Vision screening in elderly reduces falls

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The elderly man was walking back to his room after church services, gently gripping the hand of his health-care aide as she guided him down the hallways. When he arrived at his room an optician was there with his new pair of glasses.“He put the new glasses on and he looked at the health-care aide and put his hands on her cheeks and said, ‘So that’s what you look like.’”

It’s a story Sandy Bell enjoys telling as she proudly talks about the results of a unique three-year pilot project and associated research study on vision screening for the elderly.

The director of quality, patient safety and education at Winnipeg’s Misericordia Health Centre (MHC), Bell began the Focus on Falls Prevention initiative in the spring of 2006.

The study looked at establishing a vision screening program for residents in long-term care facilities. Results showed that such a program detected eye problems, and that by providing appropriate treatment, falls and fractures could be prevented and quality of life for the residents improved.

“There have been lots of studies looking at the prevalence of visual deficits in long-term care settings linked with referring these people for intervention,” Bell says. “But I’ve never come across a study like ours where once the resident was referred, we followed them up, saw them through their intervention and then after they had their vision intervention we assessed them three months later to see whether they did fall and sustain a fracture and what were their quality-of-life indicators.” About 900 residents underwent vision screening during the project, with some startling results.

The associated research study focused on 92 participants from MHC’s personal care home, Misericordia Place. After the vision screening and assessment by an optometrist, 53 residents were referred for treatment and 17 agreed to have it. The treatments varied from glaucoma drops to new glasses to cataract surgery to vitamins for those with macular degeneration. “All 17 residents who agreed to an intervention, three months post intervention did not fall, did not fracture and had improvements in at least one of their quality-of-life indicators,” explains Bell, who’s been a nurse for 33 years.

The 36 other residents who were also referred for treatment refused for a variety of reasons, including family members who said it was unnecessary because of the person’s age. Of that group of 36, 18 experienced falls (three months post vision screening) and eight of those had fractures. They included five hip fractures, two broken wrists and one resident who broke their ribs. “Three of the residents who broke their hip later died. These statistics are startling as patient safety in health care moves forward,” says Bell.

It was also discovered during the research component that 74 of the 92 residents’ health records didn’t indicate vision problems. However, after the vision screening and assessment it was discovered 72 of the 74 residents actually had visual deficits.

Bell has started presenting her findings to the boards at the MHC and its senior management team. She’ll be doing the same to senior management of the Winnipeg Health Region. She has also presented at numerous gerontological and other conferences in Canada.

She’s been lobbying the provincial government, with the help of Dawn Ridd, policy analyst, Manitoba Health, to make a vision screening program a regular service at personal care homes. “A group of optometrists used to go to personal care homes when the homes requested it, but the service is now limited due to lack of programming,” Bell says.

She’d also like to see regular clinics in the community for elderly people who are living on their own. “We want to detect and treat visual deficits in seniors prior to an emergency room visit to prevent falls and fractures,” Bell adds. “It’s a health-promotion, patient-safety strategy.”

Another key need is education – for the elderly, family members and health-care professionals. Regular eye clinics for people in long-term care homes and in the community would also save the health-care system money. “Cataract surgery might cost the system about $1,200, compare that to an elderly person who breaks their hip. That could be about $38,000 for the emergency visit, surgical procedure and rehabilitation. And that has nothing to do with the implications of the possibility of (the person) being admitted to a personal care home and all the costs associated to that,” she points out, adding 40 per cent of seniors who visit an emergency room for a fall and fracture never return home.

Her personal experiences were a catalyst for the project. When Bell was a resident care manager in one of the interim units at MHC, many people were admitted because of falls and regular eye appointments weren’t provided. Even her elderly mother, who was living in the community, had a fall and fracture. It was discovered she had cataracts, which were then surgically corrected.

Bell decided to go back to school in 2003 to get her masters in nursing. She geared all her university work toward looking at vision deficits and falls and fractures and admittance to long-term care facilities, focusing on three streams: policy, vision screening and health promotion. “While limited literature indicated that visual interventions could prevent falls and fractures, there wasn’t current research anywhere in the world to help prove it,” Bell explains.

She decided to provide it.

After getting her masters in 2005, Bell linked up with principal investigator Dr. Pamela Hawranik, then an associate professor of nursing at the University of Manitoba. She received a $3,000 grant through the Royal Canadian Legion Poppy Fund to cover expenses for the first year’s research component.

She met researchers from Aberdeen, Scotland at an international conference in Winnipeg and they decided to look at vision care in personal care homes in both cities through surveys. What was revealed was a lack of education on the importance of vision care and the lack of vision care services for this population group in both countries.

Bell also received $200,000 from the Manitoba government and $5,000 from the Manitoba Association of Optometrists to establish the Focus on Falls Prevention project.

The first two years involved holding vision screening clinics in 21 of 39 personal care homes in the Winnipeg Health Region. The third year of the project also included training professionals in the Winnipeg Health Region, Brandon and Selkirk regions and Vancouver, B.C., on how to use the vision screening tool.

“The Vancouver Coastal Health region is developing a program because of the research data and the simplicity of improving vision and the impact on falls and fractures,” Bell says. She hopes to publish her findings this spring. “It’s been remarkable to actually have people listen to a concept, support it and help move it forward and be excited.”

For more information, please visit www.misericordia.mb.ca.