Abstract
Purpose :
Vision impairment and blindness among long-term care facility (LTCF) residents are associated with poor health outcomes. Our objective is to explore the follow-up of these residents by important demographic and baseline comorbidity characteristics to better understand the patterns of longitudinal eye care for institutionalized older adults with vision loss.
Methods :
The Western North Carolina Nursing Home Study dataset comprises comprehensive vision and medical exam data for residents seen in 74 skilled care facilities between 2010 and 2018 by a dedicated optometrist. We restricted our sample to residents age ≥ 65 and < 100 years at first visit (n=11,624). We quantified differences in follow-up by baseline characteristics with t-tests and simple Cox regression.
Results :
The median (interquartile range) number of visits was 2 [1-5], with 90% of records in the database belonging to visits 1-7. The number of residents decreases sharply over time: of the 7,074 with a 2nd visit, two thirds (67%; 4,771) had a 3rd visit, and less than half (48%; 3,272) had a 4th visit (Figure 1). On average, follow-up time was statistically significantly longer by sex (female vs. male), race/ethnicity (white vs. not-specified), and baseline vision status (normal vs. blind) by 3.48 (95% CI: 2.76 – 4.19) months, 11.30 (95% CI: 10.56 – 12.04) months, and 4.00 (95% CI: 3.05 – 4.95) months respectively (P < 0.001). Those who were blind at baseline (Hazard Ratio (HR) = 1.48 [95% CI: 1.37 – 1.59]) and of unspecified race (HR = 3.67 [95% CI: 3.30 – 4.07]) reached their last visit more quickly than those with normal or impaired vision and specified race (P < 0.001) (Figure 2).
Conclusions :
These preliminary analyses suggest that some residents of LTCFs require more general health care than others, both in number of visits and duration of follow-up. The extensive vision data in this database will allow us to look at how outcomes such as falls and mental deterioration are longitudinally associated with age-related eye diseases, vision loss, and vision interventions (e.g., refractive correction). Using this database, we plan to further examine the characteristics of these residents (e.g., ocular diagnoses and co-morbidities, medications) and develop a morbidity/mortality profile so that the complexity of patients may be predicted to some degree to better plan their follow-up and resource needs, particularly vision care, in a nursing home.
This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.