Support systems help elderly get cataract surgery

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Nursing home residents with cataracts face significant barriers to obtaining surgical services, according to findings published in the Archives of Ophthalmology. The addition of a support system facilitates scheduling surgery and getting the patients to and from the hospital, and increases cataract surgery rates.

“The Salisbury Eye Evaluation in Nursing Home Groups (SEEING) is a ... trial studying the effect of a comprehensive vision restoration-rehabilitation program, including the provision of cataract surgery services when needed,” write Dr. David S. Friedman, from Johns Hopkins Medical Institutions, Baltimore, Maryland, and colleagues.

The researchers compared the uptake of cataract surgery in nursing homes where assistance in obtaining services was provided with that found in homes lacking such services. The team matched 28 nursing homes in pairs by size and payment type, then randomly assigned each pair to usual care or the support service.

Cataract surgery was recommended for patients with cataracts causing vision in the better eye to be worse than 20/40. Additional support for obtaining cataract surgery was provided for those in intervention homes.

Compared to residents without visual impairment, those recommended for cataract surgery tended to be older and were more likely to be black women. In addition, these patients had lower mental test scores and had resided in the nursing home longer.

Of 99 residents in “usual acre” homes referred for cataract surgery, just two actually underwent surgery, Friedman’s team reports. On the other hand, of 77 surgery-referred residents in homes with support services, 24 underwent surgery.

The investigators say the findings highlight the barriers to obtaining cataract surgery for elderly, mentally impaired nursing home residents. However, they also point out that in many cases the patient or guardian declined surgery, saying they were unwilling to undergo any procedure, even if it improved their quality of life.

SOURCE: Archives of Ophthalmology, November 2005.

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