title: Visual impairment and subsequent use of support services among older people: longitudinal findings from the Blue Mountains Eye Study.
abstract: OBJECTIVE
  To assess the impact of visual impairment and blindness on the incident use of community support services in the Blue Mountains Eye Study.
  
  
  METHODS
  Population-based cohort.
  
  
  METHODS
  Of 3654 baseline participants (1992-1994), 2334, 1952, and 1149 were re-examined after 5, 10, and 15 years, respectively. Incident visual impairment was defined as subsequent development of visual impairment (visual acuity <20/40) in the better eye of subjects with best-corrected visual acuity ≥20/40 at baseline. Community support service use included regular use of Meals on Wheels, Home Care, or community nurse services. Informal support included assistance from family or friends. Discrete logistic regression models with time-dependent study and outcome variables were used to assess associations between visual impairment and subsequent use of support, adjusted for potential confounders.
  
  
  RESULTS
  Among participants with bilateral visual impairment at baseline, incident use of community services over 5-15 years was 41.7% compared to 19.4% in those without visual impairment at baseline (odds ratio, 1.39; 95% confidence interval, 0.54-3.60). Persons with incident bilateral visual impairment were more likely to subsequently need community support (odds ratio, 3.32; confidence interval 1.96-5.59) in 5 years, compared to persons without visual impairment during the entire follow-up period. Baseline older age, walking disability, receiving pension, and having 2+ hospital admissions within 12 months were also significantly associated with incident use of support services.
  
  
  CONCLUSIONS
  Development of bilateral visual impairment in this cohort was associated with greater likelihood of subsequent use of community or informal support services in 5 years, independent of physical comorbidities.
authors.affiliation: Centre for Vision Research, Department of Ophthalmology and Westmead Millennium Institute, University of Sydney, Sydney, Australia.
authors.forename: Thomas
authors.initials: T
authors.lastname: Hong
authors.forename: Paul
authors.initials: P
authors.lastname: Mitchell
authors.forename: George
authors.initials: G
authors.lastname: Burlutsky
authors.forename: Calvin Sze-Un
authors.initials: CS
authors.lastname: Fong
authors.forename: Elena
authors.initials: E
authors.lastname: Rochtchina
authors.forename: Jie Jin
authors.initials: JJ
authors.lastname: Wang
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D001766:Blindness / Q000503:physiopathology*; D003153:Community Health Services / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D006301:Health Services Needs and Demand / Q000706:statistics & numerical data*; D006302:Health Services Research; D006801:Humans; D057187:Independent Living; D008297:Male; D008875:Middle Aged; D009517:New South Wales; D012944:Social Support; D011795:Surveys and Questionnaires; D015354:Vision, Low / Q000503:physiopathology*; D014792:Visual Acuity / Q000502:physiology; D019987:Persons with Visual Disabilities