Examining the impact of poor vision in a hospital setting

Dr. WillisSacramento, CA-Understanding the magnitude of patients with poor vision in a hospital setting is crucial in developing interventions that potentially limit vision-related morbidity, such as falls, said Jeffrey R. Willis, MD, PhD.

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“One-tenth of recently hospitalized older Americans have poor vision and may experience healthcare challenges,” said Dr. Willis, of the University of California Davis Eye Center, Sacramento, CA.

Dr. Willis said falls are the number-one cause of injurious death in subjects older than 65 years, and they are associated with large medical and societal costs.

One study found a two-fold higher risk of fall-related hip fractures in visually impaired inpatients (Lichtenstein MJ, et al. Risk factors for hip fractures occurring in the hospital. Am J Epidemiol. 1994;140:830-838).

A 2005 study found that the mean hospitalization cost was $17,483 in the United States, with fracture of the femur the most expensive injury costing $18,638. The mean reimbursement cost of an emergency department visit was $236 and $412 for an outpatient clinic visit (Roudsari B, et al. The acute medical care costs of fall-related injuries among the U.S. older adults. Injury. 2005;36:1316-1322).

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Additionally, it is important to develop interventions to assist those with poor vision in the hospitalized setting better comprehend hospital documents. These may include providing magnification devices, facilitating spectacle correction, enlarging font sizes in hospital documents, and developing video or audio discharge instructions.

In light of the limited visual data on this topic, Dr. Willis and colleague Pradeep Ramulu, MD, PhD-from the Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore-conducted a cross-sectional study to determine the prevalence and type of poor vision, the prevalence of subjective visual problems, and the optimal method of identifying patients with poor vision among recently hospitalized older patients in the United States.

The investigators used data from the 2001-2008 National Health and Nutrition Examination Survey.  All subjects were 50 years and older who completed the necessary examinations and had undergone a self-reported hospitalization over the last year and visual acuity evaluation.

Patients were asked about difficulty performing work or hobbies that require good near vision, such as cooking, sewing, repair work around the house, or using hand tools as well as difficulty descending steps, stairs, or curbs in dim light or at night.

The investigators found that of the 1,349 eligible hospitalized patients who participated in the study ,about 10% had poor vision (defined as worse than 20/40). These included 6% with uncorrected refractive errors and 3.8% with visual impairment.

Importantly, 86% of the hospitalized patients with poor vision had a visual acuity (VA) at presentation that was 20/80 or better.  Patients reported difficulties with reading, near work, and seeing steps, 14%, 11%, and 13%, respectively.

About 20% of hospitalized older individuals reported difficulty with at least one of the above visual functions.  When objectively measured VA was correlated with self-reported visual function, there was poor correlation, indicating that subjective questionnaires may not be an optimal method for identifying individuals with actual poor vision in the hospital setting.

“(The results show) further research is necessary to better understand the relationship between poor vision and fall-related injuries,” Dr. Willis explained.

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