Sheila K. West

Falls and Fear of Falling: Which Comes First? A Longitudinal Prediction Model Suggests Strategies for Primary and Secondary Prevention

OBJECTIVES: Previous cross‐sectional studies have shown a correlation between falls and fear of falling, but it is unclear which comes first. Our objectives were to determine the temporal relationship between falls and fear of falling, and to see whether these two outcomes share predictors.

Eye care utilization by older americans: The SEE project

OBJECTIVE To determine eye care utilization patterns among older Americans, particularly characterizing those who sought different types of providers, and the predictive factors for seeking eye care services in general and among those with diabetes and those with visual loss. DESIGN AND PARTICIPANTS The SEE Project, a population-based survey of 2520 persons aged 65 to 84 in Salisbury, Maryland, provided cross-sectional data on eye care use. Questions on eye care use, demographics, medical history, and other factors were asked on the home interview. MAIN OUTCOME MEASURES Use of an eye care provider in the previous year, with additional outcomes of use of different types of eye care providers. RESULTS Blacks were significantly less likely to see any type of eye care provider over 1 year: 50% versus 69% among whites. Those who reported having a vision problem, those with more education, and those in the older age groups were significantly more likely to see either an ophthalmologist or an optometrist. Diabetes and driving a car were predictive factors for seeing an ophthalmologist but not for seeing an optometrist. Self-report of diabetes and eye care problems, and being a current driver, were predictive of seeing an eye care professional among those with visual impairment. CONCLUSIONS Although blacks are known to be at greater risk for several age-related eye diseases, they are much less likely to see an eye care provider. Interventions that remove barriers to eye care services should be considered.

Visual and cognitive deficits predict stopping or restricting driving: the Salisbury Eye Evaluation Driving Study (SEEDS)

PURPOSE To determine the visual and other factors that predict stopping or restricting driving in older drivers. METHODS A group of 1425 licensed drivers aged 67 to 87 years, who were residents of greater Salisbury, participated. At 1 year after enrollment, this group was categorized into those who had stopped driving, drove only within their neighborhood, or continued to drive beyond their neighborhood. At baseline, a battery of structured questionnaires, vision, and cognitive tests were administered. Multivariate analysis determined the factors predictive of stopping or restricting driving 12 months later. RESULTS Of the 1425 enrolled, 1237 (87%) were followed up at 1 year. Excluding those who were already limiting their driving at baseline (n = 35), 1.5% (18/1202) had stopped and 3.4% (41/1202) had restricted their driving. The women (odds ratio [OR], 4.01; 95% confidence interval [CI], 2.05-8.20) and those who prefer to be driven (OR, 3.91; 95% CI, 1.91-8.00) were more likely to stop or restrict driving. Depressive symptoms increased likelihood of restricting or stopping driving (OR, 1.08; 95% CI, 1.009-1.16 per point Geriatric Depression Scale). Slow visual scanning and psychomotor speed (Trail Making Test, Part A: OR, 1.02; 95% CI, 1.01-1.03), poor visuoconstructional skills (Beery-Buktenica Test of Visual Motor Integration: OR, 1.14; 95% CI, 1.05-1.25), and reduced contrast sensitivity (OR, 1.15; 95% CI, 1.03-1.28) predicted stopping or reducing driving. Visual field loss and visual attention were not associated. The effect of vision on changing driving behavior was partially mediated by cognition, depression, and baseline driving preferences. CONCLUSIONS In this cohort, contrast sensitivity and cognitive function were independently associated with incident cessation or restriction of driving space. These data suggest drivers with functional deficits make difficult decisions to restrict or stop driving.

Older Drivers and Failure to Stop at Red Lights

Background Despite sensational news reports, few studies have quantified the rates of poor driving performance among older drivers and the predictors of poor performance. We determined the rate of running red traffic lights among older drivers and the relationship of failure to stop to measures of vision and cognition. Methods Multiple measures of vision and cognition were collected at the baseline examination of a population of 1,425 drivers aged 67–87 years in greater Salisbury, Maryland. Each driver had real-time data collected on 5 days of driving performance at baseline and again at 1 year. Failure to stop at a red traffic light was the primary outcome. Results Overall, 3.8% of older drivers failed to stop at red traffic lights, with 15% of those who ran the light having failed 10% or more of the traffic lights they encountered. A narrowing of the attentional visual field (AVF; the extent of peripheral vision in which objects are detected while attention is also centrally fixated) was associated with failure to stop at traffic lights at baseline and predictive 1 year later (incidence rate ratio = 1.09 per degree lost, 95% confidence interval = 1.01–1.16). Persons with smaller vertical AVF were more likely to fail to stop. No demographic or vision variable was related to failure to stop. Conclusions Failure to stop at red lights was a relatively uncommon event in older drivers and associated with reduced ability to pay attention to visual events in the vertical field of vision.

Number of Years of Annual Mass Treatment With Azithromycin Needed to Control Trachoma in Hyper-endemic Communities in Tanzania

Background. The World Health Organization recommends mass treatment as part of a trachoma control strategy. However, scant empirical data from hyperendemic communities exist on the number of rounds of treatment needed to reach a goal of <5% prevalence in children. We determined the prevalence of trachoma and infection with Chlamydia trachomatis in communities after 3–7 years of annual mass treatment in Tanzania. Methods. Seventy-one communities with trachoma and annual azithromycin coverage data were enrolled. A cross-sectional survey of ≥100 randomly selected children aged <5 years in each community was performed. Children were examined for clinical trachoma, and swab samples were taken for determination of ocular C. trachomatis infection. Results. After 3 years of mass treatment, the prevalence of trachoma decreased in a linear fashion with number of years of mass treatment, whereas decreased prevalences of C. trachomatis infection were related to the extent of the previous year’s azithromycin coverage. Our model suggests that, for communities with baseline trachoma prevalence of 50% and annual treatment coverage of 75%, >7 years of annual mass treatment will be needed to reach a prevalence of trachoma of <5%. Conclusions  Country programs in trachoma-endemic regions must realistically expect that several years of annual mass treatment may be necessary to eliminate trachoma.

A randomized trial of visual impairment interventions for nursing home residents: Study design, baseline characteristics and visual loss

Introduction Visual impairment among nursing home residents is higher than in community-dwelling elderly. The provision of eye care services may be beneficial to nursing home patients. Our project, a randomized trial of vision restoration and rehabilitation in nursing home residents, compares usual care to targeted interventions. In this paper, we present the baseline characteristics of our sample within the nursing homes. Methods Twenty-eight nursing homes on Maryland’s Eastern Shore were matched in pairs by size and payment type. Each pair was randomized to usual care or targeted intervention. Habitual and bestcorrected acuity was attempted, using standard letter symbol/charts and grating acuity charts. Visual impairment was vision in the better eye <20/40 on letter and/or grating acuity. The MiniMental State Examination (MMSE) was used to determine cognitive impairment. Results Of those participants eligible to be screened, 40% had severe cognitive impairment (MMSE score 0-9). No measure of acuity could be ascertained on 18% of eligibles. Among the 1305 persons with acuity data, 38% had presenting vision worse than 20/40. After refractive correction, 29% had visual impairment. There was no difference by race or gender in those with visual impairment, although they were older, compared to those without visual loss. Conclusions The nursing home residents had high rates of both cognitive impairment and visual impairment, creating a challenging environment for visual intervention. By improving access to eye care within the context of the clinical trial, and changing either the magnitude of visual loss or the resultant impact on function, we hope to demonstrate a change in the quality of life for nursing home residents.

Cognitive and vision loss affects the topography of the attentional visual field.

PURPOSE The attentional visual field (AVF), which describes a persons ability to divide attention and extract visual information from the visual field (VF) within a glance, has been shown to be a good predictor of driving performance. Despite this, very little is known about the shape of the AVF and the factors that affect it. The purposes of this study were to describe the AVF in a large sample of older drivers and identify demographic, cognitive, and vision factors associated with AVF performance and shape. METHODS Registered drivers between 67 and 87 years of age, residing in Greater Salisbury, Maryland, were recruited to participate in the study. Participants underwent a battery of visual and cognitive assessments and completed various questionnaires for demographics, medical history, and history of depression. The AVF was assessed using a divided-attention protocol within the central 20 degrees radius along the four principal meridians. The shape of the AVF was classified as either symmetric or one of two asymmetric shape profiles. RESULTS Symmetrically shaped AVFs were found in just 34% of participants. AVF performance was significantly better along the horizontal (15.3 degrees ) than the vertical (11.3 degrees ) meridian (P < 0.05). After adjusting for AVF area, we found that poorer cognitive and vision performance was associated with a symmetric AVF shape. Overall AVF extent was predicted by vision and cognitive measures as well as various demographic factors. CONCLUSIONS Good vision and cognitive ability appear to be associated with having an asymmetric as opposed to a symmetric AVF shape profile.

Can Clinical Signs of Trachoma Be Used after Multiple Rounds of Mass Antibiotic Treatment to Indicate Infection

PURPOSE To evaluate combinations of clinical signs, using a modified World Health Organization (WHO) grading scheme, to predict a very low prevalence of infection at the community level after at least three rounds of mass drug administration (MDA). METHODS Seventy-one villages had three to seven rounds of MDA. A random sample of 7828 children ages 5 years and younger was evaluated for trachoma, and determination of Chlamydia trachomatis infection was made. Proportions of children positive for infection were evaluated against all possible combinations of follicular trachoma (TF) and inflammatory trachoma (TI). High-risk signs (HRS) for infection were defined as those indicating the infection prevalence was >20%. The sensitivity and specificity of prevalence of HRS in identifying communities with infection was examined. RESULTS The median community infection prevalence was 3.8% interquartile range (IQR) (1.8%, 7.7%); the median trachoma prevalence was 9.4%, IQR (6.6%, 15%). Severe TI, combination of TF and TI (WHO criteria), or severe TF with signs of inflammation were predictive of infection in the community, but the absence of these HRS was not an indicator of low infection rates. CONCLUSIONS The use of HRS to determine the infection status of a community was not useful in predicting whether MDA could be stopped.

Do infants increase the risk of re-emergent infection in households after mass drug administration for trachoma?

PURPOSE Mass treatment with azithromycin for trachoma endemic communities typically excludes infants under age 6 months, whose parents are provided with tubes of tetracycline to administer daily over 4 to 6 weeks. The authors sought to determine whether infants aged <6 months are a source of re-emergent infection in their families after mass treatment in trachoma-endemic communities. METHODS In a longitudinal study of all children aged less than 10 years in four communities, the authors identified 91 infants aged <6 months living in 86 of 1241 households. All children aged <ten years in all households were examined for trachoma and ocular infection with C. trachomatis at baseline, and 6 months after mass drug administration. RESULTS The prevalence of infection at baseline in the infants was 5.9%. At 6 months post mass drug administration, the rate of infection among children older than 6 months and less than 10 years who resided in households with infants was 6.0% compared with 11.1% in children in households without infants (P = 0.18). After adjustment for age, sex, baseline infection status, and treatment, residing in a household with an infant was not associated with infection at 6 months (odds ratio [95% confidence interval] 0.50 [0.20-1.22]). CONCLUSIONS This prospective study did not find evidence that living in a household with an infant increased the risk of infection 6 months post mass drug administration in other children residing in the household.

Ophthalmology and the ageing society

Ophthalmology and the ageing society / , Ophthalmology and the ageing society / , کتابخانه دیجیتال جندی شاپور اهواز