A randomized trial of visual impairment interventions for nursing home residents: study design, baseline characteristics and visual loss.
BACKGROUND
Visual impairment among nursing home residents is higher than in community-dwelling elderly. The provision of eye care services may be beneficial to nursing home patients. Our project, a randomized trial of vision restoration and rehabilitation in nursing home residents, compares usual care to targeted interventions. In this paper, we present the baseline characteristics of our sample within the nursing homes.


METHODS
Twenty-eight nursing homes on Maryland's Eastern Shore were matched in pairs by size and payment type. Each pair was randomized to usual care or targeted intervention. Habitual and best-corrected acuity was attempted, using standard letter symbol/charts and grating acuity charts. Visual impairment was vision in the better eye <20/40 on letter and/or grating acuity. The MiniMental State Examination (MMSE) was used to determine cognitive impairment.


RESULTS
Of those participants eligible to be screened, 40% had severe cognitive impairment (MMSE score 0-9). No measure of acuity could be ascertained on 18% of eligibles. Among the 1305 persons with acuity data, 38% had presenting vision worse than 20/40. After refractive correction, 29% had visual impairment. There was no difference by race or gender in those with visual impairment, although they were older, compared to those without visual loss.


CONCLUSIONS
The nursing home residents had high rates of both cognitive impairment and visual impairment, creating a challenging environment for visual intervention. By improving access to eye care within the context of the clinical trial, and changing either the magnitude of visual loss or the resultant impact on function, we hope to demonstrate a change in the quality of life for nursing home residents.
West
Sheila K
SK
Dana Center for Preventive Ophthalmology, Wilmer Eye Institute, Johns Hopkins Medical Institutions, 600 N. Wolfe Street, Baltimore, MD 21205, USA.
Friedman
David
D
Muñoz
Beatriz
B
Roche
Karen Bandeen
KB
Park
William
W
Deremeik
James
J
Massof
Robert
R
Frick
Kevin D
KD
Broman
Aimee
A
McGill
Wendy
W
Gilbert
Donna
D
German
Pearl
P
D000368:Aged; D000369:Aged, 80 and over; D003072:Cognition Disorders / Q000453:epidemiology; D003691:Delaware / Q000453:epidemiology; D005260:Female; D006707:Homes for the Aged / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008396:Maryland / Q000453:epidemiology; D009735:Nursing Homes / Q000706:statistics & numerical data*; D012107:Research Design; D014786:Vision Disorders / Q000453:epidemiology* / Q000534:rehabilitation*; D014792:Visual Acuity; D019987:Persons with Visual Disabilities / Q000706:statistics & numerical data*