Aging and vision

AbstractGiven the increasing size of the older adult population in many countries, there is a pressing need to identify the nature of aging-related vision impairments, their underlying mechanisms, and how they impact older adults’ performance of everyday visual tasks. The results of this research can then be used to develop and evaluate interventions to slow or reverse aging-related declines in vision, thereby improving quality of life. Here we summarize salient developments in research on aging and vision over the past 25years, focusing on spatial contrast sensitivity, vision under low luminance, temporal sensitivity and motion perception, and visual processing speed

Evaluation of the AARP Driver Safety Program in Florida

OBJECTIVES Older drivers are the fastest growing group of drivers on the road in the United States, both in terms of the number of drivers and annual mileage; also, per-mile-driven, this group has a crash rate nearly equivalent to that of younger drivers. One approach to reducing crash risk in this population has been educational programs aimed at improving driving skills and/or changing driving behaviors. This retrospective cohort study describes the impact of the AARP Driver Safety Program (DSP) in Florida on motor vehicle collisions and violations. METHODS Information on individuals who participated in the AARP DSP in the state of Florida in 2001 and 2002 was provided by the AARP. The Florida Department of Highway Safety and Motor Vehicles (FDHSMV) provided licensure information on all licensed drivers who were aged 60 and older as of January 1, 2001. With respect to violations and collisions, information dating from the mid-1990s to early 2005 was provided. A total of 232,192 unique records for DSP participants were available; however, of these, 38,321 records were excluded because they contained out-of-state, erroneous or missing driver’s license numbers and therefore could not be matched to the data provided by the FDHSMV. Of the remaining 193,871 records with legitimate Florida driver’s license numbers, a total of 140,282 (72.4%) could be linked to the data provided by the FDHSMV. Two separate analyses were conducted. The first analysis compared violation and collision rates for DSP participants before and after DSP participation. The second analysis compared violation and collision rates between DSP participants and DSP non-participants. RESULTS Overall, DSP participants experienced a 7% statistically significant decrease in collisions (rate ratio [RR] 0.93, 95% confidence interval [CI] 0.89-0.97); a similar decrease was observed for injury-related collisions (RR 0.92, 95% CI 0.88-0.98) but not for fatal collisions (RR 1.20, 95% CI 0.74-1.94). The decline in the overall collision rate can be attributed to a decline in not-at-fault collisions (RR 0.85, 95% CI 0.80-0.91); there was no change in at-fault collisions (RR 1.00, 95% CI 0.94-1.07). Following DSP participation, violation rates significantly decreased 15% (RR 0.85, 95% CI 0.83-0.87). This decrease was observed for all types of violations with the exception of failure to yield, improper turning and improper lane changing, all of which showed no change, and careless driving, which showed a statistically significant 11% increase (RR 1.11, 95% CI 1.03- 1.20). Prior to DSP participation, those who participated in the DSP had a significantly higher collision rate (RR 1.11, 95% CI 1.07-1.14) compared to DSP non-participants, independent of age, gender, and race. This significantly elevated rate was consistent across all types of collisions. Following DSP participation, the overall collision rate for DSP participants was higher than that of non-participants (RR 1.21, 95% CI 1.17-1.25), though there was no difference for injurious or fatal collisions. The RR for not-at-fault and at-fault collisions indicated a lower collision rate for participants compared to non-participants. With respect to violations, prior to DSP participation, those who ultimately took part in the DSP had a lower violation rate (RR 0.96, 95% CI 0.95-0.98), however, this was mostly attributable to seat belt usage (RR 0.64, 95% CI 0.61-0.68). For all other types of violations, DSP participants had higher rates than the rest of the population. After DSP participation, participants had a higher violation rate compared to non-participants (RR 1.09, 95% CI 1.08-1.11), as well as elevated rates for most types of violations. There was no difference for failure to obey traffic signals, careless/improper driving, or improper backing. DSP participants had a lower rate of seat belt violations. CONCLUSIONS The results of this analysis suggest that though individuals who participated in the DSP had an overall reduction in collision rates, this reduction was attributable to not-at-fault collisions. This likely indicates that DSP participants modified their driving habits following the program (e.g., reduced their exposure) and did not necessarily improve their driving skills. There was also a reduction is some types of collisions, as well as an increase in careless driving-related offenses. These reductions may reflect a greater adherence to traffic laws or may simply reflect a reduction in driving brought about by changes in driving habits. Compared to similarly aged Florida drivers who did not participate in the DSP, participants had higher collision rates prior to the DSP. After DSP participation, the observed differences between participants and non-participants were either diminished or inverted such that participants had lower rates compared to non-participants. Participants had an overall lower violation rate prior to the DSP but for the most common types of violations they had elevated rates. Following participation, DSP participants had a higher crash rate compared to the rest of the population. For specific types of violations the elevated rates persisted but were diminished in magnitude

Reducing Crash Risk in Visually-Impaired Older Drivers: Medical-Surgical versus Educational Interventions

OBJECTIVES The aim of this paper is to compare the effectiveness of a medical-surgical intervention and an educational intervention in reducing the rate of crash involvement among visually impaired older drivers. Visual impairment is a common functional problem in older adults. Older drivers with visual processing deficits have an increased crash risk. Interventions that reduce these risks need to be identified in order to enhance driver safety. METHODS We have conducted two studies in an effort to examine two types of interventions to lower crash risk in visually impaired drivers. In a prospective cohort study we focused on 277 older drivers with cataracts, about half of who elected surgery and intraocular lens implantation at baseline, and the other half who declined surgery. They were followed for police-reported crash involvement for four to six years. In a second study, 403 older drivers who were visually impaired (acuity and/or useful field of view deficit) were randomly assigned to an individually administered and tailored educational intervention plus usual care, or to usual-care-only. The educational intervention promoted the use of self-regulatory driving strategies and was based on current models of health behavior change. Usual care was a comprehensive eye exam. In this study, subjects were also followed for police-reported crash involvement. RESULTS With respect to the study evaluating the cataract surgery intervention, patients who underwent cataract surgery had half the rate of crash involvement during follow-up compared with cataract patients who did not undergo surgery (rate ratio [RR] 0.47, 95% confidence interval [CI] 0.23 to 0.94; p0.05) CONCLUSIONS Cataract surgery has a previously undocumented benefit for older driver safety. However, an individualized educational intervention to promote safe driving strategies did not enhance driver safety. The most effective public health initiatives for reducing crash risk in older drivers may be to focus on the timely treatment of chronic medical conditions in order to prevent, reverse, or slow functional decline. Evidence that educational programs improve older driver safety remains unavailable

Reducing Crash Risk in Visually-Impaired Older Drivers: Medical-Surgical versus Educational Interventions

OBJECTIVES The aim of this paper is to compare the effectiveness of a medical-surgical intervention and an educational intervention in reducing the rate of crash involvement among visually impaired older drivers. Visual impairment is a common functional problem in older adults. Older drivers with visual processing deficits have an increased crash risk. Interventions that reduce these risks need to be identified in order to enhance driver safety. METHODS We have conducted two studies in an effort to examine two types of interventions to lower crash risk in visually impaired drivers. In a prospective cohort study we focused on 277 older drivers with cataracts, about half of who elected surgery and intraocular lens implantation at baseline, and the other half who declined surgery. They were followed for police-reported crash involvement for four to six years. In a second study, 403 older drivers who were visually impaired (acuity and/or useful field of view deficit) were randomly assigned to an individually administered and tailored educational intervention plus usual care, or to usual-care-only. The educational intervention promoted the use of self-regulatory driving strategies and was based on current models of health behavior change. Usual care was a comprehensive eye exam. In this study, subjects were also followed for police-reported crash involvement. RESULTS With respect to the study evaluating the cataract surgery intervention, patients who underwent cataract surgery had half the rate of crash involvement during follow-up compared with cataract patients who did not undergo surgery (rate ratio [RR] 0.47, 95% confidence interval [CI] 0.23 to 0.94; p0.05) CONCLUSIONS Cataract surgery has a previously undocumented benefit for older driver safety. However, an individualized educational intervention to promote safe driving strategies did not enhance driver safety. The most effective public health initiatives for reducing crash risk in older drivers may be to focus on the timely treatment of chronic medical conditions in order to prevent, reverse, or slow functional decline. Evidence that educational programs improve older driver safety remains unavailable

Strategic Planning for Recruitment and Retention of Older African Americans in Health Promotion Research Programs

The purpose of this study was to 1) describe a strategic plan for recruitment and retention used in conducting eye health education research with African-Americans living in urban and rural areas of Alabama and 2) characterize recruitment and retention patterns for this project. We evaluated an eye health education program tailored specifically to older African Americans. InCHARGE was designed to promote eye disease prevention by conveying the personal benefits of annual dilated comprehensive eye care and teaching strategies to minimize barriers to eye care. The InCHARGEÓ program or a social contact control program was delivered at 20 senior centers in predominately African American urban and rural communities. From pooled data across three studies, 380 African Americans completed a questionnaire about knowledge and attitudes/beliefs about eye disease and eye care before the program and by telephone at either 3 or 6 months after the presentation. The project consisted of 4 phases and 9 strategic objectives for both recruitment and retention of older African Americans that were implemented in a systematic fashion. Overall, retention rates for follow-up at either 3 or 6 months were 75% and 66% respectively. African Americans from rural areas were more likely to be lost to follow-up compared to those from urban areas. We discuss the benefits of utilizing a strategic plan that serves to address problems with underrepresentation of minorities in clinical research

Assessing Driving Performance with Moderate Visual Field Loss

The minimum binocular horizontal field extent for driver licensingvaries widely between states in the USA. We examined the relationship betweenvisual field extent and open-road driving performance using a scoring method thatmeasured the quality of specific skills for a range of general driving maneuvers,as well as maneuvers that we expected to be difficult for people with restrictedfields. Twenty-eight current drivers with mild to moderate peripheral visual fieldrestrictions (123 ± 20°, V4e target) drove the 14-mile route. While most subjectswere scored as safe drivers, those with more restricted horizontal and verticalbinocular field extents showed significantly poorer skills in maneuvers for whicha wide field of vision is likely to be important (p ≤ 0.05): speed matching whenchanging lanes, and maintaining lane position and keeping to the path of the curvewhen driving around curves. Further studies using similar assessment methodswith drivers with more restricted fields are necessary to determine the minimumfield extent for safe driving

Impact of aging and age-related maculopathy on inactivation of the a-wave of the rod-mediated electroretinogram

AbstractThis study examined the impact of aging and age-related maculopathy (ARM) on the inactivation of phototransduction in rod photoreceptors by measuring the recovery of the a-wave using a paired flash electroretinogram technique. Measurements were made on 32 older adults in normal retinal health, 25 with early ARM, 7 with late ARM, and 20 young adults for comparison purposes. ARM presence and severity were defined by the Wisconsin Age-Related Maculopathy Grading System based on grading of fundus photographs. The inactivation of rod phototransduction exhibited an aging-related slowing. Those with early ARM did not exhibit inactivation slowing over and above what would be expected based on normal retinal aging. Persons in the late stages of ARM exhibited dramatic slowing in inactivation kinetics

Preliminary Evaluation of the InCHARGE Program Among Older African Americans in Rural Alabama

Objective: Blindness rates among older African Americans are two times higher than for older whites. Our purpose was to understand attitudes about eye care and perceived barriers to care among older African Americans living in rural Alabama and to determine whether an educational program reduced perceived barriers to care. InCHARGE, an eye health education program for older African Americans, promotes eye disease prevention by conveying the personal benefits of annual dilated comprehensive eye care and by teaching strategies to minimize barriers to eye care. Design and Participants: InCHARGE was presented in five senior centers to 111 individuals. Using a questionnaire before and three months after InCHARGE, we evaluated what impact InCHARGE had on attitudes and knowledge about prevention and strategies for reducing barriers. Results: Before InCHARGE, 52.3% reported receiving an eye examination in the past year. Almost all indicated that they felt finding, getting to, and communicating with a doctor were not problems yet about one-quarter indicated that the cost of an examination and/or eyeglasses were problems. After InCHARGE the percentage saying that cost was a problem increased to almost half. Conclusions: Older African Americans in rural Alabama have positive attitudes about comprehensive eye care, yet only about half reported receiving an exam by an eye care provider in the past year. The cost of care is a barrier for many, a problem that was not mitigated by InCHARGE. In order to improve eye health in this population, eye health education initiatives are not enough; economic strategies must be implemented to address the cost barrier

American Geriatrics Society and National Institute on Aging Bench-to-Bedside conference: sensory impairment and cognitive decline in older adults

This article summarizes the presentations and recommendations of the tenth annual American Geriatrics Society and National Institute on Aging Bench‐to‐Bedside research conference, “Sensory Impairment and Cognitive Decline,” on October 2–3, 2017, in Bethesda, Maryland. The risk of impairment in hearing, vision, and other senses increases with age, and almost 15% of individuals aged 70 and older have dementia. As the number of older adults increases, sensory and cognitive impairments will affect a growing proportion of the population. To limit its scope, this conference focused on sensory impairments affecting vision and hearing. Comorbid vision, hearing, and cognitive impairments in older adults are more common than would be expected by chance alone, suggesting that some common mechanisms might affect these neurological systems. This workshop explored the mechanisms and consequences of comorbid vision, hearing, and cognitive impairment in older adults; effects of sensory loss on the aging brain; and bench‐to‐bedside innovations and research opportunities. Presenters and participants identified many research gaps and questions; the top priorities fell into 3 themes: mechanisms, measurement, and interventions. The workshop delineated specific research questions that provide opportunities to improve outcomes in this growing population.Funding was provided by National Institutes of Health (NIH) Grant U13 AG054139-01. Dr. Whitson's efforts and contributions were supported by R01AG043438, R24AG045050, UH2AG056925, and 5P30AG028716. Dr. Lin's effort and contributions were also supported by R01AG055426, R01HL096812, and R33DC015062. (U13 AG054139-01 - National Institutes of Health (NIH); R01AG043438; R24AG045050; UH2AG056925; 5P30AG028716; R01AG055426; R01HL096812; R33DC015062)Accepted manuscrip