People with vision loss are significantly more likely to access the aged care system and they enter residential aged care three years earlier on average than other older people. The rate of vision loss among people in residential aged care facilities (RACFs) is significantly higher than in older people living in the community.
Vision loss in residents of residential aged care facilities can have many negative consequences, including significantly increasing the risk of falls and hip fractures. Falls are more common among residents of aged care facilities than the general population, with up to half of all residents falling at least once a year. Vision loss has a significant impact on other aspects of quality of life, reducing social independence by two times and trebling the risk of depression.
In 2015, MDFA received a Department of Health grant to undertake a vision and eye healthcare study in residential aged care facilities (RACFs).
The study involved eye testing and medical record reviews of 193 residents across eight RACFs across Sydney. The testing was carried out by an orthoptist, and the ophthalmic images were analysed and interpreted by an ophthalmologist.
The study found high rates of eye disease, often under-diagnosed and untreated, in RACFs and highlighted an urgent need for reform of vision care within the residential aged care system.
· 78% of the 193 residents examined had some form of eye disease requiring ongoing monitoring or treatment noted in their clinical records
· once tested, 141 residents (73%) were found to have some form of eye disease, and this number is likely to be higher as glaucoma was not always able to be diagnosed through testing on-site
· of these, 56 of these residents were found to have untreated cataracts
· 68% of the residents tested had some degree of age-related macular degeneration.
This study suggests that eye disease is a significant co-morbidity of residents of RACFs in Australia.
Residents typically had spectacle lenses and frames in good condition, consistent with the relative frequency of optometry visits in these RACFs, and that the primary purpose of these visits relates to checking glasses.
Many of the residents were unable to provide reliable information about their eye health or vision, and at times their records did not provide consistent information, with some diseases diagnosed by the study orthoptist and ophthalmologist found to be under-reported in the clinical record.
This leads to a conclusion that care and management plans for residents should be based on other sources such as doctor and optometrist records and post-admission low vision assessments. However, the report also identifies that optometrist and medical specialists’ reports are usually communicated to the resident’s general practitioner rather than the RACF. Therefore, one of the recommendations of the report is for strengthened arrangements for the provision of optometry services covering referral requirements, routine and ad hoc attendance, clinical assessment frequency, documentation, reporting, referral to ophthalmologist notification, service reminders, provision of glasses and communication with family/carers for new and existing residents about vision and eye disease. In addition, that comprehensive record keeping (resident's vision and eye health status) be commenced on entry to the RACF including diagnosed eye disease, ophthalmologist's details and optometry visits along with consistent and routine updating.
Following the results of this study, MDFA developed practical educational resources focused on common eye disease, behavioural signs that may indicate loss of vision, where to go for more information and how to embed detection and treatment in aged care practices. A training video and accompanying resource was developed for aged care workers to help them better care for residents with vision loss and blindness. Resources were also developed for facility management staff & healthcare professionals, as well as family members of residents.
View the study report and resources.
The subsequent survey evaluation of the digital resources showed that 81% of survey responders reported having better understanding and awareness of eye health, eye disease and vision loss, and 38% reported applying new knowledge of how to care for people with eye disease and vision loss in their work. The evaluation further found that, despite underutilisation of the resources, they were rated as being of high quality with the potential to create high impact.