The 32-item LLQ, derived from the content of focus group comments by persons with ARM, has good construct validity, subscale scores related to rod-mediated visual function, and good test-retest reliability for five of six subscales. The LLQ may ultimately be useful in patient-centered evaluation of the outcome of interventions to prevent ARM or to arrest progression of early disease.

These results provide some guidance for the design of interventions to increase the use of routine eye care in this population. At a societal level, there is a need for affordable and accessible transportation services for older African Americans seeking eye care. For ophthalmologists, optometrists, and their staffs, there is a need for continuing education that imparts culturally sensitive and age-appropriate communication and trust-building skills for interactions with this population. In addition to reinforcing the generally positive attitudes of older African Americans toward the importance of eye care, community-based educational programs should be focused on strategies for overcoming the common barriers to care.

To examine the effect of treating uncorrected refractive error through spectacle correction on vision-targeted health-related quality of life and depressive symptoms in nursing home residents.Methods: Persons aged 55 years or older residing in nursing homes in Birmingham, Alabama, having uncorrected refractive error were randomly assigned to either immediate spectacle correction of uncorrected refractive error or delayed correction (after the 2-month follow-up visit).Main Outcome Measures: Vision-targeted healthrelated quality of life (measured with the Nursing Home Vision-Targeted Health-Related Quality-of-Life Questionnaire and the VF-14) and depressive symptoms (measured with the Geriatric Depression Scale), assessed at baseline and at 2 months.Results: At the 2-month follow-up, the immediate refractive error correction group as compared with the delayed correction group had higher scores on the Nurs-ing Home Vision-Targeted Health-Related Quality-of-Life Questionnaire subscales of general vision, reading, psychological distress, activities and hobbies, and social interaction (all PϽ.04) and the VF-14 (PϽ.001) as well as fewer depressive symptoms on the Geriatric Depression Scale (P=.003), adjusting for mental status and baseline outcome variables. Conclusions:Dispensing spectacles to treat uncorrected refractive error in nursing home residents leads to improved quality of life and decreased symptoms of depression.Application to Clinical Practice: This study demonstrates that older adults residing in nursing homes can personally benefit from access to the most basic of eye care services.

Aim: To assess the impact of cataract surgery in nursing home residents on health-related quality of life, as compared to those who have cataracts but who do not undergo surgery. Methods: A prospective cohort study enrolled 30 nursing home residents (>60 years old) who had cataracts and underwent cataract surgery, and evaluated vision-targeted and generic health-related quality of life and depressive symptoms before and approximately 4 months after surgery. This cataract surgery group was compared to 15 nursing home residents who had cataracts but who did not have surgery, over the same timeframe. Results: Visual acuity for near and distance and contrast sensitivity improved following cataract surgery (p,0.001). Adjusting for age differences in the two groups, the cataract surgery group exhibited significant score improvement in the general vision (p = 0.005), reading (p = 0.001), psychological distress (p = 0.015), and social interaction (p = 0.033) subscales of the Nursing Home Vision-targeted Health-Related Quality of Life Questionnaire and the VF-14 (p = 0.004). There were no group differences in the SF-36, Geriatric Depression Scale or the Cataract Symptom Score. Conclusion: Nursing home residents who underwent cataract surgery because of functional problems experienced significant improvements in their vision-targeted health-related quality of life, in addition to dramatically improved vision. N ursing home residents in the USA and other industrialised countries have high rates of vision impairment with estimates ranging from 3 to 15 times higher than corresponding rates for community-dwelling older adults.

Disruptive vocalization (DV) is both a prevalent and disturbing problem in nursing homes. We developed a computer-assisted data collection system for real-time observation and recording of DV and various environmental contextual factors. Both frequency and duration of DV were recorded for 11 residents along with their location in the nursing home, their activity, environmental sound, the social environment, and whether or not the resident was physically restrained. The actual time of all events was also recorded. Measures of cognitive and ADL status were administered. The average occurrence of DV was 22 per hour and the average duration per occurrence was 26 seconds. The results show a significant upward linear trend in the occurrence of DV across the day. This is consistent with the "sundowning" hypothesis. A Cox Proportional Hazards Regression model indicates that another person present in the setting (p = .004) and resident presence at the nursing home hairdresser (p = .07) were associated with shorter duration episodes of DV. Correlational analyses indicate that both higher frequency and longer duration DV are related to greater cognitive impairment, and higher frequency DV is related to greater ADL impairment. We conclude that this computer-assisted real-time observational system is a useful and promising tool for studying disruptive behavior in its environmental context.