1
|
Weber M, Parmeggiani F, Bremond-Gignac D, Daly A, Lahaye M, Lotery A, Paudel N, Ritter M, de la Rúa ER, Rotenstreich Y, Sankila EM, Stingl K, Van Denderen J, Denee T, Pungor K. The Impacts of Caregiving for Patients with X-Linked Retinitis Pigmentosa (XLRP): Findings from the EXPLORE XLRP-2 Study. Adv Ther 2025; 42:2922-2936. [PMID: 40299280 PMCID: PMC12085331 DOI: 10.1007/s12325-025-03196-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2024] [Accepted: 04/01/2025] [Indexed: 04/30/2025]
Abstract
INTRODUCTION Informal caregivers play an important part in the healthcare of patients with chronic diseases, including those leading to visual impairment. X-linked retinitis pigmentosa (XLRP) is considered one of the most severe forms of retinitis pigmentosa and causes declines in vision starting in childhood, ultimately progressing to legal blindness in adulthood. Caregivers are expected to play an increasing role in patient care, but real-world impacts of XLRP on caregivers are poorly evaluated. METHODS EXPLORE XLRP-2 was an exploratory, multicentre, non-interventional study. Cross-sectional surveys were used to gather experiences directly from caregivers across Europe and Israel by both validated and newly developed caregiver-reported outcome surveys. RESULTS Seventy caregivers of patients with XLRP associated with retinitis pigmentosa GTPase regulator (RPGR) mutations were enrolled, of whom 68 were included in analyses; 87.7% of caregivers were female and mean (standard deviation [SD]) age was 49.4 (11.7) years. They were most commonly either spouses (50.8%) or parents (41.5%) of patients. Caregivers spent a mean (SD) 28.7 (34.5) hours per week caring for patients. Of the 72.3% of caregivers who were employed, 34.8% worked part time; of the 27.7% of caregivers who were unemployed, 33.3% cited caregiving responsibilities as a cause for unemployment; 23.1% and 46.2% of caregivers reported any level of depression and anxiety, respectively, with few additional impacts captured by the surveys. CONCLUSIONS Some caregivers reported employment and mental health impacts in this study. However, despite many hours spent per week caring for patients with XLRP, the surveys did not reflect the expected burden experienced by caregivers, highlighting the need for further research in this field.
Collapse
Affiliation(s)
- Michel Weber
- Ophthalmology Department, University Hospital Centre (CHU) de Nantes, Nantes, France
- INSERM UMR 1089, University of Nantes, CHU de Nantes, Nantes, France
| | - Francesco Parmeggiani
- Department of Translational Medicine, University of Ferrara, Ferrara, Italy
- ERN-EYE Network - Center for Retinitis Pigmentosa of Veneto Region, Camposampiero Hospital, Padua, Italy
| | - Dominique Bremond-Gignac
- Ophthalmology Department, Necker Enfants Malades University Hospital, AP-HP, Paris Cité University, Paris, France
- INSERM, UMRS1138, T17, Centre de Recherche des Cordeliers, Sorbonne Paris Cité University, Paris, France
| | | | | | - Andrew Lotery
- Faculty of Medicine, University of Southampton, Southampton, UK
| | | | - Markus Ritter
- Department of Ophthalmology, Medical University of Vienna, Vienna, Austria
| | - Enrique Rodríguez de la Rúa
- Department of Ophthalmology, University Hospital Virgen Macarena, Seville, Spain
- Department of Surgery, Ophthalmology Area, University of Seville, RiCORS-REI, Instituto de Salud Carlos III (RD21/0002/0011), Seville, Spain
| | - Ygal Rotenstreich
- The Goldschleger Eye Institute, Sheba Medical Center, Tel Hashomer, Israel
- Ophthalmology Department, School of Medicine, Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv, Israel
- Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
| | - Eeva-Marja Sankila
- Department of Ophthalmology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Katarina Stingl
- Center for Ophthalmology, University Eye Hospital, University of Tübingen, Tübingen, Germany
- Center for Rare Eye Diseases, University of Tübingen, Tübingen, Germany
| | | | - Tom Denee
- Janssen-Cilag B.V., Breda, the Netherlands
| | | |
Collapse
|
2
|
Zhang W, Powell DS, Garcia Morales EE, Deal JA, Reed NS. Caregiving Time of Unpaid Family Caregivers Assisting Older Adults With Hearing Difficulty. J Aging Health 2024; 36:610-618. [PMID: 37855830 DOI: 10.1177/08982643231208240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2023]
Abstract
Objectives: We aimed to investigate the association of older adults' hearing difficulty status with caregiving time. Methods: We used data from two linked surveys of Medicare beneficiaries and family caregivers. Hearing difficulty was defined by hearing aid use and hearing capacity in functional settings. Weighted multivariable linear regression examined the association between hearing difficulty and caregiving time. Stratified analyses were conducted to investigate the moderation effects of caregiving networks and care recipient's dementia status. Results: Among 3003 caregivers, those who assisted older adults with hearing difficulty were observed to spend greater time providing care (β = 1.18, 95% Confidence Interval [CI]: 1.04, 1.32). Stronger associations in magnitude were observed among caregivers without caregiving networks (β = 1.35, 95% CI: 1.13, 1.56) and assisting older adults without dementia (β = 1.22; 95% CI = 1.06, 1.37). Discussion: Hearing difficulty may contribute to greater caregiving time and remains a potential target for caregiver support programs.
Collapse
Affiliation(s)
- Wuyang Zhang
- Cochlear Center for Hearing and Public Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Danielle S Powell
- Department of Hearing & Speech Sciences, University of Maryland, College Park, MD, USA
| | - Emmanuel E Garcia Morales
- Cochlear Center for Hearing and Public Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
- The Hopkins' Economics of Alzheimer's Disease and Services (HEADS) Center, Baltimore, MD, USA
| | - Jennifer A Deal
- Cochlear Center for Hearing and Public Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Nicholas S Reed
- Cochlear Center for Hearing and Public Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| |
Collapse
|
3
|
Xiong K, Zhang Q, Mao H, Zhou W, Huang Q, Liang Y. Association of spouse's vision impairment with depressive symptoms and cognitive decline in partner: A nationally representative study in China. J Affect Disord 2024; 355:392-398. [PMID: 38531494 DOI: 10.1016/j.jad.2024.03.097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 03/17/2024] [Accepted: 03/19/2024] [Indexed: 03/28/2024]
Abstract
BACKGROUND Although several previous studies have reported on the relationship between vision impairment and caregiver mental health, mixed results were obtained, and only one study reported the association between spousal vision impairment and partner depression. Therefore, our study aimed to examine the association between spousal vision impairment and the partner's depressive symptoms and cognitive decline. METHODS This cross-sectional study gathered baseline data from the China Health and Retirement Longitudinal Study (CHARLS) in 2011. A total of 10,956 couples were included in the study. Vision impairment was assessed by respondents' self-reported distance or near vision. Multivariate logistic and linear regression were conducted to evaluate the association between the spouse's vision impairment and the partner's depressive symptoms and cognitive function. RESULTS The prevalence of partners with depressive symptoms was significantly higher among spouses with vision impairment than among those without (43.3 % vs. 32.5 %; P < 0.001), and cognitive function was significantly lower (spousal vision impairment 14.4 ± 4.5 vs. no spousal vision impairment 15.5 ± 4.6; P < 0.001). After fully adjusting for potential confounders, the partner had greater odds of depressive symptoms for spouses with vision impairment than for those without (odds ratio: 1.525; 95 % confidence interval [CI]: 1.387 to 1.677). Furthermore, spousal vision impairment was negatively associated with the partner's cognitive function (β = -0.640; 95 % CI: -0.840 to -0.440). Sensitivity analysis was performed, and consistent results were obtained (all P < 0.05). LIMITATIONS Visual function was assessed by self-reporting. CONCLUSIONS A spouse's vision impairment is associated with depressive symptoms and cognitive decline in the partner. The findings imply the importance of considering the partner's mental health when managing their spouse's vision impairment.
Collapse
Affiliation(s)
- Kun Xiong
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, Zhejiang 325027, China
| | - Qi'ao Zhang
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, Zhejiang 325027, China
| | - Huiyan Mao
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, Zhejiang 325027, China
| | - Wenzhe Zhou
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, Zhejiang 325027, China
| | - Qiangjie Huang
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, Zhejiang 325027, China
| | - Yuanbo Liang
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, Zhejiang 325027, China.
| |
Collapse
|
4
|
Dong Y, Wang A. Health Management Service Models for the Elderly with Visual Impairment: A Scoping Review. J Multidiscip Healthc 2024; 17:2239-2250. [PMID: 38751666 PMCID: PMC11095522 DOI: 10.2147/jmdh.s463894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Accepted: 05/04/2024] [Indexed: 05/18/2024] Open
Abstract
Background The incidence of visual impairment(VI) in older people is gradually increasing. This review aimed to summarise the evidence on existing health management models and strategies for older adults with VI to improve health-related and vision-related quality of life (QoL) in older people. Methods Based on the framework of the scoping review methodology of Arksey and O'Malley (2005), a comprehensive literature search of relevant literature published between January 2010 and June 2022 in PubMed, CINAHL, EMBASE, Web of Science, Cochrane Library, CNKI, VIP, Wanfang database, Sinomed and the grey literature. Results Finally, 31 articles were included. The health management model had a multidisciplinary team low vision rehabilitation model, medical consortium two-way management model, low vision community comprehensive rehabilitation model, medical consortium-family contract service model, screening-referral-follow-up model, and three-level low vision care model. The health management strategy covers nine aspects, the combination of multi-element strategies is feasible, and network information technology has also shown positive results. Conclusion In the future, under the Internet and hierarchical management model, we should provide demand-based personalized support to rationalize and scientifically achieve hierarchical management and improve resource utilization efficiency and eye health outcomes.
Collapse
Affiliation(s)
- Yu Dong
- The First Hospital of China Medical University, Shenyang, People’s Republic of China
| | - Aiping Wang
- The First Hospital of China Medical University, Shenyang, People’s Republic of China
| |
Collapse
|
5
|
Thomas J, Almidani L, Swenor BK, Varadaraj V. Digital Technology Use Among Older Adults With Vision Impairment. JAMA Ophthalmol 2024; 142:445-452. [PMID: 38573612 PMCID: PMC11099681 DOI: 10.1001/jamaophthalmol.2024.0467] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 01/25/2024] [Indexed: 04/05/2024]
Abstract
Importance Telehealth has the potential to improve health for older adults, but many access disparities exist, including for those with vision impairment (VI). Objective To examine the associations between VI and digital technology access measures in US older adults. Design, Setting, and Participants This was a cross-sectional study that included Medicare beneficiaries 65 years and older. Beneficiary data were obtained from the National Health and Aging Trends Study (NHATS) 2021; data collection was conducted from June 2020 through January 2021. Data were analyzed September 2023. Exposure VI, measured on categorical (distance and near VI [>0.30 logMAR], contrast sensitivity impairment [CSI; <1.55 logCS], and any VI [distance VI, near VI, or CSI]), and continuous (distance and near acuity [logMAR] and contrast sensitivity [logCS]) scales. Main Outcomes Self-reported outcomes of digital technology access from the technological environment component of the NHATS. Results Of the 2822 Medicare beneficiaries (mean [SD] age, 78.5 [5.6] years; 1605 female [54.7%]) included in this study, patients self-identified with the following race and ethnicity categories (weighted percentages): 575 non-Hispanic Black (8.0%), 132 Hispanic (7.0%), 2019 non-Hispanic White (81.7%), and 63 non-Hispanic other race (3.4%), which included American Indian, Alaska Native, Asian, multiracial, Native Hawaiian, Pacific Islander, or other specified race. A total of 1077 of 2822 patients (32.3%) had any VI. In multivariable logistic regression models, older adults with any VI had lower odds of having or knowing how to use a cellphone (odds ratio [OR], 0.58; 95% CI, 0.38-0.88), computer (OR, 0.61; 95% CI, 0.47-0.79), or tablet (OR, 0.68, 95% CI = 0.54-0.85) than peers without VI. In other models, near VI was associated with lower odds of having and knowing how to use a phone (OR, 0.56; 95% CI, 0.36-0.87), computer (OR, 0.57; 95% CI, 0.44-0.75), or tablet (OR, 0.65; 95% CI, 0.52-0.81) compared with no near VI. CSI was associated with lower odds of having and knowing how to use a phone (OR, 0.66; 95% CI, 0.45-0.99) or computer (OR, 0.72; 95% CI, 0.55-0.93) compared with no CSI. Distance VI was only associated with lower odds of having and knowing how to use a cellphone (OR, 0.63; 95% CI, 0.41-0.95). Any VI and individual categorical VI measures were not associated with other outcomes of digital health- and nonhealth-related experiences. Similar associations were noted when vision was examined on a continuous scale. However, worse distance acuity (per 0.1 logMAR) was associated with being less likely to visit with family or friends on a video call (OR, 0.91; 95% CI, 0.84-0.98) and to order or refill prescriptions online (OR, 0.90; 95% CI, 0.83-0.97). Conclusions and Relevance Results suggest that older US adults with VI were less likely to have access to digital technology than peers without VI, although no differences were noted in the report of digital health- and nonhealth-related activities. These findings highlight the potential for inequities that may arise in telehealth for older adults with VI and the necessity to develop strategies to improve accessibility of telemedicine for all.
Collapse
Affiliation(s)
- Jonathan Thomas
- Texas A&M School of Medicine, Bryan, Texas
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Louay Almidani
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Bonnielin K. Swenor
- Johns Hopkins Disability Health Research Center, Johns Hopkins University, Baltimore, Maryland
- Johns Hopkins University School of Nursing, Baltimore, Maryland
| | - Varshini Varadaraj
- Johns Hopkins Disability Health Research Center, Johns Hopkins University, Baltimore, Maryland
- Johns Hopkins University School of Nursing, Baltimore, Maryland
| |
Collapse
|
6
|
Piano M, Nguyen B, Hui F, Pond CD. Access to primary eye care for people living with dementia: a call to action for primary care practitioners to 'think vision'. Aust J Prim Health 2024; 30:PY23200. [PMID: 38422501 DOI: 10.1071/py23200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 02/07/2024] [Indexed: 03/02/2024]
Abstract
Access to allied health services offers significant benefits for people living with dementia, yet access is currently fragmented and inconsistent. The 2023-2024 budget allocated AU$445million to further enable general practice-led, multidisciplinary teams, with integrated care located within practices, including employment of allied health professionals. Such team care models are recognised by The Royal Australian College of General Practitioners as vital to delivery of high-quality care for older adults. They are especially relevant for over 250,000 Australians who live with dementia in the community. However, not all allied health professionals are currently based within general practices. Future, sustainable general practice-led models of multidisciplinary care that connect patients with external allied health providers could be considered for a comprehensive and collaborative approach to care. Our focus is on people living with dementia, who are at greater risk of preventable vision impairment. Poor vision and/or ocular health can be detected and managed through regular eye examinations, which are predominantly delivered by community-based optometrists in Australia, in a primary care capacity. However, people living with dementia are also less likely to have regular eye examinations. In this paper, we highlight the value of ensuring access to primary eye care services as part of post-diagnosis dementia care. We illustrate the important role of primary care practitioners in building and sustaining connections with allied health professions, like optometry, through effective referral and interprofessional communication systems. This can help break down access barriers to dementia-friendly eye care, through promoting the importance of regular eye tests for people living with dementia.
Collapse
Affiliation(s)
- Marianne Piano
- Department of Optometry and Vision Sciences, University of Melbourne, Melbourne, Vic., Australia; and National Vision Research Institute, Australian College of Optometry, Melbourne, Vic., Australia
| | - Bao Nguyen
- Department of Optometry and Vision Sciences, University of Melbourne, Melbourne, Vic., Australia; and Department of Biomedical Engineering, University of Melbourne, Melbourne, Vic., Australia
| | - Flora Hui
- Department of Optometry and Vision Sciences, University of Melbourne, Melbourne, Vic., Australia; and Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Melbourne, Vic., Australia; and Ophthalmology, Department of Surgery, University of Melbourne, Melbourne, Vic., Australia
| | - Constance Dimity Pond
- Wicking Dementia Research and Education Centre, University of Tasmania, Hobart, Tas., Australia; and School of Rural Medicine, University of New England, Armidale, NSW, Australia; and School of Nursing and Midwifery, Western Sydney University, Penrith South, NSW, Australia
| |
Collapse
|
7
|
Almidani L, Varadaraj V, Mihailovic A, Ramulu PY. Using Objective Vision Measures to Explore the Association of Vision Impairment With Cognition Among Older Adults in the United States. Am J Ophthalmol 2023; 255:18-29. [PMID: 37286156 DOI: 10.1016/j.ajo.2023.05.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 05/14/2023] [Accepted: 05/24/2023] [Indexed: 06/09/2023]
Abstract
PURPOSE To evaluate the association between vision impairment (VI) and cognitive function using objective measures. DESIGN Cross-sectional analysis with a nationally representative sample. METHODS The association between VI and dementia was investigated in a US population-based, nationally representative sample of Medicare beneficiaries, the National Health and Aging Trends Study (NHATS), a nationally representative sample of Medicare beneficiaries aged ≥65 years, using objective vision measures. Exposures included distance VI (>20/40), near VI (>20/40), contrast sensitivity impairment (CSI) (<1.55), any objective VI (distance and near visual acuity, or contrast), and self-reported VI. The main outcome measure was dementia status defined based on survey reports, interviews, and cognitive tests. RESULTS A total of 3026 adults were included in this study; the majority were female (55%) and White (82%). The weighted prevalence rates were 10% for distance VI, 22% for near VI, 22% for CSI, 34% for any objective VI, and 7% for self-reported VI. Across all measures of VI, dementia was more than twice as prevalent in adults with VI compared to their peers without (P < .001 for all). In adjusted models, all measures of VI were associated with higher odds of dementia (distance VI: OR 1.74, 95% CI 1.24-2.44; near VI: OR 1.68, 95% CI 1.29-2.18; CSI: OR 1.95, 95% CI 1.45-2.62; any objective VI: OR 1.83, 95% CI 1.43-2.35; self-reported VI: OR 1.86, 95% CI 1.20-2.89). CONCLUSIONS In a nationally representative sample of older US adults, VI was associated with increased odds of dementia. These results suggest that maintaining good vision and eye health may help preserve cognitive function in older age, although more research is needed to investigate the potential benefits of interventions that focus on vision and eye health on cognitive outcomes.
Collapse
Affiliation(s)
- Louay Almidani
- From the Wilmer Eye Institute, Johns Hopkins University School of Medicine (L.A., A.M., P.Y.R.); Johns Hopkins Disability Health Research Center, Johns Hopkins School of Nursing (V.V.), Baltimore, Maryland, USA
| | - Varshini Varadaraj
- From the Wilmer Eye Institute, Johns Hopkins University School of Medicine (L.A., A.M., P.Y.R.); Johns Hopkins Disability Health Research Center, Johns Hopkins School of Nursing (V.V.), Baltimore, Maryland, USA
| | - Aleksandra Mihailovic
- From the Wilmer Eye Institute, Johns Hopkins University School of Medicine (L.A., A.M., P.Y.R.); Johns Hopkins Disability Health Research Center, Johns Hopkins School of Nursing (V.V.), Baltimore, Maryland, USA
| | - Pradeep Y Ramulu
- From the Wilmer Eye Institute, Johns Hopkins University School of Medicine (L.A., A.M., P.Y.R.); Johns Hopkins Disability Health Research Center, Johns Hopkins School of Nursing (V.V.), Baltimore, Maryland, USA..
| |
Collapse
|
8
|
Piano MEF, Nguyen BN, Gocuk SA, Joubert L, McKendrick AM. Primary eyecare provision for people living with dementia: what do we need to know? Clin Exp Optom 2023; 106:711-725. [PMID: 36375138 DOI: 10.1080/08164622.2022.2140032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 10/10/2022] [Accepted: 10/11/2022] [Indexed: 11/16/2022] Open
Abstract
Dementia comprises a group of brain disorders characterised by loss of cognitive function. Sensory loss, predominantly vision (the focus of this review) and hearing, is a significant problem for people living with dementia. Eyecare practitioners such as optometrists therefore play an important role in identifying and addressing vision-related care needs. To support provision of high quality "dementia-friendly" eyecare, this scoping review summarises recent primary research findings and available clinical practice guidelines, to identify research gaps relating to vision and dementia, and make recommendations for future research and clinical practice. The review set a priori guidelines for the population, concept and context based on the review questions. Primary research papers (2016-2021) were included via 3-step search strategy: preliminary search to index terms, full search, search reference lists of included articles for further inclusions. Additionally, websites of eyecare professional bodies in English-speaking countries were searched to identify current clinical eyecare practice guidelines relating to dementia. Study characteristics (e.g. country, study design) were reported descriptively. Patterns within findings/recommendations from included sources were identified using thematic analysis and reported as themes. 1651 titles/abstracts and 161 full-text articles were screened for eligibility. Three clinical practice guidelines were also identified. The final review included 21 sources: 18 primary research papers and 3 clinical practice guidelines. The thematic analysis reported five key themes: Diagnosis/Screening, dementia progression, findings on clinical visual testing, tailored approach to care, improving care. This scoping review demonstrated limited information about current practices of optometrists working with people living with dementia. Recent evidence reinforces the continuing need for improved eyecare for people living with dementia, taking into account their specific needs with an individualised approach. Up-to-date practical recommendations are synthesised for eyecare providers before, during and after a consultation with a person living with dementia, to better support their care.
Collapse
Affiliation(s)
- Marianne E F Piano
- Department of Optometry and Vision Sciences, School of Health Sciences, The University of Melbourne, Melbourne, Australia
- National Vision Research Institute, Australian College of Optometry, Carlton, Australia
| | - Bao N Nguyen
- Department of Optometry and Vision Sciences, School of Health Sciences, The University of Melbourne, Melbourne, Australia
| | - Sena A Gocuk
- Department of Optometry and Vision Sciences, School of Health Sciences, The University of Melbourne, Melbourne, Australia
| | - Lynette Joubert
- Department of Social Work, School of Health Sciences, The University of Melbourne, Melbourne, Australia
| | - Allison M McKendrick
- Department of Optometry and Vision Sciences, School of Health Sciences, The University of Melbourne, Melbourne, Australia
| |
Collapse
|
9
|
Kumar P, Chung G, Garcia-Morales E, Reed NS, Sheehan OC, Ehrlich JR, Swenor BK, Varadaraj V. Vision difficulty and dementia: economic hardships among older adults and their caregivers. FRONTIERS IN EPIDEMIOLOGY 2023; 3:1210204. [PMID: 38455918 PMCID: PMC10910956 DOI: 10.3389/fepid.2023.1210204] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 07/25/2023] [Indexed: 03/09/2024]
Abstract
Introduction Limited research has examined the economic impact of vision difficulty (VD) and dementia on older adults and their caregivers. We aimed to determine whether older adults with VD and/or dementia, and their caregivers, face more economic hardships than their counterparts without VD or dementia. Methods We used cross-sectional data from the 2015 National Health and Aging Trends Study (NHATS), a population-based survey of Medicare beneficiaries, linked to their family/unpaid caregivers from the National Study of Caregiving (NSOC). Regression models characterized the association of VD (self-report), dementia (survey and cognitive assessments), and co-occurring VD and dementia with debt, receiving financial help from relatives, government-based Supplemental Nutrition Assistance Program (SNAP), other food assistance, utility assistance, and caregiver financial difficulty. Results The NHATS sample included 6,879 community-dwelling older adults (5670 no VD/dementia, 494 VD-alone, 512 dementia-alone, 203 co-occurring VD and dementia). Adults with VD and dementia had higher odds of receiving SNAP benefits (OR = 2.6, 95%CI = 1.4-4.8) and other food assistance (OR = 4.1, 95%CI = 1.8-9.1) than adults without VD/dementia, while no differences were noted for debt, financial help, and utility assistance. Adults with VD-alone had higher odds of debt (OR = 2.1, 95%CI = 1.3-3.2), receiving financial help (OR = 1.7, 95%CI = 1.1-2.5) and other food assistance (OR = 2.7, 95%CI = 1.7-4.3); while adults with dementia-alone had higher odds of debt (OR = 2.8, 95%CI = 1.4-5.5). The NSOC sample included 1,759 caregivers (995 caring for adults without VD/dementia, 223 for VD-alone, 368 for dementia-alone, and 173 for co-occurring VD and dementia). Compared to caregivers of older adults without VD/dementia, caregivers of adults with VD and dementia had higher odds of financial difficulty (OR = 3.0, 95%CI = 1.7-5.3) while caregivers of adults with VD-alone or dementia-alone did not. Discussion While older adults with VD- or dementia-alone experienced increased economic hardships, disparities in food assistance were amplified among older adults with co-occurring disease. Caregivers of adults with co-occurring disease experienced more financial difficulty than caregivers of adults with a single or no disease. This study highlights the need for interventions across clinical and social services to support the economic wellbeing of our aging population and their caregivers.
Collapse
Affiliation(s)
- Priyanka Kumar
- Department of Medicine, University of Maryland Medical Center Midtown Campus, Baltimore, MD, United States
| | - Grace Chung
- Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor, MI, United States
| | - Emmanuel Garcia-Morales
- Cochlear Center for Hearing and Public Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Nicholas S. Reed
- Johns Hopkins Disability Health Research Center, Johns Hopkins University, Baltimore, MD, United States
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Orla C. Sheehan
- The Johns Hopkins Center on Aging and Health, Johns Hopkins University, Baltimore, MD, United States
- RCSI Hospital Group, Connolly Hospital, Dublin, Ireland
| | - Joshua R. Ehrlich
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, MI, United States
- Institute for Social Research, University of Michigan, Ann Arbor, MI, United States
| | - Bonnielin K. Swenor
- Johns Hopkins Disability Health Research Center, Johns Hopkins University, Baltimore, MD, United States
- The Johns University School of Nursing, Johns Hopkins University, Baltimore, MD, United States
| | - Varshini Varadaraj
- Johns Hopkins Disability Health Research Center, Johns Hopkins University, Baltimore, MD, United States
- The Johns University School of Nursing, Johns Hopkins University, Baltimore, MD, United States
| |
Collapse
|
10
|
Hazzan AA, Beach P, Lieberman LJ, Regan C. Home-Based Pilot Intervention to Improve Quality of Life and Related Outcomes among Unpaid Caregivers and Their Care-Recipients with Visual Impairments. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3867. [PMID: 36900883 PMCID: PMC10001718 DOI: 10.3390/ijerph20053867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 02/20/2023] [Indexed: 06/18/2023]
Abstract
The increasing lifespan of the United States population has led to a rise in the prevalence of age-related chronic diseases, increasing the need for unpaid caregivers. Currently, little research is known about this specific population beyond the limited formal training unpaid caregivers receive on the caregiving process. Acquiring visual impairments (VI) later in life places a large emotional toll on both the loved one and their caregivers. The objectives of this pilot study were: (1) to implement a multimodal intervention targeted towards improving the quality of life of unpaid caregivers and their care recipients with visual impairments; (2) to evaluate the efficacy of the multimodal intervention in improving the quality of life of unpaid caregivers and their care recipients with visual impairments. A 10-week virtual intervention (e.g., tai chi, yoga, music) was implemented with 12 caregivers and 8 older adults with VI. The targeted outcomes of interest included: QoL, health, stress, burden, problem-solving, and barriers. In addition to surveys to inform the choice of the intervention, focus group interviews were conducted to obtain participants' perspectives on the effectiveness of the intervention. Results revealed many positive outcomes in the quality of life and well-being of the participants following the 10-week intervention. Overall, these results represent a promising program for unpaid caregivers of older adults with VI.
Collapse
Affiliation(s)
- Afeez Abiola Hazzan
- Department of Healthcare Studies, State University of New York Brockport, State University of New York, 350 New Campus Drive, Brockport, New York, NY 14420, USA
| | - Pamela Beach
- Department of Kinesiology, Sport Studies & Physical Education (KSSPE), State University of New York Brockport, State University of New York, 350 New Campus Drive, Brockport, New York, NY 14420, USA
| | - Lauren J. Lieberman
- Department of Kinesiology, Sport Studies & Physical Education (KSSPE), State University of New York Brockport, State University of New York, 350 New Campus Drive, Brockport, New York, NY 14420, USA
| | - Cassidy Regan
- Department of Kinesiology, Sport Studies & Physical Education (KSSPE), State University of New York Brockport, State University of New York, 350 New Campus Drive, Brockport, New York, NY 14420, USA
| |
Collapse
|
11
|
Beach P, Hazzan AA, Regan C, Lieberman L. Quality of Life and Related Outcomes Among Unpaid Caregivers of Older Adults With Visual Impairment. Int J Aging Hum Dev 2022:914150221132167. [PMID: 36259284 DOI: 10.1177/00914150221132167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Caregivers of older adults with visual impairments are often family members who spend many hours caring for loved ones at the expense of their personal needs. The purpose of this study was to examine the quality of life of unpaid caregivers of older adults with visual impairments and determine the barriers and facilitators for improving their quality of life. To examine this population, 130 unpaid caregivers of older adults with visual impairments were surveyed using the Satisfaction with Life Scale, Living Arrangement and Indicators of Social Interaction Survey, the Geriatric Depression Scale (GDS), Caregiver Quality of Life (EQ-5D), and the Perceived Change Index (PCI). Results revealed that the unpaid caregivers face many challenges, but inexperience/difficulty with tasks and balancing their personal life were the biggest obstacles. Interventions could help improve quality of life and well-being as well as provide support services and access to community resources to reduce the family caregiver burden.
Collapse
Affiliation(s)
- Pamela Beach
- Department of Kinesiology, Sport Studies, and Physical Education, 14788State University of New York at Brockport, Brockport, NY, USA
| | - Afeez Abiola Hazzan
- Department of Healthcare Studies, Sport Studies, and Physical Education, State University of New York at Brockport, Brockport, NY, USA
| | - Cassidy Regan
- Department of Kinesiology, Sport Studies, and Physical Education, 14788State University of New York at Brockport, Brockport, NY, USA
| | - Lauren Lieberman
- Department of Kinesiology, Sport Studies, and Physical Education, 14788State University of New York at Brockport, Brockport, NY, USA
| |
Collapse
|
12
|
Varadaraj V, Swiatek KS, Chung SE, Ehrlich JR, Assi L, Wolff JL, Swenor BK. Caring for Older Adults With Self-Reported Vision Impairment: Findings from the National Study of Caregiving. Am J Ophthalmol 2021; 227:211-221. [PMID: 33831341 PMCID: PMC8817230 DOI: 10.1016/j.ajo.2021.03.031] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 03/15/2021] [Accepted: 03/18/2021] [Indexed: 01/19/2023]
Abstract
PURPOSE The purpose of this study was to examine caregiving relationships for older adults with vision impairment (VI). DESIGN Cross-sectional study with a nationally representative sample. METHODS Setting: the National Health and Aging Trends Study linked to the National Study of Caregiving, Year 2011. STUDY POPULATION 1,776 family or unpaid caregivers to community-dwelling Medicare beneficiaries age ≥65 years old. OUTCOME MEASUREMENT in the preceding month, 1) the number of hours of care provided; 2) the valued activities affected by caregiving; and 3) the odds of experiencing substantial emotional, financial, and physical difficulty related to providing care. EXPOSURE VI was defined as a report of blindness or difficulty with distance or near vision. RESULTS Among 1,776 caregivers, 428 caregivers spent an average ± standard error (SE) of 111 ± 9.1 hours per month assisting older adults with VI, whereas 1,348 spent an average of 72 ± 3.3 hours assisting older adults without VI. In fully adjusted negative binomial regression analyses, caregivers of older adults with VI spent 36% more hours (incident rate ratio [IRR]: 1.36; 95% confidence interval [CI]: 1.15-1.60) providing care and reported having 61% more valued activities affected (IRR: 1.61; 95% CI: 1.23-2.10) than caregivers of older adults without VI. In fully adjusted logistic regression analyses, caregivers of older adults with VI had greater odds of emotional (odds ratio [OR]: 1.46; 95% CI: 1.04-2.03) but not financial (OR: 1.33; 95% CI: 0.87-2.03) or physical (OR: 1.13; 95% CI: 0.74-1.74) difficulty related to providing care than caregivers of older adults without VI. CONCLUSIONS These results suggest that caring for older adults with VI places different demands on time and emotional wellbeing than caring for older adults without VI, but no differences in financial or physical difficulties.
Collapse
Affiliation(s)
- Varshini Varadaraj
- Johns Hopkins Wilmer Eye Institute, Baltimore, MD, USA,The Johns Hopkins Disability Health Research Center, Johns Hopkins University, Baltimore, MD, USA
| | | | - Shang-En Chung
- Johns Hopkins University Center on Aging and Health, Baltimore, MD, USA
| | - Joshua R. Ehrlich
- Center for Eye Policy and Innovation, Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, MI, USA
| | - Lama Assi
- Johns Hopkins Wilmer Eye Institute, Baltimore, MD, USA
| | - Jennifer L. Wolff
- Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, MD, USA,Lipitz Center for Integrated Health Care, and the Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Bonnielin K. Swenor
- Johns Hopkins Wilmer Eye Institute, Baltimore, MD, USA,The Johns Hopkins Disability Health Research Center, Johns Hopkins University, Baltimore, MD, USA,Johns Hopkins University Center on Aging and Health, Baltimore, MD, USA,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| |
Collapse
|
13
|
Sloane PD, Whitson H, Williams SW. Addressing Hearing and Vision Impairment in Long-Term Care: An Important and Often-Neglected Care Priority. J Am Med Dir Assoc 2021; 22:1151-1155. [PMID: 34088504 DOI: 10.1016/j.jamda.2021.04.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 04/19/2021] [Accepted: 04/21/2021] [Indexed: 01/01/2023]
Affiliation(s)
- Philip D Sloane
- Cecil G. Sheps Center for Health Services Research and Departments of Family Medicine and Internal Medicine, School of Medicine, University of North Carolina, Chapel Hill, NC, USA.
| | - Heather Whitson
- Departments of Medicine and Ophthalmology, Duke University School of Medicine, Durham, NC, USA
| | - Sharon Wallace Williams
- Division of Speech and Hearing Sciences, Department of Allied Health Sciences, School of Medicine, University of North Carolina, Chapel Hill, NC, USA
| |
Collapse
|
14
|
Hazzan AA, Haibach-Beach P, Lieberman L, Williams J. Interventions for quality of life and related outcomes among unpaid caregivers of older adults with visual impairments: A scoping review. BRITISH JOURNAL OF VISUAL IMPAIRMENT 2021. [DOI: 10.1177/02646196211019064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Unpaid family caregivers play a critical role in the care of older adults with visual impairments. Caring for older adults with visual impairments requires much time and energy, often resulting in psychological stress and reduced quality of life for the unpaid caregiver. However, there is a paucity of data on the impact of caregiving on quality of life and related outcomes among these caregivers. The purpose of this study was to conduct a scoping review examining issues of quality of life, health, stress, burden, and barriers among unpaid caregivers of older adults with visual impairments. The study also aimed to summarize interventions for addressing these issues. This study followed the Arksey and O’Malley five-stage approach for scoping reviews. We performed a search of published peer-reviewed articles available in PubMed, CINAHL Complete, and PsycINFO to identify relevant studies. Two reviewers conducted the screening of titles, abstracts, and full-texts. A total of 24 articles were eligible for full-text screening from the 452 records identified, and 5 articles met the final inclusion criteria. The following four themes were identified: (1) prevalence of quality of life–related barriers among unpaid caregivers of older adults with visual impairments; (2) adverse events among unpaid caregivers of older adults with visual impairments; (3) interventions for unpaid caregivers of older adults with visual impairments; and (4) potential impacts of intervention on unpaid caregivers of older adults with visual impairments. These findings point to a lack of interventions for unpaid caregivers of older adults with visual impairments, despite the prevalence of quality of life–related barriers and adverse events in this population. This study aligns with the social model of disability as it relates to the failure of the system to meet the needs of older adults with visual impairments. Research addressing these issues is urgently needed.
Collapse
|