title: Impact of visual impairment on use of community support services by elderly persons: the Blue Mountains Eye Study.
abstract: OBJECTIVE
  To estimate the impact of visual impairment in older Australians on the use of community support services.
  
  
  METHODS
  In the Blue Mountains Eye Study, 3654 people aged 49 or older were examined- 82.4% of eligible residents in an area west of Sydney, Australia. Presenting and best-corrected visual acuities were measured using a LogMAR chart. Subjects were categorized as having visual impairment if their better eye read 40 or fewer letters (20/40 or worse). Interview data included marital and other socioeconomic status measures, living status (alone or with spouse or other person), use of community support services, reliance on regular help from nonspouse family members or friends, and perceived ability to go out alone.
  
  
  RESULTS
  After adjusting for age, gender, education, living status, walking disability, and health-related factors, for each one-line (five-letter) decrease in best-corrected visual acuity, there was a corresponding increase in reliance on community support services (odds ratio [OR], 1.17; 95% confidence interval, [CI] 1.07-1.28) or combined community and family support (OR 1.22; 95% CI, 1.12-1.32). Visually impaired persons were three times as likely to use regular support services provided by the municipality (OR 3.1; 95% CI, 1.8-5.1). A similar increased reliance on regular help from community, nonspouse family members, or friends was found. Visually impaired persons were also much more likely to state that they thought they were unable to go out alone (OR 6.2; 95% CI, 2.6-14.3). The findings were similar when presenting visual acuity was used to define visual impairment or after subjects with walking disabilities were excluded. Visual impairment seemed to have a greater effect on use of community support services in women than in men.
  
  
  CONCLUSIONS
  After adjustment was made for confounding factors, visual impairment was found to affect significantly and negatively the independence of elderly people, particularly older women. Presenting visual acuity closely approximated best-corrected visual acuity in its impact on the use of community support services.
authors.affiliation: Department of Ophthalmology, University of Sydney, NSW, Australia.
authors.forename: J J
authors.initials: JJ
authors.lastname: Wang
authors.forename: P
authors.initials: P
authors.lastname: Mitchell
authors.forename: W
authors.initials: W
authors.lastname: Smith
authors.forename: R G
authors.initials: RG
authors.lastname: Cumming
authors.forename: K
authors.initials: K
authors.lastname: Attebo
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D003153:Community Health Services / Q000706:statistics & numerical data*; D005260:Female; D019538:Health Care Surveys / Q000706:statistics & numerical data*; D006302:Health Services Research / Q000379:methods; D006299:Health Services for the Aged; D006801:Humans; D008297:Male; D008875:Middle Aged; D009517:New South Wales / Q000453:epidemiology; D016017:Odds Ratio; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D014786:Vision Disorders / Q000453:epidemiology*; D014792:Visual Acuity