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The "old-elderly" - those ages 85 and older - are the fastest growing segment of the population, increasing by 43 percent by the year 2010. The "old-elderly" are at the greatest risk of being in need of health care, social services, and caregiving by friends and family. They are also most likely to suffer from one or more of the major causes of visual impairment - cataracts, age-related macular degeneration, glaucoma, and diabetic retinopathy. While many persons in this group are in relatively good health, the solution for many "well-but-frail" elderly is to enter a nursing home. The demand for nursing home beds is expected to rise by 50 percent over the next 20 years. Among nursing home residents, recent research indicates that approximately 3 percent have no vision and 25-48 percent are severely visually impaired. The primary care optometrist has an increasingly important role in helping elderly individuals maintain independent life styles, thereby reducing their need for earlier institutionalization. The optometrist also has a professional responsibility to help enhance the quality of life for those who are institutionalized. This Manual is designed to provide helpful information in regard to the evaluation of visual function and ocular health among individuals residing in nursing homes or other types of assisted living facilities. The goal of the Manual is to provide knowledge and understanding of the diagnostic and management elements needed for comprehensive evaluation and care of this growing and significantly neglected segment of the patient population. This Manual includes discussions of administrative and professional staffing, the role and clinical responsibilities of the optometric consultant, instrument and equipment needs, and nursing home records and forms, including coding and billing for services. Implicit in this Manual is the patient care responsibilities for diagnosis and management of nursing home residents by the primary care optometrist. Indeed, geriatric optometry as represented in the care of the persons within nursing facilities provides the fullest realization of primary care services. Visual impairment represents one of the most common disabilities among nursing home residents. It is also one of the most unrecognized disabilities by nursing home staffs.2One study found that visual impairment is 13-15 times more common among the nursing home population than among an age-matched ambulatory population. Multiple studies have shown that few residents receive vision care after admission to a nursing home. Although some variability is seen from study to study, it can be estimated that 80 percent or more of all nursing home residents receive no vision care at any point after admission. Vision and eye care currently are not mandated services within long term care facilities. Vision care is required to be provided by the nursing home at the request of the resident or family or if indicated by a change in status particularly in the presence of cognitive impairment. The current system of identifying residents in need of vision care services is inadequate.
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