Formal and informal care utilisation amongst elderly persons with visual impairment

Abstract

Objective: To examine the determinants of formal and informal care utilisation amongst persons with age-related macular degeneration (AMD).

Design: Cross-sectional hospital-based study.

Setting: Hospital eye clinic in Northern Ireland.

Participants: 284 persons aged >or=50 years.

Main outcome measures: Participants were questioned about their care, living arrangements, eyesight-related ability to self-care, and eyesight-related need to be more careful whilst undertaking everyday tasks.

Results: The percentage of older persons receiving formal and informal care rose with the level of visual impairment. 34.9% and 37.3% of those with no visual impairment received formal and informal care, respectively, compared with 51.6% and 69.9% of those with moderate visual impairment and 55.6% and 88.9% of those with severe visual impairment. Three factors (age, best corrected distance visual acuity in the better eye and living alone) were significant predictors (p<0.05) of care utilisation. The likelihood of someone utilising formal care rose with increasing age, severity of visual impairment and living alone. There is an approximate one-to-one trade-off between age and visual acuity such that a difference of one line of vision is equivalent to approximately 1 year of life to the affected individual as regards its impact on the probability of care utilisation.

Conclusions: Care utilisation is predicted by age, visual acuity in the better eye and living arrangement. These findings question the validity of the current practice of defining the need for statutory services on the basis of visual acuity alone. These data may have implications for cost utility analyses of new therapeutic developments in macular degeneration.