title: Visual impairment and nursing home placement in older Australians: the Blue Mountains Eye Study.
abstract: 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.
authors.affiliation: Department of Ophthalmology, Save Sight Institute, the University of Sydney, Westmead, NSW, Australia.
authors.forename: Jie Jin
authors.initials: JJ
authors.lastname: Wang
authors.forename: Paul
authors.initials: P
authors.lastname: Mitchell
authors.forename: Robert G
authors.initials: RG
authors.lastname: Cumming
authors.forename: Wayne
authors.initials: W
authors.lastname: Smith
mesh_terms: 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*