الفهرس 
IntroductionOnly 14 pages are availabe for public view
 |  | from | 193 |  |  |
| | | from | 193 | | |
Abstract
AMD is a chronic, progressive degenerative disorder of the macula. It features loss of central vision. AMD is a leading cause of visual impairment in the elderly. It can cause irreversible visual loss. Worldwide estimates approximated that 30 to 50 million people are affected by AMD and these numbers are expected to increase over time due to the aging population reaching 288 million by the year 2040.
As a result of the acute degenerative changes in the macula, AMD patients suffer from blurred vision, metamorphopsia, difficulty reading, seeing details especially in low light, color fading, recognizing faces and delayed dark adaptation.
These visual changes, especially in late stage, causes impairment and disability in performing daily activities. and cause AMD patients to complain of loss of their dependency. They are more likely to face difficulties with performing household activities, particularly those involving walking inside their houses and climbing stairs, as well as with doing heavy housework and preparing meals. They may also be more dependent on help from others in executing the activities of daily life, such as taking care of their appearance or feeding themselves.
Falls are the leading cause of injury related death in the elderly accounting for 40%. A serious fall can result in decreased functional independence and quality of life.
Aging and vision impairment are both associated with greater risk of falls. Two thirds of patients with AMD have shown slower walking speeds and visual reaction time, poor foot placement control and postural instability. These abnormal characteristics result in mobility difficulties, missteps, trips and increased fall risk.
The objective of this study is to measure the prevalence of AMD among a sample of elderly persons residing in geriatric homes in Cairo, to identify the potential associated factors of AMD, to measure effect of AMD on activities of daily living of elderly and to measure the association of AMD with falls.
Mini mental state examination was done at first to exclude cases with dementia or mild cognitive impairment. Then an interview questionnaire was designed and used to interview the participating elderly. The questionnaire included: section I socio-demographic characteristics of the studied participants, Section II: Past history of eye surgeries or eye diseases, section III: special habits of medical importance, Section IV: Medical history, Section V: medication history, Section VI: Family history of AMD, Section VII: History of falls in the past year and Morse Fall scale, Section VIII: ADL questionnaire, Section IX: IADL questionnaire.
Examination was done including anthropometry, Amsler Grid test and eye examination by a specialized ophthalmologist for all participants to exclude other eye diseases, confirm diagnosis of AMD and determine the type of AMD.
The study results revealed that the mean age (±SD) of the study participants was 73.18 (±7.09 years). There was female predominance 52.7% while males were 47.3%. About 34.3% of the participants got below high school education and 65.7% got high school education or above. Only 3.2% of the participants had Family history of AMD
About 23.7% of participants were diabetics, 62.2% were hypertensive and 8.1% had hyperlipidemia. About 19.1% of the participants were current smokers with the mean of smoking duration was 40 years (±10.84).
The prevalence of AMD among the study participants was 12.7%. About 7.4% of the participants had early AMD 1.1% and 4.2% had late dry and late wet AMD respectively. Among all participants 7.8% experienced unilateral AMD while 4.9% were bilaterally affected.
Regarding possible risk factors associated with AMD, AMD was significantly associated with increasing age, low educational level, positive family history of AMD (p ≤0.001) and female gender(p=0.012).
Diabetes, hypertension and smoking were also associated with AMD (p<0.001). However, there was no statistical significance association between AMD and hyperlipidemia, BMI nor alcoholic beverages consumption (p>0.05).
There was also a significant association between taking multivitamins, vit C and Aspirin and decreased risk of AMD.
The frequency of falling during the past year in the study participants was 53.7%. About 52.8% and 36.1% of AMD participants have moderate and high risk of falls on Morse Fall scale respectively. A statistically significant association was shown between AMD and increased risk of falls (p = 0.006).
About 52.7% and 30.6% of the AMD participants had moderate and sever ADL impairment. A high statistically significant association between AMD and ADL impairment and decreased IADL score was reported(p<0.001).
The diagnostic performance of Amsler Grid as a screening test for AMD was examined. The Amsler Grid sensitivity was 77.8%, specificity 97.6%, positive predictive value 82.4% and negative predictive value 96.8%.
Recommendation includes: To increase population awareness about AMD and its major risk factors to avoid them. Conducting health education programs about the importance of smoking cessation in reducing the severity and progression of AMD. Health education to elderly and care givers about controlling DM and HTN to decrease severity, progression of AMD and avoid complications. Health education about the beneficial effect of exposure to sun light in the early hours of the day, late noon and after noon and its protective effect against AMD and the importance of multivitamins supplements including vit A, E, C and zinc against development and progression of AMD. Health education programs about the importance of screening and early detection of AMD.