None listed
Conditions
Brief summary
The overall aim of this project is to improve and preserve optimal visual function of residents in Australian residential aged care facilities (RACFs), in order to improve or optimise this critical sensory input in their already restricted environment. There is clear evidence that people living in RACFs have more vision issues which are not adequately managed, when compared to similarly aged people living in their own home. Vision issues include macular degeneration (the main cause of blindness and major vision loss in people over 50), glaucoma, diabetic retinopathy, untreated cataract, uncorrected refractive error and many other conditions. Eye testing of residents will be conducted to quantify the extent of vision issues in these facilities, and to test the practicality of onsite testing, or alternate means when necessary. After gaining a detailed knowledge base of the current landscape, legislative requirements and issues through consultation with an expert reference group, the project will identify the existing eye health practices in eight different RACFs from four different providers (Estia Health, Presbyterian Aged Care, BaptistCare, Allambie Heights Village) using a detailed audit. The facilities to be audited will have varying levels of additional services provided. The audit will focus on existing policies and procedures to determine: a) whether appropriate baseline records of a resident's vision are obtained; b) whether residents obtain regular ongoing eye tests, and if so, how; c) whether resident care (including treatment and rehabilitation) is modified as a result of vision issues; d) the extent of communication regarding eye health with the residents' healthcare providers (eg GP and relevant specialists) and family. Using input from the expert reference group, a draft 'minimum standard of care' model will be developed. A manual will then be produced to provide a practical/workable guide for use in RACFs. In addition, an audio-visual education tool will be developed for use by RACF management and staff, as well as an educational publication for families. The manual and video will then be tested within the RACFs prior to final production and distribution to all RACFs across Australia.
Interventions
Approximately 200 consenting residents from residential aged care facilities will have their overall eye health determined by an eye exam within the aged care facility. All tests are non-invasive and will be performed at a single testing session for each participant. They include:
i) visual acuity (near and distance)
ii) contrast sensitivity
iii) simple refraction (using autorefraction)
iv) check of existing glasses using vertometer
v) slit lamp examination
vi) non-mydriatic fundus (retinal) ph
Approximately 200 consenting residents from residential aged care facilities will have their overall eye health determined by an eye exam within the aged care facility. All tests are non-invasive and will be performed at a single testing session for each participant. They include: i) visual acuity (near and distance) ii) contrast sensitivity iii) simple refraction (using autorefraction) iv) check of existing glasses using vertometer v) slit lamp examination vi) non-mydriatic fundus (retinal) photography vii) optical coherence tomography (OCT) viii) intra-ocular pressure test ("puff" test) ix) confrontational visual field test No dye injections will be given, and mydriatic eye drops (to enlarge the pupil) will not be used. Tests and scans will be reviewed by a qualified orthoptist and checked by an ophthalmologist with a subspecialty in retinal conditions. Any resident with an undiagnosed eye condition will be encouraged to seek further review and possible treatment, however this will fall outside the scope of this trial. The policies and procedures within each aged care facility in relation to their management of eye health will then be reviewed. Issues such as recording of eye diseases, ongoing eye testing, procedures (including the training of staff) regarding the management of people with low vision, transportation to eye care appointments and ongoing follow-up will be recorded. Optometrists who provide in-house testing of residents will also be interviewed to clarify their procedures, referral patterns, recording methods and tests used. Data generated by the eye testing and the surveys will be used to develop an eye health model of care for people in residential aged care facilities. This will include the development of training material for facility staff and the families of residents. The draft model of care and other resources will be developed in collaboration with an expert panel and the facilities, Following pilot testing of the draft model of care and resources, the final model and modified resources will be published and promulgated nationally.
Sponsors
Macular Disease Foundation Australia
Eligibility
Sex/Gender
All
Age
60 Years to No maximum
Healthy volunteers
Yes
Inclusion criteria
Consenting residents of 8 aged care facilities. Estia Health Mona Vale - 50 Golf Ave, Mona Vale 2103 Estia Health Epping - 64 Norfolk Rd, Epping 2121 Presbyterian Aged Care Drummoyne (Minnamurra) - 14 Clements St, Drummoyne 2047 Presbyterian Aged Care Ashfield - 40 Charlotte St, Ashfield 2131 Baptist Care Cooinda Court - 159 Balaclava Rd, Macquarie Park 2113 Baptist Care Dorothy Henderson Lodge - 157 Balaclava Rd, Macquarie Park 2113 Baptist Care Yallambi Centre - 268 Pennant Hills Rd, Carlingford 2118 Allambie Heights Village, 3 Martin Luther Cl, Allambie Heights 2100
Exclusion criteria
Non-English speaking resident with no interpreter services readily available. Residents (or their guardian) who are unwilling to sign an informed consent form. Severe dementia, extreme frailty, or other condition making testing impractical or impossible. Terminally ill residents in whom there will be no likely benefit of testing.
Outcome results
None listed