Dr Francesc March de Ribot

A comprehensive analysis of nearly 50,000 assessments has revealed significant deficiencies in vision and hearing care provision for frail older adults in New Zealand, with particularly concerning gaps in aged residential care facilities and among Indigenous (Māori) and Pacific Islander populations.

The study drew from New Zealand's interRAI database, which has been employed since 2014 for standardised assessments of older persons seeking publicly supported services or residing in aged residential care facilities. The system is also used in Australia.

Researchers analysed data from 48,038 assessments of older adults between January 2019 and December 2020, finding that although most reported adequate sensory function, access to regular examinations and corrective aids fell well short of international standards – especially for those in residential care settings.

Dr Francesc March de Ribot, an Ophthalmology Consultant who was working at University of Otago at the time of the research, described the findings as revealing “an interesting national reality similar to Australia: a lack of eye examinations, especially in rest homes; a significant gap in examinations and aids for Māori and Pasifika”.

The research identified vision impairment in 10% of patients and hearing impairment in 19%, with 7% experiencing dual sensory impairment according to the Deafblind Severity Index. The cohort comprised 65% females with a mean age of 82.2 years.

DISPARITIES IN ACCESS

The analysis found that “access to sensory assessments and the use of corrective aids were consistently lower in aged residential care than in home-based settings”, according to Dr March de Ribot.

Access to routine vision assessments declined dramatically from 55% amongst those at home to just 32% among care facility residents – a figure he said, “should be 100% as per international recommendations”.

The situation for hearing assessments was even more dire, dropping from 31% for those at home to only 21% in care facilities.

While 72% of aged residential care facility residents used visual aids, only 20% used hearing aids, suggesting either underdiagnosis or barriers to accessing appropriate hearing correction.

There were consistently lower rates of sensory assessments and use of corrective aids amongst Māori and Pacific peoples, reflecting known health inequities in New Zealand’s healthcare system.

BROADER IMPLICATIONS

Vision and hearing impairments are known to adversely affect quality of life, contribute to loneliness, impact cognitive function and physical capability, and even be associated with increased mortality rates. And, given New Zealand’s ageing population – with approximately 880,000 people experiencing hearing loss and 180,000 with severe to moderate functional vision loss out of a population of 5.1 million in 2020 – the impacts extend more broadly to healthcare system planning and resource allocation.

With this in mind, the study’s authors argue that the findings strengthen the case for developing policies that encourage greater access to services through improved diversity and wider distribution of hearing and vision services, particularly focussing on aged residential care facilities and underrepresented ethnic groups.

“Our findings raise questions about the recognition and management of sensory impairment amongst frail older people,” the researchers stated in their conclusions.

With the study finding that 20% of early challenges addressed on time could have improved outcomes, Dr March de Ribot, who has moved to Australia to work at the Australian National University and Canberra Hospital in 2026, said the team hopes to conduct further analyses to explain the impact of lack of vision, eye examinations, and aids on quality of life and health outcomes. Additionally, he said the researchers hope to replicate the study in Australia as “it is likely to have a similar reality”.

“Eight per cent of cases of vision loss could be prevented with early detection but the lack of eye examinations makes diagnosis and management more challenging. Cataracts, macular degeneration, and glaucoma are common in older adults; early detection could make a difference,” he said.

Reference
1. March de Ribot F, Bergler U, Jamieson, H et al. Epidemiology of vision and hearing impairment in older community dwelling adults in New Zealand. Australasian Journal on Ageing. doi: 10.1111/ajag.70110.