La vision dans l'exploration de la fragilité chez le sujet âgé

Frailty is defined as a clinical syndrome that carries increased risk for poor health outcomes, including loss of autonomy, institutionalisation and increased mortality. In Europe, it concerns 25 to 50% of patients over the age of 85. Frailty is associated with numerous factors including, nutritional deficiencies, sedentary lifestyle and sensory impairment, in particular visual. In France, the prevalence of visual impairment increases with ageing from the age of 60 onwards; it affects 23% to 38% of patients by the age of 90. Visual impairment is associated with an increased risk of falls and loss of autonomy in older adults. In this paper, a visual impairment testing strategy as part of the “geriatric day-hospital for assessment of frailty and prevention of disability” in the Toulouse CHU is presented and assessed. Ophthalmologic data from 1425 patients was analysed and evaluated between October 2011 and October 2014, among whom 42% presented long or short sight, or an anomaly on the Amsler grid. Results show that abnormal sight is independently associated with age, lower educational level, lower cognitive performance and a lesser degree of autonomy. Because of the prevalence of visual impairment in older adults and its associated risks, there are conclusive arguments in favour of integrating simple visual tests in standard geriatric assessments.