Koch James M, Datta Gautam, Makhdoom Sohail, Grossberg George T
Saint Louis University, St Louis, MO 53104, USA.
J Am Med Dir Assoc. 2005 Jul-Aug;6(4):233-7. doi: 10.1016/j.jamda.2005.04.001.
The purpose of this study was to determine the prevalence of uncorrected visual disorders in nursing home patients with Alzheimer's disease (AD) and to determine whether appropriate corrective measures were taken by nursing home staff. This study was conducted at 2 community nursing homes in the St Louis area. Whereas previous studies have shown that visual impairment is common among all residents of nursing facilities, our study was focused specifically on residents with AD. This population is less able to effectively express needs and more likely to endure unaddressed visual deficits. For AD patients, it is important to offer appropriate corrective remedies in order to maintain as much functional independence as possible.
A retrospective cohort study was conducted in 2 private, skilled nursing facilities in St Louis County thought to be representative of community nursing homes in the United States. All subjects were patients with a diagnosis of dementia of probable AD. Demographic information collected included age, sex, and race. Mini-Mental State Examination scores were also obtained. The patients, their families, and nursing staff were interviewed to determine the patients' visual history, corrective measures, and the usage of corrective eyewear before and after admission to the nursing homes. The data were summarized to demonstrate how many patients suffered from uncorrected errors of refraction and what factors contributed to their visual status.
Of the total of 85 patients included in the study, 80 (94.1%) required glasses for correction of presbyopia, myopia, or both. However, 25 of the 80 residents had not actively been using glasses since entering the nursing home. Of these 25 residents not wearing proper eyewear, 9 residents were too cognitively impaired to request them, 8 residents had broken or misplaced them, and 8 residents had prescriptions that were no longer sufficient to correct their vision.
Our study found that nearly one third of the visually impaired nursing home residents with AD (25 of 80 patients) were not using their required eyewear. These 25 patients were the population of most interest because they were most likely to benefit from intervention. Many of these patients were not using glasses because they had been lost, damaged, or were no longer sufficient to correct their vision.
We have presented 3 recommendations intended to prevent uncorrected visual acuity in nursing home residents with dementia: (1) Label eyewear in appropriate patient populations to provide rapid identification in the event of misplacement, (2) recommend that an extra pair of glasses be made available if the current pair would be lost or damaged, and (3) ensure that all residents have annual or biannual eye exams. If adequate steps are taken to prevent unnecessary visual impairment in AD patients, it would limit their dependence on others, reduce the burden on nursing staff, and improve the patients' overall quality of life.
本研究的目的是确定患有阿尔茨海默病（AD）的疗养院患者中未矫正视力障碍的患病率，并确定疗养院工作人员是否采取了适当的矫正措施。本研究在圣路易斯地区的两家社区疗养院进行。尽管先前的研究表明视力障碍在所有疗养院居民中都很常见，但我们的研究特别关注患有AD的居民。这一人群不太能够有效地表达需求，更有可能忍受未得到解决的视力缺陷。对于AD患者来说，提供适当的矫正措施以尽可能保持功能独立非常重要。
在圣路易斯县的两家私立专业护理机构进行了一项回顾性队列研究，这两家机构被认为代表了美国的社区疗养院。所有受试者均为被诊断患有可能的AD痴呆症的患者。收集的人口统计学信息包括年龄、性别和种族。还获得了简易精神状态检查表评分。对患者、其家属和护理人员进行了访谈，以确定患者的视力病史、矫正措施以及入院前后矫正眼镜的使用情况。对数据进行了汇总，以显示有多少患者患有未矫正的屈光不正错误以及哪些因素导致了他们的视力状况。
在纳入研究的85名患者中，80名（94.1%）需要眼镜来矫正老花眼、近视或两者兼有。然而，这80名居民中有25名自进入疗养院以来没有积极佩戴眼镜。在这25名未佩戴合适眼镜的居民中，9名居民认知能力受损严重，无法要求佩戴眼镜，8名居民的眼镜已损坏或丢失，8名居民的处方已不足以矫正其视力。
我们的研究发现，患有AD的视力受损疗养院居民中近三分之一（80名患者中的25名）没有使用所需的眼镜。这25名患者是最值得关注的人群，因为他们最有可能从干预中受益。这些患者中有许多人不戴眼镜是因为眼镜丢失、损坏或已不足以矫正视力。
我们提出了三项建议，旨在预防患有痴呆症的疗养院居民出现未矫正的视力问题：（1）在适当的患者群体中为眼镜贴上标签，以便在眼镜丢失时能快速识别；（2）如果当前的眼镜丢失或损坏，建议额外配备一副眼镜；（3）确保所有居民每年或每两年进行一次眼部检查。如果采取适当措施预防AD患者出现不必要的视力损害，将限制他们对他人的依赖，减轻护理人员的负担，并提高患者的整体生活质量。
