The Prevalence of Visual Impairment in Retirement Home Residents

Thederan, Luisa; Steinmetz, S. R.; Kampmann, Sabine; Koob-Matthes, Anna-Maria; Grehn, Franz; Klink, Thomas

doi:10.3238/arztebl.2016.0323

Cited by 21 publications

(18 citation statements)

References 13 publications

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“…Provision has indeed been made for home visits at care facilities in accordance with the Social Security Code (SGB V) and indemnity agreement, and cooperation agreements with other doctors and the facility even offer additional billing options ( § 119b SGB V Outpatient treatment in inpatient care facilities). Current studies however show that, despite the existing billing options and provision agreement, there is still clear ophthalmological underprovision for residents of senior citizensʼ homes in Germany [5,21,22]. The reasons for this could be, among other things, the time-consuming examination of elderly patients and incentives to turn towards more lucrative activities requiring less effort, outside of the provision agreement.…”

Section: Resultsmentioning

confidence: 99%

“…However, it should be borne in mind that the examination unit set up can be used over a long period of time. A comparison of the costs of both models also seems of secondary importance in respect of the clear underprovision of ophthalmological care for residents of senior citizensʼ homes, despite the billing options [5,21,22]. The present blatant underprovision shows that the current care concepts are insufficient to guarantee provision of care for retirement homes.…”

Section: Costsmentioning

confidence: 99%

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Ophthalmic Care in Nursing Homes for the Blind: A Growing Challenge

Wagner

Stifter

Engesser

et al. 2020

Klin Monbl Augenheilkd

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Background The demographic change in Germany will lead to an increase in irreversible age-related eye diseases. This will increase the need for specialised care facilities for visually impaired people. Due to reduced mobility, residents in such facilities often do not receive adequate ophthalmological care. New concepts must therefore be considered for this group of patients. One approach is to set up an ophthalmological examination unit within the facility combined with regular visits by an ophthalmologist. We now present the experience with such a model in a home for the blind. Patients and Methods The project was initiated in 2009. Since then there have been visits by medical staff of the Eye Center at Medical Center, University of Freiburg, every two weeks. All patient records (2010 – 2017) were reviewed systematically. The following data were extracted in a structured and anonymous way: Age at first presentation, gender, ophthalmological diagnoses and if a therapy was initiated. This data set was finally analysed descriptively. Results Out of 130 residents aged between 48 and 100 years, half were between 78 and 90 years old. The youngest resident was 48, the oldest 100 years old. The median visual acuity was 0.2. Sixty percent of the residents had at least mild visual impairment according to the WHO (visual acuity < 0.5; category 1 – 6). In one of 6 – 7 residents, visual acuity could not be determined using Snellen charts. The most frequent ophthalmological diagnoses included cataract (44%), age-related macular degeneration (36%) and glaucoma (29%). In 67 residents (52%), the ophthalmological examination lead to treatment, such as application of local therapy or planning an operation. Conclusion In every second resident, the ophthalmologistʼs visit lead to treatment during the observation period. This underlines the difficulty of providing ophthalmological care even in specialised institutions for the blind and visually impaired, which is possibly due to the residentsʼ mobility problems. The concept presented here has established a low-threshold, sustainable and high-quality ophthalmological service on site. These positive experiences indicate that corresponding measures may also be useful for other locations. However, in order to implement such a project on a larger scale, suitable financing and accounting modalities for the construction measures, the nursing staff and the ophthalmological procedure still need to be developed.

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Section: Resultsmentioning

confidence: 99%

Section: Costsmentioning

confidence: 99%

Ophthalmic Care in Nursing Homes for the Blind: A Growing Challenge

Wagner

Stifter

Engesser

et al. 2020

Klin Monbl Augenheilkd

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“…Interestingly, the proportion of residents being referred by GPs largely decreased after admission. With regard to the decrease in contact rates to ophthalmologists this finding might contrast with eye care needs in terms of visual impairments and needs for vision aids that are widespread among NHR [15,27,28]. NHR with diagnosed glaucoma or diabetes mellitus are faced with larger absolute reductions in contacts to ophthalmologists than those without, even though ophthalmoscopies are recommended by guidelines annually or biennially [24,26].…”

Section: Discussionmentioning

confidence: 99%

Are there changes in medical specialist contacts after transition to a nursing home? an analysis of German claims data

Spreckelsen

Schmiemann

Freitag

et al. 2020

BMC Health Serv Res

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Background: Provision of ambulatory care by medical specialists for nursing home residents (NHR) is discussed to be inadequate in Germany, however with only incomplete evidence on this topic. We wanted to know whether the transition to a nursing home is associated with a general decrease in medical specialist care and therefore compared contact rates before and after institutionalization. Methods: Claims data of 18,779 newly admitted NHR in 2013 were followed for the whole year prior to and up to two years after admission. The frequencies of contacts to specialists were assessed and stratified by sex, age, care level, dementia diagnosis and chronic conditions. Multivariate analyses were conducted to identify predictors for contacts to specialists. Results: One year after institutionalization the most pronounced decrease was found in contacts with ophthalmologists (38.4% vs. 30.6%) whereas with most other specialties only small changes were found. The only specialty with a large increase were neurologists and psychiatrists (27.2% vs. 43.0%). Differences depending on sex and age were rather small while NHR with dementia or a higher care level had lower contact rates after institutionalization. Before institutionalization most patients were referred to a specialist by a general practitioner (61.7-73.9%) while thereafter this proportion decreased substantially (27.8-58.6%). The strongest predictor for a specialist contact after admission to a nursing home was a contact to a specialist before (OR 8.8, CI 7.96-9.72 for contacts to neurologists or psychiatrists). A higher nursing care level and a higher age were also predictors for specialist contacts. Conclusions: Relevant decreases of ambulatory specialist care utilization after institutionalization are restricted to ophthalmologists. NHR of higher age and higher nursing care level had a lower chance for a specialist contact. The assessment of the adequacy of the provided care after institutionalization remains inconclusive due to little investigated but assumable changes in care needs of NHR. The decreased coordination of care by general practitioners after institutionalization conflicts with health policy goals.

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“…Nur wenige bestehende Studien zur Inanspruchnahme von Arztkontakten können allerdings Aussagen darüber machen, inwieweit der Umfang der Inanspruchnahme von Pflegeheimbewohnern bedarfsgerecht ist. Im Hinblick auf die augenärztliche Versorgung wurde in bisherigen Studien angenommen, dass 20-40 % der Pflegebedürftigen einen unbehandelten Versorgungsbedarf oder fehlende Kontrolluntersuchungen aufweisen [21][22][23]. Wir kommen hierbei sogar zu noch höheren Werten.…”

Section: Diskussionunclassified

Fachärztliche Unterversorgung bei Heimbewohnern – Prävalenzstudie und Hochrechnung

et al. 2021

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Zusammenfassung Hintergrund Bisherige Studien deuten darauf hin, dass Pflegebedürftige eine geringere fachärztliche Versorgung aufweisen als Nichtpflegebedürftige. Insbesondere im stationären Setting ist die fachärztliche Versorgungsintensität gering. Aus den bestehenden quantitativen Versorgungsunterschieden lässt sich bislang jedoch nicht ableiten, inwieweit von einer Unterversorgung bei Pflegebedürftigen ausgegangen werden muss. Für die Versorgungsbereiche Sehfähigkeit, Hörfähigkeit, Mundgesundheit und Parkinson-Syndrom wird geprüft, inwieweit Heimbewohner fachärztlich unterversorgt sind. Material und Methoden In 44 Pflegeheimen in Bremen und Niedersachsen wurde der Gesundheitszustand von 409 Pflegebedürftigen mittels standardisierter Assessments und Befragungen erhoben; zusätzlich wurden Diagnosen und die medizinische Versorgung aus der Pflegedokumentation ausgewertet. Ärzteteams beurteilten auf dieser Grundlage für jeden Pflegebedürftigen, inwieweit eine bedarfsgerechte fachärztliche Versorgung vorlag oder nicht. Ergebnisse Gemäß ärztlichem Urteil zeigt sich bei 45 % (Sehfähigkeit), 19 % (Parkinson-Syndrom), 16 % (Mundgesundheit) und 15 % (Hörfähigkeit) der Bewohner mit entsprechendem Versorgungsbedarf eine fachärztliche Unterversorgung. Bei 27 % aller Bewohner zeigt sich in mindestens einem der 4 Versorgungsbereiche eine fachärztliche Unterversorgung. Hochgerechnet entspricht dies bis zu 205.000 fachärztlich unterversorgten Pflegeheimbewohnern in Deutschland. Diskussion Die Studie liefert für ausgewählte Versorgungsbereiche die ersten empirischen Belege über das Ausmaß fachärztlicher Unterversorgung von Pflegeheimbewohnern. Daher erscheint es notwendig, entsprechende Interventionen zur Reduktion der Unterversorgung zu entwickeln und zu erproben.

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The Prevalence of Visual Impairment in Retirement Home Residents

Cited by 21 publications

References 13 publications

Ophthalmic Care in Nursing Homes for the Blind: A Growing Challenge

Ophthalmic Care in Nursing Homes for the Blind: A Growing Challenge

Are there changes in medical specialist contacts after transition to a nursing home? an analysis of German claims data

Fachärztliche Unterversorgung bei Heimbewohnern – Prävalenzstudie und Hochrechnung

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