Relationship Between Home Environment Features and Difficulty in Instrumental Activities of Daily Living and Other Patient-Reported Measures in Persons With Glaucoma

Abstract

OBJECTIVE: To determine if home environmental features (ie, lighting and home hazards) are associated with difficulties in instrumental activities of daily living (IADLs) in persons with glaucoma. DESIGN: Cross-sectional study. SETTINGS AND PARTICIPANTS: A total of 174 adults with suspect or primary glaucoma were recruited. METHODS: IADLs, fear of falling (FoF), and glaucoma quality of life (GQL) were assessed via questionnaire. FoF and GQL were prespecified as negative controls to assess discriminant/external validity, as they are not expected to be influenced specifically by in-home lighting or hazards. We classified IADL difficulty as a binary outcome (≥1 IADL difficulty vs none). Person-measure scores for FoF and GQL were calculated in logits using Rasch modeling. The home environment assessment for the visually impaired (HEAVI) tool assessed homes for the total number of hazards, frequency of hazards among graded items, and average home lighting. Multivariable logistic and linear regression models evaluated associations between home environmental measures with IADL difficulty and FoF and GQL scores, controlling for severity of visual field damage, age, race, sex, comorbidity, and polypharmacy. MAIN OUTCOME MEASURES: Association between home environmental features with difficulties in IADLs, FoF, and GQL. Results: Better home lighting was associated with less difficulty completing IADL tasks (odds ratio [OR] = 0.88 per 0.1 log unit light increment, 95% CI = 0.77-1.00, P = .04). No association was found between the number of home hazards (OR = 0.97 per 10 additional hazard, 95% CI = 0.62-1.53, P = .89) or the frequency of home hazards among graded items (OR = 1.10 per 10% increment in hazard frequency, 95% CI = 0.65 to 1.86, P = .73) with IADL difficulty. No significant associations were noted between lighting levels, frequency or number of home hazards with FoF or GQL scores. Conclusion: Better home lighting was associated with less frequent difficulty with IADLs (but not FoF or GQL) in a cohort enriched for glaucoma; no associations were noted with any measure for home hazards. Lighting may be able to improve specific aspects of function in persons with glaucoma.