Keller B K, Hejkal T, Potter J F
Department of Internal Medicine, Section of Geriatrics, University of Nebraska Medical Center, Omaha, Nebraska 68918-5620, USA.
J Am Med Dir Assoc. 2001 Jan-Feb;2(1):15-21.
To describe the prevalence of periodic eye examinations by eye professionals and to examine nursing facility resident characteristics associated with lack of periodic screening.
Retrospective chart review.
Two Midwestern nursing facilities.
Between 1995 and 1997, 134 subjects aged 60 and older were recruited from two metropolitan nursing facilities.
Nursing home charts were reviewed for: demographics, length of stay, date of eye examination, eye diagnosis,visual acuity. Nursing assessments were used to obtain information about cognition, function, behavior, and the presence of Do Not Resuscitate or Do Not Hospitalize orders. The chart was reviewed for visual acuity, intraocular pressures, and the presence of eye pathology. Individuals who had not had eye examinations in the previous 2 years were screened by an ophthalmologist. This examination included external examination of the eye, fundoscopic examination, tonometry,visual acuity with correction.
Only 62 (46%) of the subjects had been seen by an eye care professional in the previous 2 years. Visual acuity information was available for 37/64 previously examined subjects. Of those with no eye examination in the previous 2 years (n = 72), visual acuity was obtained in 32 (44%) of subjects. New eye diagnoses were made in 64% (41/64). Logistic regression models with "eye examination within the past 2 years" as the dependent variable show that residents who do not desire hospital transfer are 80% less likely to have had an eye examination than those without this designation. Sex, age, length of stay, functional status, presence of severe dementia, behavior problems, or DNR orders do not change the likelihood that a resident would have been examined. Logistic regression models with "visual acuity measured" as the dependent variable show that residents with severe dementia are 12.6 times less likely to have acuity measured than those without dementia. Those with a length of stay in the facility less than 6 months are 10% less likely to have visual acuity measured.
This study does not confirm that barriers still exist in the provision of eye care to all nursing home residents, but the prevalence of such assessments remains low. Additional screening results in a substantial increase in the identification of treatable eye diseases. Contrary to the original hypotheses that patient characteristics that make testing difficult would provide a barrier or disincentive to vision testing, this study did not show statistical differences in the rates of vision screening for those with dementia, behavior problems, or severe functional impairment. Severe dementia does seem to affect the ability of the eye care specialist to gather subjective data such as visual acuity. It also demonstrates that vision screening does take place on nursing home residents with a broad range of cognitive and functional abilities, and this screening results in the diagnosis of many treatable eye conditions. Future efforts should be made to increase vision screening and treatment in the nursing home.
描述眼科专业人员进行定期眼部检查的患病率，并检查与缺乏定期筛查相关的护理机构居民特征。
回顾性病历审查。
中西部的两家护理机构。
1995年至1997年间，从两家大都市护理机构招募了134名60岁及以上的受试者。
审查养老院病历以获取：人口统计学信息、住院时间、眼部检查日期、眼部诊断、视力。使用护理评估来获取有关认知、功能、行为以及是否存在“不要复苏”或“不要住院”医嘱的信息。审查病历以获取视力、眼压和眼部病理情况。在过去2年中未进行眼部检查的个体由眼科医生进行筛查。该检查包括眼部外部检查、眼底镜检查、眼压测量、矫正视力检查。
在过去2年中，只有62名（46%）受试者接受了眼科护理专业人员的检查。64名之前接受过检查的受试者中有37名有视力信息。在过去2年中未进行眼部检查的72名受试者中，32名（44%）获得了视力数据。新的眼部诊断在64%（41/64）的受试者中做出。以“过去2年内进行眼部检查”为因变量的逻辑回归模型显示，不希望转院的居民接受眼部检查的可能性比没有此标识的居民低80%。性别、年龄、住院时间、功能状态、是否存在严重痴呆、行为问题或“不要复苏”医嘱不会改变居民接受检查的可能性。以“测量视力”为因变量的逻辑回归模型显示，患有严重痴呆的居民测量视力的可能性比没有痴呆的居民低12.6倍。在该机构住院时间少于6个月的居民测量视力的可能性低10%。
本研究并未证实为所有养老院居民提供眼部护理仍存在障碍，但此类评估的患病率仍然较低。额外的筛查导致可治疗眼病的识别大幅增加。与最初的假设相反，即那些使测试困难的患者特征会对视力测试造成障碍或不利因素，本研究并未显示痴呆、行为问题或严重功能障碍患者的视力筛查率存在统计学差异。严重痴呆似乎确实会影响眼科护理专家收集主观数据（如视力）的能力。它还表明，视力筛查确实在认知和功能能力范围广泛的养老院居民中进行，并且这种筛查导致诊断出许多可治疗的眼部疾病。未来应努力增加养老院中的视力筛查和治疗。
