This proposal outlines a five year plan to develop a clinical research program to study the effect of visual disability on the functional abilities of older persons. Both functional ability and visual performance are reduced in old age. Population based studies have suggested that reduced visual acuity is linked to functional impairment among older persons. The relationship of these problems is less clear when examined longitudinally. Far less is known about how other aspects of visual function are related to functional performance. Studies examining the relationship between vision and activities of daily living have been limited to otherwise healthy older adults. The current study focuses on two groups of older adults. The first population consists of persons undergoing geriatric assessment at the University of Nebraska Medical Center. This is an extremely well characterized population with a high level of disability. Persons undergoing assessment are evaluated for burden of comorbid physical and psychiatric illness, mental status, medications, social support, and in detail for their functional abilities. The proposed study adds a detailed assessment of visual function including near and far acuity, contrast sensitivity, glare disability, and stereoacuity, peripheral and color vision. The second study population includes residents of an academic nursing home. These persons will also be studied longitudinally to examine the relationship between vision and functional decline. The ultimate goal of this research is detection of interventions related to vision which will improve the functional performance of older persons. This proposal also outlines a program to develop the clinical and teaching skills of the candidate. The candidate's research interest in functional disabilities is merged with the teaching aims to establish programs to teach functional assessment in the outpatient and nursing facility settings. The candidate will develop longitudinal experience for internal medicine residents in the nursing facility. The candidate will also study clinical teaching techniques and learn administrative aspects of medical direction in nursing facilities.
