To the Editor: Healthy ageing is listed as a National Research Priority by the Australian Government. The higher prevalence of sensory, cognitive and mobility impairments in older people presents a major challenge in achieving this goal. The effects of single impairments are recognised,1,2 but the cumulative effects of multiple impairments have not been reported from population-based samples.

We aimed to assess the impact of multiple impairments (vision, hearing, cognitive, mobility) on health-related quality of life (HRQOL), hospitalisation, and aged-care service use in an older Australian population. In the second cross-sectional Blue Mountains Eye Study,3 HRQOL was measured by means of the self-administered Short Form 36-item Health Survey (SF-36)4 (n = 3509; mean age, 66.7 years; 57% women). Visual impairment was defined as best-corrected visual acuity (after refraction) of less than 6/12 (better eye). Hearing impairment was defined as average hearing threshold (pure-tone air conduction, frequencies 500–4000 Hz) over 25 decibels (better ear). Possible cognitive impairment was defined as Mini Mental State Examination scores less than 24/30. Mobility impairment was recorded. General linear regression was used to calculate age-adjusted SF-36 mean scores,5 and logistic regression was used to estimate likelihood ratios for use of health and aged-care services. Models were age-adjusted to eliminate confounding.

For 2873 participants who had completed the SF-36 (90.9%), the mean physical component score (PCS) was 44.9 (95% CI, 44.5–45.3) and the mean mental component score (MCS) was 51.9 (95% CI, 51.5–52.2). Age was significantly associated with the prevalence of these impairments (P < 0.001). After adjusting for age, people with any of the impairments had poorer mean PCS and MCS than those without the impairment (Box 1). Hospitalisation within the last year was reported by 743 participants (23.5%; 58.3% women), and 97 (3.1%; 65.0% women) reported regular use of community support services. Use of community support services was reported more frequently by people with any impairment, except possible cognitive impairment (Box 1).

The presence of two or more impairments was associated with a cumulative, linear decline in HRQOL (Box 2). The successive addition of each impairment was associated with a decrease of 4.0 in mean PCS and 2.1 in mean MCS, and with greatly increased reporting of regular community support service use.

The likelihood of participating in or completing the SF-36 decreased with increasing number of impairments. Hence, the prevalence of impairments and the extent of detrimental impacts on HRQOL may be underestimated. Nevertheless, our data highlight a linear increasing pattern of cumulative effects from multiple impairments on HRQOL, hospitalisation, and use of aged-care services. Preventing and reducing these impairments is crucial in maximising healthy ageing.