Community support services (e.g., meals-on-wheels) were found to be more intensely used by those with moderate to severe visual impairment. This study, which examined the impact of sensory impairment on the use of community support services in Australia, suggested that home care programs that included assistance for everyday activities like cleaning and shopping may be essential to enable visually impaired elderly individuals to remain at home.

Background: The objective of this study was to examine if sensory impairment (hearing loss or visual deficits) was associated with increased community service utilization and low quality of life in the older community-living adult population. In Australia, government-funded community support services are designed to assist older adults to remain in their home for as long as possible. Past studies have shown that visual and hearing impairments have negative impacts on elderly functional independence and quality of life, contributing roughly the same magnitude to years of life lost from disability as stroke and osteoarthritis. Visually impaired older persons are also three times more likely to use community support services when compared to those with normal vision.

Methods: Participants included 260 frail community-dwelling individuals over the age of 65 without dementia who attended aged care assessment services at a hospital in Sydney, Australia. In this sample, vision and hearing tests were given to 168 and 167 participants, respectively. Standardized questionnaires and inperson interviews were used to ascertain socio-demographic characteristics, self-rated health, health-related quality of life, and use of government-funded community support services (i.e., meals-on-wheels services; home help in cleaning, meal preparation and shopping; and regular home visit by a community nurse).

Visual impairment was defined as inability to correctly read more than 39 letters from a standardized distance (visual acuity < 20/80). Moderate to severe hearing loss was defined as hearing thresholds >40 decibels (better ear). Participants were randomly assigned to one of four treatment groups (i.e., "visual test" group, "hearing test" group, "visual and hearing tests" group, and "no testing" group).

Findings: The average age of participants was 82 years. After controlling for factors like age, sex, marital status, the presence of two or more chronic conditions, the ability to go out alone, and fair-to-poor self-rated health, the presence of moderate-to-severe visual impairment was strongly associated with increased use of community support services. Hearing loss, conversely, was not strongly linked to increased use of services. The quality of life of participants with either visual or hearing loss was not remarkably lower than those without sensory impairments.

The socio-demographic characteristics and usage of community services of the study sample were comparable to the state population. Nearly 31% of participants used at least one type of community support service. Among those who received the visual acuity test, 21% had mild visual impairment and 12% had moderate-to-severe visual impairment. Among those who received the hearing test, mild and moderate-tosevere hearing loss was found in approximately 40% and 14% of participants, respectively. Of those with moderate-to-severe visual impairments, 60% used one or more types of community services, as did 29% of the participants with mild or no visual deficits. To a lesser extent, only 32% of those with moderate-to-severe hearing loss and 28% of those with mild or no hearing deficit used community support services.

Conclusions: This study revealed that visual impairment was a predictor of increased use of community care services. Providing support services (e.g., meals on wheels) may reduce the likelihood of visually impaired elders moving to long-term care facilities because of a breakdown in their capacity to perform household chores independently. Since visual deterioration is a normal aging process, the need for home care programs that include assistance for everyday activities such as cleaning, meal preparation and shopping may be justified in order to enable the frail and elderly population to live at home.

Reference: Tay T, Wang JJ, Lindley R, Chia EM, Landau P, Ingham N, Kifley A, Mitchell P. "Sensory impairment, use of community support services, and quality of life in aged care clients." Journal of Aging and Health 2007; 19 (2): 229-241.

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