Visual impairment and nursing home placement in older Australians: the Blue Mountains Eye Study.
OBJECTIVE
To assess whether visual impairment at baseline is an independent contributor to subsequent nursing home placement during a 6-year follow-up.


METHODS
3654 non-institutionalised people aged 49+ years (82.4% of those eligible) who participated in baseline examinations of the Blue Mountains Eye Study (1992-94) were followed during 1997-99. Presenting visual acuity was measured with current glasses and a standardised refraction performed. We defined visual impairment as visual acuity reduced to <or=20/40. Permanent nursing home admissions during follow-up were confirmed by the regional Aged Care Assessment Team and government subsidy payment records.


RESULTS
At baseline, 511 participants had presenting visual impairment. After refraction, vision improved to 20/30 or better in 346 persons (68%, "correctable"), while 165 (32%) remained visually impaired. During follow-up, 162 study participants (5.0%) were admitted permanently to a nursing home. The age-adjusted 6-year incidence was 3.6% for participants with normal vision, 16.2% for those with visual impairment after best correction and 8.1% for those with "correctable" visual impairment. After adjusting for non-cognitive factors that predicted nursing home placement, the relative risk (RR) for nursing home admission among persons with visual impairment after best correction was 1.8 (95% CI 1.1-2.9). A similar magnitude of association was found among persons with "correctable" visual impairment (RR 2.1, 95% CI 1.4-3.1). For each line of reduction in presenting visual acuity at baseline, there was a 7% increased risk of subsequent nursing home placement.


CONCLUSIONS
This study suggests that decreased vision may be a marker or contributing factor to subsequent nursing home placement in general older populations.
Wang
Jie Jin
JJ
Department of Ophthalmology, Save Sight Institute, the University of Sydney, Westmead, NSW, Australia.
Mitchell
Paul
P
Cumming
Robert G
RG
Smith
Wayne
W
D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D005260:Female; D006304:Health Status; D006707:Homes for the Aged / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009517:New South Wales / Q000453:epidemiology; D009735:Nursing Homes / Q000706:statistics & numerical data*; D010343:Patient Admission / Q000706:statistics & numerical data*; D012306:Risk; D012309:Risk-Taking; D014786:Vision Disorders / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology; D014792:Visual Acuity / Q000502:physiology; D019987:Persons with Visual Disabilities / Q000706:statistics & numerical data*