A large New Zealand study has found that while most frail older adults report adequate or only minimally impaired vision, access to regular eye examinations and visual aids drops markedly for those living in aged residential care, with persistent inequities across ethnic groups.
Published in the Australasian Journal on Ageing, the research analysed more than 48,000 interRAI* assessments conducted nationwide between January 2019 and December 2020. The cohort comprised older adults receiving publicly funded home support or living in aged residential care facilities, with a mean age of 82 years and 65% female.
Researchers found that 10% of the cohort experienced moderate or worse vision impairment, while 19% had moderate or worse hearing impairment. Dual sensory impairment, measured using the Deafblind Severity Index, was present in 7% of participants.
In terms of vision specifically, two-thirds of the cohort were assessed as having adequate vision, while 24% had minimal difficulty, 6% moderate difficulty and 3% severe difficulty. Vision impairment increased with age, particularly among those aged 85 years and older.
Despite these findings, utilisation of eye examinations and visual aids varied substantially depending on living arrangements. Among older adults receiving support at home, 55% had undergone an eye examination in the previous year. This fell to 32% among those living in aged residential care facilities.
The use of visual aids showed a similar pattern. While 72% of aged care residents were recorded as using visual aids, uptake was not evenly distributed. Māori, Pacific Peoples and Asian older adults were less likely to use visual aids compared with New Zealand Europeans and those in other ethnic groups.
The study also identified significant ethnic disparities in access to eyecare. Overall, 43% of the cohort had received an eye examination in the previous year, but this dropped to 35% for Māori and 37% for Pacific Peoples, compared with 45% for New Zealand Europeans. Māori had the lowest reported use of eye examinations across the cohort.
Although hearing impairment was more prevalent than vision impairment, eyecare was accessed more frequently than hearing care. Researchers noted that this may reflect differences in service availability, awareness, or perceived importance of vision care compared with hearing care among older adults and care providers.
The authors highlighted that international guidelines recommend annual vision screening for people aged over 65, and previous research suggests that a significant proportion of aged care residents would benefit from ophthalmic interventions to improve visual function and quality of life.
Importantly, the study relied on functional assessments rather than detailed clinical diagnoses. Vision impairment ratings were based on interRAI assessments conducted by trained professionals, reflecting how well individuals functioned in daily life with their usual visual aids, rather than formal ophthalmic testing.
Lead author Dr Hans Ulrich Bergler from the University of Otago said the findings raise important questions for eye health policy and service delivery in New Zealand, particularly in aged residential care settings and among underrepresented ethnic groups.
“Access to vision assessment was consistently lower in aged residential care than in home-based settings, and Māori and Pacific Peoples were less likely to receive eye examinations or use visual aids, despite the known impact of vision loss on independence and quality of life,” he said.
* The InterRAI is a collaborative network of researchers and practitioners in over 35 countries committed to improving care for persons who are disabled or medically complex. This network strives to promote evidence-informed clinical practice and policy decision-making.