Eye care for the elderly at L V Prasad Eye Institute

Bhubaneswar: By and large nothing ends abruptly! There is a systematic slow down before life comes to a complete stop. We all are programmed to meet this slow down towards the later years of our lives. Our body and the soul signal us well ahead of time to prepare the descent, so that the impact is soft and controlled, commonly referred to as old age morbidity.

Old age morbidity encompasses vision impairment, frailty, hearing loss, falls, depression and dementia. These medical domains though apparently distinct in themselves are in fact interwoven intricately and the most  ominous among all of these is the risk of fall. Aggravation of a single component of the morbidity or a combination may increase the falls risk profoundly. Focus on risk modification to prevent fall may concurrently address various other old age issues that may be prevalent.

Deteriorating physical, sensory and cognitive functions that mark the onset of old age should not be left unheeded as they collectively contribute to a hard bone shattering fall. It is estimated that 6,46,000 people die from falls worldwide. Falls account for being the second leading cause of accidental deaths after road traffic accident worldwide. According to the WHO global report published in 2007, 28-35% of people aged above 65 years old fall each year and this prevalence increases to 32-42% for people above 70 years old. Screening and identification of the vulnerabilities at the earliest opportunity may avert serious consequences. Paying attention to the frailty signals and discussing them openly with our care givers may help improve the quality of life.

But what is the start point? Geriatric medicine, as a technical specialty is not accessible to all. Lack of awareness about the risks is an added woe. A well-coordinated opportunistic multidisciplinary approach is the only way we can address these separate domains simultaneously. The medical therapeutic advancements have relentlessly strived to retard the progression of the old-age limitations. At some instances, it has gloriously achieved a total reversal e.g. restoration of vision with cataract surgery and correction of refractive errors of old age. With active participation of the elderly, many of the other domains of old age morbidity could also be reversed or retarded. The ophthalmologists, orthopedicians, neurologists, internists and audiologists are at an opportunistic position to screen old age morbidity and educate the elderly about the imminent fall outs of ageing.

Eye Care Hospitals: The eye care hospitals in particular could play a major role because every middle aged individual visits an eye doctor for presbyopia eye glasses and 70-80% of older adults undergo an ophthalmic surgical intervention in their lifetime. Since vision impairment is a harbinger to senility, the onus of screening lies with the ophthalmologists.

The LVPEI center for eye care for the elderly incorporated several core components to capture these key old age vulnerabilities. In a high performing eye care delivery system it called for fundamental redesign of the work flow to include systems of identifying the old age vulnerabilities and address them appropriately. The services currently offered include –

1. Patient centered care with proactive old age morbidity assessments
2. Modification of physical environment to promote safe mobility and cognitive stimulation
3. Ophthalmologist driven care plans for the prevention and management of geriatric syndromes
4. Interprofessional team meetings to individualize care
5. Follow up through telemedicine
6. Home care

The older adults at LVPEI account for a third of the total patients who visit for eye care. The entire team of our elderly care service is committed to improve the in-clinic experience. Our innovative triage system efficiently identifies the vulnerable subjects and ensures delivery of services on priority. Our well-trained staff are sensitized towards their special needs as long as they are with us in the clinic. The physical environment has been optimized for safe movement and care of the elderly. The home bound elderly subjects who fail to visit us due to mobility issues are reached through our HomeCare service, ensuring continuity in care. For enriching our elderly care, it has been our constant endeavor to look for newer frontiers, a feather in our cap has been our collaboration with the geriatric service of Thomas Jefferson University, Philadelphia, USA.

Five things the elders around us must know!

By Dr. Umesh Chandra Behera

Consultant Ophthalmologist

L V Prasad Eye Institute, Bhubaneswar