Community-based interventions to detect visual impairment in community-dwelling older adults aged ≥ 75 years: a systematic review

BACKGROUND: Globally, 2.2 billion individuals live with visual impairment (VI). However, many cases remain undetected, particularly among older adults. Therefore, novel interventions for detection are needed. Community-based interventions (CBIs) that target people where they live provide a promising approach. This systematic review aimed to synthesize the existing literature describing potentials and barriers regarding uptake, feasibility, and effects of CBIs in detecting VI among community-dwelling older adults aged ≥ 75 years.

METHODS: We conducted a mixed methods systematic literature review. PubMed, Scopus, CINAHL, PsycInfo, Cochrane, and Embase were searched for articles with no restrictions on publication date. Studies were eligible if they reported on a CBI to detect VI among older adults aged ≥ 75 years. Two reviewers independently extracted data and appraised the quality and risk of bias of the included studies using the Mixed Methods Appraisal Tool. A narrative meta-synthesis of the relevant evidence was conducted.

RESULTS: We identified 3,019 articles of which 26 of varying methodological quality were included. The VI detection methods included surveys, optometric tests, eye examinations, and self-reported visual status. Potentials and barriers regarding the uptake, feasibility, and effects of the interventions were identified at the individual, interpersonal, and community and system levels. Key potentials that may lead to successful interventions included leveraging community resources, tailoring of interventions, targeting underserved populations, high participant satisfaction, increased accessibility, and the use of tele-ophthalmology technology. Conversely, barriers that may negatively affect intervention uptake, feasibility, and effectiveness included financial constraints, poor general health, lack of eye-health awareness, poor referral systems, lack of institutional resources or access to detection technology, and technological challenges.

CONCLUSION: The synthesized results emphasize the importance of developing CBIs that target multiple levels, including the individual, interpersonal, community and system levels. Our results indicate that this may involve combining components such as eye health education, targeted strategies, use of appropriate detection methodologies, and ensuring affordability. These results may inform the development of novel CBIs to foster more effective detection of VI among older populations, improve community eye health, and reduce the burden of VI.

TRIAL REGISTRATION: CRD42023468155.