Systemic medication use and health status in the older adult population.

Elderly adults have more ocular and systemic disorders than younger adults; there is a corresponding rise in the number of medications used by older adults. Additional medication usage contributes to an increase in the number of adverse drug reactions and also interferes with the efficacy of medications. In this self-report study, the number and types of medications used by older adults (N = 50) vs. middle-aged adults (N = 20) and the systemic health status of these two groups are assessed. Significant differences were determined between the two age groups for drug usage (p = 0.0964, Fisher's exact test), for specific drug categories, the total number of reported health and ocular disorders (p = 0.0001, t-test), and the types of health disorders. These results emphasize the importance of accurate case histories in determining ocular and systemic health conditions and their associated treatment and in the detection of inappropriate drug usage.

Increasing knowledge about the older population: the role of geriatric curriculum in optometry.

Education in the area of geriatrics/gerontology alleviates misconceptions about the elderly and lessens ageism. Ageism, negative feelings toward the elderly, represents a substantial obstacle to the delivery of quality health care to older adults. As future primary health care professionals, optometry students will encounter a large segment of the older population. This study looks at the effect that a didactic course and a clinical rotation in geriatrics have on the knowledge and attitude of optometry students toward older adults. Palmore's Facts on Aging Quiz: Part 1 was administered to two classes of optometry students. One class experienced a geriatric course and clinic concurrently; the other class experienced the geriatric clinic before the course. Scores increased significantly post-test for both classes. Exposure to geriatric patients before didactic instruction did not improve pretest scores; however, the number of patient exposures was significant at post-test. Antiage bias scores also improved with intervention of a didactic course and clinical rotation in geriatrics. The results of this study indicate that ageism in optometrists may be ameliorated by providing formal instruction in geriatrics in the optometric curriculum.

Redefining the optometric examination: addressing the vision needs of older adults.

The aging of America's population will result in an increased number of older adult patients in optometric practices. Although older patients frequently report declines in their vision, the results of high contrast testing procedures often do not correlate with the symptoms. Age-related functional vision decrements can impact upon an individual's ability to perform the activities of daily living. I explored the relation between reported visual complaints and the results of objective tests for older adults (N = 50) as compared with middle-aged adults (N = 20). Decrements in visual acuity, contrast sensitivity, glare sensitivity, color vision, and stereopsis were apparent in the older group and all were significant at alpha = 0.05. Open-ended questions elicited more visual complaints from older adults than from middle-aged adults. However, only the reported complaint of decreased vision was related to visual decrements as determined by clinical testing (chi 2; p = 0.0596). These results indicate that task-specific case history questions may provide greater insight into older adults' visual performance in their normal environment. Additional testing in the areas of contrast sensitivity, glare sensitivity, stereopsis, and color vision should also be included in the optometric examination when warranted.

Are optometric faculty guilty of ageism?

Ageism (negative feelings toward the elderly) is common among health care students and impacts upon the delivery of health care. Education serves to promote positive attitudes toward the elderly and alleviates ageism. As role models, faculty in the health professions influence student attitudes and can affect the development of ageism in students. This study was designed to evaluate whether optometric faculty are guilty of ageism. Twenty-nine optometry faculty and 83 optometry students were surveyed using Palmore's "Facts on Aging Quiz: Part 1" (FAQ1). The mean percent score for faculty was 64.14% as compared to a student mean percent score of 63.96% (p = 0.9422, t-test). The faculty also exhibited a larger anti-age bias than the students. Thus, optometry faculty do possess prejudicial attitudes toward older adults and would benefit from increased education in the field of geriatrics.

Monocular vs. stereoscopic measurement of cup-to-disc ratios.

Stereoscopic viewing of the optic nerve head and cup has been reported to provide more reliable cup-to-disc (C/D) ratio estimates. We investigated the variability in C/D ratio estimates among three experienced optometric clinicians using conventional direct ophthalmoscopy and indirect biomicroscopy with the Volk 90 D lens. The pupils of 21 subjects were dilated and the discs assessed randomly by each examiner for the determination of the C/D ratio. Analysis of variance indicates that the two methods are not significantly different from each other when comparing interexaminer reliability. However, for a particular examiner, one method may be more effective than the other.

Pharmacological considerations in older adults.

The older adult population--those age 65 years and over--continues to increase in numbers and will comprise a large segment of optometric practices in the future. As the prevalence of ocular and systemic disease escalates with age, older adults will utilize more pharmaceutical agents than their younger counterparts. The increase in chronic systemic disease, ocular disease, and polymedicine which accompanies aging contributes to the higher incidence of adverse reactions present in this age group. The optometrist who is knowledgeable in the adverse reactions associated with the common ocular and systemic drugs utilized by geriatric patients will provide both better optometric care and systemic health care screening to his or her patients. This paper discusses the factors contributing to adverse reactions in the elderly and some of the common ocular and systemic medications and their associated side effects which are utilized by the older population.

Implications of biological aging to the optometric patient.

With the "greying" of the American population expected to rapidly accelerate in the next few years, the percentage of geriatric patients seen by the optometrist will also rapidly increase. A knowledge of the biological aging process will assist the optometrist in both assessing and managing the needs of his or her elderly patients. This article will discuss current theories of how the aging process occurs in the human body, as well as biological changes associated with aging.

Common systemic diseases in geriatric patients.

The elderly population will substantially increase by the year 2000, leading to an increased number of elderly patients in the optometric practice. The elderly differ substantially from other patient groups as aging is accompanied by many functional deficits. However, the majority of these decrements do not result in illness or disability. Disease states exist separately or are superimposed upon the already compromised body systems of the elderly. The average geriatric patient suffers from two or more chronic diseases. As primary care practitioners, optometrists should be familiar with the more prevalent diseases of the elderly and their impact upon performance during the vision examination. A review of the common diseases associated with aging is presented.