Hyderabad Ocular Morbidity in Elderly Study (HOMES) – Rationale, Study Design and Methodology

Figures & data

Figure 1. The map showing the study location.

Table 1. Sample size calculations for various cluster sizes, expected prevalence of visual impaiment (VI) and number of people with VI in the sample.

Expected Prevalence of VI	Cluster size	Design effect	Sample size with 25% inflation	Expected number of homes to be covered for the estimated sample	Expected number of participants with VI
15%	40	1.4	916	23	137
15%	50	1.5	982	20	147
15%	60	1.6	1047	18	157
20%	40	1.4	666	17	133
20%	50	1.5	714	15	143
20%	60	1.6	761	13	152
25%	40	1.4	509	13	127
25%	50	1.5	545	11	136
25%	60	1.6	581	10	145

Table 2. Study questionnaires used in the HOMES project.

Code	Instrument name	Details included	Grading / Comment
1A	Home for the Elderly profile	Details of the home, address, type of home, funding source, amenities	Descriptive data
1B	Personal and socio demographic information	Age, gender, education, previous occupation, family structure	Based on the age, the participants are classified as young old (60–69 years), Middle old (70–79 years) and older old (80 years and older).
2	Cognition Function	Mini Mental State Examination questionnaire is used to assess cognition function (19 Questions)	<24 is considered as abnormal. No cognitive impairment = 24–30; mild cognitive impairment = 19–23; moderate cognitive impairment = 10–18; and severe cognitive impairment≤9.
3	Risk factors	Smoking, alcohol consumption, both current and the past use	Binary variable; yes/no
4	Visual Functions	Rasch analyzed Indian Visual Function Questionnaire (IND-VFQ 33) is used. It included 33 questions covering four domains (General functioning (21), psychosocial impact (5), Visual symptoms (7))	Sum of scores of each of the domains/Maximum score possible for each domain
5	Depression	Patient Health Questionnaire (PHQ 9) is used to assess depression	PHQ-9 scores of 5, 10, 15, and 20 represented mild, moderate, moderately severe, and severe depression, respectively
6	Hearing	Hearing is assessed using (10 questions) Hearing Handicap Inventory for the Elderly Screening questionnaire	0–8 suggest no hearing handicap, 10–24 suggest mild-moderate hearing handicap, 26–40 suggest significant hearing handicap
7	Fear of Falling and falls history	Falls history is assessed. Fear of falling is assessed using Short Falls Efficacy Scale (SFES) questionnaire	Fear of Falling is graded as : Low Concern: 7–8, Moderate Concern: 9–13, and High Concern: 14–28
8	Performed based measures	Included computer based tests such as face recognition, facial expression recognition, visual search tasks	Accuracy and time taken to accomplish the task
9	Systemic history	History of systemic conditions such as hypertension, diabetes, heart disease and others are asked along with duration and current medication	Binary variable; yes/no Deatils of current medication
10	Ocular history	Included cataract surgery, spectacles use, and other eye care services obtained	Binary variable; yes/no Details of the services obtained
11	Measures of frailty and anthropometry	Short Physical Performance Battery (SPPB)^Citation42 (Gait speed test (3-meter distance), Chair stand test, Hand grip strength), Height, weight, blood pressure	Continuous / Ordinal scale
12	Clinical Examination	Visual acuity assessment, refraction, slit lamp examination, applanation tonometry, fundus examination and retinal imaging	World Health Organization Categories of visual impairment

Table 3. Results of the reliability study.

Questionnaire/Procedure	n	Intra Class Correlation quotient (ICC) (95% CI)
Mini Mental State Examination (MMSE)	92	0.73 (0.62–0.81)
Indian Visual Function Questionnaire (IND VFQ) domains
Mobility	138	0.84 (0.78–0.88)
Activity limitation	138	0.88 (0.84–0.91)
Psychosocial impact	138	0.66 (0.55–0.74)
Visual symptoms	138	0.83 (0.76–0.87)
Patient Health Questionnaire (PHQ9)	92	0.67 (0.54–0.77)
Hearing Handicap Inventory (HHIE)	92	0.63 (0.48–0.74)
Short Falls Efficacy Scale (SFES) questionnaire	89	0.70 (0.58–0.79)
Visual acuity assessment	101	0.94 (0.92–0.96)

Figure 2. Flowchart showing the sequence of eye examination.

Reed-Jones RJ, Solis GR, Lawson KA, Loya AM, Cude-Islas D, Berger CS. Vision and falls: a multidisciplinary review of the contributions of visual impairment to falls among older adults. Maturitas. 2013;75:22–28. doi:10.1016/j.maturitas.2013.01.019.

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