Blindness, low vision, and other handicaps as risk factors attached to institutional residence.
OBJECTIVE
To estimate the risk of living in an institution and being visually impaired.


METHODS
Two national surveys were pooled: (1) 2075 institutions (for children or adults with handicaps, old people, and psychiatric centres) were selected randomly, in 18 predefined strata, from the French health ministry files. From these institutions, 15 403 subjects were selected randomly and handicap was documented by interview in 14 603 (94.9%) of them; (2) level of handicap was documented in a randomised, stratified sample of 356 208 citizens living in the community; from this sample, 21 760 subjects were further selected at random and 16 945 people were interviewed. Data on handicaps (visual, auditory, speech, brain, visceral, motor, and other) and activities of daily living (ADL) were extracted. The odds ratio (OR) of living in an institution was estimated, using stepwise logistic regressions with age, geographical area, handicaps, and ADL as co-variables.


RESULTS
Subjects in institutions, compared to those living at home, were, respectively, more often female (64.3% v 52.4%) and older (68.7 v 38.0 years); they more often had handicaps (ORs: speech, 6.59; brain, 10.17; motor, 8.86; visceral, 3.49; auditory, 2.66; other, 1.53); and were less often able to perform their ADL (46.2% v 97.1%) without assistance. Below 80 years, blind people were more often in institutions (ORs 0.239 to 0.306); whereas in older people the association was reversed (OR: 3.277). Low vision was always significantly associated with institutional residence (ORs from 0.262 to 0.752).


CONCLUSIONS
Visual handicap was associated with institutional residence. The link persisted after adjustment for known confounding factors.
Brézin
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AP
Hôpital Cochin-Université Paris 5, Service d'ophtalmologie, 24 rue du Faubourg Saint Jacques, F-75014 Paris, France. antoine.brezin@cch.ap-hop-paris.fr
Lafuma
A
A
Fagnani
F
F
Mesbah
M
M
Berdeaux
G
G
D000203:Activities of Daily Living; D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D001766:Blindness / Q000453:epidemiology* / Q000534:rehabilitation; D002648:Child; D002675:Child, Preschool; D004185:Disability Evaluation; D006233:Persons with Disabilities / Q000534:rehabilitation / Q000706:statistics & numerical data*; D005260:Female; D005602:France / Q000453:epidemiology; D006306:Health Surveys; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007326:Institutionalization / Q000706:statistics & numerical data*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012307:Risk Factors; D015354:Vision, Low / Q000453:epidemiology* / Q000534:rehabilitation