ISiTO - Improving Sight Therapy for Older-people - A Quality Improvement Project (QIP) at a Tertiary Hospital

Introduction

Reduced visual acuity is a frequent contributing factor to admission to an acute hospital for older people yet there is little attention paid to its importance. Vision assessment is meant to be offered to all adults at risk of falling as per Montero-Odasso et al 2022(1). The NHS funds vision assessments in the community for all adults >65 years of age.

Aims

This project aims to assess current understanding and uptake of vision assessment in the community for patients admitted to a tertiary hospital, and whether targeted information giving can improve uptake of primary care services.

Methods

Patients admitted to a Cambridge University Hospital’s geriatric medicine department were selected for participation in this project. Initial baseline questionnaire and population characteristics were collected, followed by written and verbal information about accessing community services. A follow up questionnaire was performed four weeks later to assess response.

Results

Of the initial population (n=23) 1 was not able to be followed up. The median age of participants was 87. 100% (n=22) of the remaining population wore prescription glasses, with 39% having not had any assessment of their vision in the past 2 years. 61% had at least one fall in the preceding 12 months, with 26% reporting concerns about their vision pre admission. Only 64% of the population were aware of criteria for NHS funded assessment, improving to 95% post intervention. 27% of patients had vision assessments booked initially improving to 41%.

Conclusions

Uptake of vision assessment in the community is variable, with poor understanding of existing pathways. The data suggests that education is an important way of improving uptake of existing resources. Future avenues of improvement include: education for all patients at discharge, inpatient vision assessment, and developing a pathway for referral from secondary care to primary care services.

References

1. World guidelines for falls prevention and management for older adults: a global initiative: Montero-Odasso et al 2022