Functional blindness and visual impairment in older adults from three communities

Incurable Blindness: The Final Frontier in Vision Restoration

Blindness with no light perception is clinically irreversible. This cross-sectional hospital-based study analyzed patients presenting with no light perception in at least one eye. Between 2010 and 2022, 60,668 (1.85%) such patients were identified, of which 3,476 (5.73%) had bilateral and 57,192 (94.27%) had unilateral blindness. The major causes were glaucoma (21.8%), trauma (17.7%), phthisis bulbi (13.1%), retinal diseases (10.6%), anophthalmos (7.8%), and optic atrophy (4.9%). The majority of the affected individuals were adults (89.9%) and male (64%), and affected individuals were more likely to be from the lower socio-economic strata (3.14%) and from a rural location (1.99%). Despite recent therapeutic advances in ophthalmology, many patients with blindness cannot be restored to sight. Although preventive measures can mitigate sight loss to some extent, regenerative therapies, retinal and ciliary body transplantation, and whole eyeball transplantation need to be developed as sight restorative procedures to help those who currently have no hope of regaining vision.

Visual Function and Visual Acuity in An Urban Adult Population

In this survey, 6,850 Baltimore residents aged 40 and older were interviewed about activities they had difficulty doing or could no longer do because of poor vision. One-fourth of the sample reported limitations in activities, most frequently reading and other near-vision tasks, because of poor vision. In addition to poor vision, general health status, educational level, and time since the last eye care visit were associated with the loss of visual function.

Change in Visual Perceptual Detection Distances for Low Vision Travelers as a Result of Dynamic Visual Assessment and Training

This study evaluated the ability of a dynamic visual assessment and training protocol to improve the ability of 65 persons who were legally blind to detect environmental hazards. Training improved the ability of the majority of subjects to detect hazards, and the assessments identified those who did not need training or would not benefit from it.

Falls and Recurrent Falls among Adults in A Multi-ethnic Asian Population: The Singapore Epidemiology of Eye Diseases Study

We evaluated the rate and risk factors associated with falls and recurrent falls in a multi-ethnic Asian population. 10,009 participants aged ≥40 years (mean[SD] age = 58.9[10.4] years) underwent clinical examinations and completed interviewer-administered questionnaires. Participants who self-reported at least one fall or ≥2 falls in past 12 months were defined as fallers and recurrent fallers, respectively. Age-standardized rates for falls and recurrent falls were 13.8% (95%CI, 13.1–14.6%) and 4.6% (95%CI, 4.2–5.1%), respectively. Multivariable analyses showed older age (OR = 1.20; 95%CI, 1.11–1.30), female gender (OR = 1.79; 95%CI, 1.54–2.07), diabetes (OR = 1.22; 95%CI, 1.07–1.40), cardiovascular disease (CVD, OR = 1.37; 95%CI, 1.14–1.65), ≥3 systemic comorbidities (OR = 1.35; 95%CI, 1.09–1.67), lower European Quality of Life-5 Dimensions (EQ-5D) score (OR = 1.36; 95%CI, 1.29–1.44), alcohol consumption (OR = 1.41, 95%CI, 1.11–1.78) and presenting visual impairment (VI, OR = 1.23; 95%CI, 1.02–1.47) were associated with falls. For recurrent falls, female gender (OR = 2.27; 95%CI, 1.75–2.94), diabetes (OR = 1.28; 95%CI, 1.03–1.61), CVD (OR = 2.00; 95%CI, 1.53–2.62), ≥3 systemic comorbidities (OR = 1.69; 95%CI, 1.19–2.39), lower EQ-5D score (OR = 1.47; 95%CI, 1.35–1.59), living in 1–2 room public flat (OR = 1.57; 95%CI, 1.05–2.33), monthly income <2000 Singapore Dollar (OR = 1.62; 95%CI, 1.13–2.31), alcohol consumption (OR = 1.81, 95%CI, 1.23–2.66) and presenting VI (OR = 1.34; 95%CI, 1.01–1.79) were significant risk factors. These findings will be useful for the formulation of fall prevention programs.

Ophthalmologic evaluation in geriatric patients: Assessment of consistency between patients' complaints and ocular diagnoses

PURPOSE

This study aimed to assess the consistency between patients' complaints and their eye diseases.

DESIGN

Cross-sectional study.

METHODS

RESULTS: The frequencies of at least one newly diagnosed visually important ocular disease were 25.9%, 27.0%, and 45.3% in groups 1, 2, and 3, respectively (p<0.001). The same frequencies were significantly higher in patients >75 years of age compared with the younger group (59.1% vs. 22.0%, p<0.001). Although these values were statistically significant in patients ≤75 years of age (p<0.001), they were insignificant in patients >75 years of age according to type of complaints (p=0.773). Patients with diabetes mellitus exhibited significantly lower vision, higher rate of visually important ocular diseases, and higher intraocular pressure readings than patients without diabetes mellitus (p=0.009, 0.015, and 0.002, respectively).

CONCLUSIONS

Visually important ocular diseases were diagnosed approximately in a quarter of patients who had no complaints about decrease in vision and in more than half of the oldest geriatric patients (>75years) irrespective of the type of complaints.

Prevalence and Risk Factors for Self-Reported Visual Impairment Among Middle-Aged and Older Adults

This study examined the prevalence of and risk factors for self-reported visual impairment among American adults. Data were collected via telephone interviews with a nationally representative sample ( n= 1,219) aged 45 and older and were weighted for population parameter estimates. Hierarchical logistic regression examined independent risk factors of self-reported visual impairment. Seventeen percent of adults aged 45 and older self-reported visual impairments, increasing to 26.5% of those aged 75 and older. Greater age, not being Hispanic, in poor or fair self-rated health, and low availability of informal social support were significant risk factors associated with visual impairment. The prevalence of vision problems among adults suggests unmet needs for both basic eye care and vision rehabilitation interventions to reduce functional limitations that can result from visual impairment. Longitudinal research is needed to examine prevalence and incidence of vision loss as a function of population aging and changing health behaviors.

The Role of Vision and Hearing in Physical, Social, and Emotional Functioning Among Older Adults

The present study examined the comparative roles of vision and hearing in differentaspects of older individuals' lives. The significance of vision and hearing on physical, social, and emotional functioning (disability, social activity, and depressive symptoms) was assessed along with the role of personality traits and social resources, using a stratified sample of 425 community-dwelling older individuals ( M age = 72.2). Vision was a significant factor for disability, while hearing was significantly associated with social activity, implying the unique contribution of vision and hearing. The association between sensory performance and depressive symptoms became nonsignificant in multivariate analysis. After adjusting for vision and hearing, psychosocial factors increased the amount of explained variance in physical, social, and emotional outcomes. The findings demonstrate the important roles of personality and social resources along with vision and hearing and suggest a need to consider them when planning interventions.

Impact of low vision services on the quality of life of low vision patients in Ghana

Patients’ perspectives on the impact of clinical interventions have been recognised as critical elements in patient care. Quality-of-life instruments are designed to measure these perspectives. We used the National Eye Institute’s 25-item Visual Function Questionnaire (NEI VFQ) to measure the impact of optical low vision devices on the quality of life of 22 low vision patients who obtained and were using low vision devices from a secondary low vision clinic in the Eastern Region, Ghana. The study employed a pre- and post-intervention technique. We found statistically significant improvements in measured visual acuity and NEI VFQ scores in 8 of the 10 domains evaluated. We conclude that optical low vision devices have a positive impact on the quality of life of low vision patients in Ghana.Keywords: low vision; quality of life; visual acuity; visual impairment; Ghana

Social inequalities in blindness and visual impairment: a review of social determinants

Health inequities are related to social determinants based on gender, socioeconomic status, ethnicity, race, living in a specific geographic region, or having a specific health condition. Such inequities were reviewed for blindness and visual impairment by searching for studies on the subject in PubMed from 2000 to 2011 in the English and Spanish languages. The goal of this article is to provide a current review in understanding how inequities based specifically on the aforementioned social determinants on health influence the prevalence of visual impairment and blindness. With regards to gender inequality, women have a higher prevalence of visual impairment and blindness, which cannot be only reasoned based on age or access to service. Socioeconomic status measured as higher income, higher educational status, or non-manual occupational social class was inversely associated with prevalence of blindness or visual impairment. Ethnicity and race were associated with visual impairment and blindness, although there is general confusion over this socioeconomic position determinant. Geographic inequalities and visual impairment were related to income (of the region, nation or continent), living in a rural area, and an association with socioeconomic and political context was suggested. While inequalities related to blindness and visual impairment have rarely been specifically addressed in research, there is still evidence of the association of social determinants and prevalence of blindness and visual impairment. Additional research should be done on the associations with intermediary determinants and socioeconomic and political context.

Visual impairment and quality of life among older adults: an examination of explanations for the relationship

OBJECTIVES

We examine 4 potential explanations for the lower quality of life reported by older adults with greater visual impairment.

METHODS

Using 2 waves of data from a nationally representative sample of older persons (a subsample of the Americans' Changing Lives Study, 1986 and 1989), we run residual change regression analysis to assess the extent to which the effect of visual impairment on quality of life, indicated by depressive symptoms and life satisfaction, is explained by changes in each of the following: (1) activity limitations; (2) socioeconomic resources, measured as income and financial strain; (3) social resources, indicated by social integration and perceived support; and (4) psychological resources, measured by self-efficacy.

RESULTS

Higher levels of visual impairment are associated with more depressive symptoms and lower life satisfaction over the 3-year period. Each hypothesized mediator plays a role in explaining the effect of visual impairment on declines in quality of life; however, the strongest mediating effects are found for self-efficacy.

DISCUSSION

By identifying multiple pathways through which visual impairment diminishes quality of life among older adults, this study highlights the importance of multipronged intervention efforts.

Relationship between frailty and cognitive decline in older Mexican Americans

OBJECTIVES

To examine the association between frailty status and change in cognitive function over time in older Mexican Americans.

DESIGN

Data used were from the Hispanic Established Population for the Epidemiological Study of the Elderly.

SETTING

Five southwestern states: Texas, New Mexico, Colorado, Arizona, and California.

PARTICIPANTS

One thousand three hundred seventy noninstitutionalized Mexican-American men and women aged 65 and older with a Mini-Mental State Examination (MMSE) score of 21 or higher at baseline (1995/96).

MEASUREMENTS

Frailty, defined as three or more of the following components: unintentional weight loss of more than 10 pounds, weakness (lowest 20% in grip strength), self-reported exhaustion, slow walking speed (lowest 20% in 16-foot walk time in seconds), and low physical activity level (lowest 20% on Physical Activity Scale for the Elderly score). Information about sociodemographic factors, MMSE score, medical conditions (stroke, heart attack, diabetes mellitus, arthritis, cancer, and hypertension), depressive symptoms, and visual impairment was obtained.

RESULTS

Of the 1,370 subjects, 684 (49.9%) were not frail, 626 (45.7%) were prefrail (1-2 components), and 60 (4.4%) were frail (>/=3 components) in 1995/96. Using general linear mixed models, it was found that frail subjects had greater cognitive decline over 10 years than not frail subjects (estimate=-0.67, standard error=0.13; P<.001). This association remained statistically significant after controlling for potential confounding factors.

CONCLUSION

Frail status in older Mexican Americans with MMSE scores of 21 or higher at baseline is an independent predictor of MMSE score decline over a 10-year period. Future research is needed to establish pathophysiological components that can clarify the relationship between frailty and cognitive decline.

Church attendance mediates the association between depressive symptoms and cognitive functioning among older Mexican Americans

BACKGROUND

The objective of this study was to examine how the effect of depressive symptoms on cognitive function is modified by church attendance.

METHODS

We used a sample of 2759 older Mexican Americans. Cognitive function was assessed using the Mini-Mental State Examination (MMSE) at baseline, 2, 5, 7, and 11 years of follow-up. Church attendance was dichotomized as frequent attendance (e.g., going to church at least once a month) versus infrequent attendance (e.g., never or several times a year). Depressive symptoms were assessed by the Center for Epidemiologic Studies Depression Scale (CES-D; score >or=16 vs <16). General linear mixed models with time-dependent covariates were used to explore cognitive change at follow-up.

RESULTS

In unadjusted models, infrequent church attendees had a greater decline in MMSE scores (drop of 0.151 points more each year, standard error [SE] = 0.02, p <.001) compared to frequent church attendees; participants having CES-D scores >or=16 also had greater declines in MMSE scores (drop of 0.132 points more each year, SE = 0.03, p <.001) compared to participants with CES-D score <16 at follow-up. In fully adjusted models, a significant Church attendance x CES-D x Time interaction (p =.001) indicated that, among participants with CES-D scores >or=16, infrequent church attendees had greater decline in MMSE scores (drop of 0.236 points more each year, SE = 0.05, p <.001) compared to frequent church attendees at follow-up.

CONCLUSION

Church attendance appears to be beneficial for maintaining cognitive function of older persons. Church attendance moderates the impact of clinically relevant depressive symptoms on subsequent cognitive function.

Blindness and poverty in India: the way forward

A few recent studies have shown that poverty is an exacerbating and often determining factor in the incidence of disabling conditions, including visual impairment. Recent estimates from the World Health Organization indicate that 90 per cent of all those affected by visual impairment live in the poorest countries of the world. India is home to one-fifth of the world's visually impaired people and therefore, any strategies to combat avoidable blindness must take into account the socio-economic conditions within which people live. This paper looks at the relationship between poverty and blindness in India and suggests strategies to address blindness prevention in a comprehensive manner.

Prévalence, causes et facteurs de risque de la cécité et de la malvoyance chez les personnes âgées des maisons de retraite libanaises

AIMS

To determine the prevalence, causes, and risk factors for blindness and visual impairment in the elderly population of Lebanese nursing homes, to encourage the development of an effective campaign against blindness.

METHODS

Transversal study in all nursing homes in two Lebanese regions (298 residents). All respondents (89.6%) underwent a complete ocular examination. Personal and medical data were also gathered for each participant.

RESULTS

The prevalence of blindness (visual acuity<or=20/200 in both eyes) was 22.4% (20.3% in residents aged between 80 and 89 years old, 42.9% in patients 90 years or older). The prevalence of visual impairment (visual acuity<or=20/40 and>20/200 in the best eye) was 36%. The rate of blindness in underprivileged residents was found to be double that of the well-off residents (27% and 15%, respectively). Cataract was the leading cause of blindness, followed by age-related macular degeneration and open-angle glaucoma. At least 55% of the causes of blindness and 58% of the causes of visual impairment are potentially curable or avoidable.

CONCLUSION

Blindness and visual impairment were high among Lebanese nursing home residents. This is an unfortunate observation given that the leading ocular diseases are treatable and that good vision is essential to these residents' quality of life.

Changes in visual acuity in a population over a 15-year period: the Beaver Dam Eye Study

PURPOSE

To describe the change in visual acuity in a 15-year period.

DESIGN

Population-based study.

METHODS

setting: Beaver Dam, Wisconsin. participants: 4068 persons 43 to 86 years of age at the time of a baseline examination in 1988 to 1990, and with follow-up examinations every five years thereafter. observation procedures: Best-corrected visual acuity after refraction, assessed by a modification of the ETDRS protocol. main outcome measure: Doubling of the visual angle; incidence of visual impairment.

RESULTS

Eight percent of the population developed impaired vision (20/40 or worse), 0.8% developed severe visual impairment (20/200 or worse), 7% had doubling of the visual angle, and 2% had improved vision. People 75 years of age or older at baseline were more likely to develop impaired vision (odds ratio [OR] 12.8, 95% confidence interval [CI] 9.6 to 17.1, P < .001), doubling of the visual angle (OR 7.8, 95% CI 5.6 to 10.7, P < .001), and severe visual impairment (OR 20.6, 95% CI 9.5 to 44.8, P<0.001) compared with people younger than 75 years of age.

CONCLUSIONS

These data provide population-based estimates of the cumulative 15-year incidence of loss of vision over a wide spectrum of ages. In people 75 years of age or older the cumulative incidence of visual impairment accounting for the competing risk of death is 25%, of which 4% is severe, indicating a public health problem of considerable proportions as the US population in this age is expected to increase by 55% from 18 million in the year 2005 to 28 million by the year 2025.

Handgrip strength and cognitive decline in older Mexican Americans

BACKGROUND

Cognitive decline and dementia are associated with disability and premature death in old age. We examined whether low handgrip strength predicts subsequent cognitive decline in older Mexican Americans.

METHODS

We worked with a 7-year prospective cohort of 2160 noninstitutionalized Mexican Americans aged 65 years or older from the Hispanic Established Population for the Epidemiological Study of the Elderly (H-EPESE) who had a Mini-Mental State Examination (MMSE) score > or = 21 at baseline. Measures included: (i) sociodemographic factors (age, gender, and education), handgrip strength, and near and distant visual impairment from baseline interview; and (ii) MMSE, body mass index (BMI), and medical conditions (stroke, heart attack, diabetes, depression, and hypertension) from four waves of data collection.

RESULTS

Using general linear mixed models, we found a significant trend with scores in the lowest quartile of handgrip strength at baseline to be associated with lower MMSE scores over time (estimate = -1.28, standard error = 0.16; p <.0001). There was a significant handgrip Strength-by-Time interaction with MMSE scores. Participants in the lowest handgrip strength quartile had a greater cognitive decline over time (estimate = -0.26, standard error = 0.07; p <.001) than did those participants in the highest quartile. This association remained statistically significant after controlling for potential confounding factors.

CONCLUSION

Older Mexican Americans with reduced handgrip strength at baseline demonstrated a statistically significant decline in cognitive function over a 7-year period. By contrast, participants in the highest handgrip strength quartile maintained a higher level of cognitive function.

Cognitive status, body mass index, and hip fracture in older Hispanic adults

OBJECTIVES

To examine the interactive effect of cognition and body weight on hip fracture.

DESIGN

A 7-year (1993-2000) prospective cohort study.

SETTING

Five southwestern states (Texas, New Mexico, Arizona, Colorado, and California).

PARTICIPANTS

Noninstitutionalized Mexican Americans (N=2,653) aged 65 and older and free of hip fracture at baseline interview.

MEASUREMENTS

Incidence of hip fracture at 2-, 5-, and 7-year follow-up interviews. Body weight and cognition were measured using body mass index (BMI) and Mini-Mental State Examination score, respectively. Covariates included sociodemographics, self-reported medical conditions, visual acuity, and Short Physical Performance Battery.

RESULTS

A significant interaction between BMI and hip fracture was found in persons with cognitive impairment (hazard ratio =0.91, 95% confidence interval=0.85-0.98; P=.02), after adjusting for covariates. In the lowest BMI category, the hip fracture rate in cognitively impaired subjects was more than four times the hip fracture rate for subjects who were not cognitively impaired with the same BMI (34.6% vs 8.7%). Hip fracture rates in the highest BMI category were similar in persons with and without cognitive impairment (9.3% vs 6.1%).

CONCLUSION

Low cognitive function increased the conditional association between BMI and hip fracture in older Mexican Americans. The relationship between BMI and cognition is potentially important in identifying persons at risk for hip fracture and supports the need to include cognitive and anthropometric measures in the assessment of hip fracture risk into osteoporosis screening programs.

Psychometric Performance of the National Eye Institute Visual Function Questionnaire in Latinos and Non-Latinos

OBJECTIVE

To compare the psychometric performance of Spanish versions of the 25-item National Eye Institute Visual Function Questionnaire (NEI VFQ-25) and the NEI VFQ-39 administered to Latino patients with the psychometric performance of the standard English NEI VFQ-25 and NEI VFQ-39 administered to non-Latino patients.

DESIGN

Clinic-based cross-sectional survey.

PARTICIPANTS

Four hundred three patients (160 Latinos and 243 non-Latinos) recruited from general ophthalmology clinics of an urban public hospital over a 6-month period.

METHODS

Structured face-to-face interviews were conducted in Spanish and English to collect data for the NEI VFQ-25 and NEI VFQ-39. We calculated the mean, standard deviation, and percentage of participants having the minimum (floor) and maximum (ceiling) possible score for each item and scale. Internal consistency reliability of the NEI VFQ-25 and NEI VFQ-39 was estimated using the Cronbach alpha and average inter-item correlation. Construct validity for the instruments was assessed by comparing scores for participants classified as having normal versus impaired visual acuity.

MAIN OUTCOME MEASURES

Instrument scales for general health; general vision; ocular pain; near activities; distance activities; vision-specific social functioning, mental health, role difficulties, and dependency; driving; color vision; and peripheral vision.

RESULTS

Internal consistency reliability was significantly lower in the Spanish version than in the English version for 3 scales of the NEI VFQ-25. More importantly, 3 scales in the Spanish version manifested inadequate reliability (alpha< or =0.70), compared with only 1 inadequately reliable subscale in the English version. Reliability coefficients associated with the Spanish NEI VFQ-39 scales exceeded commonly accepted minimum standards. Comparison of reliability coefficients between Latino and non-Latino subgroups demonstrated statistically significant differences for 4 scales: Ocular Pain, Mental Health, Role Difficulties, and Dependency. In each case, the Latino group had the lower internal consistency reliability. However, only for the Ocular Pain subscale was reliability both significantly lower and inadequate (alpha<0.70).

CONCLUSION

Overall performance of the NEI VFQ in Latino populations is adequate. However, in the absence of modifications to improve the reliability of specific Spanish version subscales, comparisons between Latino and non-Latino subgroups using the NEI VFQ must be interpreted with appropriate caution.

Utility and Validity of the Self-administered SF-36: Findings From an Older Population

Introduction: The objectives of this study were to assess the utility and validity of the self-administered SF-36 and the effect of visual or cognitive impairment on these measures in an older population. Materials and Methods: Attempt rates, completion rates and internal consistency (Cronbach α) were compared within the second cross-sectional, population-based Blue Mountains Eye Study (n = 3509, mean age 66.7 years, 57% women). Results: The SF-36 was attempted by 3162 (90.1%) participants, of which 2470 (78.1%) completed all items and 2873 (90.9%) completed sufficient items for calculation of all dimensions. In a multivariate model adjusting for age, sex, and presenting visual and cognitive impairments, women (P = 0.011) and participants with visual or cognitive impairments (P<0.0001) were less likely to attempt the questionnaire. Completion rates were significantly lower with increasing age (P <0.0001), in men (P ≤0.0005) and in those with cognitive impairment (P <0.0001). A high level of internal consistency (Cronbach α >0.85 for all dimensions) and construct validity was demonstrated, the latter distinguishing between those with and without medical conditions, disabilities or recent hospital admissions (P <0.01). As the prevalence of visual or cognitive impairment was relatively low in this population, we found no apparent effect of these impairments on the validity of SF-36. Conclusions: Attempt and completion rates, but not internal consistency and construct validity, of the SF-36 were influenced by age, gender, and presenting visual and cognitive impairments. The overall high attempt and completion rates, internal consistency and construct validity suggest that the self-administered SF-36 is a suitable health-related quality of life (HRQOL) measure in similar older community-living populations. Key words: Blood amino acid, Normal ranges, Reference values, Urine amino acids

Socioeconomic differences in glaucoma patients' knowledge, need for information and expectations of treatments

PURPOSE

To study the specific items for which socioeconomic differences in glaucoma patients' knowledge, need for information and expectations of treatments exist, with the aim of developing a patient education programme.

METHODS

A total of 44 randomly selected ophthalmologists assigned 166 consecutive outpatient glaucoma patients to complete a questionnaire that had been systematically developed based on focus group interviews, suggestions from several experts and a pilot test. Topics included knowledge about glaucoma and its treatment, need for information and expectations of treatment. Educational level was used as a measure for socioeconomic status. Logistic regression analysis was conducted to adjust for age, sex and duration of glaucoma.

RESULTS

After adjusting for age, sex and duration of glaucoma, knowledge of glaucoma and its treatment was found to be positively correlated with socioeconomic status. Items on knowledge with socioeconomic differences concerned risk factors, pathophysiology and consequences of glaucoma, as well as effects and adverse effects of treatments. The lowest socioeconomic group demonstrated more need for information on public assistance and practical aspects of glaucoma and more often expected that glaucoma damage could be repaired.

CONCLUSION

Important socioeconomic differences in knowledge, need for information and expectations of treatment exist in glaucoma patients. Patient education should focus on every glaucoma patient, but better information for the lower socioeconomic groups about specific items mentioned in this study might reduce the negative effects of low socioeconomic status on visual impairment.

A Nationwide Population-Based Survey on Visual Acuity, Near Vision, and Self-Reported Visual Function in the Adult Population in Finland

PURPOSE

To estimate the prevalence rates of habitual visual acuity (VA) levels and visual impairment in Finland and to assess their correlation with self-reported visual function.

DESIGN

Cross-sectional population-based study.

PARTICIPANTS

Subjects were selected randomly from the Finnish population aged 30 years or older. Of 7979 eligible people, 7393 (93%) were interviewed, 6771 (85%) were examined, and 6663 (84%) had distance VA assessed.

METHODS

Participants underwent a home interview and a comprehensive examination including measuring binocular VA for distance and for near with the participants' current spectacles, if any.

MAIN OUTCOME MEASURES

The level of VA for distance and for near with current spectacle correction. The self-reported capability to read newsprint and television text and the ability to move about without being restricted by reduced vision.

RESULTS

The prevalence of good to moderate VA for distance (VA> or =0.5 [> or =20/40]) measured with current spectacles was 95.9%, and 87.4% had a VA level of 0.8 (20/25) or better. The prevalence of habitual visual impairment (VA< or =0.25 [< or =20/80]) was 1.6%, and 0.5% were blind (VA<0.1 [<20/200]). The prevalence of visual impairment increased significantly with age (P<0.001), especially in the age group of 65 to 74 years and upward. There was no gender difference in VA for distance, but decreased near vision (VA< or =0.25 [< or =20/80]) was significantly more common in men than in women (P<0.01). By applying the imputated numbers of visually impaired and blind participants to the Finnish population (approximately 3 million aged 30 years or older), there were approximately 65000 (2.1%) visually impaired and 17000 (0.6%) blind adult persons in the country in 2000. The correlation between self-reported visual ability and measured visual function was moderate but statistically significant (r = 0.27-0.40; P<0.0001). The proportion of people with reading difficulties or who were unable to read newsprint has decreased 7% during the last 2 decades.

CONCLUSIONS

Functional visual impairment increased with age especially in the age group of 65 to 74 years and upward and was as prevalent in women as in men. The prevalence of people with reading difficulties has decreased considerably since 1980.

Association between acculturation and structural assimilation and mini-mental state examination-assessed cognitive impairment in older Mexican Americans: findings from the San Antonio Longitudinal Study of Aging

Older Mexican Americans (MAs) have consistently scored lower on the Folstein Mini-Mental State Examination (MMSE) than older European Americans (EAs). These lower scores may arise from factors other than those traditionally posited (age and education). Thus, this study examined the association between acculturation and structural assimilation and MMSE-assessed cognitive impairment, taking into account education, income, and other contextual factors. Subjects were participants in the San Antonio Longitudinal Study of Aging, a community-based study of chronic disease and functional status in 457 older MAs and 376 older EAs. Scales were used to measure two dimensions of acculturation: (family attitude, cultural values) and structural assimilation (functional integration into the broader American society). Logistic regression was used to examine the association between age, sex, acculturation, and structural assimilation and MMSE scores suggestive of cognitive impairment (<24). After adjusting for contextual factors (age, sex, education and household income), diseases (diabetes mellitus, stroke, and hypertension), and sensory impairments (hearing and vision), structural assimilation, but neither dimension of acculturation, was significantly and negatively associated with MMSE-assessed cognitive impairment. Older MAs in the lowest structural assimilation stratum were 1.89 times as likely to have MMSE-assessed cognitive impairment as those in the highest. Age, education, and visual impairment were also independently associated with cognitive impairment. These findings highlight the need for geriatricians to take contextual factors (including age, education, and structural assimilation) into account when interpreting MMSE scores of MA patients.

Effect of presentation modality on immediate and delayed recall in individuals with Alzheimer's disease

Episodic memory (EM) deficits are the hallmark of Alzheimer's disease (AD). Story-retelling tasks are particularly sensitive to EM impairments and require participants to recall a short story immediately and after a delay. The purpose of this study was to determine whether presentation modality influences story recall in AD participants. Thirty AD participants and 30 healthy elders recalled short stories in (a) auditory, (b) visual, and (c) combined auditory-visual modalities. Recall was assessed immediately as well as after 15- and 30-min delays. Presentation modality significantly influenced story recall in AD participants. AD participants demonstrated better recall after silently reading a story than after hearing an examiner tell the story or simultaneously hearing and reading the story. Clinical implications of these results are discussed.

Near Vision Impairment Predicts Cognitive Decline: Data from the Hispanic Established Populations for Epidemiologic Studies of the Elderly

OBJECTIVES

To estimate the association between sensory impairment and cognitive decline in older Mexican Americans.

DESIGN

A prospective cohort study.

SETTING

The Hispanic Established Populations for Epidemiologic Studies of the Elderly from five southwestern states.

PARTICIPANTS

The sample consisted of 2,140 noninstitutionalized Mexican Americans aged 65 and older followed from 1993/1994 until 2000/2001.

MEASUREMENTS

The outcome, cognitive function decline, was assessed using the Mini-Mental State Examination blind version (MMSE-blind) at baseline and at 2, 5, and 7 years of follow-up. Other variables were near vision, distance vision, hearing, demographics (age, sex, marital status, living arrangements, and education), depressive symptoms, hypertension, diabetes mellitus, stroke, heart attack, and functional status. A general linear mixed model was used to estimate cognitive decline at follow-up.

RESULTS

In a fully adjusted model, MMSE-blind scores of subjects with near vision impairment decreased 0.62 points (standard error (SE)=0.29, P=.03) over 2 years and decreased (slope of decline) 0.13 points (SE=0.07, P=.045) more per year than scores of subjects with adequate near vision. Other independent predictors of cognitive decline were baseline MMSE-blind score, age, education, marital status, depressive symptoms, and number of activity of daily living limitations.

CONCLUSION

Near vision impairment, but not distance vision or hearing impairments, was associated with cognitive decline in older Mexican Americans.

A longitudinal study of visual acuity and visual rehabilitation needs in an urban Swedish population followed from the ages of 70 to 97 years of age

PURPOSE

To investigate the longitudinal change in visual acuity (VA) in the oldest members of the elderly population, to estimate future numbers of people with visual impairments, and to estimate needs for and the effects of visual rehabilitation.

METHODS

In the Gerontological and Geriatric Population Studies in Gothenburg, Sweden (H 70), subjects underwent repeated eye examinations at the ages of 70, 82, 88, 95 and 97 years. Logistic regression analysis was used to estimate the probability of independent living as a function of distance VA at different ages.

RESULTS

Rates of normal VA (>or= 0.8) declined from 86% of the study group at age 70 to 7% of the study group at age 95 (0% at age 97). The incidence of VA <or= 0.1 increased from 1.4% at age 70 to 27% (all women) at age 97. The deterioration was faster at higher ages. No statistically significant difference in best-corrected distance VA between genders was found. A substantial improvement was achieved by correcting refractive errors. There was a statistically significant correlation between distance VA and the probability of independent living at all ages except age 97. At ages 95 and 97, about 50% of the study group were able to read newspaper print with best-corrected glasses.

CONCLUSIONS

The number of old people with impaired vision will increase. People aged 80 years and older should have regular eye-screening in order to preserve vision and present conditions of living. Cataract surgery and low vision rehabilitation should be offered when the subject can still benefit from it, preferably during their 80s at the latest.

Diabetes mellitus as a risk factor for hip fracture in mexican american older adults

BACKGROUND

Hip fracture in older adults is a significant medical, social, and economic concern to society. Little is known regarding diabetes as a risk factor for hip fracture in the Mexican American population. The objective of this study was to examine diabetes and other potential risk factors for hip fracture in a sample of community-dwelling, older, Mexican American adults.

METHODS

The study was a prospective cohort design involving the Hispanic Established Population for the Epidemiologic Study of the Elderly, a longitudinal study involving a weighted probability sample of Mexican American adults (>65 years) living in the southwestern United States. Included in the study were 3050 older Mexican American subjects who were originally interviewed and tested at baseline and then followed with reassessment at 2, 5, and 7 years. Incidence of hip fracture was examined for subjects over 7-year follow-up.

RESULTS

At baseline, 690 subjects were identified with diabetes. One hundred and thirty-four subjects experienced a first-time hip fracture during follow-up. Cox proportional hazard regression revealed an increased hazard ratio for hip fracture in subjects with diabetes compared to those without diabetes (hazard ratio = 1.57, 95% confidence interval [CI(95)] = 1.03, 2.39, p <.04) when adjusted for age, body mass index, smoking, and previous stroke. The hazard ratio for Mexican Americans taking insulin was 2.84 (CI(95) = 1.49, 5.43, p <.002) when adjusted for covariates.

CONCLUSIONS

We found diabetes was associated with increased risk for a hip fracture in older Mexican Americans, particularly subjects taking insulin. Diabetes has not previously been considered a risk factor for hip fracture in older adults. The high incidence of type 2 diabetes in the Mexican American population highlights the need for increased research on risk factors in this ethnic group.

Factors associated with undercorrected refractive errors in an older population: the Blue Mountains Eye Study

AIMS

To identify characteristics of people with clinically relevant undercorrected refractive errors.

METHODS

The Blue Mountains Eye Study was a population based survey of 3654 Australians aged 49-97 years. Examinations included a standardised refraction and measurement of presenting and best corrected visual acuity. Clinically relevant undercorrected refractive error was defined as improvement of >/=10 letters (2+ lines on the logMAR chart) in subjects with presenting acuity 6/9 or worse. Associations with a range of demographic and ocular variables were explored, adjusting for age and sex, presented as odds ratios (OR) with 95% confidence intervals (CI).

RESULTS

Undercorrected refractive error was present in 814/3654 subjects (10.2%). Older age (p <0.001), hyperopia (OR 1.45, CI 1.15 to 1.83), longer interval from last eye examination (p <0.001), past occupation as tradesperson (OR 1.64, 1.13 to 3.29) or labourer (OR 2.00, CI 1.39 to 2.89), receipt of government pension (OR 1.47, CI 1.12 to 1.94), and living alone (OR 1.34, CI 1.05 to 1.72) were all associated with undercorrected refractive error. Past or current use of distance glasses (OR 0.25, CI 0.20 to 0.32) and driving (OR 0.67, CI 0.52 to 0.86) were associated with a lower prevalence.

CONCLUSIONS

Increasing age and measures of socioeconomic disadvantage and isolation were found to predict undercorrected refractive error. Given the documented impacts from correctable visual impairment, these findings suggest a need to target education and eye care services.

Prevalence of visual impairment and utilization of rehabilitation services in the visually impaired elderly population of Quebec

Data on the prevalence of reported visual impairment and on the utilization of rehabilitation services were collected on a sample consisting of 1777 community-residing people aged at least 65 years. A visual disability was considered to be present if the answer to at least one of the following two questions was positive: Do you have trouble reading ordinary newsprint with glasses (if normally worn)? Do you have trouble clearly seeing the face of someone 12 feet away with glasses (if normally worn)? Prevalence of a reported near disability was 7.6%, prevalence of a reported distance disability was 4.4%, and 3.5% of subjects reported both types of disability. In a subsample of the surveyed population, the positive predictive value was 21% and the negative predictive value was 100%, using moderate or worse visual impairment as the gold standard. Among those answering yes to both questions, 11.4% received services from a rehabilitation center and 10.0% from a nonprofit agency. The utilization rates (adjusted to apply only to those whose visual impairment was confirmed by visual examination) reached 20% for rehabilitation centers and 17.5% for nonprofit agencies. Low utilization of rehabilitation services raises questions concerning the role of general eye care practitioners, community-based health centers, and rehabilitation centers in the rehabilitative process of the visually impaired elderly.

Nonauditory determinants of self-perceived hearing problems among older adults: the role of stressful life conditions, neuroticism, and social resources

BACKGROUND

The present study explored factors that influenced older individuals' subjective perception of hearing problems. In addition to objectively screened hearing ability, nonauditory factors such as stressful life conditions (visual impairment, chronic disease, disability, and recent stressful life events), neuroticism, and social resources were hypothesized to be predictors of self-perceived hearing problems.

METHODS

These hypotheses were tested with a hierarchical regression model using a stratified sample of 425 community-dwelling older individuals (mean age = 72.2).

RESULTS

Individuals with more recent stressful life events, higher levels of neuroticism, and less emotional support reported greater hearing problems after controlling for objectively screened hearing. In addition to the main effects, a significant interaction was observed between neuroticism and screened hearing, indicating that the combination of poor hearing and high neuroticism increased the level of self-perceived hearing problems.

CONCLUSIONS

The findings suggest that the effects of nonauditory factors should be taken into account in the application of self-assessed measures of hearing problems.

Blindness and visual impairment in the Americas and the Caribbean

AIM

To summarise available data on the prevalence and causes of visual impairment and blindness in the Americas and the Caribbean.

METHODS

The published literature was searched in Medline and LILACS using the following key words: blindness, visual impairment, prevalence. Articles were reviewed, and the references of the articles were also searched for relevant articles, which were also reviewed.

RESULTS

Using the mortality in children under the age of 5 as an indicator, the overall prevalence of childhood blindness (in the under age 15 group) for the region was estimated at 0.45/1000, with the majority (67%) living in countries with mortality of children under age 5 above 30/1000 live births. Corneal opacities were more common in countries where the under 5 year mortality are above 30/1000 live births and retinopathy of prematurity (ROP) was an important cause in countries with intermediate death rates. For adults, overall blindness rates were not estimated because of the social, economic, and ethnic diversity in the region. The primary causes of visual loss in adults in the Americas were age related eye diseases, notably cataract and glaucoma in the African-American and Hispanic populations, and age related macular degeneration in the white population. Uncorrected refractive error was a significant cause of decreased vision across ages, ethnic groups, and countries.

CONCLUSION

More data are needed on the magnitude and causes of visual loss for the Caribbean and Latin American countries. Rates of blindness and visual loss from available data within these countries are widely disparate. Prevention and control of avoidable blindness needs to be an ongoing focus in this region.

Is vision function related to physical functional ability in older adults?

OBJECTIVES

To assess the relationship between a broad range of vision functions and measures of physical performance in older adults.

DESIGN

Cross-sectional study.

SETTING

Population-based cohort of community-dwelling older adults, subset of an on-going longitudinal study.

PARTICIPANTS

Seven hundred eighty-two adults aged 55 and older (65% of living eligible subjects) had subjective health measures and objective physical performance evaluated in 1989/91 and again in 1993/95 and a battery of vision functions tested in 1993/95.

MEASUREMENTS

Comprehensive battery of vision tests (visual acuity, contrast sensitivity, effects of illumination level, contrast and glare on acuity, visual fields with and without attentional load, color vision, temporal sensitivity, and the impact of dimming light on walking ability) and physical function measures (self-reported mobility limitations and observed measures of walking, rising from a chair and tandem balance).

RESULTS

The failure rate for all vision functions and physical performance measures increased exponentially with age. Standard high-contrast visual acuity and standard visual fields showed the lowest failure rates. Nonstandard vision tests showed much higher failure rates. Poor performance on many individual vision functions was significantly associated with particular individual measures of physical performance. Using constructed combination vision variables, significant associations were found between spatial vision, field integrity, binocularity and/or adaptation, and each of the functional outcomes.

CONCLUSIONS

Vision functions other than standard visual acuity may affect day-to-day functioning of older adults. Additional studies of these other aspects of vision and how they can be treated or rehabilitated are needed to determine whether these aspects play a role in strategies for reducing disability in older adults.

Visual impairment in a Taiwanese population: prevalence, causes, and socioeconomic factors

PURPOSE

We sought to estimate the prevalence of visual impairment among an elderly population in urban Taiwan, determine the causes of visual impairment, and gain information about certain socioeconomic factors associated with visual impairment.

METHODS

A population-based survey of ocular diseases in residents aged 50 years or older was conducted in Peitou Precinct, Taipei, Taiwan. All participants underwent a comprehensive ophthalmic examination, including visual acuity measurement, using standardized protocols. Demographic data, marital status, employment status, and educational level were gathered through an interview.

RESULTS

A total of 2034 participants completed the visual acuity measurements. The prevalence of visual impairment (defined as best-corrected visual acuity in the better eye <6/18) among this population was 2.75% (95% confidence intervals: 2.04%-3.46%). Three major causes of visual impairment were cataract (30.4%), high myopic macular degeneration (25.0%), and age-related macular degeneration (14.3%). In multivariate analysis, age was positively correlated with visual impairment (P < 0.001), and higher education level was associated with a significant decrease in the odds of being visually impaired (P < 0.001). No relation was found between visual impairment and sex, or marital and employment status. CONCLUSIONS This study provides the first information about the prevalence and causes of visual impairment in Taiwan, and identifies age and educational level as the most important factors related to visual impairment. Additional educational programs should be developed to improve individual awareness of age-related ocular diseases and the availability of current ophthalmic intervention.

Changes in visual acuity in a population over a 10-year period : The Beaver Dam Eye Study

PURPOSE

To describe the change in visual acuity in a 10-year period.

DESIGN

Population-based cohort study.

PARTICIPANTS

Included 3684 persons 43 to 86 years of age at the time of a baseline examination in 1988 to 1990, living in Beaver Dam, Wisconsin, at a follow-up examination in 1993 to 1995 and/or 1998 to 2000.

METHODS

Best-corrected visual acuity was measured, after refraction, with logarithm of the minimum angle of resolution charts using a modification of the Early Treatment Diabetic Retinopathy Study protocol.

MAIN OUTCOMES MEASURES

Doubling of the visual angle and incidence of visual impairment.

RESULTS

The change in the mean number of letters read correctly over the 10-year period varied in the right eye from -0.9 (standard deviation [SD] = 5.5) and in the left eye from -1.2 (SD = 6.6) in people between 43 and 54 years of age to -11.0 (SD = 20.0) in the right eye and -12.6 (SD = 20.4) in the left eye in people 75 years of age or older (n = 184) at baseline. Over the 10-year period, 5.9% of the population had impaired vision (20/40 or worse in the better eye) develop, 0.8% had severe visual impairment (20/200 or worse in the better eye) develop, 4.8% had doubling of the visual angle, and 3.9% had improved vision. People who were 75 years of age or older at baseline were 15.0 times (95% confidence interval [CI], 10.9-20.6; P < 0.001) as likely to have impaired vision develop, 9.3 times (95% CI, 6.5-13.3; P < 0.001) as likely to have doubling of the visual angle, and 19.8 times as likely (95% CI, 8.4-46.4; P < or = 0.001) to have severe visual impairment develop than people younger than 75 years of age at baseline. For the 82 persons 75 years of age or older, currently residing in a nursing or group home at follow-up, they were 2.6 times (95% CI, 1.45-4.52) as likely to have impaired vision develop, 1.6 times (95% CI, 0.47-5.62) as likely to have severely impaired vision develop, and 3.6 times (95% CI, 1.96-6.78) as likely to have had a doubling of the visual angle than those not residing in a nursing or group home at follow-up.

CONCLUSIONS

These data provide precise population-based estimates of the 10-year incidence of loss of vision over a wide spectrum of ages and show that decreased visual acuity in people 75 years of age after 10 years is a common finding, especially in those who are admitted to nursing or group homes.

Prevalence [correction of prevalance] of functional blindness, visual impairment, and related functional deficits among elderly Mexican Americans

BACKGROUND

This report describes the prevalence and correlates of functional blindness and visual impairment among older Mexican Americans, using data on 2800 respondents from the Hispanic Established Populations for the Epidemiological Study of the Elderly.

METHODS

Bivariate and multivariate logistic regression analyses were used to examine the associations between corrected bilateral distant vision and sociodemographic characteristics, selected health conditions, self-reported health status, health care utilization, and functional dependence on the basis of assistance needed for basic and instrumental activities of daily living (ADLs).

RESULTS

Using a modified Snellen test for distance visual acuity, 5% of older Mexican Americans were found to be functionally blind, and 13.5% were found to be visually impaired. Vision loss was significantly associated with older age, lower education, hypertension, diabetes, poor self-rated health, and hospitalization during the year prior to the interview. Over 50% of functionally blind subjects required assistance with at least one basic ADL, compared with 15% of those who were visually impaired and 8% of those who were not visually impaired.

CONCLUSIONS

The prevalence of functional blindness in this sample of elderly Mexican Americans was higher than reported for the general elderly population, yet they also have higher rates of adequate vision because of the low prevalence of visual impairment. The results suggest a need for more research on the prevalence and impact of functional blindness and visual impairment on the health of older Mexican Americans.

Screening for hearing and visual loss among elderly with questionnaires and tests: which method is the most convincing for action?

OBJECTIVE

To examine the extent to which self-report and performance-based measures identify the same people, and also whether one of these methods any more than the other induces the general practitioner (GP) to offer a patient help?

DESIGN

Comparison of tests and questionnaire in a screening programme for hearing and visual loss.

SETTING

Twelve general practices in the western part of The Netherlands.

PATIENTS

1121 people 75 years of age and older.

MAIN OUTCOME MEASURES

Hearing loss according to the whispered voice test and two questions (Q1, Q2) and visual loss according to the Snellen and low vision charts and two questions (Q3, Q4). The extent to which test and questions influence the GP's judgment regarding intervention is calculated using logistic regression.

RESULTS

For hearing loss, the concordance of the whispered voice test with Q1 was 67%, and with Q2, 71%. For visual loss, the concordance of the Snellen chart with Q3 was 79% and of the Low Vision Chart with Q4, 69%. For hearing loss, the results of the test were noticeably more significant for the GP in offering help than the answers to the questions, and for visual loss the results of the Snellen chart slightly more convincing than the answers to the questions.

CONCLUSION

When in a screening programme with simple instruments for visual and hearing loss the choice has to be made between questionnaire and tests, the tests will be the best choice.

Prevalence, incidence, and risk factors associated with hip fractures in community-dwelling older Mexican Americans: results of the Hispanic EPESE study. Establish Population for the Epidemiologic Study for the Elderly

OBJECTIVES

To determine the rates and risk factors associated with hip fractures in the community-dwelling older Mexican-American population.

DESIGN

A prospective survey of a regional probability sample of older Mexican Americans aged 65 and over.

SETTING

The 1993-1996 Hispanic Established Population for the Epidemiologic Study of the Elderly (H-EPESE), a probability sample of noninstitutionalized Mexican Americans, aged 65 and over, living in the Southwestern states of Texas, New Mexico, Colorado, Arizona, and California.

PARTICIPANTS

In 1993-1994 and in 1995-1996, 2895 persons, aged 65 and over, considered Mexican American, were selected at baseline as a weighted probability sample. Sample weights were used to extrapolate to the estimated 498,176 older Mexican Americans residing in the Southwest US.

MEASUREMENTS

Self-reported hip fracture and functional measures by in home interviews.

RESULTS

Hip fracture prevalence was 4.0% at baseline. The overall incidence of hip fractures for women was 9.1 fractures/1000 person-years. The incidence rate for men was 4.8 fractures/1000 person-years. Extrapolation from these data to the entire older Mexican American population indicated that approximately 5162 new fractures occurred in the population during the 2 year study period. In women, hip fractures were associated independently with advanced age, not being married/living alone, having had a stroke, limitations with activities of daily living and instrumental activities of daily living. In men, only the latter limitations were associated independently with hip fracture.

CONCLUSIONS

This study indicates that older Mexican American people may have hip fracture incidence rates that place them at highest risk among the Hispanic subgroups. In light of a sparse literature on this population, the fracture estimates derived from this work contributes to our understanding of the true fracture estimates in this population. Based on the extrapolated population rates, hip fracture in this population is a significant public health problem. Adequate preventive measures need to be implemented in this growing US population.

Age-specific prevalence and causes of bilateral and unilateral visual impairment in older Australians: the Blue Mountains Eye Study

PURPOSE

To report age-specific prevalence and causes of bilateral and unilateral visual impairment in a representative older Australian population.

METHODS

Participants in the Blue Mountains Eye Study (n = 3654) underwent a detailed eye examination. Any visual impairment was defined as best-corrected visual acuity (VA) of 6/12 or worse, moderate impairment as VA 6/24-6/60 and severe impairment as VA worse than 6/60 (the Australian definition for legal blindness). Bilateral visual impairment was defined from the better eye and unilateral impairment from the worse eye. Proportional causes for visual loss were determined by the examining ophthalmologist.

RESULTS

Prevalence of bilateral and unilateral visual impairment was strongly age related. Corresponding bilateral and unilateral visual impairment prevalence rates were, respectively, 0.6% and 3.6% for persons aged 49-59 years, 1.1% and 8.2% for ages 60-69, 5.4% and 20.1% for ages 70-79, and 26.3% and 52.2% for persons aged 80+ years. Overwhelmingly, age-related maculopathy (ARM) was the predominant cause of bilateral blindness (13/17) and of moderate to severe bilateral visual impairment in persons aged 70+ years. However, cataract was the most frequent cause of mild bilateral visual impairment among persons aged 60+ years. Amblyopia was the most frequent cause of mild or worse unilateral visual impairment in persons aged 49-59 years. Cataract was the most common cause of mild unilateral visual impairment in people aged 60+ years, while ARM and cataract were jointly the most frequent causes of moderate to severe unilateral visual impairment in people aged 70+ years.

CONCLUSIONS

These findings indicate that around half of visually impaired persons aged 60 years or over had cataract, a cause amenable to treatment.

Visual acuity measurements in a national sample of British elderly people

BACKGROUND

Despite the fact that visual function has an important role in the quality of life in later years, very few studies have measured visual acuity in population based nationwide samples of British elderly people. Such measurements were carried out in the context of the national diet and nutrition survey of people aged 65 years or over (NDNS).

METHODS

NDNS participants, who were living in 80 different randomly selected postcode areas of mainland Britain, were visited at their home by a nurse who measured visual acuity at 3 metres, using the Glasgow acuity card (GAC) method. In addition, a brief questionnaire related to ocular health was administered.

RESULTS

Visual acuity was measured in 1362 NDNS participants who were not classified as mentally impaired. Visual impairment (using the WHO low vision criteria) was measured in 195 (14.3%) subjects. Prevalence of visual impairment increased significantly with age (65-74 years 3.1%; 75-84 years 11.6%; 85+ years 35.5%, p<0.001 for trend). Impaired vision was more common in subjects living in a nursing home (odds ratio adjusted for age 2.59 (95% CI 2.23 to 2. 96)) and in women (odds ratio adjusted for age 1.55 (95% CI 1.21 to 1.89)). 132 (9.7%) subjects had previously undergone cataract surgery and another 157 (11.5%) had been told that they currently had cataract. Vision improved 0.2 log units or more (at least one Snellen line) with the aid of a pinhole occluder in 289 subjects (21. 2%).

CONCLUSION

Results of this nationwide, community based study confirm that problems with poor distance visual acuity exist in a substantial part of the elderly community, particularly in women and people living in nursing homes.

Visual function tests, eye disease and symptoms of visual disability: a population-based assessment

PURPOSE

To examine associations between eye disease and tests of visual function with self-reported visual disability.

METHODS

The Blue Mountains Eye Study is a cross-sectional census-based survey of eye disease in two postcode areas in the Blue Mountains, west of Sydney, Australia. Of 4433 eligible residents, 3654 (82,4%) participated. Subjects had a detailed eye examination, including tests of visual acuity, contrast sensitivity, disability glare and visual field. Lens and retinal photographs were taken and graded according to standardized protocols for presence of cataract, early and late age-related maculopathy, glaucoma, diabetic retinopathy, retinal vein occlusion and other eye diseases. An interviewer-administered questionnaire included questions about perception of visual disability.

RESULTS

Scores on all tests of visual function significantly decreased with age (P < 0.0001). This decrease persisted for all tests except disability glare after excluding subjects with identifiable eye disease. The presence of one or more eye diseases was significantly associated with all (self-reported) measures of visual disability (trouble driving at night, difficulty recognizing a friend across the street, reading a newspaper or recognizing detail on televsion): mixed cataract (cortical and nuclear, or posterior subcapsular and nuclear) was associated with trouble driving at night and difficulty recognizing a friend across the street. A 10-letter (two-line) decrease in best corrected or presenting visual acuity was significantly associated with all self-reported measures of vsual dsability, as was a two-step decrease in contrast sensitvity. A five-point increase in points missing in the visual field was weakly but significantly associated with all self-reported measures of visual disability except trouble driving at night.

CONCLUSIONS

Visual function declines with age. Impaired visual function was strongly, and eye disease relatively weakly associated with reports of visual disability.

Geriatric assessment

A comprehensive geriatric assessment involves the evaluation of the physical, psychosocial, and environmental factors affecting the health of an elderly person. In the office setting a geriatric assessment is best accomplished by the use of screening questions, which are incorporated into the patient's medical questionnaire; the use of validated, brief screening tests that measure the patient's performance of daily living activities, cognition, nutritional status, and risk of falls; and a review of the patient's personal values and social support network. The screening assessment can be completed in an average of ten minutes by using self-administered questionnaires and brief performance-based measures of physical functioning. The comprehensive assessment performed on the initial visit with an elderly patient will help to (1) improve diagnostic accuracy, (2) guide the selection of interventions to restore or preserve health, (3) recommend an optimal environment for care, (4) predict health outcomes, and (5) monitor clinical change over time. The effectiveness of geriatric assessment has been demonstrated in clinical trials and is likely to be most effective when conducted by the patient's primary care physician.

The relationship of self-rated vision and hearing to functional status and well-being among seniors 70 years and older

PURPOSE

To describe the relationship between self-reported visual and hearing impairment and an index of global functional status among seniors age 70 years or older.

METHODS

A total of 7,320 United States community-dwelling persons aged 70 years or older participating in the 1993 Assets and Health Dynamics of the Oldest Old Survey (AHEAD) completed detailed questionnaires about their demographic, socioeconomic, and health status. Multivariate analyses of functional status (using a global index of functional status based on self-reported limitations in 11 activities) were conducted, controlling for demographic and socioeconomic status and common medical conditions, as well as independently for hearing and vision.

RESULTS

Of the respondents, 27% rated their vision as fair or poor, whereas 25% rated their hearing as fair or poor. Controlling for demographic factors, socioeconomic status, medical conditions, and general health status, limitations in both vision and hearing correlated independently with worsened functional status. Controlling for income, wealth, and education did not greatly reduce the strength of the association between visual and hearing impairment and function.

CONCLUSIONS

Visual and hearing impairment appear to have a significant relationship to overall functioning in the oldest old, regardless of income or wealth. By confirming these findings across income and household wealth groups, adjusted for medical conditions and general health status, in a nationally representative population of Americans age 70 years or older, this study provides a powerful added impetus to efforts for improving vision and hearing for all other Americans, including the oldest old.

The prevalence and health burden of self-reported diabetes in older Mexican Americans: findings from the Hispanic established populations for epidemiologic studies of the elderly

OBJECTIVES

The prevalence and health burden of self-reported adult-onset diabetes mellitus were examined in older Mexican Americans.

METHODS

Data from the Hispanic Established Populations for Epidemiologic Studies of the Elderly were used to assess the prevalence of self-reported diabetes and its association with other chronic conditions, disability, sensory impairments, health behaviors, and health service use in 3050 community-dwelling Mexican Americans 65 years and older.

RESULTS

The prevalence of self-reported diabetes in this sample was 22%, and there were high rates of obesity, diabetes-related complications, and diabetic medication use. Myocardial infarction, stroke, hypertension, angina, and cancer were significantly more common in diabetics than in nondiabetics, as were high levels of depressive symptoms, low perceived health status, disability, incontinence, vision impairment, and health service use. Many of the rate differences found in this sample of older Mexican Americans were higher than those reported among other groups of older adults.

CONCLUSIONS

Our findings indicate that the prevalence and health burden of diabetes are greater in older Mexican Americans than in older non-Hispanic Whites and African Americans, particularly among elderly men.