Correction of Vision in Nursing Home Residents Relieves Depression

November 20, 2007 — The simple gesture of providing nursing home residents with corrective eyeglasses not only improves their vision but also reduces depressive symptoms and improves psychological well-being, according to a study in the November issue of the Archives of Ophthalmology.
Vision impairment rates among nursing home residents are an estimated 3 to 15 times higher than among older adults living in the community, the authors write, despite the fact that about one-third of this vision impairment could be reversed by treatment of uncorrected refractory error.
These high vision impairment rates are "shocking," corresponding author Cynthia Owsley, PhD, Nathan E. Miles Chair of Ophthalmology and vice chair for clinical research, department of ophthalmology, school of medicine, University of Alabama, in Birmingham, told Medscape Psychiatry.
"There are so many chronic eye diseases of aging that you can't really reverse, but things like nearsightedness, farsightedness, needing glasses to see up close" are not among them, she said. "There's really not a routine provision of eye care in nursing homes. It might be considered on paper as a part of comprehensive medical care, but it's simply not happening."
This is unfortunate, since people with vision problems are at higher risk for depression, she said. Depression rates in nursing homes are as high as 43%, the study authors note.
"Modest Yet Consistent Effect"
The current study included residents aged 55 years and older in 17 nursing homes in the Birmingham, Alabama area who had uncorrected refractive error (myopia, hyperopia, and/or presbyopia) in 1 or both eyes and could answer simple questions about vision. The residents completed quality-of-life questionnaires, and researchers measured their depressive symptoms using the 15- item Geriatric Depression Scale (GDS).
Following the baseline assessment, each participant selected a pair of eyeglass frames at no charge. The residents were then randomly assigned to either the "immediate" group, who received their spectacles within about a week, or to a "delayed" group, who did not receive their glasses until 2 months later.
Residents in both groups had similar demographics and medical characteristics. On average, participants were in their late 70s and had 5 to 6 chronic medical conditions. The distribution of refractory error was similar in both groups.
At the end of the protocol, there were 78 residents still in the "immediate" group and 64 in the "delayed" group.
At follow-up, the researchers found that the "immediate" group had a score of 3.6 on the GDS, compared with 4.9 in the delayed group. "It's somewhat misrepresentational to look at averages, but on average it [the depression score] changed by about 1.5 symptoms," said Dr. Owsley. "It doesn't sound like a lot, but some individuals had more of an effect than others. It was a modest yet consistent effect."
The "immediate" group also had higher scores on subscales of general vision, reading, psychological distress (eg, worry, frustration), activities and hobbies, and social interaction.
Communication Problems a Possible Factor
One possible contributing factor for these high vision impairment rates is the pervasive opinion among health providers and others that nursing home residents would not benefit from treatments to improve vision because of cognitive impairment. Communication problems among medical staff could also play a role, said Dr. Owsley, adding that eye specialists may not consider nursing homes a venue for providing care. Only half of nursing homes in the United States report having contracts for vision services, according to the study.
Dr. Owsley also thinks that families may put corrective eye wear low on a list of priorities for a loved one who is dealing with so many other health issues. "I'm not disputing that individuals who reside in nursing homes have very serious chronic conditions, many of which are dementia related, but you have to think beyond that," she said. "We're visual entities. That's how we interact with our environment. It just adds an additional frustration in your day when you can't see."
Nursing home residents, she said, spend a good deal of time reading, watching TV, interacting with other people, and doing hobbies. "Much of their work is up-close work, and that's why it's so important that their presbyopia be corrected."
In most cases, financial barriers are not keeping these residents from getting glasses. Vision correction is covered by Medicaid, and most people (68%) in nursing homes are on Medicaid or similar coverage, the authors note. Therefore, supplying corrective eyeglasses to nursing home residents is not something that requires huge policy changes, said Dr. Owsley.
The researchers now plan to do another study to "see where the breakdown in the system lies . . . so we can make very practical practice-oriented recommendations," said Dr. Owsley.
The research was supported by the Retirement Research Foundation, the EyeSight Foundation of Alabama, the Pearle Vision Foundation, the National Institutes of Health, and Research to Prevent Blindness Inc. The authors report no conflicts of interest.
Arch Ophthalmol. 2007;125:1471-1477. Abstract