Improving Ophthalmic Care Access and Treatment Among Aging Adults Series

The Aging of Americans

The number of individuals 65 years or older is continuously growing in the United States. This population is projected to account for 20% of Americans by 2030, and 24% by 2060. Advanced age is associated with an increased prevalence of multiple chronic conditions (MCC). According to an analysis of data from the Centers for Disease Control and Prevention’s (CDC’s) 2017 Behavioral Risk Factor Surveillance System (BRFSS), the prevalence of MCC (defined as the presence at least two of 12 chronic conditions listed on the survey) in the United States among those aged 45 to 64 ranged from 51% to 74%, depending on the state or U.S. territory of residence, and ranged from 69% to 86% among those 65 years or older, again depending on the state or U.S. territory of residence.

Across all states and territories, the prevalence of MCC among adults aged 65 or older was significantly higher than for those aged 18-44 (P <.05). Chronic conditions included on the BRFSS include arthritis, asthma, cancer, chronic obstructive pulmonary disease (COPD), depression, diabetes, heart disease, high blood pressure, high cholesterol, kidney disease, obesity and stroke. The high prevalence of MCC among individuals in the United States aged 65 years or older suggests that resource allocation for this patient population will continue to present challenges to both health care systems and payers.

Eye diseases are also prevalent among older adults. According to a pooled analysis of data from six large population-based studies (the Beaver Dam Eye Study, Baltimore Eye Survey and Salisbury Eye Evaluation Study, Proyecto VER and Los Angeles Latino Eye Study [LALES], and the Chinese American Eye Study [CHES]), the prevalence of visual impairment (defined as visual acuity better than 20/200 but less than 20/40) among those aged 40-49, 50-59, 60-69, 70-79, and 80 years or older in the United States was projected to be 0.13 million, 0.17 million, 0.59 million, 0.99 million, and 1.77 million, respectively, for the year 2020, and was projected to be 0.16 million, 0.21 million, 0.70 million, 1.43 million, and 4.44 million, respectively, by the year 2050. For blindness (defined as visual acuity of 20/200 or less), the projected prevalence by age group was projected to be 0.11 million, 0.14 million, 0.19 million, 0.21 million, and 0.47 million, respectively, for the year 2020 and was projected to increase to 0.13 million, 0.15 million, 0.23 million, 0.32 million, and 1.18 million, respectively, by the year 2050. As visual impairment and blindness can have deleterious effects on both physical and mental health, the impact on health care spending both currently and in the future is likely to be substantial.

Eye examinations are a focal point of many quality measures and related programs, such as the Healthcare Effectiveness Data and Information Set (HEDIS), which includes a performance measure for DR screening in individuals with diabetes aged 18 to 75 years. Providers and payers who begin considering such preventative care measures now and plan in advance for the needs of the aging population will be better prepared for optimal management and effective resource allocation in the future.

The Impact for Older Adults With Eye Disease

Eye disease can have an effect on activities of daily living (ADLs), such as dressing, bathing, toileting, hobbies, housekeeping, cooking, shopping and transportation. Poor vision is associated with a lower rate of medication adherence resulting from an inability to accurately read important information contained on product labeling. Other consequences may include emotional distress from vision loss, decreased social engagement, situational depression, loss of independence, physical inactivity, falls, injuries and an increased likelihood to be admitted to long-term care facilities (LTCFs). In addition, persons with visual impairment have higher morbidity and mortality rates compared with those in the overall population.