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Claire Murphy, PhD; Carla R. Schubert, MS; Karen J. Cruickshanks, PhD; Barbara E. K. Klein, MD, MPH; Ronald Klein, MD, MPH; David M. Nondahl, MS

JAMA. 2002;288:2307-2312.

Context  Older adults represent the fastest-growing segment of the US population, and prevalences of vision and hearing impairment have been extensively evaluated. However, despite the importance of sense of smell for nutrition and safety, the prevalence of olfactory impairment in older US adults has not been studied.

Objective  To determine the prevalence of olfactory impairment in older adults.

Design, Setting, and Participants  A total of 2491 Beaver Dam, Wis, residents aged 53 to 97 years participating in the 5-year follow-up examination (1998-2000) for the Epidemiology of Hearing Loss Study, a population-based, cross-sectional study.

Main Outcome Measures  Olfactory impairment, assessed by the San Diego Odor Identification Test and self-report.

Results  The mean (SD) prevalence of impaired olfaction was 24.5% (1.7%). The prevalence increased with age; 62.5% (95% confidence interval [CI], 57.4%-67.7%) of 80- to 97-year-olds had olfactory impairment. Olfactory impairment was more prevalent among men (adjusted prevalence ratio, 1.92; 95% CI, 1.65-2.19). Current smoking, stroke, epilepsy, and nasal congestion or upper respiratory tract infection were also associated with increased prevalence of olfactory impairment. Self-reported olfactory impairment was low (9.5%) and this measure became less accurate with age. In the oldest group, aged 80 to 97 years, sensitivity of self-report was 12% for women and 18% for men.

Conclusions  This study demonstrates that prevalence of olfactory impairment among older adults is high and increases with age. Self-report significantly underestimated prevalence rates obtained by olfaction testing. Physicians and caregivers should be particularly alert to the potential for olfactory impairment in the elderly population.

Author Affiliations: San Diego State University and University of California, San Diego, School of Medicine (Dr Murphy); and the Departments of Ophthalmology and Visual Sciences (Ms Schubert, Drs Cruickshanks, B. Klein, and R. Klein, and Mr Nondahl) and Population Health Sciences (Dr Cruickshanks), University of Wisconsin, Madison.

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