White House Conference on Aging Solutions Forum

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White House Conference on Aging Solutions Forum

• Vision-Related Issues Facing Baby Boomers and the
  Elderly Population

Jennifer Kaldenberg, MSA, OTR/L, CLVT Director,
Occupational Therapy Department, and Lecturer,
New England College of Optometry
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Barriers to Vision Care and Rehabilitation
Services

• Access to care
• Language, cultural, and economic
• Funding limitations
• Awareness of visual impairment by individuals and
  health care providers
• Numbers of practitioners adequately trained in
  vision rehabilitation
• Attitudinal
• Provider ageism, capabilities of disabled
• Patient denial, embarrassment, part of the
  aging process

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Current Issues in Vision

• Visual impairment has been linked to
• -Difficulty with ADLs
• - High blood pressure
• - Heart disease
• - Strokes
• - Falls
• - Depression
• Aging population
• Greater number of comorbidities
• Impact of multiple impairments
• -Hearing and visual impairment
• -Visual and cognitive impairment
• Impact of social networks on health and wellbeing

Data from the CDC, MMWR Surveillance Survey for
Sensory Impairment, 1999.
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Current Issues in Vision

• 18.1 of adults 70 (3.6 million people) reported
  difficulty with their vision.
• Visual impairment has been linked to
• Hypertension (53.7 vs. 43.1)
• Heart disease (30.2 vs. 19.7)
• Stroke (17.4 vs. 7.3)
• Depression or anxiety (13.3 vs. 7.0).

Data from the CDC, MMWR Surveillance Survey for
Sensory Impairment, 1999.
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Current Issues in Vision

• Difficulty walking
• (43.3 vs. 20.2)
• Difficulty getting outside
• (28.6 vs. 10.4)
• Difficulty getting in and out of a bed/chair
• (22.1 vs. 9.3)

Data from the CDC, MMWR Surveillance Survey for
Sensory Impairment, 1999.
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Current Issues in Vision

• Difficulty managing medication
• (11.8 vs. 4.4)
• Difficulty preparing meals
• (18.7 vs. 6.7)
• More likely to have experienced falls during the
  preceding 12 months
• (31.2 vs. 19.2)
• Have suffered a broken hip
• (7.1 vs. 4.2)

Data from the CDC, MMWR Surveillance Survey for
Sensory Impairment, 1999.
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Psychosocial Issues and Vision Loss

• Lack of privacy
• Sense of dependency
• Hope for magical cure
• Loss of security
• Loss in basic skills
• Loss in facial communication
• Loss of occupation/financial status
• Loss of self-esteem, adequacy, role

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Grieving Process of Vision Loss

• Shock and denial
• Anger and withdrawal
• Succumbing to depression
• Reassessment and reaffirmation
• Coping and mobilization
• (Tuttle)

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Psychosocial Symptoms and Vision Loss

• Depression, decreased self-esteem, excessive
  dependence, decreased morale (Branch, Horowitz,
  Carr Gillman, Simmel, Simon)
• Depression and adjustment disorder-most common
  with vision loss (Leinhass Hedstrom)
• Suicide-increased risk with vision loss
• (De Leo et al.)
• Low vision vs. blind more depression, anger,
  and hostility with low vision (Oehler
  Fitzgerald)

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Falls

• One of every three adults 65 years old or older
  falls each year.
• In 1998, about 9,600 people over the age of 65
  died from fall-related injuries.
• Of all fall deaths, more than 60 involve people
  who are 75 years or older.
• Fall-related death rates are higher among men
  than women and differ by race. White men have the
  highest death rate, followed by white women,
  black men, and black women.

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What Can Occupational Therapy Do?

• Provide hope
• Provide rehabilitation services to maximize
  independence and participation in daily tasks
• Provide education and resources
• Support self-advocacy

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Analysis of Performance

• BADL
• IADL
• Education
• Work
• Play
• Leisure
• Social participation

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Intervention

• Lighting
• Glare
• Size
• Contrast
• Talking/tactile
• Visual strategies
• Optical aids
• Magnifiers
• Microscopes
• Telescopes
• CCTV
• Prisms