Effectiveness of a Comprehensive Health Management Program for High-Risk Elderly With Visual Impairment Based on an Intelligent Management Platform: A Randomized Controlled Trial

Abstract

Background: Visual impairment has become a major public health issue worldwide. In China, the growing aging population and changing lifestyles have led to increasing demand for eye health management. Primary prevention is crucial for delaying or preventing visual impairment among older adults who are at risk but not yet affected. Objective: This study aimed to evaluate the effectiveness of an intelligent health management platform in improving the health outcomes of elderly individuals at high risk of visual impairment. Methods: Ninety participants meeting the inclusion criteria were randomly assigned to an intelligent health management group or a natural follow-up group, with forty-five in each. The intervention group received comprehensive health management through the intelligent platform, while the control group received routine care. Outcomes were measured at baseline, one, three, and six months, including quality of life, physiological function, self-management, social function, disease burden, and risk of visual impairment. Data were analyzed using repeated measures analysis of variance. Results: Significant improvements were observed in physiological and social domains, self-management, disease burden, and comprehensive scores in the intervention group compared with the control group. Quality of life also improved significantly, and after six months, the intervention group showed a lower risk of visual impairment. Conclusions: The intelligent health management program effectively enhanced physical and social function, improved self-management, reduced disease burden, and decreased the risk of visual impairment, thereby improving overall quality of life in high-risk elderly individuals.

Keywords

Visual impairment / High-risk / Elderly / Intelligent health management / Quality of life / Nursing

References

[1] Alkawaldeh, M. Y., Jacelon, C. S., & Choi, J. (2020). Older adults' experiences with a tablet-based self-management intervention for diabetes mellitus type II: A qualitative study. Geriatric Nursing, 41(3), 305-312. https://doi.org/10.1016/j.gerinurse.2019.11.010

[2] Bourne, R., Steinmetz, J. D., Flaxman, S., Briant, P. S., Taylor, H. R., Resnikoff, S., ... & Tareque, M. I. (2021). Trends in prevalence of blindness and distance and near vision impairment over 30 years: An analysis for the Global Burden of Disease Study. The Lancet Global Health, 9(2), e130-e143. https://doi.org/10.1016/S2214-109X(20)30425-3

[3] Bobitt, J., Aguayo, L., Payne, L., Jansen, T., & Schwingel, A. (2019). Geographic and social factors associated with chronic disease self-management program participation: Going the “Extra-Mile” for disease prevention. Preventing Chronic Disease, 16, E25. https://doi.org/10.5888/pcd16.180385

[4] Cesareo, M., Ciuffoletti, E., Ricci, F., Missiroli, F., Giuliano, M. A., Mancino, R., & Nucci, C. (2015). Visual disability and quality of life in glaucoma patients. Progress in Brain Research, 221, 359-374. https://doi.org/10.1016/bs.pbr.2015.07.003

[5] Chang, C. P., Lee, T. T., & Mills, M. E. (2017). Experience of home telehealth technology in older patients with diabetes. Computational and Informational Nursing, 35(10), 530-537. https://doi.org/10.1097/CIN.0000000000000341

[6] Chen, H. T., & Li, X. Q. (2017). The contribution of mobile social media to social capital and psychological well-being: Examining the role of communicative use, friending and self-disclosure. Computers in Human Behavior, 75, 958-965. https://doi.org/10.1016/j.chb.2017.06.011

[7] Chen, T., Zhu, W., Tang, B., Jin, L., Fu, H., Chen, Y., … & Liu, J. (2018). A mobile phone informational reminder to improve eye care adherence among diabetic patients in rural China: A randomized controlled trial. American Journal of Ophthalmology, 194, 54-62. https://doi.org/10.1016/j.ajo.2018.07.006

[8] Crews, J. E., Chou, C. F., Stevens, J. A., & Saaddine, J. B. (2016). Falls among persons aged ≥ 65 years with and without severe vision impairment-United States, 2014. MMWR Morbidity and Mortality Weekly Report, 65(17), 433-437. https://doi.org/10.15585/mmwr.mm6517a2

[9] Ding, Y. F. (2023). Construction and application of a control index system for vision impairment in the elderly population [Master's thesis]. China Medical University.

[10] Dubey, S., Bedi, H., Bedi, M., Matah, P., Sahu, J., Mukherjee, S., & Chauhan, L. (2020). Impact of visual impairment on the wellbeing and functional disability of patients with glaucoma in India. Journal of Current Ophthalmology, 32(1), 14-18. https://doi.org/10.1016/j.joco.2019.09.006

[11] Eckert, K. A., Carter, M. J., Lansingh, V. C., Wilson, D. A., Furtado, J. M., Frick, K. D., & Resnikoff, S. (2015). A simple method for estimating the economic cost of productivity loss due to blindness and moderate to severe visual impairment. Ophthalmic Epidemiology, 22(5), 349-355. https://doi.org/10.3109/09286586.2015.1066394

[12] Frank, C. R., Xiang, X. L., Stagg, B. C., & Ehrlich, J. R. (2019). Longitudinal associations of self-reported vision impairment with symptoms of anxiety and depression among older adults in the United States. JAMA Ophthalmology, 137(7), 793-800. https://doi.org/10.1001/jamaophthalmol.2019.1085

[13] Fu, L. X. (2022). Development and reliability/validity testing of the Self-Care Ability Scale for older adults with visual impairment [Master’s thesis]. China Medical University. https://doi.org/10.27652/d.cnki.gzyku.2022.000531

[14] Guillory, J., Chang, P., Henderson, C. R., Jr., Shengelia, R., Lama, S., Warmington, M., … & Reid, M. C. (2015). Piloting a text message-based social support intervention for patients with chronic pain: Establishing feasibility and preliminary efficacy. Clinical Journal of Pain, 31(6), 548-556. https://doi.org/10.1097/AJP.0000000000000193

[15] Guo, J. Y., Kong, X., & Yan, J. (2023). The role of home-based nursing guided by personalized multimedia technology in ophthalmic nursing management. Chinese Journal of Modern Nursing, 29(3), 380-384.

[16] Haegele, J. A., Kirk, T. N., & Zhu, X. H. (2018). Self-efficacy and physical activity among adults with visual impairments. Disability and Health Journal, 11(2), 324-329. https://doi.org/10.1016/j.dhjo.2017.10.012

[17] Harithasan, D., Mukari, S. Z. S., Ishak, W. S., Shahar, S., & Yeong, W. L. (2020). The impact of sensory impairment on cognitive performance, quality of life, depression, and loneliness in older adults. International Journal of Geriatric Psychiatry, 35(4), 358-364. https://doi.org/10.1002/gps.5237

[18] Heesterbeek, T. J., van der Aa, H. P. A., van Rens, G., Twisk, J. W. R., & van Nispen, R. M. A. (2017). The incidence and predictors of depressive and anxiety symptoms in older adults with vision impairment: A longitudinal prospective cohort study. Ophthalmic & Physiological Optics, 37(4), 385-398. https://doi.org/10.1111/opo.12388

[19] He, Q. D., Ye, X. F., Huang, L. Q., & Lu, S. F. (2021). Application of WeChat platform in continuous nursing of patients with complicated cataract after phakic intraocular lens implantation. Acta Ophthalmologica Sinica, 36(2), 139-143.

[20] Hu, J. Y., Yan, L., Chen, Y. D., Du, X. H., Li, T. T., Liu, D. A., … & Wu, Q. (2017). Population-based survey of prevalence, causes, and risk factors for blindness and visual impairment in an aging Chinese metropolitan population. International Journal of Ophthalmology, 10(1), 140-147. https://doi.org/10.18240/ijo.2017.01.23

[21] Hwang, J., Rudnisky, C., Bowen, S. , & Johnson, J. A. (2020). Income-related inequalities in visual impairment and eye screening services in patients with type 2 diabetes.

[22] Park, H. Y., Rhee, H., Kim, H. Y., Lee, H., & Kim, J. W. (2015). Clinical and economic burden of visual impairment in an aging society of South Korea. Asia Pacific Journal of Public Health, 27(6), 631-642. https://doi.org/10.1177/1010539515588944

[23] Jin, I., Tang, D., Gengaroli, J., Nicholson Perry, K., Burlutsky, G., Craig, A., … & Gopinath, B. (2021). Cross-sectional study evaluating burden and depressive symptoms in family carers of persons with age-related macular degeneration in Australia. BMJ Open, 11(9), e048658. https://doi.org/10.1136/bmjopen-2021-048658

[24] Jin, X. F., Wu, X. Y., & Tao, R. (2020). Research progress on factors influencing inpatient satisfaction. Jiefangjun Yiyuan Guanli Zazhi, 27(3), 227-229.

[25] Kent de Grey, R. G., Uchino, B. N., Smith, T. W., & Baucom, B. R. W. (2018). (Too) anxious to help? Social support provider anxiety and cardiovascular function. International Journal of Psychophysiology, 123, 171-178. https://doi.org/10.1016/j.ijpsycho.2017.09.014

[26] Kim, J., Byun, M., & Kim, M. (2020). Physical and psychological factors associated with poor self-reported health status in older adults with falls. International Journal of Environmental Research and Public Health, 17(10), 3548. https://doi.org/10.3390/ijerph17103548

[27] Kulkarni, S., Gilbert, C., Zuurmond, M., Agashe, S., & Deshpande, M. (2018). Blinding retinopathy of prematurity in Western India: Characteristics of children, reasons for late presentation and impact on families. Indian Pediatrics, 55(8), 665-670. https://doi.org/10.1007/s13312-018-1355-8

[28] Li, S., & Wang, A. P. (2022). Demand preferences for health management services in a population of older adults with visual impairment in China: A conjoint analysis. BMC Geriatrics, 22(1), 252. https://doi.org/10.1186/s12877-022-02957-0

[29] Li, Z., Xu, K., Wu, S., Sun, Y., Song, Z., Jin, D., & Liu, P. (2014). Alcohol consumption and visual impairment in a rural Northern Chinese population. Ophthalmic Epidemiology, 21(6), 384-390. https://doi.org/10.3109/09286586.2014.967360

[30] Livingston, G., Huntley, J., Sommerlad, A., Ames, D., Ballard, C., Banerjee, S., … & Mukadam, N. (2020). Dementia prevention, intervention, and care: 2020 report of the Lancet Commission. Lancet, 396(10248), 413-446. https://doi.org/10.1016/S0140-6736(20)30367-6

[31] Malkin, A., Deemer, A., Contreras, M., Edmonds, H., Quan, A. C., Koskey, J., … & Lawrenson, J. G. (2025). Self-management interventions for quality of life in adults with visual impairment. Cochrane Database of Systematic Reviews, 2, CD015790. https://doi.org/10.1002/14651858.CD015790

[32] Mei, Y., Xu, X., & Li, X. (2020). Encouraging patient engagement behaviors from the perspective of functional quality. International Journal of Environmental Research and Public Health, 17(22), 8613. https://doi.org/10.3390/ijerph17228613

[33] Menezes, C., Vilaça, K. H. C., & Menezes, R. L. d. (2016). Falls and quality of life of people with cataracts. Revista Brasileira de Oftalmologia, 75, 40-44.

[34] Mick, P., Parfyonov, M., Wittich, W., Phillips, N., Guthrie, D., & Pichora-Fuller, M. K. (2018). Associations between sensory loss and social networks, participation, support, and loneliness. Canadian Family Physician, 64(2), e33. https://doi.org/10.46993/cfp.64.2.e33

[35] Naidoo, K. S., Fricke, T. R., Frick, K. D., Jong, M., Naduvilath, T. J., Resnikoff, S., & Sankaridurg, P. (2019). Potential lost productivity resulting from the global burden of myopia: Systematic review, meta-analysis, and modeling. Ophthalmology, 126(3), 338-346. https://doi.org/10.1016/j.ophtha.2018.10.029

[36] Petrovcic, A., Fortunati, L., Vehovar, V., Kavcic, M., & Dolnicar, V. (2015). Mobile phone communication in social support networks of older adults in Slovenia. Telematics and Informatics, 32(4), 642-655. https://doi.org/10.1016/j.tele.2015.02.005

[37] Quaranta, L., Riva, I., Gerardi, C., Oddone, F., Floriani, I., & Konstas, A. G. P. (2016). Quality of life in glaucoma: A review of the literature. Advances in Therapy, 33(6), 959-982. https://doi.org/10.1007/s12325-016-0342-5

[38] Quinn, C. C., Khokhar, B., Weed, K., Barr, E., & Gruber-Baldini, A. L. (2015). Older adult self-efficacy study of mobile phone diabetes management. Diabetes Technology & Therapeutics, 17(7), 455-461. https://doi.org/10.1089/dia.2014.0341

[39] Robinson, J. L., Braimah Avery, V., Chun, R., Pusateri, G., & Jay, W. M. (2017). Usage of accessibility options for the iPhone and iPad in a visually impaired population. Seminars in Ophthalmology, 32(2), 163-171. https://doi.org/10.3109/08820538.2015.1045151

[40] Saydah, S. H., Gerzoff, R. B., Saaddine, J. B., Zhang, X., & Cotch, M. F. (2020). Eye care among US adults at high risk for vision loss in the United States in 2002 and 2017.

[41] Schwennesen, N., Barghadouch, A., & Olesen, K. (2019). Health literacy and self-care among visually impaired people with type 1 diabetes in Denmark. Chronic Illness, 15(2), 157-164. https://doi.org/10.1177/1742395318789476

[42] Silva, B. M., Rodrigues, J. J., de la Torre Diez, I., Lopez-Coronado, M., & Saleem, K. (2015). Mobile-health: A review of current state in 2015. Journal of Biomedical Informatics, 56, 265-272. https://doi.org/10.1016/j.jbi.2015.06.003

[43] Singh, R. R., & Maurya, P. (2022). Visual impairment and falls among older adults and elderly: Evidence from longitudinal study of ageing in India. BMC Public Health, 22(1), 2324. https://doi.org/10.1186/s12889-022-14697-2

[44] Swenor, B. K., Muñoz, B., & West, S. K. (2014). A longitudinal study of the association between visual impairment and mobility performance in older adults: The Salisbury Eye Evaluation Study. American Journal of Epidemiology, 179(3), 313-322. https://doi.org/10.1093/aje/kwt270

[45] Tan, C., Qin, Y., Liao, C., Liu, J., Peng, Q., Jiang, W., & Gan, X. (2022). Effect of continuous nursing model based on WeChat public health education on self-management level and treatment compliance of stroke patients. Iranian Journal of Public Health, 51(5), 1040-1048. https://doi.org/10.18502/ijph.v51i5.9419

[46] Tseng, Y. C., Liu, S. H., Lou, M. F., & Huang, G. S. (2018). Quality of life in older adults with sensory impairments: A systematic review. Quality of Life Research, 27(8), 1957-1971. https://doi.org/10.1007/s11136-018-1799-2

[47] Tu, N., Liu, S. S., Xu, X., Wang, W., & Zhou, M. (2019). Effects of mobile internet-based disease management and health science education in patients with type 2 diabetes. China Modern Doctor, 57(18), 157-160.

[48] van der Aa, H. P., Comijs, H. C., Penninx, B. W., van Rens, G. H., & van Nispen, R. M. (2015). Major depressive and anxiety disorders in visually impaired older adults. Investigative Ophthalmology & Visual Science, 56(2), 849-854. https://doi.org/10.1167/iovs.14-15848

[49] van Nispen, R. M., Vreeken, H. L., Comijs, H. C., Deeg, D. J., & van Rens, G. H. (2016). Role of vision loss, functional limitations and the supporting network in depression in a general population. Acta Ophthalmologica, 94(1), 76-82. https://doi.org/10.1111/aos.12896

[50] Wagner, H., Stifter, J., Engesser, D., Atzrodt, L., Betancor, P. K., Bohringer, D., … & Reinhard, T. (2020). Ophthalmic care in nursing homes for the blind: A growing challenge. Klinische Monatsblätter für Augenheilkunde, 237(11), 1326-1333. https://doi.org/10.1055/a-1194-5381

[51] Wang, C. K., Hu, Z. F., & Liu, Y. (2001). A study on the reliability and validity of the General Self-Efficacy Scale. Chinese Journal of Applied Psychology, 7(1), 37-40. https://doi.org/10.3969/j.issn.1006-6020.2001.01.007

[52] Wang, W. L., Chen, N., Sheu, M. M., Wang, J. H., Hsu, W. L., & Hu, Y. J. (2016). The prevalence and risk factors of visual impairment among the elderly in Eastern Taiwan. Kaohsiung Journal of Medical Sciences, 32(9), 475-481. https://doi.org/10.1016/j.kjms.2016.07.009

[53] Wang, Y., Wu, T., & Chen, Z. (2021). Active usage of mobile health applications: Cross-sectional study. Journal of Medical Internet Research, 23(12), e25330. https://doi.org/10.2196/25330

[54] Wu, V. X., Dong, Y., Tan, P. C., Gan, P., Zhang, D., Chi, Y., … & Tan, Y. Q. (2022). Development of a community-based e-health program for older adults with chronic diseases: Pilot pre-post study. JMIR Aging, 5(1), e33118. https://doi.org/10.2196/33118

[55] Wu, X. A., Wang, J. J., Dai, D. Q., Wang, H. C., & Li, L. Q. (2019). Evaluation of the application effect of mobile Internet + STEP in the management of type 2 diabetes. Medical Forum, 23(17), 2370-2371. https://doi.org/10.19435/j.1672-1721.2019.17.002

[56] Xie, M., Deng, H. Y., Li, Z. Y., Zou, Y. P., & Song, B. Y. (2022). Influence of WeChat-platform-based management model on psychological emotions, complications and quality of life of patients after retinal detachment surgery. Chinese Journal of General Practice, 20(12), 2164-2167. https://doi.org/10.16766/j.cnki.issn.1674-4152.002794

[57] Yan, W. Y., & Yan, J. Q. (2020). Application effect of continuous remote nursing intervention in home rehabilitation of glaucoma patients. International Journal of Nursing, 39(19), 3635-3638. https://doi.org/10.3760/cma.j.cn221370-20190527-01119

[58] Yang, Y., Wang, R. N., Ding, R., & Wang, Y. (2023). Meta-analysis of the current situation of self-perceived burden among elderly patients with chronic diseases in China. Soft Science of Health , 37(5), 33-37. https://doi.org/10.3969/j.issn.1003-2800.2023.05.008

[59] Zhang, C. C. (2022). A preliminary study on the case management model based on WeChat platform + applet for the management of glaucoma patients [Master's thesis]. Jilin University.

[60] Zhao, N., Li, Y., & Shi, Y. (2022). Analysis of the effect of continuous nursing based on WeChat platform for patients after vitrectomy for retinal detachment. Chinese Journal of Chinese Ophthalmology, 32(2), 146-150. https://doi.org/10.13444/j.cnki.zgzyykzz.2022.02.015

[61] Zhao, Y., & Wang, A. (2023). Development and validation of a risk prediction model for visual impairment in older adults. International Journal of Nursing Sciences, 10(3), 383-390. https://doi.org/10.1016/j.ijnss.2023.06.018

[62] Zhang, H. Y. (1999). A study on the correlation between family support and self-care behavior of breast cancer patients. Journal of Nursing Science, 14(4), 195. https://doi.org/10.3969/j.issn.1001-4152.1999.04.001