Glaucoma: Repercussions in the Older Adult

Jeannette Y. Wick, RPh, MBA, FASCP
Published Online: Thursday, July 26, 2012
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Older glaucoma patients are likely to be less adherent to medication and more wary of falling, recent studies indicate.

The prevalence of glaucoma increases with age. At the same time, as cognitive impairment increases, adherence to glaucoma medication declines, putting aged glaucoma patients at risk of experiencing increasing ocular pressure and irreversible loss of eyesight.
 
Failing Minds, Failing Adherence
 
Cognitive impairment affects adherence to treatment, regardless of its complexity, in many diseases. Glaucoma treatment is considered complex, since it requires manual dexterity to instill topical medications as prescribed, frequent medication refills, and routine physician appointments. Until now, most studies examining the relationship between cognitive impairment and adherence in glaucoma have used brief cognitive assessments that required patients to use their vision to complete.
 
For a study published in the April-May 2012 issue of the Journal of Glaucoma, investigators from the University of Colorado at Colorado Springs coupled two cognition tests with adherence measures that did not require patients to use their vision. The study included 41 glaucoma patients with an average age of 70 years. The researchers found that 44% of the participants were impaired in at least 1 measure of cognition, 20% of participants had memory impairment, and 22% had impaired executive functioning. Both of these brain functions are essential for optimal adherence. Further study is needed in larger samples to validate these findings.
 
Patients who have memory problems will need help to remain adherent. Pharmacists should remember to counsel the patient and caregivers to ensure that topical treatments are instilled correctly.
 
Falls—A Real Problem
 
Falling, a common problem in older adults, is considered an indicator that a geriatric syndrome is present. Many older people, having fallen in the past, develop a fear of falling that limits their activity, makes them overly dependent on others, and halts their participation in many previously enjoyable activities. Their fear is not without merit—after all, falls cause 3 times as many deaths in the elderly as automobile accidents.
 
Building on previous research that found that glaucoma is associated with poorer balance, a greater likelihood of bumping into objects, and more falls, a team of researchers at Johns Hopkins University hypothesized that glaucoma would also be associated with greater fear of falling. They used a tested questionnaire and compared 60 control subjects and 83 glaucoma subjects with comparable demographics.

Their results, published in the July 2012 issue of Ophthalmology, showed that glaucoma is indeed associated with a greater fear of falling. Patients’ fear increased in severity as their loss of vision progressed. Women, patients with decreased strength, those with multiple comorbidities, and those with a higher body mass index were more likely to develop a fear of falling.
 
Once patients develop a fear of falling, social isolation and reduced quality of life are almost inevitable consequences. Pharmacists and other members of the health care team should be on the lookout for this syndrome and refer patients for help to deal with their fear. Mental health therapists, geriatricians, and occupational therapists can help them develop coping mechanisms and recommend changes that reduce fall risk.

Ms. Wick is a visiting professor at the University of Connecticut School of Pharmacy and a freelance writer from Virginia.

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