Unrecognized Visual Problems amongst Residents of Part III Homes

Sturgess, Ian; Rudd, Anthony; Shilling, J S

doi:10.1093/ageing/23.1.54

Cited by 25 publications

(22 citation statements)

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“…This is not unexpected particu larly when the numbers from nursing homes and residual homes were so small, thereby making analysis less robust. However, in the recently reported survey by Sturgess et al [4] on the ocular pathology in elderly residents in old peoples homes the authors reported prev alence rates of 51% for cataract and 18% for glaucoma. Their screening methods were dif ferent from those employed in this study and in addition they included cognitively im paired residents.…”

Section: Discussionmentioning

confidence: 94%

“…However, in this later study reduced vision was taken as best corrected 6/9 or worse and thus direct comparisons are not possible. A similar study from England re ported a high prevalence of reduced vision in the over 75 year age group [3], A study of one hundred residents of old peoples homes re vealed a 51 % prevalence of cataract and un recognised significant refractive errors were present in 34% [4], Vision of 6/18 or less is usually taken as sufficient impairment to have difficulty watching television and is well be low the legal requirement to drive (6/10).…”

Section: Introductionmentioning

confidence: 99%

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Prevalence of Low Vision in Elderly Patients Admitted to an Acute Geriatric Unit in Liverpool: Elderly People Who Fall Are More Likely to Have Low Vision

et al. 1995

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The prevalence of visual impairment among elderly patients admitted to hospital is unknown. This group of patients may be particularly at risk from poor vision which could jeopardise their independence. A prospective study of visual impairment and its aetiology in acute geriatric admissions assessed after the acute illness had settled was performed. Subjects were all patients aged 65 years or over, excluding those chronically confused, admitted to the Department of Geriatric Medicine at the Royal Liverpool University Hospital with an acute medical illness. After the acute illness had settled visual impairment, as defined by the American criteria (best acuity 6/18), was assessed on the ward with a Snellen chart read at 6 m using binocular vision and current glasses. Those patients identified with impaired vision on initial screening were formally assessed in the ophthalmology department to identify the cause. 200 patients were examined. 101 patients (50.5%) had impaired vision. In these patients, correctable refractive errors were present in 40%, cataract in 37% and senile macular degeneration in 14%. Of the 101 patients with impaired vision 79% had a reversible cause. Comparing these results with a recent study in the community showed a much higher incidence for patients admitted to hospital. There was a particularly high prevalence in those elderly patients who were admitted with falls (76%, p = 0.0003). In conclusion, elderly patients, especially those presenting with falls, admitted to hospital have a high prevalence of visual impairment. Visual impairment may be compounding or causing falls. Hence, screening the elderly ‘faller’ admitted to hospital for visual impairment may be beneficial to the patient and cost-effective as many of the causes are simply reversible.

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Section: Discussionmentioning

confidence: 94%

Section: Introductionmentioning

confidence: 99%

Prevalence of Low Vision in Elderly Patients Admitted to an Acute Geriatric Unit in Liverpool: Elderly People Who Fall Are More Likely to Have Low Vision

et al. 1995

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“…Previous studies of care home residents have reported high prevalence rates of vision problems both in the UK 118 and in Australia. 119 It has been suggested that VI may be a contributory factor to older people being placed in care homes.…”

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confidence: 97%

The Prevalence of Visual Impairment in People with Dementia (the PrOVIDe study): a cross-sectional study of people aged 60–89 years with dementia and qualitative exploration of individual, carer and professional perspectives

Bowen

Edgar

Hancock

et al. 2016

Health Serv Deliv Res

121

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BackgroundThe prevalence of visual impairment (VI) and dementia increases with age and these conditions may coexist, but few UK data exist on VI among people with dementia.ObjectivesTo measure the prevalence of eye conditions causing VI in people with dementia and to identify/describe reasons for underdetection or inappropriate management.DesignStage 1 – cross-sectional prevalence study. Stage 2 – qualitative research exploring participant, carer and professional perspectives of eye care.SettingStage 1 – 20 NHS sites in six English regions. Stage 2 – six English regions.ParticipantsStage 1 – 708 participants with dementia (aged 60–89 years): 389 lived in the community (group 1) and 319 lived in care homes (group 2). Stage 2 – 119 participants.InterventionsStage 1 gathered eye examination data following domiciliary sight tests complying with General Ophthalmic Services requirements and professional guidelines. Cognitive impairment was assessed using the Standardised Mini-Mental State Examination (sMMSE) test, and functional ability and behaviour were assessed using the Bristol Activities of Daily Living Scale and Cambridge Behavioural Inventory – Revised. Stage 2 involved individual interviews (36 people with dementia and 11 care workers); and separate focus groups (34 optometrists; 38 family and professional carers).Main outcome measures.VI defined by visual acuity (VA) worse than 6/12 or worse than 6/18 measured before and after refraction.ResultsStage 1 – when participants wore their current spectacles, VI prevalence was 32.5% [95% confidence interval (CI) 28.7% to 36.5%] and 16.3% (95% CI 13.5% to 19.6%) for commonly used criteria for VI of VA worse than 6/12 and 6/18, respectively. Of those with VI, 44% (VA < 6/12) and 47% (VA < 6/18) were correctable with new spectacles. Almost 50% of remaining uncorrectable VI (VA < 6/12) was associated with cataract, and was, therefore, potentially remediable, and one-third was associated with macular degeneration. Uncorrected/undercorrected VI prevalence (VA < 6/12) was significantly higher in participants in care homes (odds ratio 2.19, 95% CI 1.30 to 3.73;p < 0.01) when adjusted for age, sex and sMMSE score. VA could not be measured in 2.6% of group 1 and 34.2% of group 2 participants (p < 0.01). The main eye examination elements (excluding visual fields) could be performed in > 80% of participants. There was no evidence that the management of VI in people with dementia differed from that in older people in general. Exploratory analysis suggested significant deficits in some vision-related aspects of function and behaviour in participants with VI. Stage 2 key messages – carers and care workers underestimated how much can be achieved in an eye examination. People with dementia and carers were unaware of domiciliary sight test availability. Improved communication is needed between optometrists and carers; optometrists should be informed of the person’s dementia. Tailoring eye examinations to individual needs includes allowing extra time. Optometrists wanted training and guidance about dementia. Correcting VI may improve the quality of life of people with dementia but should be weighed against the risks and burdens of undergoing examinations and cataract surgery on an individual basis.LimitationsSampling bias is possible owing to quota-sampling and response bias.ConclusionsThe prevalence of VI is disproportionately higher in people with dementia living in care homes. Almost 50% of presenting VI is correctable with spectacles, and more with cataract surgery. Areas for future research are the development of an eye-care pathway for people with dementia; assessment of the benefits of early cataract surgery; and research into the feasibility of specialist optometrists for older people.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

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“…[1][2][3][4][5][6][7][8][9][10][11] Studies suggest that vision impairment in about one-third of nursing home residents could largely be reversed by treatment of uncorrected refractive error (myopia, hyperopia, presbyopia). 4,12 There are several factors that could be contributing to these high vision impairment rates. Persons with vision impairment are more likely to be admitted to nursing homes as compared with those with normal sight.…”

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confidence: 99%

Effect of Refractive Error Correction on Health-Related Quality of Life and Depression in Older Nursing Home Residents

Owsley

McGwin²,

Scilley³

et al. 2007

Arch Ophthalmol

116

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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.

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Unrecognized Visual Problems amongst Residents of Part III Homes

Cited by 25 publications

References 0 publications

Prevalence of Low Vision in Elderly Patients Admitted to an Acute Geriatric Unit in Liverpool: Elderly People Who Fall Are More Likely to Have Low Vision

Prevalence of Low Vision in Elderly Patients Admitted to an Acute Geriatric Unit in Liverpool: Elderly People Who Fall Are More Likely to Have Low Vision

The Prevalence of Visual Impairment in People with Dementia (the PrOVIDe study): a cross-sectional study of people aged 60–89 years with dementia and qualitative exploration of individual, carer and professional perspectives

Effect of Refractive Error Correction on Health-Related Quality of Life and Depression in Older Nursing Home Residents

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