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This chapter addresses the following Geriatric Fellowship Curriculum Milestones: #3, #9, #14, #45, #46, #68

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LEARNING OBJECTIVES

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Learning Objectives

  • Understand the prevalence of vision impairment among older adults, its functional implications, as well as the costs to the older adult who develops it, to the family, and to society.

  • Understand the normal age-related vision changes, and the functional indications and losses of the most prevalent age-related eye diseases.

  • Care for older adults who have vision loss with evaluations, recommendations, supportive education, and appropriate referrals to eye care and rehabilitation providers.

  • Assure that older adults with low vision who are in long-term and palliative care have their specific visual needs addressed.

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Key Clinical Points

  1. Visual impairment among older adults is treated through examination, prescription and recommendation of assistive devices and interventions, rehabilitation training, and education of family and other health professionals.

  2. Vision loss among older adults is associated with depression, comorbid health problems, and other disabilities. Treatment and rehabilitation for vision loss increase independence and mental health.

  3. Geriatricians can play an important role in assuring that older adults receive low-vision rehabilitation, and supporting the full range of services that can be provided.

  4. Addressing visual impairment and assuring that older adults maintain their visual abilities and strategies can be included as a part of long-term and palliative care plans.

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DEMOGRAPHICS

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Population Studies

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Many large, population-based, cross-sectional studies have documented the increase in prevalence of eye disease and visual impairment with increasing age, particularly in people over the age of 75. The Centers for Disease Control and Prevention (CDC) and the National Centers for Health Statistics (NCHS) estimate the prevalence of significant visual impairment among Americans age 18 to 44 with vision loss is 5.5%; the prevalence in those age 45 to 74 is approximately 12% and is rising to more than 15% for those 75 and over. After age 85, one in four older people are vision-impaired—unable to read, drive, recognize faces, and perform everyday activities without assistive devices and rehabilitation training.

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Cost of Age-Related Vision Loss

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Age-related visual impairment is not only challenging to the person who develops it, but also affects society as a whole. For the year 2004, the total financial cost to the United States of four common eye disorders (age-related macular degeneration, cataract, diabetic retinopathy, and glaucoma), refractive error, visual impairment, and blindness in US residents aged 40 and older was estimated at $35.4 billion. (This includes direct medical costs, direct nonmedical costs, and lost productivity.)

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Medicare beneficiaries with coded diagnoses of vision loss have also been shown to incur an additional $2.14 billion in non–eye-related medical costs, incurring significantly higher costs than those with normal vision. Additional eye-related costs per patient yearly are approximately $345 for those with moderate vision loss, $407 for those with severe vision ...

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