VISUAL IMPAIRMENT IN NURSING-HOME RESIDENTS - THE BLUE MOUNTAINS EYE STUDY

Objectives: To assess the prevalence and causes of visual impairment, and the proportion of treatable eye conditions, among nursing home res idents. Design and setting: The Blue Mountains Eye Study is a populati on-based survey of vision and common eye diseases in people aged 50 or older in two postcode areas west of Sydney. Nursing home examinations were conducted during 1993. Participants: Three representative nursin g homes were selected from the nine in the study area. There were 128 residents aged 50 or older (64% females), representing 21% of all elig ible nursing home residents in the two postcode areas. Main outcome me asure: Blindness or visual impairment in one or both eyes. Results: Ey e examinations were refused by five nursing home residents, and dement ia precluded eye examination in 34 (28%) of the remainder. We found si gnificantly higher prevalences (fivefold increase) of bilateral (11%) and unilateral (21%) blindness in nursing home residents compared with local community residents (bilateral, 0.5%; unilateral, 2%). In seven of the 10 blind nursing home residents, the blindness was potentially reversible (advanced cataract); late age-related macular degeneration (AMD) was the second most frequent cause of blindness, affecting one or both eyes of 12% of residents. Open-angle glaucoma affected 10% and advanced cataract 11%, a history of past cataract surgery was obtaine d in 14%. Conclusions: These data confirm earlier reports of a substan tial number of treatable eye diseases, particularly advanced cataract, in nursing home residents, and indicate a need for increased surveill ance of these communities. The high rate of visual impairment and blin dness, compared with similar age groups in the local community, sugges ts that visual disability may contribute to nursing home placement.