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Thomas H. Hong, Paul Mitchell, George Burlutsky, Calvin S. Fong, Elena Rochtchina, Jie J. Wang; Visual Impairment And The Use Of Community Support Services Among Older People: Longitudinal Findings From The Blue Mountains Eye Study. Invest. Ophthalmol. Vis. Sci. 2011;52(14):2598.
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We previously reported cross-sectional associations between visual impairment (VI) and the use of community support services from the baseline survey of the Blue Mountains Eye Study (BMES). We now assess the impact of long-term or newly developed bilateral VI on the incidence of use of community support services using BMES longitudinal data.
Of 3654 BMES baseline participants, 2334, 1952 and 1146 were re-examined after 5, 10 and 15 years respectively. Bilateral VI was defined as best corrected visual acuity <20/40 in the better eye. Incident VI was defined in participants with bilateral best corrected visual acuity ≥20/40 at baseline but who developed VI subsequently. Community support service use included regular use of meals on wheels, homecare or community nurse visits. Informal support included assistance from either family members or friends for house cleaning, shopping or going out. Incidence of the use of support was defined in participants who did not report use of such services at the previous visit but did so at the later visit. Discrete logistical models with time-dependant study (VI) and outcome (needing support) variables were used to analyze the associations between VI and subsequent uptake of these support services, compared to persons without VI, and adjusted for baseline age, sex, walking disability, socio-economic status, hospital admissions and having 3+ co-morbidities.
Among participants with VI at baseline, the incident rate of new use of community support in 5-15 years was 41.7% compared to 19.4% of those without VI at baseline (adjusted OR 1.6 95% CI 0.7-3.6). Persons with incident VI were subsequently more likely to need community support (OR 5.1 95% CI 2.3-11.2) or combined community and informal support (OR 3.6 95 % CI 1.4-8.8) than persons without VI over the entire follow-up period. Men were more likely to use support compared to women (OR 1.7 95% CI 1.4-2.1). Other significant factors associated with incident need of support were age (per year older, OR 1.07 95% CI 1.05-1.08) and the presence of walking disability (OR 3.4, 95% CI 2.4-4.8).
We documented longitudinal associations between VI and the subsequent use of community or informal support services in this older cohort, independent of other measured potential confounders. These findings support the need for prevention and treatment of VI.
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