Wang Jie Jin, Mitchell Paul, Cumming Robert G, Smith Wayne
Department of Ophthalmology, Save Sight Institute, the University of Sydney, Westmead, NSW, Australia.
Ophthalmic Epidemiol. 2003 Feb;10(1):3-13. doi: 10.1076/opep.10.1.3.13773.
To assess whether visual impairment at baseline is an independent contributor to subsequent nursing home placement during a 6-year follow-up.
3654 non-institutionalised people aged 49+ years (82.4% of those eligible) who participated in baseline examinations of the Blue Mountains Eye Study (1992-94) were followed during 1997-99. Presenting visual acuity was measured with current glasses and a standardised refraction performed. We defined visual impairment as visual acuity reduced to <or=20/40. Permanent nursing home admissions during follow-up were confirmed by the regional Aged Care Assessment Team and government subsidy payment records.
At baseline, 511 participants had presenting visual impairment. After refraction, vision improved to 20/30 or better in 346 persons (68%, "correctable"), while 165 (32%) remained visually impaired. During follow-up, 162 study participants (5.0%) were admitted permanently to a nursing home. The age-adjusted 6-year incidence was 3.6% for participants with normal vision, 16.2% for those with visual impairment after best correction and 8.1% for those with "correctable" visual impairment. After adjusting for non-cognitive factors that predicted nursing home placement, the relative risk (RR) for nursing home admission among persons with visual impairment after best correction was 1.8 (95% CI 1.1-2.9). A similar magnitude of association was found among persons with "correctable" visual impairment (RR 2.1, 95% CI 1.4-3.1). For each line of reduction in presenting visual acuity at baseline, there was a 7% increased risk of subsequent nursing home placement.
This study suggests that decreased vision may be a marker or contributing factor to subsequent nursing home placement in general older populations.
评估基线时的视力损害是否是6年随访期间后续入住养老院的独立影响因素。
对参加蓝山眼科研究（1992 - 1994年）基线检查的3654名49岁及以上的非机构化人员（占符合条件者的82.4%）在1997 - 1999年期间进行随访。使用当前佩戴的眼镜测量呈现的视力，并进行标准化验光。我们将视力损害定义为视力降至≤20/40。随访期间入住养老院的情况由地区老年护理评估团队和政府补贴支付记录确认。
基线时，511名参与者存在呈现的视力损害。验光后，346人（68%，“可矫正的”）视力提高到20/30或更好，而165人（32%）仍有视力损害。随访期间，162名研究参与者（5.0%）被永久送入养老院。视力正常的参与者经年龄调整后的6年发病率为3.6%，最佳矫正后仍有视力损害的参与者为16.2%，“可矫正的”视力损害参与者为8.1%。在调整了预测入住养老院的非认知因素后，最佳矫正后有视力损害者入住养老院的相对风险（RR）为1.8（95%可信区间1.1 - 2.9）。在“可矫正的”视力损害者中也发现了类似程度的关联（RR 2.1，95%可信区间1.4 - 3.1）。基线时呈现的视力每降低一行，后续入住养老院的风险增加7%。
本研究表明，视力下降可能是一般老年人群后续入住养老院的一个标志或影响因素。
