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A randomized trial of visual impairment interventions for nursing home residents: study design, baseline
Sheila K West1, David Friedman, Beatriz Muñoz
1Dana Center for Preventive Ophthalmology, Wilmer Eye Institute, Johns Hopkins Medical Institutions, 600 N. Wolfe Street, Baltimore, MD 21205, USA.
Introduction:
Visual impairment among nursing home residents is higher than in community-dwelling elderly. The provision of eye care services may be beneficial to nursing home patients. Our project, a randomized trial of vision restoration and rehabilitation in nursing home residents, compares usual care to targeted interventions. In this paper, we present the baseline characteristics of our sample within the nursing homes.
Methods:
Twenty-eight nursing homes on Maryland's Eastern Shore were matched in pairs by size and payment type. Each pair was randomized to usual care or targeted intervention. Habitual and best-corrected acuity was attempted, using standard letter symbol/charts and grating acuity charts. Visual impairment was vision in the better eye <20/40 on letter and/or grating acuity. The MiniMental State Examination (MMSE) was used to determine cognitive impairment.
Results:
Of those participants eligible to be screened, 40% had severe cognitive impairment (MMSE score 0-9). No measure of acuity could be ascertained on 18% of eligibles. Among the 1305 persons with acuity data, 38% had presenting vision worse than 20/40. After refractive correction, 29% had visual impairment. There was no difference by race or gender in those with visual impairment, although they were older, compared to those without visual loss.
Conclusions:
The nursing home residents had high rates of both cognitive impairment and visual impairment, creating a challenging environment for visual intervention. By improving access to eye care within the context of the clinical trial, and changing either the magnitude of visual loss or the resultant impact on function, we hope to demonstrate a change in the quality of life for nursing home residents.