视力损害与居家状态、家庭危害和支持服务利用之间的关系：国家健康和老龄化趋势研究。

IF 4.2 1区医学 Q1 OPHTHALMOLOGY

American Journal of Ophthalmology Pub Date : 2025-09-05 DOI:10.1016/j.ajo.2025.09.005

Xindi Chen , Louay Almidani , Seema Banerjee , Jonathan Thomas , Aleksandra Mihailovic , Fasika A. Woreta , Pradeep Y. Ramulu

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引用次数: 0

摘要

目的探讨老年人视力障碍（VI）与(1)居家状态、(2)家庭危险存在和(3)家庭长期服务和支持（LTSS）利用之间的关系。设计使用2021-2023年国家健康与老龄化趋势研究（NHATS）数据进行纵向和横断面分析。受试者3022名年龄≥71岁（平均78.8岁，55.3%为女性）的医疗保险受益人，具有完整的居家状态和视觉功能数据。方法svi定义为远视力或近视力（<0.3 logMAR）或对比敏感度（<1.55 logCS）受损。根据离家的频率和难易程度，将居家状态分为居家、半居家和非居家。家访期间记录了家庭危险（油漆剥落、家具破损、地板损坏和绊倒危险）。LTSS的使用包括辅助设备、家庭改造、交通服务、老年人住房、送餐、有偿护理和高负担家庭护理。回归模型（logistic和Cox比例风险）评估了VI的存在、严重程度和下降率与结果之间的横断面和纵向关系。主要观察指标：存在或过渡到居家或半居家状态，存在居家安全隐患，以及使用居家LTSS。结果3022名参与者（平均年龄78.8岁，女性55.3%）中，5.7%为居家者，14.4%为半居家者。任何VI的存在都与以下两种可能性相关（OR=1.52, 95% CI: 1.17-1.98, p=.002）以及成为居家或半居家（HR=1.35, 95% CI: 1.04-1.74, p=.02）。满足所有三个VI标准的参与者有更高的风险（HR=1.86, 95% CI: 1.35-2.58, p<.001）。患有VI的个体更有可能有家庭危害（OR=1.88, 95% CI: 1.32-2.69, p=.001），更有可能使用基于家庭的LTSS （OR=1.35, 95% CI: 1.10-1.66, p=.005）。结论svi是老年人居家生活的重要危险因素，随着svi严重程度和广度的增加，这一风险进一步加剧。VI患者也面临着更大的家庭危险，需要更多的以家庭为基础的LTSS，这表明随着他们越来越局限于家庭，维护家庭安全和功能面临挑战。早期视力干预、全面的家庭安全评估和有针对性的LTSS可能是维持视力受损老年人独立性的重要预防策略。

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Associations Between Visual Impairment and Homebound Status, Home Hazards, and Support Service Utilization: The National Health and Aging Trends Study

Objective

To examine the association between visual impairment (VI) and (1) homebound status, (2) presence of home hazards, and (3) utilization of home-based long-term services and supports (LTSS) among older adults. Design: Longitudinal and cross-sectional analyses using National Health and Aging Trends Study (NHATS) data (2021–2023).

Subjects

A total of 3022 Medicare beneficiaries aged ≥71 years (mean age 78.8 years, 55.3% female) with complete data on homebound status and visual function.

Methods

VI was defined as impairment in distance visual acuity or near visual acuity (<0.3 logMAR), or in contrast sensitivity (<1.55 logCS). Homebound status was classified as homebound, semi-homebound, or non-homebound based on frequency and difficulty leaving home. Home hazards (peeling paint, broken furniture, flooring damage, and tripping hazards) were documented during in-home visits. LTSS utilization encompassed assistive devices, home modifications, transportation services, senior housing, meal delivery, paid care, and high-burden family caregiving. Regression models (logistic and Cox proportional hazards) assessed cross-sectional and longitudinal relationships between VI – its presence, severity, and rate of decline – and outcomes.

Main Outcome Measures

Presence or transition to homebound or semi-homebound status, presence of home safety hazards, and utilization of home-based LTSS.

Results

Among 3,022 participants (mean age 78.8 years, 55.3% female), 5.7% were homebound, and 14.4% semi-homebound. The presence of any VI was associated with a higher likelihood of both being (OR = 1.52, 95% CI: 1.17-1.98, P = .002) and becoming homebound or semi-homebound (HR = 1.35, 95% CI: 1.04-1.74, P = .02). Participants meeting all three VI criteria had an even higher risk (HR = 1.86, 95% CI: 1.35-2.58, P < .001). Individuals with VI were more likely to have home hazards (OR = 1.88, 95% CI: 1.32-2.69, P = .001) and utilize home-based LTSS (OR = 1.35, 95% CI: 1.10-1.66, p = 0.005).

Conclusions

VI is a significant risk factor for being and becoming homebound in older adults, with increasing severity and breadth of VI compounding this risk. Individuals with VI also face greater home hazards and require more home-based LTSS, suggesting challenges maintaining home safety and functionality as they become more confined to the home. Early vision interventions, comprehensive home safety assessments, and targeted LTSS may be important preventive strategies for maintaining independence in visually impaired older adults.

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来源期刊

American Journal of Ophthalmology 医学-眼科学

CiteScore

9.20

自引率

7.10%

发文量

406

审稿时长

36 days

期刊介绍： The American Journal of Ophthalmology is a peer-reviewed, scientific publication that welcomes the submission of original, previously unpublished manuscripts directed to ophthalmologists and visual science specialists describing clinical investigations, clinical observations, and clinically relevant laboratory investigations. Published monthly since 1884, the full text of the American Journal of Ophthalmology and supplementary material are also presented online at www.AJO.com and on ScienceDirect. The American Journal of Ophthalmology publishes Full-Length Articles, Perspectives, Editorials, Correspondences, Books Reports and Announcements. Brief Reports and Case Reports are no longer published. We recommend submitting Brief Reports and Case Reports to our companion publication, the American Journal of Ophthalmology Case Reports. Manuscripts are accepted with the understanding that they have not been and will not be published elsewhere substantially in any format, and that there are no ethical problems with the content or data collection. Authors may be requested to produce the data upon which the manuscript is based and to answer expeditiously any questions about the manuscript or its authors.