An Epidemiological Study of Visual Impairment
and Visual Function Related Quality of Life
among The Elderly.
(Total Pages 178 )
AUTHOR： Chang, Hsueh-Hui
SUPERVISOR：Dr. Li, Chung-Yi
DEGREE： Master of Science in Public Health
Dept of Public Health, College of Medicine, Fu-Jen Catholic University
KEY WORD： elderly, vision, visual function, screening, quality of life, cross-sectional study, epidemiology
BACKGROUND AND PURPOSE: The prevalence of visual impairment increases as a result of the growth of elderly population and changes of disease pattern. Many elderly people do not receive timely and appropriate eye treatment since they are not examined. This study was conducted to characterize and compare the prevalence rates of visual impairment and scores of visual function related quality of life (VFRQOL) among the elderly people living in four districts with different ways of living in Hisn-Chu County. Further analyses were also performed to explore demographic characteristics and disease histories that could significantly predict visual capability and VFRQOL. Results from this study may be of help to the health policy toward eye care of the elderly, community health research, and policy formulation.
METHODS: This study used a cross-sectional design. Using a stratified random sampling technique, we selected a total of 2,006 elderly participants aged 65 and more and lived in four townships (Jhubei, Guansi, Emei, and Wufong) of Hsin-Chu County. Each study participant received an eye screening for visual impairment and was administered a questionnaire for VFRQOL. A total of 1,392 study participants completed the interview, representing a response rate of 69.4%. Instrument used in this study included the Snellen E chart, the simplified visual acuity card, and the 25-item Visual Function Questionnaire (VFQ-25). The study participants whose presenting visual acuity of the better eye was worst than 6/12 were classified as subjects with visual impairment. The study also calculated the total score and sub-scale scores of VFQ-25 to indicate an individual’s VFRQOL. Percentage and mean were calculated for description of categorical and continuous variables, respectively. Statistical testing was performed with various techniques including Chi-square test, One-way analysis of variance, logistic regression (calculation of odds ratios), and linear regression (calculation of the difference in score).
RESULTS: The highest and lowest prevalence rate of visual impairment was observed in Emei and Guansi, respectively. Among the VFQ-25 sub-scales, the highest score was noted for “color vision” irrespective of the study township (average score was 93.1, the highest and lowest township-specific score was noted for Jhubei (97.4) and Wufong (82.8), respectively). The lowest sub-scale specific score was observed for “general health” (average score of 33.0) with the highest and lowest township-specific score noted for Guansi (37.6) and Jhubei (30.4). Results from multivariate analyses indicated that prevalence of visual impairment was significantly associated with township of living, age, diabetes, and eye disorder, but not with gender, education, marital status, living condition, body mass index (BMI), and histories of hypertension and hyperlipidemia. Additionally, the total score of VFQ-25 can be significantly predicted by the factors including visual impairment, township of living, age, gender, education, marital status, BMI, and disease histories of hypertension, diabetes, and eye disorders, but was unrelated to living condition and hyperlipidemia. Moreover, visual impairment, township of living, and eye disorders were factors that can significantly predict scores of all VFQ-25 subs-scales; and age was also a significant predictor for all VFQ-25 subs-scales except “driving”. As compared to the healthy subjects, the study participants with visual impairment tended to experience a significantly reduced VFQ-25 total score and scores of all sub-scales. The largest and smallest difference associated with visual impairment was “driving” (14.4) and “general health” (5.5). Overall, there was a significant difference in VFQ-25 score between four townships, and the elderly in Wefong township had the least total score and scores of nearly all sub-scales except for “general health” for which the elderly in Jhubei township experienced the least score.
CONCLUSION: We found that the prevalence of visual impairment was significantly associated with township of living, age, diabetes, and eye disorder. Additionally, visual impairment, township of living, and eye disorders were factors that can significantly predict scores of all VFQ-25 subs-scales. In the future, community visual health care should deliver its visual screen program to the elderly people who are older, living in rural, with the history of diabetes, and eye disorder. Moreover, visual health care and visual health education should also be further enforced. Besides, after adjustment for the demographic characteristics, the history of disease, and visual impairment, we still noted a significant geographic variation in the score of VFRQOL. Future studies should aim to explore the specific factors that may be responsible for such geographic variation.
KEY WORDS: elderly, vision, visual function, screening, quality of life, cross-sectional study, epidemiology
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