Factors influencing survival in elderly dialysis patients

Abstract

Introduction.– Poor vision and inappropriate visual aids increases falls risk. We undertook a prospective audit to evaluate the vision and use of visual aids of patients admitted to an elderly care ward and patients’ use of optometric services. Methods.– Fifty consecutive patients with MMSE>24/30 were assessed. A questionnaire regarding existing glasses, pre-existing ophthalmic conditions and use of optometric services was administered. Visual acuity (VA) testingwas undertaken using amodified 3m Snellen chart. The audit standard of vision was 6/12 as recommended by the joint British Optometrists and British Geriatrics Society Guidance. Results.– Eighty-eight percent of patients had VA worse than 6/12 in one eye and 54% in both eyes. Sixteen percent had known irreversible visual impairment. Fourteen percent had 6/60 or no vision in at least one eye with no known diagnosis. Ninety-eight percent wore glasses of which 93% were prescribed. Seventy-one percent wore bifocal or varifocal lenses with 28% wearing single vision lenses. Ninety-three percent had brought their glasses into hospital. Of these, 11%were inpoor condition. Age of glasses ranged from 1 day to 10years old. Duration since last optician review ranged from 3days to never. Thirty-eight percent were unable to attend an optician, mainly through ill health and transport unavailability. Only 1 of these patients was known to domiciliary optometric services. In total, 82% of patients reported a fall within the last 12months. Key conclusion.– Despite guidance suggesting that visual screening is a part of falls assessment, 1/3 of our surveyed patients were unable to attend optometric screening. To investigate further we plan to assess the impact of domiciliary optometric assessment in frail, community dwelling older people.