Visual impairment and eye diseases in elderly institutionalized Australians

doi:10.1016/S0161-6420(00)00459-0

Ophthalmology

Volume 107, Issue 12, December 2000, Pages 2203-2208

https://doi.org/10.1016/S0161-6420(00)00459-0 Get rights and content

Abstract

Objective

To study the prevalence and distribution of visual impairment and eye diseases by age and gender in an urban institutionalized population.

Design

Cross-sectional study.

Participants

Four hundred three residents of nursing homes and hostels.

Methods

Fourteen nursing homes were randomly selected from 104 nursing homes and hostels located within a 5-km radius of each of nine clusters studied in the Visual Impairment Project (VIP) urban cohort. Participants completed a standardized orthoptic and dilated ophthalmic examination, including measurement of visual acuity and visual fields. The major cause of vision loss was identified for participants with visual impairment.

Main outcome measures

Presenting visual acuity and ophthalmic diagnoses.

Results

The participants’ mean age was 82 years (standard deviation, 9.24), with an age range of 46 years to 101 years. Women outnumbered men by 318 to 85. Seventy-one (22%) of 318 women had bilateral profound visual impairment (blindness), defined as best-corrected visual acuity <3/60 and/or visual field constriction <5° compared with 10 (12%) of 85 men. However, this difference is not significant when age-standardized. Age-related macular degeneration was the principal diagnosis of vision loss in the better eye of 74 (44%) of the 167 participants with bilateral low vision (<6/18 and/or visual field constriction to <20° radius). The age-adjusted rate of blindness or profound visual impairment in the VIP institutional cohort of 5.2% (95% confidence interval [CI], 1.8, 8.6) was significantly greater than in the VIP urban and rural cohorts of 0.13% (95% CI, 0, 0.25) and 0.29% (95% CI, 0, 0.57), respectively.

Conclusions

Underestimation of visual impairment may occur in residential population-based studies that exclude institutional or residential nursing homes and hostels for the aged citizens. Expanded methods are required for visual assessment in institutional populations.

Section snippets

Methods

The VIP method used in this study has been described in detail elsewhere.9

It was estimated that a cluster sample size of 500 would allow the detection, at a 95% confidence interval and a power of β = 10, of a minimum of 5% difference in prevalence of visual impairment between the nursing home institutional sample and other samples. This estimate assumes that prevalence of visual impairment is 10% in the nursing home institutional sample. This was believed to be a conservative estimate on the

Results

This study examined 403 (90.4%) of the eligible 446 adult hostel and nursing home residents as completely as possible. The 43 eligible but unexamined residents were classified as nonparticipants. The mean age of the 43 nonparticipants was 82.5 years (standard deviation = 11.1). This was not significantly different than the participants’ mean age of 82 years (standard deviation = 9.24). The age range of the participants was 46 years to 101 years.

Women outnumbered men in each age group except 60

Discussion

Profound visual impairment or blindness is much more frequent in the institutional cohort population than in the urban cohort population of Melbourne. This finding is similar to that of the Baltimore nursing home study that reported a prevalence of bilateral severe visual impairment of 19.6%, 16 times higher for white nursing home residents and 13 times higher for black nursing home residents than in the community study of the Baltimore Eye Survey.1

Moderate and severe visual impairment, that

Conclusion

Underestimation of visual impairment in the populations may occur in residential population-based studies that exclude institutional nursing homes and hostels for the aged citizens. Expanded methods are required to assess the visual and mental status of the institutional population, because some of the institutional residents cannot be accurately assessed with conventional examination methods.

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Several studies have published data on the necessity of eye care services in the elderly residing in nursing homes or long-term care units, and the fact that this population is under-serviced. Many of these studies have presented data based on questionnaires16 or the results of specific tests performed in these institutions for the purpose of investigating the visual needs of these patients.8,17 However, some of these studies have excluded patients with more severe forms of dementia.8
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Retrospective file review.
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440 patient files.
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^☆: Supported by Victorian Health Promotion Foundation, Estate of the late Dorothy Edols, Ansell Ophthalmology Foundation, and the Jack Brockhoff Foundation, Melbourne, Australia; Ophthalmic Research Institute of Australia, Sydney, Australia.

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Visual impairment and eye diseases in elderly institutionalized Australians☆

Abstract

Objective

Design

Participants

Methods

Main outcome measures

Results

Conclusions

Section snippets

Methods

Results

Discussion

Conclusion

Ophthalmology

Am J Ophthalmol

Ophthalmology

Surv Ophthalmol

Ophthalmology

Ophthalmology

The prevalence of blindness and visual impairment among nursing home residents in Baltimore

N Engl J Med

Visual impairment in nursing homes residentsthe Blue Mountains Eye Study

Med J Aust

The Hong Kong vision studya pilot assessment of visual impairment in adults

Trans Am Ophthalmol Soc

Census of Population and Housing

Projections of the Populations of Australia, States, and Territories, 1995–2051

Methods for a population-based studythe Melbourne Visual Impairment Project

Ophthalmic Epidemiol