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Piano MEF, Nguyen BN, Gocuk SA, Joubert L, McKendrick AM. Primary eyecare provision for people living with dementia: what do we need to know? Clin Exp Optom 2023; 106:711-725. [PMID: 36375138 DOI: 10.1080/08164622.2022.2140032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 10/10/2022] [Accepted: 10/11/2022] [Indexed: 11/16/2022] Open
Abstract
Dementia comprises a group of brain disorders characterised by loss of cognitive function. Sensory loss, predominantly vision (the focus of this review) and hearing, is a significant problem for people living with dementia. Eyecare practitioners such as optometrists therefore play an important role in identifying and addressing vision-related care needs. To support provision of high quality "dementia-friendly" eyecare, this scoping review summarises recent primary research findings and available clinical practice guidelines, to identify research gaps relating to vision and dementia, and make recommendations for future research and clinical practice. The review set a priori guidelines for the population, concept and context based on the review questions. Primary research papers (2016-2021) were included via 3-step search strategy: preliminary search to index terms, full search, search reference lists of included articles for further inclusions. Additionally, websites of eyecare professional bodies in English-speaking countries were searched to identify current clinical eyecare practice guidelines relating to dementia. Study characteristics (e.g. country, study design) were reported descriptively. Patterns within findings/recommendations from included sources were identified using thematic analysis and reported as themes. 1651 titles/abstracts and 161 full-text articles were screened for eligibility. Three clinical practice guidelines were also identified. The final review included 21 sources: 18 primary research papers and 3 clinical practice guidelines. The thematic analysis reported five key themes: Diagnosis/Screening, dementia progression, findings on clinical visual testing, tailored approach to care, improving care. This scoping review demonstrated limited information about current practices of optometrists working with people living with dementia. Recent evidence reinforces the continuing need for improved eyecare for people living with dementia, taking into account their specific needs with an individualised approach. Up-to-date practical recommendations are synthesised for eyecare providers before, during and after a consultation with a person living with dementia, to better support their care.
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Affiliation(s)
- Marianne E F Piano
- Department of Optometry and Vision Sciences, School of Health Sciences, The University of Melbourne, Melbourne, Australia
- National Vision Research Institute, Australian College of Optometry, Carlton, Australia
| | - Bao N Nguyen
- Department of Optometry and Vision Sciences, School of Health Sciences, The University of Melbourne, Melbourne, Australia
| | - Sena A Gocuk
- Department of Optometry and Vision Sciences, School of Health Sciences, The University of Melbourne, Melbourne, Australia
| | - Lynette Joubert
- Department of Social Work, School of Health Sciences, The University of Melbourne, Melbourne, Australia
| | - Allison M McKendrick
- Department of Optometry and Vision Sciences, School of Health Sciences, The University of Melbourne, Melbourne, Australia
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Kwok CPC, Kwok JOT, Yan RWK, Lee KKW, Richards M, Chan WC, Chiu HFK, Lee RSY, Lam LCW, Lee ATC. Dementia and risk of visual impairment in Chinese older adults. Sci Rep 2022; 12:18033. [PMID: 36302807 PMCID: PMC9613925 DOI: 10.1038/s41598-022-22785-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 10/19/2022] [Indexed: 01/24/2023] Open
Abstract
We had previously identified visual impairment increasing risk of incident dementia. While a bi-directional vision-cognition association has subsequently been proposed, no study has specifically examined the longitudinal association between dementia and incidence of clinically defined visual impairment. In this territory-wide community cohort study of 10,806 visually unimpaired older adults, we examined their visual acuity annually for 6 years and tested if dementia at baseline was independently associated with higher risk of incident visual impairment (LogMAR ≥ 0.50 in the better eye despite best correction, which is equivalent to moderate visual impairment according to the World Health Organization definition). By the end of Year 6, a total of 3151 (29.2%) participants developed visual impairment. However, we did not find baseline dementia associating with higher risk of incident visual impairment, after controlling for baseline visual acuity, cataract, glaucoma, diabetes, hypertension, hypercholesterolemia, heart diseases, stroke, Parkinson's disease, depression, hearing and physical impairments, physical, intellectual and social activities, diet, smoking, age, sex, educational level, and socioeconomic status. Among different covariables, baseline visual acuity appears to be more important than dementia in contributing to the development of visual impairment. Our present findings highlight the need for re-evaluating whether dementia is indeed a risk factor for visual impairment.
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Affiliation(s)
- Charlotte P C Kwok
- Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Jessie O T Kwok
- Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Rachel W K Yan
- Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Kaspar K W Lee
- Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | | | - Wai C Chan
- Department of Psychiatry, The University of Hong Kong, Hong Kong SAR, China
| | - Helen F K Chiu
- Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Ruby S Y Lee
- Elderly Health Service, Department of Health, The Government of Hong Kong SAR, Hong Kong SAR, China
| | - Linda C W Lam
- Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Allen T C Lee
- Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China.
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Frame G, Schuller A, Smith MA, Crish SD, Dengler-Crish CM. Alterations in Retinal Signaling Across Age and Sex in 3xTg Alzheimer’s Disease Mice. J Alzheimers Dis 2022; 88:471-492. [PMID: 35599482 PMCID: PMC9398084 DOI: 10.3233/jad-220016] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Background: Visual disturbances often precede cognitive dysfunction in patients with Alzheimer’s disease (AD) and may coincide with early accumulation of amyloid-β (Aβ) protein in the retina. These findings have inspired critical research on in vivo ophthalmic Aβ imaging for disease biomarker detection but have not fully answered mechanistic questions on how retinal pathology affects visual signaling between the eye and brain. Objective: The goal of this study was to provide a functional and structural assessment of eye-brain communication between retinal ganglion cells (RGCs) and their primary projection target, the superior colliculus, in female and male 3xTg-AD mice across disease stages. Methods: Retinal electrophysiology, axonal transport, and immunofluorescence were used to determine RGC projection integrity, and retinal and collicular Aβ levels were assessed with advanced protein quantitation techniques. Results: 3xTg mice exhibited nuanced deficits in RGC electrical signaling, axonal transport, and synaptic integrity that exceeded normal age-related decrements in RGC function in age- and sex-matched healthy control mice. These deficits presented in sex-specific patterns among 3xTg mice, differing in the timing and severity of changes. Conclusion: These data support the premise that retinal Aβ is not just a benign biomarker in the eye, but may contribute to subtle, nuanced visual processing deficits. Such disruptions might enhance the biomarker potential of ocular amyloid and differentiate patients with incipient AD from patients experiencing normal age-related decrements in visual function.
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Affiliation(s)
- Gabrielle Frame
- Department of Pharmaceutical Sciences, Northeast Ohio Medical University, Rootstown, OH, USA
- Biomedical Sciences Graduate Program, Kent State University, Kent, OH, USA
| | - Adam Schuller
- Department of Pharmaceutical Sciences, Northeast Ohio Medical University, Rootstown, OH, USA
| | - Matthew A. Smith
- Department of Pharmaceutical Sciences, Northeast Ohio Medical University, Rootstown, OH, USA
- Rebecca D. Considine Research Institute, Akron Children’s Hospital, Akron, OH, USA
| | - Samuel D. Crish
- Department of Pharmaceutical Sciences, Northeast Ohio Medical University, Rootstown, OH, USA
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Zimmerman S, Resnick B, Ouslander J, Levy C, Gaugler JE, Sloane PD, Mor V. Pragmatic Trials and Improving Long-Term Care: Recommendations From a National Institutes of Health Conference. J Am Med Dir Assoc 2022; 23:323-327. [DOI: 10.1016/j.jamda.2022.01.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 01/06/2022] [Indexed: 12/27/2022]
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Zimmerman S, Resnick B, Ouslander J, Levy C, Gaugler JE, Sloane PD, Mor V. Pragmatic Trials and Improving Long-Term Care: Recommendations From a National Institutes of Health Conference. J Am Geriatr Soc 2022; 70:688-694. [PMID: 35195278 PMCID: PMC8915540 DOI: 10.1111/jgs.17697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 02/01/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Sheryl Zimmerman
- Cecil G. Sheps Center for Health Services Research and Schools of Social Work and Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA,Address correspondence to Sheryl Zimmerman, PhD, Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, 725 Martin Luther King Jr Blvd, Campus Box 7590, Chapel Hill, NC 27599-7590, USA. (S. Zimmerman)
| | - Barbara Resnick
- University of Maryland School of Nursing, Baltimore, MD, USA
| | - Joseph Ouslander
- Department of Integrated Medical Sciences, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, USA
| | - Cari Levy
- Department of Veterans Affairs, Rocky Mountain Regional VA Medical Center, and University of Colorado, Aurora, CO, USA
| | - Joseph E. Gaugler
- Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Philip D. Sloane
- Cecil G. Sheps Center for Health Services Research and Department of Family Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Vincent Mor
- Center of Innovation in Long-term Services and Supports, Providence VA Medical Center; Department of Health Services, Policy & Practice, Brown University School of Public Health, Providence, RI, USA
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Zimmerman S, Resnick B, Ouslander J, Levy C, Gaugler JE, Sloane PD, Mor V. Pragmatic trials and improving long-term care: Recommendations from a national institutes of health conference. Geriatr Nurs 2022; 44:288-292. [DOI: 10.1016/j.gerinurse.2022.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Khadka J, Ratcliffe J, Caughey GE, Wesselingh SL, Inacio MC. Prevalence of Eye Conditions, Utilization of Eye Health Care Services, and Ophthalmic Medications After Entering Residential Aged Care in Australia. Transl Vis Sci Technol 2021; 10:3. [PMID: 34854894 PMCID: PMC8648054 DOI: 10.1167/tvst.10.14.3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 10/25/2021] [Indexed: 01/08/2023] Open
Abstract
Purpose This study aims to evaluate the burden and trends of eye diseases, utilisation of eye health care services, and ophthalmic medications among older people living in residential aged care facilities in Australia. Methods A cross-sectional study was conducted using data from the Registry of Senior Australians. Individuals aged ≥65 years who entered permanent residential aged care facilities between 2008 and 2015 were included. The prevalence (95% confidence interval [CI]) of eye diseases by year, eye health care services, and ophthalmic medication use within a year of entry into the service were evaluated. Poisson regression models estimated adjusted rate of change using prevalence ratio (PR) by age, sex, state, and frailty scores. Results Of the 409,186 people studied, 43.6% (N = 178,367) had an eye condition. Of the total cohort, 32.9% (N = 134,566) had chronic eye conditions and 19.7% (N = 80,661) had an acute eye condition. Common chronic eye conditions were glaucoma (13.6%, N = 55,830), cataract (8%, (N = 32,779), blindness (4.5%, N = 18,856), and poor vision (10.3%, N = 42,245). Prevalence of any eye condition (2008: 42.7%, 95% CI = 42.2%-43.2% and 2015: 41.2%, 95% CI = 40.8-41.6%, PR = 0.99, 95% CI = 0.99-0.99, P < 0.001), acute eye conditions (2008: 19.8%, 95% CI = 19.4%-20.2% and 2015: 17.4%, 95% CI = 17.1%-17.6%, PR = 0.97, 95% CI = 0.97-0.98, P < 0.001), and blindness (2008: 5.2%, 95% CI = 5.0%-5.4% and 2015: 3.7%, 95% CI = 3.5%-3.9%, PR = 0.93, 95% CI = 0.93-0.94, p < 0.001). decreased over the study period. The prevalence of glaucoma (2008: 13.5%, 95% CI = 13.2%-13.8% and 2015: 13.8%, 95% CI = 13.5%-13.7%; PR = 1.01, 95% CI = 0.99-1.10, P < 0.001) and cataract (2008: 7.4%, 95% CI = 7.2%-7.7% and 2015: 8.5%, 95% CI = 8.3%-8.7%, PR = 1.00, 95% CI = 1.00-1.01, P < 0.001) remained stable or slightly increased. Overall, 46.4% (N = 82,769) of individuals with eye conditions, accessed at least one eye health service within the first year of entering residential care and 70.5% (N = 125,673) used at least one ophthalmic medication. Optometric services (41.7%, N = 74,358) were the most used eye health care services and anti-infective eye drops (37.2%, N = 66,331) were the most commonly dispensed medications. Conclusions The prevalence of blindness among older Australian using residential aged care services decreased over the study period. However, the burden of eye diseases remained high between 2008 and 2015, whereas the use of eye health care services was disproportionately low. This study provides evidence of a significant need for eye health care services for older people with an eye disease in residential aged care facilities. Translational Relevance Four in ten long term aged care residents in Australia had at least one eye condition over the study period, indicating potential for a high eye health care needs in aged care settings.
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Affiliation(s)
- Jyoti Khadka
- Registry of Senior Australians, South Australian Health and Medical Research Institute, Adelaide, Australia
- Health Economics and Social Care Group, Caring Future Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | - Julie Ratcliffe
- Health Economics and Social Care Group, Caring Future Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | - Gillian E. Caughey
- Registry of Senior Australians, South Australian Health and Medical Research Institute, Adelaide, Australia
- UniSA Allied Health and Human Performance, University of South Australia, Adelaide, South Australia, Australia
| | - Steve L. Wesselingh
- Registry of Senior Australians, South Australian Health and Medical Research Institute, Adelaide, Australia
| | - Maria C. Inacio
- Registry of Senior Australians, South Australian Health and Medical Research Institute, Adelaide, Australia
- UniSA Allied Health and Human Performance, University of South Australia, Adelaide, South Australia, Australia
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Association between vision impairment and cognitive decline in older adults with stroke: Health and Retirement Study. Aging Clin Exp Res 2021; 33:2605-2610. [PMID: 33428171 DOI: 10.1007/s40520-020-01776-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 12/07/2020] [Indexed: 10/22/2022]
Abstract
Stroke survivors may experience multiple residual symptoms post-stroke, including vision impairment (VI) and cognitive decline. Prior studies have shown that VI is associated with cognitive decline, but have not evaluated the contribution of VI to post-stroke cognitive changes. We used data from four waves (2010-2016) of the Health and Retirement Study to investigate the cognitive trajectories of stroke survivors with and without VI. Vision (excellent-very good[ref], good, fair-poor) and stroke diagnosis were self-reported. Cognition was defined using the Telephone Interview for Cognitive Status. Regression was used to model the association between vision and change in cognitive function, adjusting for confounders. The final sample included 1,439 stroke survivors and the average follow-up time was 4.1 years. Fair-poor overall (B = -1.30, p < 0.01), near (B = -1.53, p < 0.001), and distance (B = -1.27, p < 0.001) vision were associated with significantly lower baseline cognitive function. VI was not associated with the rate of cognitive decline. Future research should determine whether specific types of VI potentiate the risk of cognitive impairment and dementia in stroke survivors.
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Armstrong RA. Visual signs and symptoms of dementia with Lewy bodies. Clin Exp Optom 2021; 95:621-30. [DOI: 10.1111/j.1444-0938.2012.00770.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2011] [Revised: 01/31/2012] [Accepted: 04/03/2012] [Indexed: 11/28/2022] Open
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Zhu Z, He Y, Yang J, Li Q, Cheng H, Zhong L, Wang T, Wang T, Ling S. Study time, glasses utilization and age affect quality of life among senior first-year Chinese myopia students. Eur J Ophthalmol 2021; 31:2969-2976. [PMID: 33401944 DOI: 10.1177/1120672120982528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE To compare the quality of life of senior first-year students with normal vision and myopia, and to explore the risk factors related to quality of life in students with myopia. METHODS In this study, 1103 senior first-year students were enrolled in ten high schools. These students were divided according to the diopter degree, with 916 myopia students and 187 normal vision students. Visual function indexes, such as naked eye vision, were measured and recorded, and social demographic indexes and the National Eye Institute 25-Item Visual Function Questionnaire (NEI VFQ-25) was used. The differences in quality of life between the two groups were compared. Multiple linear regression analysis was used to explore the possible risk factors for quality of life in myopia students. RESULTS In the NEI VFQ-25, the total quality of life scores of myopia students (77.06 ± 15.66) were lower than those of normal vision students (85.49 ± 12.37). The difference was statistically significant (p = 0.007). In the correlation analysis, the total scores of quality of life in myopia students were positively correlated with wearing glasses (p = 0.049), and were negatively correlated with study time (p = 0.029). Multiple linear regression analysis showed that study time, wearing glasses and age were risk factors affecting quality of life in myopia students. CONCLUSION Our results show that senior first-year myopia students have lower quality of life scores than students with normal vision. Study time, wearing glasses and age are risk factors for quality of life in senior first-year myopia students.
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Affiliation(s)
- Ziqian Zhu
- Department of Ophthalmology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Yan He
- Department of English, Guangzhou Pui Ching Middle School, Guangzhou, China
| | - Jiezheng Yang
- Department of Ophthalmology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Qiaoli Li
- Department of Ophthalmology, Nanhai Hospital of Southern Medical University, Guangzhou, China
| | - HuanHuan Cheng
- Department of Ophthalmology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Lei Zhong
- Department of Ophthalmology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Ting Wang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Tao Wang
- Department of Ophthalmology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Shiqi Ling
- Department of Ophthalmology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
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Monaco WA, Crews JE, Nguyen ATH, Arif A. Prevalence of Vision Loss and Associations With Age-Related Eye Diseases Among Nursing Home Residents Aged ≥65 Years. J Am Med Dir Assoc 2020; 22:1156-1161. [PMID: 33041233 DOI: 10.1016/j.jamda.2020.08.036] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 08/24/2020] [Accepted: 08/26/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To examine data from Delaware nursing homes to determine prevalence of age-related eye diseases (AREDs), vision impairment, and blindness and to compare the findings with the results of 11 US investigations of vision and eye health in nursing homes. DESIGN This is a cross-sectional, retrospective study of nursing home patients. SETTING AND PARTICIPANTS Twenty nursing homes in Delaware participated in the study, yielding comprehensive eye examination records for 2019 study participants. METHODS Summary statistics and regression analyses. RESULTS The overall prevalence of vision impairment or blindness was 63.8% and was above 60% for each age, sex, and race category. Prevalence of vision impairment or blindness was 68.4% among patients with cataracts, 69.4% among patients with macular degeneration, 70.5% among patients with glaucoma, and 68.4% among patients with diabetic retinopathy. Prevalence of blindness was 14.1%. Among patients with AREDs, prevalence of blindness ranged from 15.0% for patients with cataracts to 22.6% for patients with diabetic retinopathy. When compared with other investigations, we found wide variation in vision and eye factors reported and wide variation in the prevalence of those factors. Only 4 studies diagnosed both AREDs and visual function. Seven studies reported AREDs, and 7 reported vision impairment and/or blindness. Vision impairment or blindness ranged from 29% to 67%; cataract ranged from 32% to 83%; macular degeneration ranged from 4.6% to 70.7%. Glaucoma ranged from 5.3% to 41.4%; diabetic retinopathy ranged from 1.7% to 3.1%. CONCLUSIONS AND IMPLICATIONS Comprehensive eye examinations showed that vision impairment and blindness affected 63.8% of nursing home residents. Compared with other studies, there was a wide range of vision factors reported and wide variation in the prevalence of vision impairment or blindness and AREDs. This investigation suggests the importance of eye care in nursing homes and the importance of reporting standard vision and eye health factors to inform policy and practice.
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Affiliation(s)
| | | | | | - Areeb Arif
- University of South Florida, Tampa, FL, USA
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Andrusjak W, Barbosa A, Mountain G. Identifying and Managing Hearing and Vision Loss in Older People in Care Homes: A Scoping Review of the Evidence. THE GERONTOLOGIST 2020; 60:e155-e168. [PMID: 31322168 DOI: 10.1093/geront/gnz087] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Poor identification of sensory impairments in care homes can be due to multiple factors. This scoping review identifies and synthesizes the literature into the detection of hearing and vision loss in the care home environment, and the management of these sensory losses once identified. RESEARCH DESIGN AND METHODS A scoping review methodology was used to identify primary research of any design published from 1985 to September 2018. Six electronic databases were searched, and articles were also sourced from reference lists, relevant charity organizations and published experts. RESULTS Six electronic databases and multiple gray literature sources identified 51 articles for inclusion. The evidence confirmed that lack of knowledge in care home staff, poor management of assistive aids, unsuitable environment, lack of connections with optometrists and audiologists, underuse of effective screening tools, and the added complexity of assisting those with dementia are all barriers to effective practice. Conversely, flexible training programs, availability of a variety of assistive aids, simple screening tools, and adaptions to the environment are effective facilitators. DISCUSSION AND IMPLICATION This review acknowledges that the barriers to identification and management of hearing and vision loss in care homes are multifaceted and that collaboration of multiple stakeholders is required to implement change and improve the residents' ear and eye care. Recommendations are offered to support more effective service provision tailored to meet the needs of people with sensory impairments living in care homes, and this could subsequently improve best practice.
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Affiliation(s)
- Wendy Andrusjak
- Centre for Applied Dementia Studies, Faculty of Health Studies, University of Bradford, UK
| | - Ana Barbosa
- Centre for Applied Dementia Studies, Faculty of Health Studies, University of Bradford, UK
| | - Gail Mountain
- Centre for Applied Dementia Studies, Faculty of Health Studies, University of Bradford, UK
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Receipt of Eye Care Services among Medicare Beneficiaries with and without Dementia. Ophthalmology 2020; 127:1000-1011. [PMID: 32317179 PMCID: PMC7384939 DOI: 10.1016/j.ophtha.2020.02.022] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2019] [Revised: 01/17/2020] [Accepted: 02/14/2020] [Indexed: 11/21/2022] Open
Abstract
PURPOSE To examine the relationship between dementia status and receipt of eye care among US Medicare beneficiaries. DESIGN Retrospective, claims-based analysis. PARTICIPANTS A 20% representative sample of Medicare beneficiaries who received care between January 1, 2006, and December 31, 2015. METHODS Dementia was identified from diagnosis codes documented in a beneficiary's first 3 years of observed Medicare enrollment. Eye care visits were identified from provider specialty codes on each encounter claim. We used multivariable Cox proportional hazards regression models with time-varying covariates to compare the likelihood of receiving eye care between beneficiaries with and without dementia. All models were adjusted for potential confounders, including demographics, urban/rural residence, systemic health (Charlson Index), and ocular comorbidities. MAIN OUTCOME MEASURES Hazard ratio (HR) and 95% confidence interval (CI) for (1) being seen by any eye care provider (ophthalmologist or optometrist); (2) being seen by an ophthalmologist specifically; and (3) receiving cataract surgery (among beneficiaries with ophthalmologist encounters). RESULTS A total of 4 451 200 beneficiaries met inclusion criteria; 3 805 718 (85.5%) received eye care during the study period, and 391 556 (8.8%) had diagnosed dementia. Some 73.4% of beneficiaries diagnosed with dementia saw an eye care provider during the study period and 55.4% saw an ophthalmologist versus 86.7% and 74.0% of beneficiaries, respectively, without dementia diagnoses. Compared with those without dementia diagnoses, beneficiaries with diagnosed dementia had lower likelihood of seeing any eye care provider (adjusted HR, 0.69; 95% CI, 0.69-0.70) and were less likely to see an ophthalmologist (adjusted HR, 0.55; 95% CI, 0.55-0.55). Among the subset of beneficiaries who did see ophthalmologists, those with diagnosed dementia were also less likely to receive cataract surgery than beneficiaries without diagnosed dementia (HR, 0.62; 95% CI, 0.62-0.63) and less likely to receive a cataract diagnosis (18% vs. 82%). CONCLUSIONS US Medicare beneficiaries diagnosed with dementia are less likely to receive eye care than those without diagnosed dementia. Depending on visual acuity and functional status, this may have implications for injury prevention, physical and cognitive function, and quality of life. Further work is needed to identify barriers to receiving eye care, determine eye care services and settings that provide greatest value to patients with dementia, and implement measures to improve access to appropriate eye care.
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Dry Eyes, Ocular Lubricants, and Use of Systemic Medications Known or Suspected to Cause Dry Eyes in Residents of Aged Care Services. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17155349. [PMID: 32722254 PMCID: PMC7432788 DOI: 10.3390/ijerph17155349] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 07/15/2020] [Accepted: 07/22/2020] [Indexed: 12/14/2022]
Abstract
Ocular issues are common, burdensome, and under-researched among residents of aged care services. This study aims to investigate the prevalence of dry eyes or use of ocular lubricants among residents, and the possible association with systemic medications known or suspected to cause dry eyes. A cross-sectional study of 383 residents of six aged care services in South Australia was conducted. Data were extracted from participants' medical histories, medication charts, and validated assessments. The main exposure was systemic medications known to cause, contribute to, or aggravate dry eyes. The primary outcome was documented dry eyes or regular administration of ocular lubricants. Logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for the association between systemic medications and dry eyes/use of ocular lubricants. Dry eyes were documented for 53 (13.8%) residents and 98 (25.6%) residents were administered ocular lubricants. Overall, 116 (30.3%) residents had documented dry eyes/used ocular lubricants. Of these, half (n = 58) were taking a medication known to cause, contribute to, or aggravate dry eyes. Taking one or more medications listed as known to cause dry eyes was associated with having dry eyes/use of ocular lubricants (OR 1.83, 95% CI 1.15-2.94). In sub-analyses, no individual medication was associated with dry eyes/use of ocular lubricants. Dry eyes and use of ocular lubricants are common in residential aged care. Our hypothesis generating findings suggest the need for further research into the clinical significance of systemic medications as a possible cause of dry eyes.
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Marquié M, Castilla-Martí M, Valero S, Martínez J, Sánchez D, Hernández I, Rosende-Roca M, Vargas L, Mauleón A, Rodríguez-Gómez O, Abdelnour C, Gil S, Santos-Santos MA, Alegret M, Espinosa A, Ortega G, Pérez-Cordón A, Sanabria Á, Roberto N, Moreno-Grau S, de Rojas I, Simó R, Ciudin A, Hernández C, Orellana A, Monté-Rubio G, Benaque A, Ruiz A, Tárraga L, Boada M. Visual impairment in aging and cognitive decline: experience in a Memory Clinic. Sci Rep 2019; 9:8698. [PMID: 31213626 PMCID: PMC6581941 DOI: 10.1038/s41598-019-45055-9] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Accepted: 05/23/2019] [Indexed: 12/13/2022] Open
Abstract
Visual impairment is common in people living with dementia and regular ophthalmological exams may improve their quality of life. We evaluated visual function in a cohort of elderly individuals and analyzed its association with their degree of cognitive impairment. Participants underwent neurological and neuropsychological exams, neuro-ophthalmological assessment (visual acuity, intraocular pressure, rates of past ophthalmological pathologies, use of ocular correction, treatments and surgeries) and optical coherence tomography (OCT) scan. We analyzed differences in ophthalmological characteristics among diagnostic groups. The final sample of 1746 study participants aged ≥ 50 comprised 229 individuals with Subjective Cognitive Decline (SCD), 695 with mild cognitive impairment (MCI) and 833 with Dementia (Alzheimer disease: n = 660; vascular dementia: n = 92, Lewy body dementia: n = 34; frontotemporal dementia: n = 19 and other: n = 28). Age, gender and education were used as covariates. Patients with Dementia, compared to those with SCD and MCI, presented worse visual acuity (p < 0.001), used less visual correction (p = 0.02 and p < 0.001, respectively) and fewer ophthalmological treatments (p = 0.004 and p < 0.001, respectively) and underwent fewer ocular surgeries (p = 0.009 and p < 0.001, respectively). OCT image quality worsened in parallel to cognitive decline (Dementia vs SCD: p = 0.008; Dementia vs MCI: p < 0.001). No group differences in past ophthalmological disorders or abnormal OCT findings were detected. Efforts should be made to ensure dementia patients undergo regular ophthalmological assessments to correct their visual function in order to improve their quality of life.
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Affiliation(s)
- Marta Marquié
- Alzheimer Research Center and Memory Clinic, Fundació ACE Institut Català de Neurociències Aplicades - Universitat Internacional de Catalunya (UIC), Barcelona, Spain.
| | - Miguel Castilla-Martí
- Clínica Oftalmológica Dr. Castilla, Barcelona, Spain.,Department of Ophthalmology, Hospital del Mar and Hospital de l'Esperança - Parc de Salut Mar, Barcelona, Spain
| | - Sergi Valero
- Alzheimer Research Center and Memory Clinic, Fundació ACE Institut Català de Neurociències Aplicades - Universitat Internacional de Catalunya (UIC), Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas (CIBERNED), Instituto de Salud Carlos III, Madrid, Spain
| | - Joan Martínez
- Alzheimer Research Center and Memory Clinic, Fundació ACE Institut Català de Neurociències Aplicades - Universitat Internacional de Catalunya (UIC), Barcelona, Spain
| | - Domingo Sánchez
- Alzheimer Research Center and Memory Clinic, Fundació ACE Institut Català de Neurociències Aplicades - Universitat Internacional de Catalunya (UIC), Barcelona, Spain
| | - Isabel Hernández
- Alzheimer Research Center and Memory Clinic, Fundació ACE Institut Català de Neurociències Aplicades - Universitat Internacional de Catalunya (UIC), Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas (CIBERNED), Instituto de Salud Carlos III, Madrid, Spain
| | - Maitée Rosende-Roca
- Alzheimer Research Center and Memory Clinic, Fundació ACE Institut Català de Neurociències Aplicades - Universitat Internacional de Catalunya (UIC), Barcelona, Spain
| | - Liliana Vargas
- Alzheimer Research Center and Memory Clinic, Fundació ACE Institut Català de Neurociències Aplicades - Universitat Internacional de Catalunya (UIC), Barcelona, Spain
| | - Ana Mauleón
- Alzheimer Research Center and Memory Clinic, Fundació ACE Institut Català de Neurociències Aplicades - Universitat Internacional de Catalunya (UIC), Barcelona, Spain
| | - Octavio Rodríguez-Gómez
- Alzheimer Research Center and Memory Clinic, Fundació ACE Institut Català de Neurociències Aplicades - Universitat Internacional de Catalunya (UIC), Barcelona, Spain
| | - Carla Abdelnour
- Alzheimer Research Center and Memory Clinic, Fundació ACE Institut Català de Neurociències Aplicades - Universitat Internacional de Catalunya (UIC), Barcelona, Spain
| | - Silvia Gil
- Alzheimer Research Center and Memory Clinic, Fundació ACE Institut Català de Neurociències Aplicades - Universitat Internacional de Catalunya (UIC), Barcelona, Spain
| | - Miguel A Santos-Santos
- Alzheimer Research Center and Memory Clinic, Fundació ACE Institut Català de Neurociències Aplicades - Universitat Internacional de Catalunya (UIC), Barcelona, Spain
| | - Montserrat Alegret
- Alzheimer Research Center and Memory Clinic, Fundació ACE Institut Català de Neurociències Aplicades - Universitat Internacional de Catalunya (UIC), Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas (CIBERNED), Instituto de Salud Carlos III, Madrid, Spain
| | - Ana Espinosa
- Alzheimer Research Center and Memory Clinic, Fundació ACE Institut Català de Neurociències Aplicades - Universitat Internacional de Catalunya (UIC), Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas (CIBERNED), Instituto de Salud Carlos III, Madrid, Spain
| | - Gemma Ortega
- Alzheimer Research Center and Memory Clinic, Fundació ACE Institut Català de Neurociències Aplicades - Universitat Internacional de Catalunya (UIC), Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas (CIBERNED), Instituto de Salud Carlos III, Madrid, Spain
| | - Alba Pérez-Cordón
- Alzheimer Research Center and Memory Clinic, Fundació ACE Institut Català de Neurociències Aplicades - Universitat Internacional de Catalunya (UIC), Barcelona, Spain
| | - Ángela Sanabria
- Alzheimer Research Center and Memory Clinic, Fundació ACE Institut Català de Neurociències Aplicades - Universitat Internacional de Catalunya (UIC), Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas (CIBERNED), Instituto de Salud Carlos III, Madrid, Spain
| | - Natalia Roberto
- Alzheimer Research Center and Memory Clinic, Fundació ACE Institut Català de Neurociències Aplicades - Universitat Internacional de Catalunya (UIC), Barcelona, Spain
| | - Sonia Moreno-Grau
- Alzheimer Research Center and Memory Clinic, Fundació ACE Institut Català de Neurociències Aplicades - Universitat Internacional de Catalunya (UIC), Barcelona, Spain
| | - Itziar de Rojas
- Alzheimer Research Center and Memory Clinic, Fundació ACE Institut Català de Neurociències Aplicades - Universitat Internacional de Catalunya (UIC), Barcelona, Spain
| | - Rafael Simó
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III, Madrid, Spain.,Institut de Recerca Vall d'Hebron, Universitat Autònoma de Barcelona (VHIR-UAB), Barcelona, Spain
| | - Andreea Ciudin
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III, Madrid, Spain.,Institut de Recerca Vall d'Hebron, Universitat Autònoma de Barcelona (VHIR-UAB), Barcelona, Spain
| | - Cristina Hernández
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III, Madrid, Spain.,Institut de Recerca Vall d'Hebron, Universitat Autònoma de Barcelona (VHIR-UAB), Barcelona, Spain
| | - Adelina Orellana
- Alzheimer Research Center and Memory Clinic, Fundació ACE Institut Català de Neurociències Aplicades - Universitat Internacional de Catalunya (UIC), Barcelona, Spain
| | - Gemma Monté-Rubio
- Alzheimer Research Center and Memory Clinic, Fundació ACE Institut Català de Neurociències Aplicades - Universitat Internacional de Catalunya (UIC), Barcelona, Spain
| | - Alba Benaque
- Alzheimer Research Center and Memory Clinic, Fundació ACE Institut Català de Neurociències Aplicades - Universitat Internacional de Catalunya (UIC), Barcelona, Spain
| | - Agustín Ruiz
- Alzheimer Research Center and Memory Clinic, Fundació ACE Institut Català de Neurociències Aplicades - Universitat Internacional de Catalunya (UIC), Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas (CIBERNED), Instituto de Salud Carlos III, Madrid, Spain
| | - Lluís Tárraga
- Alzheimer Research Center and Memory Clinic, Fundació ACE Institut Català de Neurociències Aplicades - Universitat Internacional de Catalunya (UIC), Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas (CIBERNED), Instituto de Salud Carlos III, Madrid, Spain
| | - Mercè Boada
- Alzheimer Research Center and Memory Clinic, Fundació ACE Institut Català de Neurociències Aplicades - Universitat Internacional de Catalunya (UIC), Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas (CIBERNED), Instituto de Salud Carlos III, Madrid, Spain
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Abstract
The prevalence of dementia is expected to rise with the aging of our population for decades to come. Neuropsychiatric symptoms of dementia, also known as behavioral and psychologic symptoms of dementia, are extremely common. Symptoms are most prevalent in the moderate stages of the disease, often increase with advancing disease stage, and often more than one symptom is present. These symptoms can cause a great deal of distress for patients and families, and take a toll on society as well. Evaluation and management can be challenging, with nonpharmacologic strategies recommended as first-line approach. There is growing evidence for specific pharmacologic strategies, but these come with significant risk, such that informed consent with the patient and surrogate decision maker is critical. In this chapter, we focus on general principles of etiology, assessment, and management, and then turn to individual symptoms of agitation, psychosis, apathy, sleep disturbance, and feeding and eating problems more specifically. Depression and anxiety are covered elsewhere in this text.
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Affiliation(s)
- Rebecca Radue
- Division of Geriatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States; Geriatric Research, Education and Clinic Center, William S. Middleton Memorial Veterans Hospital, Madison, WI, United States
| | - Art Walaszek
- Department of Psychiatry, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States.
| | - Sanjay Asthana
- Division of Geriatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States
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Girard B, Chouard B, Hardy F. [Cataract surgery among 50 Alzheimer's patient (55 eyes)]. J Fr Ophtalmol 2017; 40:487-498. [PMID: 28571835 DOI: 10.1016/j.jfo.2017.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Revised: 01/02/2017] [Accepted: 01/03/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Cataract surgery for 50 Alzheimer patients (55 eyes). METHODS Cinquante Alzheimer's patients with 0≤MMS≤25, with bilateral disabling cataracts were included for surgery. The surgical technique is analyzed. RESULTS AND CONCLUSION The preoperative examination of Alzheimer's patients is time consuming and requires experience in this area, which is important to integrate into the practice of ophthalmology. The type of cataract is unusual, with a predilection for pseudoexfoliation syndrome and zonular fragility that has to be managed during surgery. The procedure may be performed under local anesthesia. Three months after surgery, Alzheimer's patients demonstrated improved visual acuity (P<0.001) with no worsening of their dementia.
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Affiliation(s)
- B Girard
- Service d'ophtalmologie, hôpital Tenon, AP-HP, 4, rue de la Chine, 75020 Paris, France; Service d'ophtalmologie V, centre hospitalier national d'ophtalmologie des Quinze-Vingts, 28, rue de Charenton, 75012 Paris, France.
| | - B Chouard
- Service d'ophtalmologie, hôpital Tenon, AP-HP, 4, rue de la Chine, 75020 Paris, France
| | - F Hardy
- Service d'anesthésie, centre hospitalier national d'ophtalmologie des Quinze-Vingts, 28, rue de Charenton, 75012 Paris, France
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18
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Girard B, Chouard B, Levy P, Luquel L, Seux ML, Drunat O. Modifications des troubles du comportement après l’opération de la cataracte chez les patients Alzheimer. J Fr Ophtalmol 2016; 39:675-686. [DOI: 10.1016/j.jfo.2016.05.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Revised: 05/17/2016] [Accepted: 05/25/2016] [Indexed: 11/26/2022]
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19
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Thibault L, Kergoat H. Eye care services for older institutionalised individuals affected by cognitive and visual deficits: a systematic review. Ophthalmic Physiol Opt 2016; 36:566-83. [DOI: 10.1111/opo.12311] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Accepted: 06/03/2016] [Indexed: 11/30/2022]
Affiliation(s)
| | - Hélène Kergoat
- École d'optométrie; Université de Montréal; Montréal Canada
- Institut universitaire de gériatrie de Montréal; Montréal Canada
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20
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Armstrong R, Kergoat H. Oculo-visual changes and clinical considerations affecting older patients with dementia. Ophthalmic Physiol Opt 2015; 35:352-76. [DOI: 10.1111/opo.12220] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2014] [Accepted: 05/19/2015] [Indexed: 12/18/2022]
Affiliation(s)
| | - Hélène Kergoat
- École d'optométrie; Université de Montréal; Montreal Canada
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21
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Barnes SS, Sewell DD. The value and underutilization of simple reading glasses in geropsychiatry inpatient settings. Am J Alzheimers Dis Other Demen 2014; 29:657-9. [PMID: 24928818 PMCID: PMC10852888 DOI: 10.1177/1533317514539034] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2024]
Abstract
For almost everyone, the need for reading glasses is an inevitable part of the second half of life. Forgetting one's reading glasses at a restaurant can be a disturbing reminder of one's dependence on them. For geriatric inpatients, however, the value of reading glasses in improving quality of life and preventing delirium may be overlooked. Subsequently, the authors present a brief review of visual impairment, the relationship of visual impairment and cognition and the cost of reading glass, and the results of a survey that was conducted to determine the proportion of inpatient geriatric psychiatry inpatient units in the United States, which provide reading glasses to inpatients as well as to assess the knowledge of medical directors of these units regarding the cost and perceived value of providing reading glasses to hospitalized patients.
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Affiliation(s)
- Shawn S Barnes
- Department of Psychiatry, University of California, San Diego, CA, USA
| | - Daniel D Sewell
- Department of Psychiatry, University of California, San Diego, CA, USA
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22
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Armstrong RA. Visual signs and symptoms of multiple system atrophy. Clin Exp Optom 2014; 97:483-91. [PMID: 25256122 DOI: 10.1111/cxo.12206] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2013] [Revised: 04/24/2014] [Accepted: 06/05/2014] [Indexed: 11/26/2022] Open
Abstract
Multiple system atrophy (MSA) is a rare movement disorder and a member of the 'parkinsonian syndromes', which also include Parkinson's disease (PD), progressive supranuclear palsy (PSP), dementia with Lewy bodies (DLB) and corticobasal degeneration (CBD). Multiple system atrophy is a complex syndrome, in which patients exhibit a variety of signs and symptoms, including parkinsonism, ataxia and autonomic dysfunction. It can be difficult to separate MSA from the other parkinsonian syndromes but if ocular signs and symptoms are present, they may aid differential diagnosis. Typical ocular features of MSA include blepharospasm, excessive square-wave jerks, mild to moderate hypometria of saccades, impaired vestibular-ocular reflex (VOR), nystagmus and impaired event-related evoked potentials. Less typical features include slowing of saccadic eye movements, the presence of vertical gaze palsy, visual hallucinations and an impaired electroretinogram (ERG). Aspects of primary vision such as visual acuity, colour vision or visual fields are usually unaffected. Management of the disease to deal with problems of walking, movement, daily tasks and speech problems is important in MSA. Optometrists can work in collaboration with the patient and health-care providers to identify and manage the patient's visual deficits. A more specific role for the optometrist is to correct vision to prevent falls and to monitor the anterior eye to prevent dry eye and control blepharospasm.
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23
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Morley JE. Mild Cognitive Impairment—A Treatable Condition. J Am Med Dir Assoc 2014; 15:1-5. [DOI: 10.1016/j.jamda.2013.11.001] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2013] [Accepted: 11/04/2013] [Indexed: 01/24/2023]
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Cadieux MA, Garcia LJ, Patrick J. Needs of people with dementia in long-term care: a systematic review. Am J Alzheimers Dis Other Demen 2013; 28:723-33. [PMID: 24005852 PMCID: PMC10852926 DOI: 10.1177/1533317513500840] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
With the aging of the population and the projected increase of dementia in the coming years, it is crucial that we understand the needs of people with dementia (PWD) in order to provide appropriate care. The aim of this study is to determine, using the best evidence possible, the care needs of PWD living in long-term care (LTC). A total of 68 studies, published between January 2000 and September 2010, were identified from six databases. From the selected studies, 19 needs of PWD were identified. The existing evidence suggests that psychosocial needs such as the need to engage in daily individualized activities and care must not be ignored in LTC. This review aims to provide a clearer picture of the needs of this growing patient population.
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Affiliation(s)
- Marie-Andrée Cadieux
- Faculty of Health Sciences, Interdisciplinary School of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Linda J. Garcia
- Faculty of Health Sciences, Interdisciplinary School of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
- Bruyère Research Institute, Ottawa, Ontario, Canada
| | - Jonathan Patrick
- Telfer School of Management, University of Ottawa, Ottawa, Ontario, Canada
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25
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Lawrence V, Murray J. Promoting independent living among people with dementia and sight loss. ACTA ACUST UNITED AC 2013. [DOI: 10.1179/csm.2009.3.3.261] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Factors favoring a degradation or an improvement in activities of daily living (ADL) performance among nursing home (NH) residents: A survival analysis. Arch Gerontol Geriatr 2013; 56:250-7. [DOI: 10.1016/j.archger.2012.09.001] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2012] [Revised: 09/06/2012] [Accepted: 09/07/2012] [Indexed: 11/19/2022]
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27
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Kang H. Correlates of Social Engagement in Nursing Home Residents with Dementia. Asian Nurs Res (Korean Soc Nurs Sci) 2012; 6:75-81. [DOI: 10.1016/j.anr.2012.05.006] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2011] [Revised: 05/15/2012] [Accepted: 05/15/2012] [Indexed: 11/16/2022] Open
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Abstract
Progressive supranuclear palsy is a rare, degenerative brain disorder and the second most common syndrome in which the patient exhibits 'parkinsonism', that is, a variety of symptoms involving problems with movement. General symptoms include difficulties with gait and balance; the patient walking clumsily and often falling backwards. The syndrome can be difficult to diagnose and visual signs and symptoms can help to separate it from closely related movement disorders such as Parkinson's disease, multiple system atrophy, dementia with Lewy bodies and corticobasal degeneration. A combination of the presence of vertical supranuclear gaze palsy, fixation instability, lid retraction, blepharospasm and apraxia of eyelid opening and closing may be useful visual signs in the identification of progressive supranuclear palsy. As primary eye-care practitioners, optometrists should be able to identify the visual problems of patients with this disorder and be expected to work with patients and their carers to manage their visual welfare.
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Labreche T, Stolee P, McLeod J. An optometrist-led eye care program for older residents of retirement homes and long-term care facilities. Can Geriatr J 2011; 14:8-11. [PMID: 23251304 PMCID: PMC3516338 DOI: 10.5770/cgj.v14i1.3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background and Purpose Visual impairment among older adults residing in long-term care (LTC) facilities and retirement homes is common and can have a significant adverse impact on their quality of life. Despite the burden of illness, they frequently receive inadequate eye care. We describe an optometrist-led eye care program serving this population, including a profile of participants and the program’s educational role for optometry students. Methods An optometrist assessed residents of LTC facilities and retirement homes. Participants received their routine eye care, which included a report to the resident’s family physician, through the program. A chart review was conducted for a consecutive series of patients; data were recorded on a standardized data abstraction form. Results All residents examined had at least one (average 1.8) ocular condition. Challenges presented by residents in their assessment, such as confusion and/or impaired comprehension (14.3%), refusal or poor cooperation (13.2%), and physical limitations (8.8%), were common, indicating the necessity of adapting eye assessment procedures to the needs of this population. Conclusion This study supports the involvement of optometrists in the eye care for residents of retirement homes and LTC facilities, where optometrists can be an important clinical and educational resource. The program is a useful learning opportunity for optometry students.
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Affiliation(s)
- Tammy Labreche
- School of Optometry, University of Waterloo, Waterloo, Ontario
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30
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Ishii S, Streim JE, Saliba D. Potentially Reversible Resident Factors Associated with Rejection of Care Behaviors. J Am Geriatr Soc 2010; 58:1693-700. [DOI: 10.1111/j.1532-5415.2010.03020.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Kymes SM, Plotzke MR, Li JZ, Nichol MB, Wu J, Fain J. The increased cost of medical services for people diagnosed with primary open-angle glaucoma: a decision analytic approach. Am J Ophthalmol 2010; 150:74-81. [PMID: 20493465 DOI: 10.1016/j.ajo.2010.01.037] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2008] [Revised: 01/12/2010] [Accepted: 01/15/2010] [Indexed: 11/19/2022]
Abstract
PURPOSE Glaucoma accounts for more than 11% of all cases of blindness in the United States, but there have been few studies of economic impact. We examine incremental cost of primary open-angle glaucoma considering both visual and nonvisual medical costs over a lifetime of glaucoma. DESIGN A decision analytic approach taking the payor's perspective with microsimulation estimation. METHODS We constructed a Markov model to replicate health events over the remaining lifetime of someone newly diagnosed with glaucoma. Costs of this group were compared with those estimated for a control group without glaucoma. The cost of management of glaucoma (including medications) before the onset of visual impairment was not considered. The model was populated with probability data estimated from Medicare claims data (1999 through 2005). Cost of nonocular medications and nursing home use was estimated from California Medicare claims, and all other costs were estimated from Medicare claims data. RESULTS We found modest differences in the incidence of comorbid conditions and health service use between people with glaucoma and the control group. Over their expected lifetime, the cost of care for people with primary open-angle glaucoma was higher than that of people without primary open-angle glaucoma by $1688 or approximately $137 per year. CONCLUSIONS Among Medicare beneficiaries, glaucoma diagnosis not found to be associated with significant risk of comorbidities before development of visual impairment. Further study is necessary to consider the impact of glaucoma on quality of life, as well as aspects of physical and visual function not captured in this claims-based analysis.
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Affiliation(s)
- Steven M Kymes
- Department of Ophthalmology and Visual Sciences, Washington University School of Medicine, St. Louis, Missouri 63110-1093, USA.
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"Out of sight, out of mind": a qualitative study of visual impairment and dementia from three perspectives. Int Psychogeriatr 2009; 21:511-8. [PMID: 19265571 DOI: 10.1017/s1041610209008424] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Dementia and visual impairment are among the most common medical conditions in later life. Almost nothing is known about the experiences and needs of older adults with both conditions. METHOD In this qualitative study using in-depth individual interviews, multiple perspectives were sought through a case-study approach. Fifty-two interviews were conducted: 17 with older adults with visual impairment and dementia, 17 with family caregivers, and 18 with care professionals. RESULTS Impaired memory and a lack of visual cues created profound disorientation and distress, which could be manifested in disruptive behavior. Visual hallucinations compounded older adults' disorientation, and caregivers were uncertain about how to manage them. Visual impairments reduced the ability of older adults to perform certain activities safely, while dementia impaired their ability to assess the risks accurately. Concerns about safety prompted family members to limit their relatives' activities even in early stages of dementia. Low-vision services perceived themselves to be ill equipped to manage dementia-related needs, while visual needs were accorded a low priority by dementia services. A lack of joint working by the two services led to an overcautious approach. CONCLUSIONS The research identified considerable unmet needs and opportunities to improve care. The provision of clear verbal communication and optimized visual inputs is likely to reduce disorientation, distress and agitated behavior, while one-to-one contact is needed to overcome feelings of isolation. Family caregivers require additional respite services and advice on managing hallucinations. Increased sharing of information and skills between mental health and low-vision professionals would help maximize older adults' independence.
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Jung S, Coleman A, Weintraub NT. Vision Screening in the Elderly. J Am Med Dir Assoc 2007; 8:355-62. [PMID: 17619034 DOI: 10.1016/j.jamda.2007.01.096] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2006] [Revised: 01/22/2007] [Indexed: 11/20/2022]
Affiliation(s)
- Susan Jung
- David Geffen School of Medicine at UCLA, Los Angeles, CA
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