The Prevalence of Visual Impairment in People with Dementia (the PrOVIDe study): a cross-sectional study of people aged 60–89 years with dementia and qualitative exploration of individual, carer and professional perspectives

• DOI: 10.3310/hsdr04210
• Publication Date: 2016-07-28T08:32:48Z
• Authors: Michael Bowen; David F Edgar; Beverley Hancock; Sayeed Haque; Rakhee Shah; Sarah Buchanan; Steve Iliffe; Susan Maskell; James Pickett; John-Paul Taylor; Neil O’Leary
• Keywords: Visual Impairment; Cross-sectional study; Clinical Dementia Rating

Background The prevalence of visual impairment (VI) and dementia increases with age these conditions may coexist, but few UK data exist on VI among people dementia. Objectives To measure the eye causing in to identify/describe reasons for underdetection or inappropriate management. Design Stage 1 – cross-sectional study. 2 qualitative research exploring participant, carer professional perspectives care. Setting 20 NHS sites six English regions. Participants 708 participants (aged 60–89 years): 389 lived community (group 1) 319 care homes 2). 119 participants. Interventions gathered examination following domiciliary sight tests complying General Ophthalmic Services requirements guidelines. Cognitive was assessed using Standardised Mini-Mental State Examination (sMMSE) test, functional ability behaviour were Bristol Activities Daily Living Scale Cambridge Behavioural Inventory Revised. involved individual interviews (36 11 workers); separate focus groups (34 optometrists; 38 family carers). Main outcome measures. defined by acuity (VA) worse than 6/12 6/18 measured before after refraction. Results when wore their current spectacles, 32.5% [95% confidence interval (CI) 28.7% 36.5%] 16.3% (95% CI 13.5% 19.6%) commonly used criteria VA 6/18, respectively. Of those VI, 44% (VA < 6/12) 47% 6/18) correctable new spectacles. Almost 50% remaining uncorrectable associated cataract, was, therefore, potentially remediable, one-third macular degeneration. Uncorrected/undercorrected significantly higher (odds ratio 2.19, 95% 1.30 3.73; p 0.01) adjusted age, sex sMMSE score. could not be 2.6% group 34.2% ( 0.01). main elements (excluding fields) performed > 80% There no evidence that management differed from older general. Exploratory analysis suggested significant deficits some vision-related aspects function VI. key messages carers workers underestimated how much can achieved an examination. People unaware test availability. Improved communication is needed between optometrists carers; should informed person’s Tailoring examinations needs includes allowing extra time. Optometrists wanted training guidance about Correcting improve quality life weighed against risks burdens undergoing cataract surgery basis. Limitations Sampling bias possible owing quota-sampling response bias. Conclusions disproportionately living homes. presenting more surgery. Areas future are development eye-care pathway dementia; assessment benefits early surgery; into feasibility specialist people. Funding National Institute Health Research Delivery programme.