الفهرس 
Introduction and Review of LiteratureOnly 14 pages are availabe for public view
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Abstract
The ageing process is natural phenomena and the fate of all life species. Living happy life is depending on the degree of the quality of life which is a reflection of the person’s wellbeing. Glaucoma as any disease affects the quality of life, which defined as a group of diseases that can damage the eye’s optic nerve and result in vision loss and blindness, and known as a second cause of blindness worldwide (175). Glaucoma risk factors are old age, male gender, chronic disease (hypertension, and diabetes), elevation of intraocular pressure, and smoking. The glaucoma disease knows as a silent thief of vision. It’s because the symptoms of glaucoma which are not very clear. Early detection, early diagnosis, and early treatment can save the vision of the elder from deterioration and being blind. Also, it can decrease probability of fall or accident because of vision impairment due to glaucoma. Thus can elevate the quality of life and encourage patient especially the elder to life happy and decrease the financial burden of visual impairment on the society (88,113). Aim of the study The aim of this study was to assess the quality of life among elderly with glaucoma. Subjects and method Study design Descriptive study design was utilized in the study. Study settings This study was conducted at Ali Ibn Aby-Talip’s ophthalmic outpatient clinic affiliated to the health insurance in Tanta city. Chapter Study subjects: A convenient sample was utilized in the current study. All the available elderly who attend the clinic within two months were included in the study. The total study sample was 310 elder with glaucoma. Tools of data collection: Three tools were used in this study to collect the necessary data. Tool I: Structured interview schedule: A structured interview schedule was developed by the researcher based on literature review; it consisted of two parts as follows: Part (1): Socio-demographic characteristics of elderly with glaucoma. This part included socio-demographic characteristics of elderly with glaucoma such as age, gender, occupation before the retirement or before 60 years old, educational level, residence, and family income. Part (2): Medical history of the elderly: It included the data such as the history of glaucoma, family history, and complaints of other chronic illness as diabetes or hypertension. Tool II: National Eye Institute Visual Functioning Questionnaire - 25 (VFQ-25) The NEI-VFQ is a widely used instrument measuring a broad range of visual functions. The National Eye Institute (NEI) was sponsored the development of the VFQ-25 at 1996. It was 51-item NEIVFQ after that it was modified at 2005 into a 25-item questionnaire with the same validity and reproducibility. The VFQ-25is generate the following vision-targeted subscales: global vision rating (1question), difficulty with near vision activities (3 questions), difficulty with distance vision activities (3 questions), limitations in social functioning due to vision (2 questions), role limitations due to vision (2 questions), dependency on others due to vision (3 questions), mental health symptoms due to vision (4 questions), driving difficulties (3 questions), limitations with peripheral (1 question), color vision (1 question), and ocular pain (2 questions). Scoring system: original numeric values from the survey were recoded following the scoring rules of the questionnaire. All items are scored so that a high score represents better functioning. Each item is then converted to a (0) to (100) scale, so that the lowest and highest possible scores were set at (0) to (100) points, respectively. The total scoring system of visual functioning was classified as follows: - Poor visual function from 0% -< 50%. - Moderate visual function from 50%- to less than 70%. - Good visual function from ≥70%. Tool III: The European Quality of Life-5 Dimensions (EQ-5D). EQ-5D is a standardized measure of health status that provides a simple, generic measure of health for clinical and economic appraisal that developed by the (EuroQol Group). Scoring system: The descriptive system of it comprises of 5 dimensions (mobility, self-care, usual activities, pain/discomfort, and anxiety/depression). However, each dimension has 5 levels: no problems scored (1), slight problems scored (2), moderate problems scored (3), severe problems scored (4), and extreme problems scored (5). This information can be used as a quantitative measure of health as judged by the individual respondents. The total score ranged from 5: 25. The total score was categorized as follows: - Worse quality of life from 80% -100 %. - Poor quality of life from 60 % - < 80 %. - Fair quality of life from 20 % - < 60 %. - Best quality of life from 5% - < 20%. Results: The results of this study can be summarized as follows:- - The age of the studied elderly was ranged from 60 to 84 years. - Almost half of the studied elderly were in the age group of (60 >70). - About two thirds (68.7%) of the studied elderly was male. - Less than half (48.7%) of the studied elderly had glaucoma from less than (< 5) years. - The duration of years that studied elderly had glaucoma ranged from (1-18) years with mean of (5.2 ±2.8). - More than half (61.7%) of the studied elderly had hypertension. - Nearly half (49.7%) of the studied elderly had diabetes. - A bout three quarters (75.7%) of the studied elderly wearing spectacles or lenses. - Most of the studied elderly (96.6%) who have family history of glaucoma were among the first degree relatives. - More than half (54.0%) of the studied elderly had very good general health. - More than half (52.3%) of the studied elderly had good general vision with using (glasses or contact lenses). - About one half (43.3%) of the studied elderly had mild pain or discomfort around eyes. - Only 6% of the studied elderly had no difficulty at all in reading ordinary newspaper. - More than one quarter (28.7% and 27.7%) of the studied elderly had moderate and extreme difficulty in doing work or hobbies that need to close up respectively. - About one half (43.3%) of the studied elderly had extreme difficulty in going down steps, stairs, or curbs in dim light or at night. - Less than half (46.0%) of studied elderly had no or little difficulty in social function. - More than half (59.0%) of the studied elderly feel frustrated a lot of the time because of the eyesight. About one half (48.0%) of them being less control over what doing because of the eyesight. - About one half (47.3%) of the studied elderly were not worrying about doing things that will embarrass them or others because of the eyesight. from the previous two sentences, the mental health of the elderly is good. - About one third (34.7%) of the studied elderly had no limitation in their work because of vision. - About one half (47.7%) definitely didn’t need a lot of help from others because of the eyesight. - About three quarters (71.0%) of the studied elderly didn’t have difficulty in driving during the daytime in familiar places if they derived. But more than one third (38.7%) of the studied elderly had moderate difficulty in driving at night and driving in difficult conditions. - About half (45.7%) of the studied elderly had moderate visual function, followed by 30.0% and 24.3% of the studied elderly had poor and good visual function respectively. - About the half (45%) of the studied elderly had a little difficulty in mobility domain. - More than one third (42% and 35.7%) of the studied elderly had no difficulty and little difficulty in self-care domain respectively. - More than one third (39.3%) of the studied elderly had a little difficulty in doing daily living activities. - More than two fifths (42%) of the studied elderly had a little difficulty in pain domain. - Nearest the half (46.7%) of the studied elderly didn’t feel depressed any more. - About two fifths (43.3%) of the studied elderly had good quality of life, followed by nearly one third (33.0%) had fair quality of life. - There was a statistically significant positive relationship between the total score of visual functioning of the elderly with glaucoma and their socio demographic characteristics (p <0.05). - There was a statistically significant positive relationship between the total score of visual functioning of the elderly with glaucoma and their medical history (p = 0.05). - There was a statistically significant positive relationship between the total score of the Euro quality of life 5 dimensions (EQ-5D) of the elderly patients with glaucoma and their sociodemographic characteristics (p < 0.001). - There was a statistically significant positive relationship between the total score of the Euro quality of life 5 dimensions (EQ-5D) of the elderly patients with glaucoma and their medical history (p < 0.05). - There was a highly statistically significant positive relationship between the total score of the Euro quality of life 5 dimensions (EQ- 5D) of the elderly patients with glaucoma and the total scoring of visual functioning (VFQ-25) (p < 0.05). Based on the result of the present study, the following recommendations are suggested: 1- Community health nurses should motivate vulnerable group of glaucoma ( people who are old age, have chronic diseases, or have family history for glaucoma) to get tested early and often at least once a year, preferably twice or more if the vision is on the worse side. 2- Community health nurses should advice glaucoma patient to don’t take any risk in driving under abnormal conditions, wear perfect glasses in sun light to protect their eye, and ask for help if not see any signal well in the street. 3- Community health nurses should advice people from youth to senior age to make tastes about diabetes and hypertension disease for early detection of disease that can decrease probability of having glaucoma disease. 4- Instructional guidelines about glaucoma disease should be applied on a wide range through different health clinics that elderly attend and special education programs in senior centers about glaucoma disease. 5- A healthy lifestyle, patient education, family counseling and social support network should be strengthen in health promotion programs in order to enhance compliance of glaucoma patients with treatment regimen and to improve their quality of life. 6- Additional studies should be conducted for glaucoma disease awareness among elder to decrease health care costs.