The Prevalence of Visual Impairment in People with Dementia (the PrOVIDe study): a cross-sectional study of people aged 60–89 years with dementia and qualitative exploration of individual, carer and professional perspectives
Background: The prevalence of visual impairment (VI) and dementia increases with age and these conditions may coexist, but few UK data exist on VI among people with dementia. Objectives: To measure the prevalence of eye conditions causing VI in people with dementia and to identify/describe reasons f...
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| Format: | Article |
| Language: | English |
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National Institute for Health Research
2016-07-01
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| Series: | Health Services and Delivery Research |
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| Online Access: | https://doi.org/10.3310/hsdr04210 |
| _version_ | 1817991077009817600 |
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| author | Michael Bowen David F Edgar Beverley Hancock Sayeed Haque Rakhee Shah Sarah Buchanan Steve Iliffe Susan Maskell James Pickett John-Paul Taylor Neil O’Leary |
| author_facet | Michael Bowen David F Edgar Beverley Hancock Sayeed Haque Rakhee Shah Sarah Buchanan Steve Iliffe Susan Maskell James Pickett John-Paul Taylor Neil O’Leary |
| author_sort | Michael Bowen |
| collection | DOAJ |
| description | Background: The prevalence of visual impairment (VI) and dementia increases with age and these conditions may coexist, but few UK data exist on VI among people with dementia. Objectives: To measure the prevalence of eye conditions causing VI in people with dementia and to identify/describe reasons for underdetection or inappropriate management. Design: Stage 1 – cross-sectional prevalence study. Stage 2 – qualitative research exploring participant, carer and professional perspectives of eye care. Setting: Stage 1 – 20 NHS sites in six English regions. Stage 2 – six English regions. Participants: Stage 1 – 708 participants with dementia (aged 60–89 years): 389 lived in the community (group 1) and 319 lived in care homes (group 2). Stage 2 – 119 participants. Interventions: Stage 1 gathered eye examination data following domiciliary sight tests complying with General Ophthalmic Services requirements and professional guidelines. Cognitive impairment was assessed using the Standardised Mini-Mental State Examination (sMMSE) test, and functional ability and behaviour were assessed using the Bristol Activities of Daily Living Scale and Cambridge Behavioural Inventory – Revised. Stage 2 involved individual interviews (36 people with dementia and 11 care workers); and separate focus groups (34 optometrists; 38 family and professional carers). Main outcome measures.: VI defined by visual acuity (VA) worse than 6/12 or worse than 6/18 measured before and after refraction. Results: Stage 1 – when participants wore their current spectacles, VI prevalence was 32.5% [95% confidence interval (CI) 28.7% to 36.5%] and 16.3% (95% CI 13.5% to 19.6%) for commonly used criteria for VI of VA worse than 6/12 and 6/18, respectively. Of those with VI, 44% (VA < 6/12) and 47% (VA < 6/18) were correctable with new spectacles. Almost 50% of remaining uncorrectable VI (VA < 6/12) was associated with cataract, and was, therefore, potentially remediable, and one-third was associated with macular degeneration. Uncorrected/undercorrected VI prevalence (VA < 6/12) was significantly higher in participants in care homes (odds ratio 2.19, 95% CI 1.30 to 3.73; p < 0.01) when adjusted for age, sex and sMMSE score. VA could not be measured in 2.6% of group 1 and 34.2% of group 2 participants (p < 0.01). The main eye examination elements (excluding visual fields) could be performed in > 80% of participants. There was no evidence that the management of VI in people with dementia differed from that in older people in general. Exploratory analysis suggested significant deficits in some vision-related aspects of function and behaviour in participants with VI. Stage 2 key messages – carers and care workers underestimated how much can be achieved in an eye examination. People with dementia and carers were unaware of domiciliary sight test availability. Improved communication is needed between optometrists and carers; optometrists should be informed of the person’s dementia. Tailoring eye examinations to individual needs includes allowing extra time. Optometrists wanted training and guidance about dementia. Correcting VI may improve the quality of life of people with dementia but should be weighed against the risks and burdens of undergoing examinations and cataract surgery on an individual basis. Limitations: Sampling bias is possible owing to quota-sampling and response bias. Conclusions: The prevalence of VI is disproportionately higher in people with dementia living in care homes. Almost 50% of presenting VI is correctable with spectacles, and more with cataract surgery. Areas for future research are the development of an eye-care pathway for people with dementia; assessment of the benefits of early cataract surgery; and research into the feasibility of specialist optometrists for older people. Funding: The National Institute for Health Research Health Services and Delivery Research programme. |
| first_indexed | 2024-04-14T01:07:21Z |
| format | Article |
| id | doaj.art-802cdfd79a5c433291becd6ddb4a7ab4 |
| institution | Directory Open Access Journal |
| issn | 2050-4349 2050-4357 |
| language | English |
| last_indexed | 2024-04-14T01:07:21Z |
| publishDate | 2016-07-01 |
| publisher | National Institute for Health Research |
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| series | Health Services and Delivery Research |
| spelling | doaj.art-802cdfd79a5c433291becd6ddb4a7ab42022-12-22T02:21:11ZengNational Institute for Health ResearchHealth Services and Delivery Research2050-43492050-43572016-07-0142110.3310/hsdr0421011/2000/13The Prevalence of Visual Impairment in People with Dementia (the PrOVIDe study): a cross-sectional study of people aged 60–89 years with dementia and qualitative exploration of individual, carer and professional perspectivesMichael Bowen0David F Edgar1Beverley Hancock2Sayeed Haque3Rakhee Shah4Sarah Buchanan5Steve Iliffe6Susan Maskell7James Pickett8John-Paul Taylor9Neil O’Leary10Research Department, College of Optometrists, London, UKDivision of Optometry and Visual Science, City University London, London, UKResearch Department, College of Optometrists, London, UKPrimary Care Clinical Sciences, University of Birmingham, Birmingham, UKResearch Department, College of Optometrists, London, UKResearch Department, Thomas Pocklington Trust, London, UKDepartment of Primary Care and Population Health, University College London, London, UKPublic and participant involvement representative, Alzheimer’s Society Research Network, London, UKResearch Department, Alzheimer’s Society, London, UKInstitute for Neuroscience, Newcastle University, Newcastle upon Tyne, UKThe Irish Longitudinal Study on Ageing (TILDA), Trinity College Dublin, Dublin, Republic of IrelandBackground: The prevalence of visual impairment (VI) and dementia increases with age and these conditions may coexist, but few UK data exist on VI among people with dementia. Objectives: To measure the prevalence of eye conditions causing VI in people with dementia and to identify/describe reasons for underdetection or inappropriate management. Design: Stage 1 – cross-sectional prevalence study. Stage 2 – qualitative research exploring participant, carer and professional perspectives of eye care. Setting: Stage 1 – 20 NHS sites in six English regions. Stage 2 – six English regions. Participants: Stage 1 – 708 participants with dementia (aged 60–89 years): 389 lived in the community (group 1) and 319 lived in care homes (group 2). Stage 2 – 119 participants. Interventions: Stage 1 gathered eye examination data following domiciliary sight tests complying with General Ophthalmic Services requirements and professional guidelines. Cognitive impairment was assessed using the Standardised Mini-Mental State Examination (sMMSE) test, and functional ability and behaviour were assessed using the Bristol Activities of Daily Living Scale and Cambridge Behavioural Inventory – Revised. Stage 2 involved individual interviews (36 people with dementia and 11 care workers); and separate focus groups (34 optometrists; 38 family and professional carers). Main outcome measures.: VI defined by visual acuity (VA) worse than 6/12 or worse than 6/18 measured before and after refraction. Results: Stage 1 – when participants wore their current spectacles, VI prevalence was 32.5% [95% confidence interval (CI) 28.7% to 36.5%] and 16.3% (95% CI 13.5% to 19.6%) for commonly used criteria for VI of VA worse than 6/12 and 6/18, respectively. Of those with VI, 44% (VA < 6/12) and 47% (VA < 6/18) were correctable with new spectacles. Almost 50% of remaining uncorrectable VI (VA < 6/12) was associated with cataract, and was, therefore, potentially remediable, and one-third was associated with macular degeneration. Uncorrected/undercorrected VI prevalence (VA < 6/12) was significantly higher in participants in care homes (odds ratio 2.19, 95% CI 1.30 to 3.73; p < 0.01) when adjusted for age, sex and sMMSE score. VA could not be measured in 2.6% of group 1 and 34.2% of group 2 participants (p < 0.01). The main eye examination elements (excluding visual fields) could be performed in > 80% of participants. There was no evidence that the management of VI in people with dementia differed from that in older people in general. Exploratory analysis suggested significant deficits in some vision-related aspects of function and behaviour in participants with VI. Stage 2 key messages – carers and care workers underestimated how much can be achieved in an eye examination. People with dementia and carers were unaware of domiciliary sight test availability. Improved communication is needed between optometrists and carers; optometrists should be informed of the person’s dementia. Tailoring eye examinations to individual needs includes allowing extra time. Optometrists wanted training and guidance about dementia. Correcting VI may improve the quality of life of people with dementia but should be weighed against the risks and burdens of undergoing examinations and cataract surgery on an individual basis. Limitations: Sampling bias is possible owing to quota-sampling and response bias. Conclusions: The prevalence of VI is disproportionately higher in people with dementia living in care homes. Almost 50% of presenting VI is correctable with spectacles, and more with cataract surgery. Areas for future research are the development of an eye-care pathway for people with dementia; assessment of the benefits of early cataract surgery; and research into the feasibility of specialist optometrists for older people. Funding: The National Institute for Health Research Health Services and Delivery Research programme.https://doi.org/10.3310/hsdr04210visual impairmentdementiaeye examinationsquality of lifecross-sectional studyvisual acuityglaucomadiabetic retinopathyoptometryophthalmoscopy |
| spellingShingle | Michael Bowen David F Edgar Beverley Hancock Sayeed Haque Rakhee Shah Sarah Buchanan Steve Iliffe Susan Maskell James Pickett John-Paul Taylor Neil O’Leary The Prevalence of Visual Impairment in People with Dementia (the PrOVIDe study): a cross-sectional study of people aged 60–89 years with dementia and qualitative exploration of individual, carer and professional perspectives Health Services and Delivery Research visual impairment dementia eye examinations quality of life cross-sectional study visual acuity glaucoma diabetic retinopathy optometry ophthalmoscopy |
| title | The Prevalence of Visual Impairment in People with Dementia (the PrOVIDe study): a cross-sectional study of people aged 60–89 years with dementia and qualitative exploration of individual, carer and professional perspectives |
| title_full | The Prevalence of Visual Impairment in People with Dementia (the PrOVIDe study): a cross-sectional study of people aged 60–89 years with dementia and qualitative exploration of individual, carer and professional perspectives |
| title_fullStr | The Prevalence of Visual Impairment in People with Dementia (the PrOVIDe study): a cross-sectional study of people aged 60–89 years with dementia and qualitative exploration of individual, carer and professional perspectives |
| title_full_unstemmed | The Prevalence of Visual Impairment in People with Dementia (the PrOVIDe study): a cross-sectional study of people aged 60–89 years with dementia and qualitative exploration of individual, carer and professional perspectives |
| title_short | The Prevalence of Visual Impairment in People with Dementia (the PrOVIDe study): a cross-sectional study of people aged 60–89 years with dementia and qualitative exploration of individual, carer and professional perspectives |
| title_sort | prevalence of visual impairment in people with dementia the provide study a cross sectional study of people aged 60 89 years with dementia and qualitative exploration of individual carer and professional perspectives |
| topic | visual impairment dementia eye examinations quality of life cross-sectional study visual acuity glaucoma diabetic retinopathy optometry ophthalmoscopy |
| url | https://doi.org/10.3310/hsdr04210 |
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