NCHS Data Brief ■ No. 31 ■ April 2010

u.s. department of health and human services

Centers for Disease Control and Preven

National Center for Health Statis

Key findings

•	 Sensory impairments are a 

substantial problem for older 

Americans: One out of six has 

impaired vision; one out of 

four has impaired hearing; one 

out of four has loss of feeling 

in the feet; and three out of 

four have abnormal postural 

balance testing.

•	 Sensory impairments 

increase with age: Vision and 

hearing impairments each 

double, and loss of feeling 

in the feet increases by 40% 

in persons aged 80 years and 

over compared with persons 

aged 70–79 years.

•	 One in five Americans

below the poverty threshold 

has impaired vision: 50% 

higher than other Americans. 

Balance problems are also 

common among the poor.

•	 Over one-half of those with 

impaired vision could improve 

their eyesight by using glasses 

or by getting a corrected 

prescription. For those with 

hearing problems, 72% might 

benefit from a hearing aid but

do not use one.

Sensory impairments such as problems with vision, hearing, postural 

balance, or loss of feeling in the feet, are known to increase with age. The 

prevalence of sensory impairments will increase as U.S. life expectancy 

increases. Important public health goals for older adults include maintaining 

independent living, health, and quality of life (1). Minimizing the impact of 

sensory impairments is therefore important. This report provides updated 

examination-based estimates for sensory impairments: overall and for 

specific subgroups of older Americans.

Keywords: Health survey • prevalence • aged • NHANES

How common are sensory impairments among older adults?

Many Americans aged 70 years and over have sensory impairment.

•	 One out of six has visual impairment.

•	 One out of four has hearing impairment. 

Vision, Hearing, Balance, and Sensory Impairment in Americans 

Aged 70 Years and Over: United States, 1999–2006

Charles F. Dillon, M.D., Ph.D.; Qiuping Gu, M.D., Ph.D.; Howard J. Hof

Chia-Wen Ko, Ph

Figure 1. The prevalence of sensory impairments among persons aged 70 years and over: 

United States, 1999–2006

SOURCE: CDC/NCHS, National Health and Nutrition Examination Survey.

75.3

27.2

15.4

26.3

0

20

40

60

80

100

 Loss of feeling

 in feet

 Balance

 impairment

 Hearing

 impairment 

 Visual

 impairment

Percent
NCHS Data Brief ■ No. 31 ■ April 2010

■  2  ■

•	 Three out of four have abnormal testing for postural balance.

•	 One out of four has loss of feeling in the feet (Figure 1).

Are sensory impairments more common among older men or among older 

women?

•	 Men are more likely than women to have hearing impairment and loss of feeling in the feet. 

•	 Women are more likely than men to have a balance impairment, but the difference is small.

•	 There is no difference in the prevalence of vision impairment between men and women 

(Figure 2). 

Figure 2. The prevalence of sensory impairments among men and women aged 70 years and over: United States, 

1999–2006

1

Significantly different from men.

SOURCE: CDC/NCHS, National Health and Nutrition Examination Survey.

15.7

33.9

71.3

78.3

35.3

0

20

40

60

80

100 Male Female

 Loss of feeling

in feet

 Balance 

impairment

 Hearing 

impairment 

 Visual 

impairment

Percent

15.1

20.7 1 21.6 1

In older Americans, do sensory impairments keep increasing with age?

Among older Americans, the prevalence of sensory impairments is significantly higher among

persons aged 80 years and over compared with persons aged 70–79 years.

•	 The prevalence of vision and hearing impairments more than doubled among persons aged 

80 years and over compared with persons aged 70–79 years.

•	 The prevalence of loss of feeling in the feet increases by 40% in the older age group and the 

prevalence of balance problems increases by almost 30% (Figure 3).
NCHS Data Brief ■ No. 31 ■ April 2010

■  3  ■

Are there differences in sensory impairments among race or ethnic groups? 

There are disparities in the prevalence of sensory impairment among race or ethnic groups. 

•	 Non-Hispanic black and Mexican-American persons have a higher prevalence of vision 

impairment than non-Hispanic white persons. 

•	 Non-Hispanic white and Mexican-American persons have a higher prevalence of hearing 

problems than non-Hispanic black persons.

•	 Mexican-American persons have the highest prevalence of balance problems.

•	 Non-Hispanic black persons have a higher prevalence of loss of feeling in the feet compared 

with non-Hispanic white persons (Figure 4).

Figure 3. The prevalence of sensory impairments among persons aged 70–79 years compared with persons aged

80 years and over: United States, 1999–2006

1

Significantly different from the 70–79 age group.

SOURCE: CDC/NCHS, National Health and Nutrition Examination Survey.

24.6

16.8

88.5

69.3

45.4

34.3

24.0

0

20

40

60

80

100 70–79 years 80 years and over

 Loss of feeling

 in feet

 Balance

 impairment

 Hearing

 impairment 

 Visual

 impairment

Percent

11.0

1

1

1

1
NCHS Data Brief ■ No. 31 ■ April 2010

■  4  ■

How common are sensory impairments among those living below the poverty 

line?

Vision and balance impairment is more common among older American adults living below the 

poverty level compared with those who are at or above the poverty level.

•	 One in five older adults living below the poverty threshold has vision impairment, a rate that

is 50% higher than among all other older adults. 

•	 Balance problems were 15% more likely among older adults living below the poverty level 

(Figure 5).

Figure 4.The prevalence of sensory impairments among older Americans, by race and ethnicity: United States, 1999–2006

1

Significantly different from Non-Hispanic black and Mexican-American persons.

2

Significantly different from Non-Hispanic white and Mexican-American persons.

3

Significantly different from Non-Hispanic black and Non-Hispanic white persons.

4

Significantly different from Non-Hispanic white.

SOURCE: CDC/NCHS, National Health and Nutrition Examination Survey.

24.0

12.5

27.2 27.5

74.6 73.6

85.7

21.1

34.9

30.0

26.4

0

20

40

60

80

100 Non-Hispanic white Non-Hispanic black Mexican American

 Loss of feeling

 in feet

 Balance

 impairment

 Hearing

 impairment 

 Visual

 impairment

Percent

13.8 1 2

3

4
NCHS Data Brief ■ No. 31 ■ April 2010

■  5  ■

What percentage of older U.S. adults with vision or hearing problems could 

improve their situation with new glasses or by using a hearing aid?

•	 Almost 60% of older persons with vision problems do not use glasses at all or have glasses 

that do not completely correct their vision. 

•	 Approximately 70% of older Americans with hearing loss in at least one ear could 

potentially benefit from using a hearing aid, but do not use one (Figure 6).

Figure 5. The prevalence of sensory impairments in older Americans, by family income: United States, 1999–2006

1

Significantly different from the group below the poverty level.

SOURCE: CDC/NCHS, National Health and Nutrition Examination Survey.

26.1

22.2

86.4

25.2 26.2

29.8

0

20

40

60

80

100 Below poverty level At or above poverty level

 Loss of feeling

 in feet

 Balance

 impairment

 Hearing

 impairment 

 Visual

 impairment

Percent

14.0 1

73.9 1

Figure 6. The percentage of older Americans with vision or hearing problems who could benefit from using new glasses 

or a hearing aid 

SOURCE: CDC/NCHS, National Health and Nutrition Examination Survey.

71.8

56.5

0

20

40

60

80

100

Use of new glasses Use of hearing aid

Could benefit from

Percent
NCHS Data Brief ■ No. 31 ■ April 2010

■  6  ■

Summary

Long-term public health goals for the older U.S. adult population are to decrease morbidity, 

to reduce functional limitations, to preserve a good quality of life, and maintain independent 

functioning. Each of these areas can potentially be impacted by sensory impairment, which is also 

linked to increased mortality, hip fractures, and depression (2). Hearing and vision impairment in 

older adults may present particular challenges to families and caregivers. Although some degree 

of sensory loss may be irreversible, these data indicate that significant numbers of persons may be

helped by the use of better glasses or by hearing aid use. More attention will need to be given to 

this basic health issue.

Definitions

Visual impairment: Not being able to read letters or numbers of the line 20/50 or below on 

the visual acuity chart in the Better-Seeing Eye. This is the individual’s distance visual acuity, 

measured with the person’s distance glasses or contact lenses on, if the person wears them (3–5).

Percentage of persons who may benefit from new glasses: The ratio of the number of persons 

whose visual acuity could be corrected to 20/40 or better in their Better-Seeing Eye (using 

automatic refraction testing) to the number of persons with visual impairment. 

Hearing impairment (moderate to severe): Defined as an unassisted, pure tone audiometric

average (at 500 Hz, 1000 Hz, 2000, and 4000 Hz) of greater than 40 dB in the better ear (6–8). 

This degree of hearing loss means that you are not able to hear and repeat words that a person 

says if they talk to you in a normal voice from across a quiet room. In formal testing, an examinee 

should not be able to see the examiners lips when they are talking.

The percentage of persons who may benefit from using a hearing aid: This is not directly 

measured, rather, this estimate is the percentage of persons who do not currently use a hearing aid 

among the group of persons with a pure tone audiometric average at 500 Hz, 1000 Hz, 2000, and 

4000 Hz of greater than 40 dB in at least one ear. 

Balance (vestibular) impairment: Failure to be able to stand on one’s own to complete test 

condition 4 of the Modified Romberg Test of Standing Balance (3,9). Test condition 4 is standing

on a 3 inch thick foam pad for 30 seconds with the eyes shut. 

Loss of feeling in the feet (lower extremity insensate peripheral sensory neuropathy): No 

feeling in the feet, defined as complete failure to feel a standard 5.07 Semmes-Weinstein nylon

monofilament in one or more test areas of either foot (3).

Data source and methods

The most recent U.S. National Health and Nutrition Examination Survey (NHANES) data were 

used for these analyses (vision, 1999–2006; hearing, 2005–2006; balance, 2001–2004; and 

peripheral neuropathy, 1999–2004). NHANES is a cross-sectional survey monitoring the health 

and nutritional status of the civilian, noninstitutionalized population. Health interviews, health 

examinations, and laboratory tests are performed in mobile examination centers. The NHANES 

sample is selected through a complex design to be nationally representative. In 1999–2006, nonHispanic black persons, Mexican-American persons, persons with low-income, and persons aged 
NCHS Data Brief ■ No. 31 ■ April 2010

■  7  ■

60 years and over were oversampled for reliable subgroup prevalence estimation. Sample weights 

accounting for the complex survey design, nonresponse, and noncoverage were used for analysis. 

Variance estimates used Taylor series linearization. Group differences were analyzed by a 

univariate t-statistic. Reported differences are statistically significant at the .05 level (unadjusted).

Statistical analyses used SASTM (Release 9.2; SAS Institute Inc, Cary, N.C.) and SUDAANTM

(Release 10.0; Research Triangle Institute, Research Triangle Park, N.C.).

About the authors

Charles Dillon and Qiuping Gu are with the Centers for Disease Control and Prevention’s

National Center for Health Statistics, Division of Health and Nutrition Examination Surveys.

Howard Hoffman and Chia-Wen Ko are with the National Institutes of Health, National Institute

on Deafness and Other Communication Disorders.

References:

1. Diwan S, Moriarty D. A conceptual framework for identifying unmet health care needs of 

community dwelling elderly. Journal of Applied Gerontology 14:47-63. 1995. 

2. Campbell VA, Crews JE, Moriarty DG, Zack MM, Blackman DK. Surveillance for sensory

impairment, activity limitation, and health-related quality of life among older adults--United 

States, 1993-1997. MMWR CDC Surveill Summ. 48(8):131-56. 1999.

3. The National Health and Nutrition Examination Survey (NHANES) Examination Manuals 

(1999-2000; 2001-2002; 2003-2004; 2005-2006). National Center for Health Statistics,

Hyattsville, MD. http://www.cdc.gov/nchs/nhanes/currentnhanes.htm Oct 27, 2009.

4. Vitale S, Cotch MF, Sperduto RD. Prevalence of visual impairment in the United States.

JAMA. 295(18):2158-63. 2006.

5. Dandona L, Dandona R. Revision of visual impairment definitions in the International

Statistical Classification of Diseases. BMC Med. 4:7. 2006.

6. Davis A. The prevalence of hearing impairment and reported hearing disability among adults 

in Great Britain. Intl J Epidemiol; 18: 911-917. 1989.

7. World Health Organization Prevention of Blindness and Deafness (PBD) Program. 

Prevention Of Deafness And Hearing Impairment Grades Of Hearing Impairment. http://www.

who.int/pbd/deafness/hearing_impairment_grades/en/index.html. Oct 27, 2009.

8. Mathers C, Smith A, Concha M. Global Burden of Hearing Loss in The Year 2000. World

Health Organization Health Statistics and Health Information Systems: the Global Burden of 

Disease (GBD). http://www.who.int/healthinfo/statistics/bod_hearingloss.pdf Oct 27, 2009. 

9. Weber PC, Cass SP. Clinical assessment of postural stability. Am J Otol. 14:566–9. 1993.
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Suggested citation

Dillon CF, Gu Q, Hoffman H, Ko CW.

Vision, hearing, balance, and sensory 

impairment in Americans aged 70 years 

and over: United States, 1999–2006. NCHS

data brief, no 31. Hyattsville, MD: National 

Center for Health Statistics. 2010.

Copyright information

All material appearing in this report is in 

the public domain and may be reproduced 

or copied without permission; citation as to 

source, however, is appreciated.

National Center for Health 

Statistics

Edward J. Sondik, Ph.D., Director

Jennifer H. Madans, Ph.D., Associate 

Director for Science

Division of Health and Nutrition 

Examination Surveys

Clifford L. Johnson, M.S.P.H., Director