地域在住高齢者の視機能と関連要因の検討

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  • Visual functions and risk factors for visual impairment in community-dwelling Japanese elderly
  • チイキ ザイジュウ コウレイシャ ノ シキノウ ト カンレン ヨウイン ノ ケントウ

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Purpose: To investigate age-related changes in visual functions and risk factors for visual impairment in community-dwellingJapanese elderly. Visual function assessment included static visual acuity (SVA), kinetic visual acuity (KVA), dynamic visual acuity(DVA), night vision (NV), depth perception (DP), ocular motor skill (OMS), and visual reaction time (VRT).Methods: A total of 321 community-dwelling people (112 men and 209 women, mean age: 67.3 ± 10.4, range: 40 to 91 years old)participated in this study. They reported any history of eye or chronic diseases in a self-administered questionnaire. Functionalcapacity was evaluated using the Tokyo Metropolitan Institute of Gerontology Index of Competence (TMIG Index). Visualassessments were made using a visual acuity measurement device.Data analysis: SVA and KVA were converted into logarithms of the minimum angle of resolution for analysis, while participantswere classified into 4 age groups: 40 to 54 (early middle-aged); 55 to 64 (late middle-aged); 65 to 74 (young-old); and 75 and over(old-old). Statistical analyses were performed using a Jonckheere-Terpstra trend test, a Mantel-Haenszel test, and logistic regressionanalyses (univariate and multivariate analyses). Logistic regression analyses were performed with the visual functions as dependentvariables and sex, age group, history of eye disease, and history of chronic disease as independent variables. In logistic regressionanalyses with visual functions other than SVA, SVA was included as a moderator variable. For statistical analysis, IBM SPSS version21.0 was used, while setting the significance level at 5%.Results: A marked tendency for scores of the TMIG-index to decrease with age was observed (p=0.012). In measurements of DVA,NV, KVA, and DP, some participants had difficulty in reading the target. There was a marked tendency for this proportion to increasewith age. Similarly, analysis of the data regarding visual functions, excluding data of participants with reading difficulty, revealedthat all these functions, except for NV, markedly decrease with age. According to multivariate analysis, risk of impaired KVA beganto increase in the late middle-aged group compared to the early middle-aged group. Risk of impaired DVA, NV, DP, and VRT began to increase in the young-old group, and risk of impaired SVA and OMS began to increase in the old-old group. Risk of impaired DPwas higher in women than in men. Furthermore, univariate analysis showed that a history of eye disease was significantly associatedwith impaired DP, and a history of chronic disease was significantly associated with impaired OMS and impaired VRT.Conclusion: Visual impairments in community-dwelling elderly increase with age. According to multivariate analysis, age wasa significant risk factor of each impaired visual function examined in this study, and sex was a significant risk factor of impairedDP. Considering that impaired visual functions particularly affect ADL and QOL in the elderly, it is important to take preventivemeasures against such impairment. However, since it is difficult to routinely assess visual functions, visual impairments arecommonly overlooked in community-dwelling elderly. Therefore, the findings obtained from this study may be useful for thoseexamining appropriate methods to support community-dwelling elderly with visual impairment.

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