Visual impairment and the use of formal and informal home care in Canada: the Canadian Longitudinal Study on Aging

Objective: To determine the use of home care services in those with and without visual impairment in Canada. Design: Population-based cross-sectional study. Participants: Participants came from the baseline examination of the Canadian Longitudinal Study on Aging Comprehensive Cohort. Inclusion criteria included age between 45 and 85 years, community dwelling, and living near one of the 11 data collection sites across 7 Canadian provinces. People were excluded if they were in an institution, were living on a First Nations reserve, were full-time members of the Canadian Armed Forces, did not speak French or English, or had cognitive impairment. Methods: Presenting visual acuity was measured using the Early Treatment of Diabetic Retinopathy Study chart at 2 meters. Visual impairment was defined as binocular acuity worse than 20/60. The use of formal, informal, and both types of home care was determined by questionnaire. Results: For 29 666 participants, the use of any home care was greater in those with visual impairment than in those without (28% vs 12%, respectively, p < 0.01). After adjusting for demographics and health, people with visual impairment were more likely to use informal home care (odds ratio [OR] = 1.89, 95% CI 1.35 +/- 2.63) and formal home care/both types of home care (OR = 2.70, 95% CI 1.79 +/- 4.07) than those without visual impairment. Marital status was a modifier. Conclusion: Visual impairment is associated with use of home care services. These findings warrant further exploration and, if confirmed, have major health service implications, given the rising prevalence of visual impairment due to age-related eye diseases.