Skip to main content
SpringerLink
Log in

Sensitivity and Specificity of Self-Reported Olfactory Function in a Home-Based Study of Independent-Living, Healthy Older Women

  • Published:
Chemosensory Perception

Abstract

Introduction

The 2011–14 US National Health and Nutrition Examination Survey chemosensory protocol asks adults to self-rate their orthonasal (via nostrils) and retronasal (via mouth) smell abilities for subsequent odor identification testing. From data collected with a similar protocol, we aimed to identify a self-reported olfactory index that showed the best sensitivity (correctly identifying dysfunction) and specificity (correctly indentifying normosmia) with measured olfaction.

Methods

In home-based testing, 121 independent-living older women (age 73 ± 7 years) reported their olfactory function by interviewer-administered survey. Olfactory function was measured orthonasally via composite (odor threshold, identification task) or identification task alone.

Results

Only 16 % of women self-rated “below average” smell function. More women perceived loss of smell (38 %) or flavor (30 %) with aging. The rate of measured dysfunction was 30 % by composite (threshold and identification) and 21.5 % by identification task, the latter misclassifying some mild dysfunction as normosmia. An index of self-rated smell function and perceived loss yielded the most favorable sensitivity (65 %) and specificity (77 %) to measured function. Self-rated olfaction showed better agreement with severe measured dysfunction; mild dysfunction was less noticed.

Conclusions

Self-reported indices that query about current and perceived changes in smell and flavor with aging showed better sensitivity estimates than those previously reported. Specificity was somewhat lower—some older adults may correctly perceive loss unidentified in a single assessment, or have a retronasal impairment that was undetected by an orthonasal measure.

Implications

Our findings should inform self-rated measures that screen for severe olfactory dysfunction in clinical/community settings where testing is not routine.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

Abbreviations

α:

Cronbach’s alpha, a coefficient of reliability (or consistency) across variables, not a statistical test

CCCRC:

Connecticut Chemosensory Clinical Research Center olfactory test, a measure of olfactory function from a single odor threshold (n-butanol) and seven-odor identification task

EHLS:

Epidemiology of Hearing Loss Study, a population-based, longitudinal cohort study based on community residents in Beaver Dam, WI, town or township

κ :

Cohen’s kappa, a statistical measure ranging from 0.0 to 1.0, with larger values indicating better inter-rater agreement or reliability; used to assess reliability when observing or coding qualitative or categorical variables

NHANES:

The National Health and Nutrition Examination Survey, a federally sponsored examination survey to assess the health and nutritional status of adults and children in the civilian, noninstitutionalized population of the USA; it combines the collection of health interview (questionnaire) data in the home with subsequent physical examinations in a mobile examination center (MEC)

r :

Pearson correlation coefficient or product-moment correlation, a measure of the linear correlation (or strength of linear dependence) between two variables; values range between –1.0 and +1.0

r s :

Spearman rank correlation coefficient r s, a nonparametric alternative to the Pearson correlation coefficient; uses the rank-order values instead of the real number values assumed by two variables

SEM:

Standard error of the mean

SPSS:

Statistical Package for the Social Sciences, a software package used for statistical analysis (www-01.ibm.com/software/analytics/spss)

References

  • AOA (2012) A Profile of Older Americans: 2012. Administration on Aging. http://www.aoa.gov/AoARoot/Aging_Statistics/Profile/index.aspx. Accessed 31 January 2014

  • Boerma T, Verdese E, Hosseinpoor A, Chatterji S (2012) Gender differences in self-reported health measures. World Health Organization. http://www.who.int/healthinfo/sage/SAGE_Meeting_Dec2012_BoermaT.pdf. Accessed 31 January 2014

  • Bojanowski V, Hummel T (2012) Retronasal perception of odors. Physiol Behav 107(4):484–7

    Article  CAS  Google Scholar 

  • Bramerson A, Johansson L, Ek L, Nordin S, Bende M (2004) Prevalence of olfactory dysfunction: the Skovde population-based study. Laryngoscope 114(4):733–7

    Article  Google Scholar 

  • Cain WS, Rabin MD (1989) Comparability of two tests of olfactory functioning. Chem Senses 14(4):479–485

    Article  Google Scholar 

  • Cain WS, Gent JF, Goodspeed RB, Leonard G (1988) Evaluation of olfactory dysfunction in the Connecticut chemosensory clinical research center. Laryngoscope 98(1):83–8

    Article  CAS  Google Scholar 

  • Cain WS, Schmidt R, Cometto-Muñiz JE, Park S, Warren CB, Abraham MH, Tabert M (2013) Fragrance materials extend the range of a model for odor potency. In: Abstracts from the 35th Association for Chemoreception Sciences meeting (p. A78), Huntington Beach, CA, 17–20 April 2013.

  • Centers for Disease Control and Prevention (CDC), National Center for Health Statistics (NCHS). National Health and Nutrion Examination Survey (NHANES) Taste and Smell Examination Component Manual. Hyattsville, MD; NHANES Division, NCHS, CDC; 90 pp. http://www.cdc.gov/nchs/data/nhanes/nhanes_13_14/Taste_Smell.pdf. Accessed 14 Feb 2014

  • Chapo AK (2002) Age related changes in oral sensations: Associations with preference for and intake of dietary salt and fat. Dissertation, University of Connecticut

  • Croy I, Landis BN, Meusel T, Seo HS, Krone F, Hummel T (2011) Patient adjustment to reduced olfactory function. Arch Otolaryngol Head Neck Surg 137(4):377–82

    Article  Google Scholar 

  • de Araujo IE, Rolls ET, Kringelbach ML, McGlone F, Phillips N (2003) Taste-olfactory convergence, and the representation of the pleasantness of flavour, in the human brain. Eur J Neurosci 18(7):2059–68

    Article  Google Scholar 

  • de Jong N, Mulder I, de Graaf C, van Staveren WA (1999) Impaired sensory functioning in elders: the relation with its potential determinants and nutritional intake. J Gerontol A Biol Sci Med Sci 54(8):B324–31

    Article  Google Scholar 

  • Deems DA, Doty RL, Settle RG, Moore-Gillon V, Shaman P, Mester AF, Kimmelman CP, Brightman VJ, Snow JB Jr (1991) Smell and taste disorders, a study of 750 patients from the university of Pennsylvania smell and taste center. Arch Otolaryngol Head Neck Surg 117(5):519–28

    Article  CAS  Google Scholar 

  • Deepthi R, Kasthuri A (2012) Validation of the use of self-reported hearing loss and the Hearing Handicap Inventory for elderly among rural Indian elderly population. Arch Gerontol Geriatr 55(3):762–7

    Article  CAS  Google Scholar 

  • Doty RL, Shaman P, Applebaum SL, Giberson R, Siksorski L, Rosenberg L (1984a) Smell identification ability: changes with age. Science 226(4681):1441–3

    Article  CAS  Google Scholar 

  • Doty RL, Shaman P, Dann M (1984b) Development of the University of Pennsylvania smell identification test: a standardized microencapsulated test of olfactory function. Physiol Behav 32(3):489–502

    Article  CAS  Google Scholar 

  • Doty RL, Smith R, McKeown DA, Raj J (1994) Tests of human olfactory function: principal components analysis suggests that most measure a common source of variance. Percept Psychophys 56(6):701–7

    Article  CAS  Google Scholar 

  • Duffy VB, Backstrand JR, Ferris AM (1995) Olfactory dysfunction and related nutritional risk in free-living, elderly women. J Am Diet Assoc 95(8):879–84

    Article  CAS  Google Scholar 

  • Duffy VB, Cain WS, Ferris AM (1999) Measurement of sensitivity to olfactory flavor: application in a study of aging and dentures. Chem Senses 24(6):671–7

    Article  CAS  Google Scholar 

  • Duffy VB, Doty RL, Hayes JE, Rawal S, Hoffman HJ (2012) A chemosensory component in the 2012 National Health and Nutrition Examination Survey (NHANES): adults ages 40+ years. In: Abstracts from the 34th Association for Chemoreception Sciences meeting (p. A29), Huntington Beach, CA, 25–28 April 2012

  • Elsawy B, Higgins KE (2011) The geriatric assessment. Am Fam Physician 83(1):48–56

    Google Scholar 

  • Fillenbaum G (1988) Multidimensional functional assessment of older adults, 3rd edn. The Duke Older Americans Resources and Services Procedures, Hillsdale

    Google Scholar 

  • Heywood PG, Costanzo RM (1986) Identifying normosmics: a comparison of two populations. Am J Otolaryngol 7(3):194–9

    Article  CAS  Google Scholar 

  • Hoffman HJ, Ishii EK, MacTurk RH (1998) Age-related changes in the prevalence of smell/taste problems among the United States adult population. Results of the 1994 disability supplement to the national health interview survey (NHIS). Ann N Y Acad Sci 855:716–22

    Article  CAS  Google Scholar 

  • Hummel T, Sekinger B, Wolf SR, Pauli E, Kobal G (1997) ‘Sniffin’ sticks’: olfactory performance assessed by the combined testing of odor identification, odor discrimination and olfactory threshold. Chem Senses 22(1):39–52

    Article  CAS  Google Scholar 

  • Hunt SM, McEwen J, McKenna SP (1984) Perceived health: age and sex comparisons in a community. J Epidemiol Community Health 38(2):156–60

    Article  CAS  Google Scholar 

  • Kalogjera L, Dzepina D (2012) Management of smell dysfunction. Curr Allergy Asthma Rep 12:154–162

    Article  Google Scholar 

  • Karpa MJ, Gopinath B, Rochtchina E, Jie Jin W, Cumming RG, Sue CM, Mitchell P (2010) Prevalence and neurodegenerative or other associations with olfactory impairment in an older community. J Aging Health 22(2):154–68

    Article  Google Scholar 

  • Keller A, Malaspina D (2013) Hidden consequences of olfactory dysfunction: a patient report series. BMC Ear Nose Throat Disord 13(1):8

    Article  Google Scholar 

  • Koskinen S, Vento S, Malmberg H, Tuorila H (2004) Correspondence between three olfactory tests and suprathreshold odor intensity ratings. Acta Otolaryngol 124(9):1072–7

    Article  Google Scholar 

  • Larsson M, Nilsson LG, Olofsson JK, Nordin S (2004) Demographic and cognitive predictors of cued odor identification: evidence from a population-based study. Chem Senses 29(6):547–54

    Article  Google Scholar 

  • Lee WH, Wee JH, Kim DK, Rhee CS, Lee CH, Ahn S, Lee JH, Cho YS, Lee KH, Kim KS et al (2013) Prevalence of subjective olfactory dysfunction and its risk factors: Korean national health and nutrition examination survey. PLoS One 8(5):e62725

    Article  CAS  Google Scholar 

  • Mann NM, Lafreniere D (2004) Anosmia and nasal sinus disease. Otolaryngol Clin North Am 37(2):289–300, vi

    Article  Google Scholar 

  • Minski KR, Duffy VB (2009) Odor intensity, diet and nutrition-related health indices among females. In: Abstracts from the 31st Association for Chemoreception Sciences meeting (p. A37–8), Sarasota, FL, 22–26 April 2009

  • Mojet J, Heidema J, Christ-Hazelhof E (2003) Taste perception with age: generic or specific losses in supra-threshold intensities of five taste qualities? Chem Senses 28(5):397–413

    Article  Google Scholar 

  • Mullol J, Alobid I, Marino-Sanchez F, Quinto L, de Haro J, Bernal-Sprekelsen M, Valero A, Picado C, Marin C (2012) Furthering the understanding of olfaction, prevalence of loss of smell and risk factors: a population-based survey (OLFACAT study). BMJ Open 2(6)

  • Murphy C, Schubert CR, Cruickshanks KJ, Klein BE, Klein R, Nondahl DM (2002) Prevalence of olfactory impairment in older adults. JAMA 288(18):2307–12

    Article  Google Scholar 

  • Nordin S, Monsch AU, Murphy C (1995) Unawareness of smell loss in normal aging and Alzheimer’s disease: discrepancy between self-reported and diagnosed smell sensitivity. J Gerontol B Psychol Sci Soc Sci 50(4):P187–92

    Article  CAS  Google Scholar 

  • Pusswald G, Auff E, Lehrner J (2012) Development of a brief self-report inventory to measure olfactory dysfunction and quality of life in patients with problems with the sense of smell. Chemosens Percept 5(3–4):292–299

    Article  Google Scholar 

  • Rawal S, Hoffman HJ, Bainbridge K, Duffy VB (2013) The chemosensory component in the 2012 National Health and Nutrition Examination Survey (NHANES): test-retest analysis and comparison with laboratory-based measures. . In: Abstracts from the 35th Association for Chemoreception Sciences meeting (p. A123–4), Huntington Beach, CA, 17–20 April 2013

  • Rawson NE (2006) Olfactory loss in aging. Sci Aging Knowledge Environ 2006(5):pe6

  • Rubin GS, Bandeen-Roche K, Huang GH, Munoz B, Schein OD, Fried LP, West SK (2001) The association of multiple visual impairments with self-reported visual disability: SEE project. Invest Ophthalmol Vis Sci 42(1):64–72

    CAS  Google Scholar 

  • Russell MJ, Cummings BJ, Profitt BF, Wysocki CJ, Gilbert AN, Cotman CW (1993) Life span changes in the verbal categorization of odors. J Gerontol 48(2):P49–53

    Article  CAS  Google Scholar 

  • Santos DV, Reiter ER, DiNardo LJ, Costanzo RM (2004) Hazardous events associated with impaired olfactory function. Arch Otolaryngol Head Neck Surg 130(3):317–9

    Article  Google Scholar 

  • Schubert CR, Cruickshanks KJ, Murphy C, Huang GH, Klein BE, Klein R, Nieto FJ, Pankow JS, Tweed TS (2009) Olfactory impairment in adults. Ann N Y Acad Sci 1170:531–6

    Article  Google Scholar 

  • Schubert CR, Cruickshanks KJ, Fischer ME, Huang GH, Klein BE, Klein R, Pankow JS, Nondahl DM (2012) Olfactory impairment in an adult population: the beaver dam offspring study. Chem Senses 37(4):325–34

    Article  Google Scholar 

  • Seid M, Varni JW, Segall D, Kurtin PS (2004) Health-related quality of life as a predictor of pediatric healthcare costs: a two-year prospective cohort analysis. Health Qual Life Outcomes 2:48

    Article  Google Scholar 

  • Ship JA, Weiffenbach JM (1993) Age, gender, medical treatment, and medication effects on smell identification. J Gerontol 48(1):M26–32

    Article  CAS  Google Scholar 

  • Ship JA, Pearson JD, Cruise LJ, Brant LJ, Metter EJ (1996) Longitudinal changes in smell identification. J Gerontol A Biol Sci Med Sci 51(2):M86–91

    Article  CAS  Google Scholar 

  • Shu CH, Hummel T, Lee PL, Chiu CH, Lin SH, Yuan BC (2009) The proportion of self-rated olfactory dysfunction does not change across the life span. Am J Rhinol Allergy 23(4):413–6

    Article  Google Scholar 

  • Small DM, Prescott J (2005) Odor/taste integration and the perception of flavor. Exp Brain Res 166(3–4):345–57

    Article  Google Scholar 

  • Smeets MA, Veldhuizen MG, Galle S, Gouweloos J, de Haan AM, Vernooij J, Visscher F, Kroeze JH (2009) Sense of smell disorder and health-related quality of life. Rehabil Psychol 54(4):404–12

    Article  Google Scholar 

  • Vennemann MM, Hummel T, Berger K (2008) The association between smoking and smell and taste impairment in the general population. J Neurol 255(8):1121–6

    Article  Google Scholar 

  • Wehling E, Nordin S, Espeseth T, Reinvang I, Lundervold AJ (2011) Unawareness of olfactory dysfunction and its association with cognitive functioning in middle aged and old adults. Arch Clin Neuropsychol 26(3):260–9

    Article  Google Scholar 

  • Wysocki CJ, Gilbert AN (1989) National Geographic Smell Survey. Effects of age are heterogenous. Ann N Y Acad Sci 561:12–28

    Article  CAS  Google Scholar 

Download references

Acknowledgments

We extend a special thanks to the study participants. This project was supported in part by funds from the US Department of Agriculture Hatch Project 396 [CONS00827 and PEN04332] and the NIH/NIDCD Interagency Agreement (Y1-DC-0013) with CDC/NCHS for support of the NHANES Chemosensory (Taste and Smell) Protocol.

Compliance with Ethics Requirements

ᅟ

Conflict of Interest

Shristi Rawal declares that she has no conflict of interest.

Howard J. Hoffman declares he has no conflict of interest.

Audrey K. Chapo declares that she has no conflict of interest.

Valerie B. Duffy declares that she has no conflict of interest.

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2008 (5). Informed consent was obtained from all patients for being included in the study.

Author information

Authors and Affiliations

  1. Department of Allied Health Sciences, College of Agriculture, Health, and Natural Resources, University of Connecticut-UCONN, 358 Mansfield Road, Box U1101, Storrs, CT, 06269-2101, USA

    Shristi Rawal, Audrey K. Chapo & Valerie B. Duffy

  2. Epidemiology & Statistics Program, Division of Scientific Programs, National Institute on Deafness and Other Communication Disorders, National Institutes of Health, Suite 8300, 6001 Executive Boulevard, Bethesda, MD, 20892-9670, USA

    Howard J. Hoffman

Authors
  1. Shristi Rawal
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Howard J. Hoffman
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Audrey K. Chapo
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Valerie B. Duffy
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Valerie B. Duffy.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Rawal, S., Hoffman, H.J., Chapo, A.K. et al. Sensitivity and Specificity of Self-Reported Olfactory Function in a Home-Based Study of Independent-Living, Healthy Older Women. Chem. Percept. 7, 108–116 (2014). https://doi.org/10.1007/s12078-014-9170-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12078-014-9170-7

Keywords

Search

Navigation