0.001 0.253 0.198 (0.071) 0.006 0.040 0.452 (0.044) <0.001 0.385 0.220 (0.045) <0.001 0.136
þTo al choles e ol 0.453 (0.053) <0.001 0.240 0.213 (0.067) 0.002 0.042 0.520 (0.039) <0.001 0.372 0.269 (0.042) <0.001 0.134
þBlood p essu e 0.416 (0.051) <0.001 0.241 0.168 (0.065) 0.011 0.042 0.527 (0.036) <0.001 0.376 0.277 (0.040) <0.001 0.151
þBMI 0.437 (0.048) <0.001 0.239 0.181 (0.061) 0.003 0.040 0.522 (0.034) <0.001 0.374 0.257 (0.039) <0.001 0.133
þSmoking 0.436 (0.048) <0.001 0.237 0.204 (0.064) 0.002 0.046 0.532 (0.035) <0.001 0.377 0.258 (0.039) <0.001 0.129
þAll 0.368 (0.068) <0.001 0.244 0.233 (0.085) 0.009 0.052 0.454 (0.050) <0.001 0.384 0.231 (0.051) <0.001 0.128
No es: β=Uns anda dized be a indica es mean coho di e ences (E e g een coho as a e e ences g oup); SE=S anda d E o ; Adj R
2
=Model Adjus ed R; Each
co a ia e was added in he model one a a ime and all oge he in he inal “All” model; P esen ing isual acui y exp essed in Snellen decimal equi alen s whe e a
highe alue indica es be e acui y.
M. V¨
alimaa e al.
A chi es o Ge on ology and Ge ia ics 129 (2025) 105653
6
The s eng h o his s udy elies on he compa able popula ion-based
coho s bo n 28 yea s apa . The ec ui men p ocedu es we e iden ical
and non-pa icipan s did no di e be ween coho s acco ding o sel -
a ed heal h o easons o non-pa icipa ion (Koi unen e al., 2021).
Howe e , due o he smalle pa icipa ion a e in he la e -bo n coho i
is s ill possible ha his coho is a mo e selec ed and po en ially
heal hie g oup. We canno he e o e comple ely ule ou he possibili y
ha selec ion bias explains some o he esul s. Ano he s eng h o his
s udy is ha besides senso y impai men s we also s udied coho di -
e ences in isual and hea ing acui y o unde s and he ision and
hea ing ends mo e comp ehensi ely. Examining hese a ia ions can
e eal how mo e sub le changes in ision and hea ing, e en in he
absence o clinical impai men , migh in luence unc ioning and heal hy
aging. Fu he mo e, we also analyzed ac o s unde lying he coho
di e ences which p o ides new insigh in o he exis ing li e a u e.
Howe e , some limi a ions should be conside ed. In he ea lie -bo n
coho , isual acui y was measu ed monocula ly, and be e eye isual
acui y was used in he analyses. In he la e -bo n coho , acui y was
measu ed binocula ly. P e ious s udies compa ing communi y-li ing
olde people show a high co ela ion be ween monocula and binoc-
ula acui ies ( =0.93, p <0.001) (Schneck e al., 2010). In addi ion, he
s udies epo ha a highe p opo ion had equi alen acui ies be ween
monocula and binocula measu emen s, and only 15–20 % o pa ici-
pan s showed be e o wo se binocula ision compa ed o be e eye
monocula ision. Al hough binocula acui y migh be sligh ly ad an-
ageous o be e eye monocula acui y, binocula summa ion, a condi-
ion whe e binocula acui y is be e compa ed o monocula acui y,
dec eases wi h age (Rubin e al., 2000; Schneck e al., 2010; Azen e al.,
Fig. 1. Median hea ing h esholds o 75-and 80-yea -old men and women in he be e and wo se ea o measu ed equencies. Bi h coho di e ences in median
hea ing h esholds we e analyzed wi h he Mann-Whi ney U es ; p- alues a e shown o each equency.
M. V¨
alimaa e al.
A chi es o Ge on ology and Ge ia ics 129 (2025) 105653
7
Fig. 1. (con inued).
Table 4
Linea eg ession o he associa ion be ween bi h coho and hea ing acui y.
Men Women
75-yea -old 80-yea -old 75-yea -old 80-yea -old
β (SE) pAdj R
2
β (SE) pAdj R
2
β (SE) pAdj R
2
β (SE) pAdj R
2
Bi h Coho −3.907 (1.578) 0.014 0.018 −3.448 (2.441) 0.159 0.005 1.609 (1.131) 0.155 0.002 1.160 (1.486) 0.436 −0.001
þEduca ion −0.046 (1.872) 0.980 0.045 −2.421 (2.886) 0.403 0.003 2.510 (1.422) 0.078 0.003 2.949 (1.745) 0.092 0.007
þTo al choles e ol −4.801 (1.785) 0.008 0.019 −1.485 (2.676) 0.580 0.016 1.515 (1.321) 0.252 0.000 0.905 (1.644) 0.582 −0.004
þBlood p essu e −4.348 (1.712) 0.012 0.021 −4.265 (2.613) 0.104 0.004 1.567 (1.188) 0.188 −0.001 0.809 (1.581) 0.609 −0.003
þBMI −3.965 (1.601) 0.014 0.015 −3.462 (2.465) 0.162 0.000 1.589 (1.130) 0.160 0.004 1.118 (1.504) 0.458 −0.005
þSmoking −3.511 (1.625) 0.032 0.030 −3.779 (2.574) 0.144 0.002 1.254 (1.148) 0.275 0.008 1.129 (1.494) 0.450 −0.005
þAll −0.856 (2.217) 0.700 0.059 −1.857 (3.428) 0.589 0.005 2.440 (1.617) 0.132 0.003 1.947 (1.995) 0.330 −0.002
No es: β=Uns anda dized be a indica es mean coho di e ences (E e g een coho as a e e ences g oup); SE=S anda d E o ; Adj R
2
=Model Adjus ed R; Each
co a ia e was added in he model one a a ime and all oge he in he inal “All” model; Hea ing acui y measu ed as he be e ea PTA
0.5–4 kHz
whe e a highe alue
indica es wo se hea ing acui y;.
M. V¨
alimaa e al.
A chi es o Ge on ology and Ge ia ics 129 (2025) 105653
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