A self-management programme for older adults with age-related macular degeneration (AMD)

Abstract

Age-related macular degeneration (AMD) causes vision impairment which is not recoverable under existing treatment options. It has been a major leading cause of blindness in the aged population. To ameliorate the self-care ability for AMD patients, educational interventions to mediate negative impacts of the disease on quality of life have become a research interest. Current practice in the proposed Hong Kong setting, Elderly Health Centre A and Elderly Health Centre B, depends on nurses giving general advice which is lack of scientific support and non-specific to AMD. Purpose of this dissertation is to translate the best evidence to practice for improving the care of older adults with AMD in the proposed setting. Evidences showed that self-management education programmes were effective in improving emotional distress and self-efficacy. Electronic searches located 9 relevant RCTs of high level and methodologically strong evidences. Data was extracted into tables of evidence. Data summary and synthesis was presented. Assessment on the implementation potential indicated that the SEP was worth to try in the local setting. Twelve recommendations for the practice guidelines of SEP were presented and a communication process to facilitate the change in a top-down approach was introduced. A pilot study plan in Centre A followed by a main study in Centre A and Centre B was presented. A total of 98 elderly patients with AMD will be recruited as 10 SEP groups. Approximately 1.8 years will be used to finish the main study. Outcomes will be measured at the 6th week follow-up. ‘Emotional distress’ will be measured as primary outcome and ‘self-efficacy’ will be measured as secondary outcome. ‘Client satisfaction’, ‘staff satisfaction’ and the ‘utilization rate of the innovation’ will also be assessed in evaluation. A two-tailed paired (one-sample) t-test will be adopted for analysis, with a 95% confidence interval. The basis for effectiveness for the outcome measurements and basis for adoption of the clinical guidelines were stated. Adoption of the developed guidelines in the local setting will optimistically improve the substantial clinical outcomes for AMD patients, mediating the negative impacts of vision impairment or vision loss on their quality of life.