Characterizing Vision Impairment and Its Impact on Independence in Older Adults

摘要 视力障碍(VI)是老年人的一个重大公共卫生问题。VI影响范围广泛 而且与生活质量下降和身心健康状况较差有关。随着人口的增加 是老龄化，VI将成为一个日益重要的问题。然而，年龄最大的老年人(80岁以上)的VI数据是 有限的。现有数据表明，相当大比例的老年人有未经矫正的屈光不正 (URE)-一种很容易用眼镜解决的疾病-以及限制视力的白内障。边走边走 视觉敏感度是VI最常用的测量方面，即对比敏感度(CS；辨别能力 弱光环境中的物体)对许多活动也很重要。然而，很少有以人群为基础的研究 在老年人中测量对比敏感度；需要数据来了解距离敏感度和 对比年龄最大的老年人的敏感度缺陷。 在这项研究中，我们将在已经资助的一次性家庭访问的基础上增加远程视力和CS测试 参加妇女健康倡议近30年的4200名老年妇女。这些数据 将被用来表征VI在高龄老年人中的患病率(目标1)，并评估VI对 社会、心理社会、认知和身体健康指标(目标2)。如果有独特的机会链接到 正在进行的队列，我们将能够描述横截面关联(目标2a)并前瞻性地评估 功能衰退的轨迹(目标2b)。此外，我们将利用WHI-Medicare索赔链接来分析 VI与医疗保健利用和成本之间的联系(目标2c)。我们将建议对以下患者进行眼部护理 患有VI和Will的人与寻求治疗的人和不寻求和愿意接受治疗的人之间的区别 审查报告的护理障碍(目标3a)。通过使用患者护理导航器，我们的目标是帮助促进护理 对于那些最初没有寻求的人，我们将评估患者护理导航在以下方面的潜在影响 改善对所需眼部护理的吸收(目标3b)。 将这些愿景措施添加到丰富的WHI数据存储库中，为评估 VI在广泛的卫生领域中的作用。项目成果将用于制定干预措施，以改善 老年人的视力健康，最终目标是延长独立性并提高老年人的生活质量 上了年纪的人。著名的视力专家强调了获得视觉指数质量估计的必要性 最年长的老年人，以便卫生系统为日益增长的受影响个人人口做好准备。这 创新项目填补了我们对VI的认识的一个重要空白，以及它对我们社会最古老的人生活的影响 会员。

ABSTRACT Vision impairment (VI) is a significant public health problem among older adults. VI impacts a broad range of activities and is associated with reduced quality of life and poorer physical and mental health. As the population is aging, VI will become an increasingly important problem. Yet, data on VI in the oldest old (aged 80+) are limited. Available data suggest that a significant proportion of older adults have uncorrected refractive error (URE) – a condition that is easily addressed with spectacles – as well as vision-limiting cataract. While distance visual acuity is the most commonly measured aspect of VI, contrast sensitivity (CS; the ability to differentiate objects in low light settings) is also important for many activities. However, few population-based studies have measured contrast sensitivity in older adults; data are needed to understand the impact of distance acuity and contrast sensitivity deficits in the oldest old. In this study, we will add distance visual acuity and CS tests to an already funded, one-time visit in the homes of 4,200 older women who have participated in the Women’s Health Initiative (WHI) for nearly 30 years. These data will be used to characterize the prevalence of VI in the oldest old (Aim 1) and to assess the impact of VI on social, psychosocial, cognitive, and physical health indicators (Aim 2). Given the unique opportunity to link to an ongoing cohort, we will be able to describe cross-sectional associations (Aim 2a) and to prospectively evaluate trajectories of functional decline (Aim 2b). Additionally, we will utilize the WHI-Medicare claims link to analyze associations between VI and healthcare utilization and costs (Aim 2c). We will recommend eye care for individuals with VI and will characterize differences between those who seek care vs. those who do not and will examine reported barriers to care (Aim 3a). By engaging a patient care navigator, we aim to help facilitate care for those who do not initially seek it, and we will evaluate the potential impact of patient care navigation on improving uptake of needed eye care (Aim 3b). Adding these vision measures to the rich repository of WHI data provides a unique opportunity to evaluate the role of VI on a broad range of health domains. Project results will be used to develop interventions to improve vision health in older adults, with the ultimate goal of extending independence and improving quality of life in older adults. Renowned vision experts have highlighted the need for obtaining quality estimates of VI in the oldest old, in order for health systems to prepare for serving the growing population of affected individuals. This innovative project fills an important gap in our knowledge of VI and its impact on the lives of our society’s oldest members.