Psycho-social impact of visual impairment on health-related quality of life among nursing home residents

Provision of eye care services and interventions in care homes: a narrative synthesis review

BACKGROUND

The prevalence of eye disease and visual impairment in care home residents is disproportionately higher compared to the general population. Access to eye care services and treatment can be variable for this vulnerable population.

OBJECTIVE

This paper reviews the available evidence of services and interventions for delivering eye care to care home residents. The key review questions are: (1) What is the existing evidence for eye care interventions or services (including service configuration) for care home residents? (2) Does the provision of these interventions or services improve outcomes?

METHODS

Literature search of EMBASE/MEDLINE for original papers published since 1995. Two reviewers independently reviewed abstracts/papers. Data were extracted and evaluated using narrative synthesis.

RESULTS

13 original papers met the inclusion criteria. Domiciliary optometrist services improved diagnosis and management of eye conditions, with one study showing 53% of residents benefited from direct ophthalmology intervention. Provision of interventions, such as cataract surgery, refractive error correction and low-vision rehabilitation, improved visual acuity and vision-related quality of life but did not improve cognitive or physical function, depression or health-related quality of life. There was little UK-based literature to inform eye service design or interventions to improve outcomes such as falls.

CONCLUSION

Care home-based eye assessments improve the management of eye conditions. Interventions improve visual acuity and vision-related quality of life. Further research is needed to better understand current UK services, access difficulties or examples of good practice as well as to identify and test cost-effective service models for this vulnerable group.

Socio-demographic variables related to self-esteem, psychological stress and health-related quality of life among older adults: A cross-sectional study in Kavrepalanchowk district of Nepal

Objective

The study aimed to assess how socio-demographic variables related to self-esteem, psychological stress and health-related quality of life among older adults in Nepal.

Method

A cross-sectional community-based study was conducted in the Kavrepalanchowk district of Nepal. A two-stage cluster sampling technique was used for selecting the study areas, and 239 older adult participants were selected randomly from the clusters. The interview technique was applied to gather data using validated tools. The tools used in the study were Rosenberg self-esteem scale, Perceived Stress Scale and WHOQOL-BREF scale. Scoring was carried out for self-esteem, perceived stress and WHOQOL-BREF in accordance with the procedures. Data were analyzed using descriptive statistics and inferential statistics (Chi-square, independent t-test and one-way analysis of variance).

Results

Among the total participants, 27.2% were 60-64 years old and more than two-thirds (69.9%) were male. The majority of participants were married (65.5%) and cannot read and write (60.7%). Half of the older adults (49.8%) were living with their partners. Self-esteem was high among the age group 70-74 years (24.80 ± 3.01), and psychological stress was high among the age group 60-64 years (17.23 ± 2.93) within the older adults. Furthermore, the mean score for the social relationship domain and physical health domain of health-related quality of life were 12.0 and 11.9, respectively. Comparing the domains of physical health, psychological health and social relationship with age and education level were statistically significant.

Conclusion

Self-esteem was lower among older male adults aged 60-64 years and those who attended secondary level education. An increase in participants' age increases the psychological stress and decreases the psychological domain of health-related quality of life.

Association of vision problems with psychosocial factors among middle-aged and older individuals: findings from a nationally representative study

Objectives: Little is known about the specific association of vision loss and psychosocial outcome measures in contrast to other health limitations. The aim of this study was to identify whether vision problems are associated with psychosocial outcomes among middle-aged and older adults and to compare it with the association between other chronic health conditions and psychosocial factors.Method: Cross-sectional data came from wave 5 (2014) of the German Ageing Survey which is a representative sample of non-institutionalized individuals ≥ 40 years in Germany. Psychosocial outcomes (life satisfaction, positive affect, negative affect, depressive symptoms, optimism, general self-esteem, and social isolation) were assessed using well-established and widely used scales. Self-rated trouble reading the newspaper due to vision problems and self-rated difficulties recognizing known people on the street due to vision problems were used as independent variables of interest.Results: Regressions showed that both 'vision problems: reading the newspaper' and 'vision problems: difficulties recognizing people' are consistently associated with worse psychosocial outcomes (decreased life satisfaction, decreased positive affect, increased negative affect, increased depressive symptoms, decreased optimism, decreased self-esteem and increased social isolation). In contrast, none of the physical illnesses was consistently associated with all psychosocial outcome measures.Conclusion: Adjusting for various potential confounders and in contrast to various chronic diseases, our findings emphasize an association between vision problems and worse psychosocial outcomes in middle-aged and older adults. Future longitudinal studies are needed to validate our findings.

Quality of life of low vision patients: a systematic review and meta-analysis

OBJECTIVE

Quality of vision plays an important role in everyday living, and low vision (LV) can take a toll on individual's quality of life (QOL). The objective of this paper is to evaluate the impact of LV on QOL and depressive symptoms in LV patients compared with healthy controls.

DESIGN

Systematic review and meta-analysis.

METHODS

Literature was systematically searched to obtain all relevant records. Covidence software was used to conduct the systematic review. Duplicate records were removed, and 2 independent reviewers screened records for relevance. After screening, risk of bias assessment was carried out. Data were extracted and meta-analysis was performed using STATA 15.0. Fixed-effect and random-effect models were computed based on heterogeneity.

RESULTS

In total, 2870 records were retrieved from database and grey literature searches. Twelve articles (35 341 subjects) were included for quantitative analysis. Overall, the QOL of LV patients was significantly lower compared with healthy individuals. Common QOL questionnaires, including 25-item visual function questionnaire (VFQ-25) (standard mean difference [SMD] = 0.91, confidence interval [CI]: [0.42-1.40]), 36-item short form survey (SMD = 0.53, CI: [0.26-0.80]), VFQ-14 (SMD = 0.58, CI: [0.42-0.74]), and visual function QOL questionnaire (SMD = 0.68, CI: [0.54-0.82]), demonstrated a poor QOL in LV patients compared with healthy controls. Additionally, odds of depressive symptoms were significantly greater (odds ratio = 2.25, CI: [1.58-3.21]) in LV patients compared with controls.

CONCLUSION

LV patients demonstrated a poor QOL and higher odds of depressive symptoms compared with healthy controls.

Dual sensory impairment and psychosocial factors. Findings based on a nationally representative sample

BACKGROUND

A considerable proportion of individuals in late life experience dual sensory impairment (DSI), which can be defined as the combined presence of hearing and visual problems. However, there is little knowledge regarding the psychosocial correlates of DSI. Consequently, our objective of this study was to identify the link between DSI and psychosocial factors in middle-aged and older adults.

METHODS

Data were used from the sixth wave of the nationally representative German Ageing Survey. Individuals were classified as dual sensory impaired when both visual and hearing impairments existed. As psychosocial correlates, we included life satisfaction, positive affect, negative affect, depressive symptoms, loneliness, social isolation, self-esteem and autonomy. Outcome measures were quantified using widely established scales. In our analytical sample, there were 5138 observations.

RESULTS

Bivariate analysis showed that, compared to individuals with no sensory impairment, individuals with DSI had markedly worse psychosocial factors (in terms of life satisfaction, positive affect, negative affect, depressive symptoms, loneliness, social isolation, self-esteem and autonomy). Adjusting for various covariates, regression analysis showed that individuals with DSI consistently experienced worse psychosocial factors compared to individuals with no sensory impairment.

CONCLUSION

Our current study stressed the cross-sectional association between DSI and worse psychosocial factors. Longitudinal studies are needed to confirm our findings.

Quality-of-Life and Psychosocial Aspects in Patients with Ocular Toxoplasmosis: A Clinical Study in a Tertiary Care Hospital in Brazil

PURPOSE

To evaluate quality of life in patients with uveitis-related to toxoplasmosis and its correlation with demographic, ocular involvement and psychosocial aspects.Methods: Data were collected through standardized interviews using a form to collect clinical and demographic data, in addition forms such as HADS, SF-12, NEI-VFQ-25 for health-related quality of life and anxiety and depression symptoms.Results: 81 patients were included with a mean age of 41.5 ± 14.5 years, females (50.6%) They were divided into three categories of best corrected visual acuity in the better seeing eye: normal (0-0.4 logMAR, 60 participants), low vision (0.48-0.9 logMAR, 9 participants) and blindness (>1 logMAR, 12 participants). The mean of VFQ-25 score was 75.5 ± 19.5 and the mean of SF-12 physical and mental components scores were 48.5 ± 7.4 and 52.4 ± 10.6 for health-related quality of life (HRQol). Anxiety symptoms were most prevalente than depression and were found in 38% of the subjects.Conclusions: Slightly more than a quarter of the sample presented impaired vision. It is associated with worsening of the quality of life since it affects mostly mental and related to the vision domains. This affects familiar, social and in addition, labor relations, since the majority of the subjects are in the economically active age group.

The association between visual impairment and fatigue: a systematic review and meta-analysis of observational studies

PURPOSE

The aim was to compare fatigue levels between patients with visual impairment and controls with normal sight and to examine the association between fatigue and vision loss severity.

METHODS

A systematic literature search was performed using databases of PubMed, Embase, PsycINFO and Cochrane to identify observational studies with outcomes related to fatigue (e.g. vitality subscale of the Short-Form 36, Fatigue Assessment Scale). A meta-analysis was performed using standardised mean differences (SMDs) and odds ratios (OR) to quantitatively summarise the association between visual impairment and fatigue. Sources of heterogeneity were explored by subgroup and sensitivity analyses. Study quality was assessed with the Newcastle-Ottawa scale.

RESULTS

After reviewing 4477 studies, 22 studies with a total of 40 004 participants were included, of which 18 contributed to meta-analysis. Among these, eight were assessed as moderate quality studies and 10 as high quality studies. Pooled analysis involving 2500 patients and 8395 controls showed higher fatigue severity levels (S.M.D. = -0.36, 95% CI -0.50 to -0.22, 14 studies) among visually impaired patients compared to normally sighted controls. This effect size was small and persisted in sensitivity analyses that involved study quality, fatigue assessment tools and visual acuity data. Furthermore, pooled analysis of four studies including 2615 patients and 5438 controls showed a significant association between visual impairment and fatigue (OR = 2.61, 95% CI 1.69 to 4.04). Secondary meta-analysis of four studies showed no significant difference in fatigue severity (S.M.D. = 0.01, 95% CI -0.37 to 0.39) between patients with moderate visual impairment and patients with severe visual impairment or blindness.

CONCLUSIONS

Current moderate to high quality evidence suggest that patients with visual impairment experience more severe fatigue symptoms than persons with normal sight. However, a limited number of available studies indicates that fatigue is not associated with severity of vision loss. Future studies are required to determine which factors and underlying mechanisms may explain the association between visual impairment and fatigue. Discussing fatigue at an early stage and developing intervention options for vision-related fatigue should be considered within the field of low vision rehabilitation.

Vision Loss Among Delaware Nursing Home Residents

Objectives: To determine the prevalence of vision loss among Delaware nursing home residents for further data collection to expand the existing evidence about the vision loss among nursing home residents on a national level. Methods: This cross-sectional study involved the statistical analysis of comprehensive eye examination records of 1,856 nursing residents residing in 20 Delaware nursing homes from 2005 to 2011. Descriptive statistical analyses were conducted to identify age-specific prevalence rates of vision loss (moderate-to-severe vision impairment and blindness). Results: The mean age of nursing home residents was 82.54 years (range: 65-111 years), and 61.70% were over the age of 80 years. The majority of nursing home residents were female (64.10%) and White (76.30%). The overall prevalence rates of moderate-to-severe vision impairment and blindness were 47.40% and 16.20%, respectively. Discussion: The high prevalence of vision loss among Delaware Nursing home residents indicates a demand for further data collection for expanding the existing evidence about the vision loss among nursing home residents on a national level.

Investigating the effect of physical games on the memory and attention of the elderly in adult day-care centers in Babol and Amol

Background: Physical activity is a behavioral strategy that increases general (public) health, including the mental performance of individuals. The goal of this study was to investigate the effect of group physical games on cognitive performance (memory, attention) of old people in adult day-care centers.

Methods: In this quasi-experimental study, 50 elderly people (aged >60 years) were selected from two adult day-care centers using available sampling and divided into two groups: control and intervention. As approval was received from the Babol Hamrah Salamat adult day-care center to modify the design of the center’s yard, this center was selected to conduct an intervention program. The intervention group received a physical activity program twice a week for 6 weeks. Questionnaires that were used for collecting data included demographic questions, a standard questionnaire for daily activities of living, and a short-term test, the Abbreviated Mental Test Score. Cognitive function was assessed with the Wechsler Memory Scale (WMS) (Form A), before and after the intervention. Statistical analysis of normal variables was performed using independent and paired t-tests and in non-standard cases with Mann–Whitney and Wilcoxon non-parametric tests at a significance level of P<0.05, using SPSS software (version 22).

Results: Statistical analysis showed that the scores of the subjects in the intervention group, compared to the control group, had significantly improved. The calculated mean differences in the intervention groupwere, for memory function d=8.4±3.3 (P=0.001), and for attention and concentration d=4.18±2.38 (P<0.001) (WMS). This level of change in the intervention group was significant.

Conclusion: The results of this study showed that a physical exercise program can improve the memory and attention/concentration of the elderly. Therefore, it seems that such activities are a useful method for maintaining cognitive function.

Regulation of Dietary Habits: The effect of losing weight on quality of life

OBJECTIVE

This study aimed to investigate the effects of regulation of nutritional habits on quality of life by applying Short Form (SF-36) Quality of Life Scale.

METHODS

SF-36 was administered through face-to-face interviews to a total of 129 individuals (112 female, 17 male) aged 18-65 years. Anthropometric measurements, body mass index, and waist circumference measurement were undertaken simultaneously. The changes in weight, body mass index, waist circumference measurement, and SF-36 scores were compared at baseline and three months after modification of dietary habits.

RESULTS

At three months after the regulation of dietary habits, a statistically significant decrease was found in weight, body mass index, and waist circumference measurements (p<0.05). Overall improvement was observed in all the quality of life parameters assessed with SF-36, and among them, the sub-scales of general health, bodily pain and vitality were statistically significant (p<0.05). The improvement in these sub-scale scores was similar to the literature.

CONCLUSION

The individuals who lost weight through adopting healthy dietary habits had increased SF-36 scores, indicating the positive effect of regulating diet on their quality of life.

Depression, malnutrition, and health-related quality of life among Nepali older patients

BACKGROUND

Little is known about the health, nutrition, and quality of life of the aging population in Nepal. Consequently, we aimed to assess the nutritional status, depression and health-related quality of life (HRQOL) of Nepali older patients and evaluate the associated factors. Furthermore, a secondary aim was to investigate the proposed mediation-moderation models between depression, nutrition, and HRQOL.

METHODS

A cross-sectional survey was conducted from January-April of 2017 among 289 Nepali older patients in an outpatient clinic at Nepal Medical College in Kathmandu. Nutritional status, depression and HRQOL were assessed using a mini nutritional assessment, geriatric depression scales, and the European quality of life tool, respectively. Linear regression models were used to find the factors associated with nutritional status, depression, and HRQOL. The potential mediating and moderating role of nutritional status on the relationship between depression and HRQOL was explored; likewise, for depression on the relationship between nutritional status and HRQOL.

RESULTS

The prevalence of malnutrition and depression was 10% and 57.4% respectively; depression-malnutrition comorbidity was 7%. After adjusting for age and gender, nutritional score (β = 2.87; BCa 95%CI = 2.12, 3.62) was positively associated and depression score (β = - 1.23; BCa 95%CI = - 1.72, - 0.72) was negatively associated with HRQOL. After controlling for covariates, nutritional status mediated 41% of the total effect of depression on HRQOL, while depression mediated 6.0% of the total effect of the nutrition on HRQOL.

CONCLUSIONS

A sizeable proportion of older patients had malnutrition and depression. Given that nutritional status had a significant direct (independently) and indirect (as a mediator) effect on HRQOL, we believe that nutritional screening and optimal nutrition among the older patients can make a significant contribution to the health and well-being of Nepali older patients. Nonetheless, these findings should be replicated in prospective studies before generalization.

Quality of life in older adults with sensory impairments: a systematic review

PURPOSE

Sensory impairments are common in older adults. Hearing and visual impairments affect their physical and mental health and quality of life adversely. However, systematic reviews of the relationship between hearing impairment, visual impairment, dual sensory impairment, and quality of life are scarce. The purpose of this systematic review was to determine the relationship between hearing impairment, visual impairment, dual sensory impairment, and quality of life.

METHODS

Searches of EMBASE, PubMed, CINAHL, MEDLINE, Cochrane Library, and Airiti Library were conducted between January 2006 and December 2017 using the keywords "quality of life," "life satisfaction," "well-being," "hearing impairment," and "visual impairment." Two authors independently assessed methodologic quality using a modified Downs and Black tool. Data were extracted by the first author and then cross-checked by the second author.

RESULTS

Twenty-three studies consisting mostly of community-dwelling older adults were included in our review. Sensory impairment was found to be in significant association with quality of life, with an increase in hearing impairment or visual impairment severity resulting in a lower quality of life. Quality of life for dual sensory impairment was worse than for hearing impairment or visual impairment individually.

CONCLUSIONS

A significant association was confirmed between hearing impairment, visual impairment, dual sensory impairment, and quality of life. Our review can be used to enhance health care personnel's understanding of sensory impairment in older adults and enable health care personnel to actively assess older adults' sensory functions, so that they can help alleviate the negative impact of sensory impairments on QOL in older adults.

Health-Related Quality of Life at Admission Is Associated with Postdischarge Mortality, Functional Decline, and Institutionalization in Acutely Hospitalized Older Medical Patients

OBJECTIVES

To assess the independent association between health-related quality of life (HRQOL) at admission and mortality, functional decline, and institutionalization 3 and 12 months after admission in acutely hospitalized older adults.

DESIGN

Post hoc analysis of data from prospective cohort study, 2006 to 2009, 12-month follow-up.

SETTING

Eleven medical wards in three hospitals in the Netherlands.

PARTICIPANTS

Medical patients aged 65 and older acutely hospitalized for 48 hours or longer (N = 473).

MEASUREMENTS

OUTCOMES

mortality, functional decline, and institutionalization, 3 and 12 months after admission. Main determinant was HRQOL (utility based on the EuroQol-5D at admission, reflecting the relative desirability of a particular health state and is measured on a scale from 0 (death) to 1 (full health). Some health states are regarded as being worse than death, resulting in negative utilities, with a minimum of -0.330). Participants were split into two groups based on median utility at admission. Unadjusted and adjusted odds ratios (ORs) and 95% confidence intervals (CIs) were estimated using Cox and logistic regression analyses, adjusted for sociodemographic and health variables.

RESULTS

Median utility was 0.775 (interquartile range 0.399-0.861). Utility greater than 0.775, indicating high HRQOL, was associated with lower risk of mortality (hazard ratio = 0.38, 95% CI = 0.18-0.83) and functional decline (OR = 0.47, 95% CI = 0.28-0.79) at 3 months in the adjusted models. At 12 months, these associations were statistically significant in the crude models but not in the adjusted models. Utility was not associated with risk of institutionalization at 3 or 12 months.

CONCLUSION

Higher HRQOL at admission was associated with lower risk of mortality and functional decline 3 months after admission. In older, acutely hospitalized individuals, the EQ-5D may provide a means of risk stratification and may ultimately guide individuals, their families, and professionals in treatment decisions during hospitalization.