Helping Residents with Vision Impairments

Vision impairment is one of the biggest challenges facing the elderly. The ability to see properly has a profound effect on a resident's functional ability, independence, and emotional well-being. The American Foundation for the Blind estimates that 30% to 50% of nursing home residents are severely visually impaired. Unfortunately, vision impairments in nursing homes can easily go unrecognized, unreported and unassessed. Staff can reduce these residents' feelings of anxiety, frustration, and worthlessness through a variety of simple techniques. The following two-part Council Close-Up series provides creative, practical, and needed advice for improving the quality of life of the visually impaired.

Vision Challenges Associated with Aging

With the aging process come many changes in a person's vision ability These changes reflect the fact that the lens in the eye generally stiffens over time, making it more difficult to focus accurately. For instance, many older people find it more difficult to see things close by. Referred to as presbyopia, this condition is often corrected with reading glasses or bifocal lenses

Older adults may experience other visual challenges such as spots in their eyes, problems with too many or too few tears, or reduced night vision. They commonly have difficulties in distinguishing between some colors, particularly between shades of blue and green. Many may also have a harder time adjusting to glare and sudden changes in light intensity Their visual reaction time -- the ability to respond promptly to what one sees -- becomes much slower. As opthamologist Eleanor E. Faye, Director of Low Vision Services at The Lighthouse in New York states "We are living longer than our eyes"

Older adults generally require much more light than younger people to see properly. Research indicates that the visual performance of those in their 20's is about eight times better than those in their sixties, and almost four times better than those in their fifties.

While some changes in vision are a normal part of the aging process, many older adults are at risk for low vision. Next to arthritis and heart disease, low vision is the single most common disability among senior citizens. Low vision is defined as when a person's vision in the best eye even while wearing corrective lenses, is worse than 20/70. As a rule, persons with low vision can tell that something is in front of them, but not be able to tell who or what it is.

The following are the four most common eye diseases associated with the aging process which causes low vision. These diseases affect both visual acuity (how clearly one sees detail) and visual field (how great an area a person can see):

Macular degeneration -- This progressive disease is the leading cause of severe vision loss in persons over the age of 65. It involves the deterioration of the macula, a small area of the retina responsible for fine acute vision. This deterioration results in an impairment of central vision, with side or peripheral vision left intact. Currently, there is no effective cure for most cases of this disease.

Cataracts -- Cataracts involve a clouding of the lens which causes a general loss of detail in what a person sees. In some cases, cataracts may decrease vision substantially by causing blurriness, distortions, and double images. Surgical removal of cataracts has proven to be a simple, safe, and successful procedure.

Glaucoma -- This disease involves an increase in pressure in the eye due to faulty draining of normal eye fluids. This build-up of pressure can damage the eye's structure. If not treated soon enough, glaucoma can destroy side vision, leaving "tunnel vision" - a small central area in which the person sees. Early diagnosis and treatment are essential.

Diabetic retinopathy -- Resulting from inadequate or faulty insulin production, diabetic retinopathy involves damage to the small blood vessels nourishing the eye's retina. The disease may cause blurring in the central visual field. Laser Surgery can seal off or destroy abnormal retinal blood vessels and may reduce the risk of severe vision loss.

The Social and Psychological Effects of Having Low Vision

A resident with low vision can have difficulty in doing even the simplest of tasks, leading to feelings of fear, anger and frustration. Staircases that were once descended easily are now perilous, with one step indistinguishable from another. Small tables and chair legs seem to appear out of nowhere, leading to bruised shins and possible accidents. Trying to sit in a chair can lead to falling on the floor. It becomes difficult or impossible to read a newspaper, recognize the face of a friend, or navigate across a room. The resident's life can become tragically restricted.

With these many difficulties, residents often stay in their rooms, giving up on activities that mean a great deal to their lives due to fear of embarrassment. They may experience feelings of anger, loneliness, and depression. Residents may lose faith in their abilities, becoming overly dependent on staff members.

Many elderly residents who experience vision loss may deny that there even is a problem. Dr. Alfred A. Rosenbloom, former president of the Illinois College of Optometry, explains, "Elderly people are apt to accept loss of vision as an inevitable result of aging, and consequently many of them don't ask for help. Many who do seek help have trouble articulating their needs."

Recognizing Vision Loss in Older People

One of the biggest challenges faring nursing home residents is that their vision loss often goes unrecognized and untreated. The American Foundation for the Blind recommends that caregivers be alert for the following common indications of vision loss, such as noticing that a female resident:

  • changes the way she reads, watches television, walks, or performs hobbies
  • squints or tilts her head to the side to get an object in focus
  • has difficulty identifying faces or objects
  • has difficulty in locating familiar objects
  • can no longer read the mail or newspaper
  • holds reading material close to face or at an angle/writes less clearly or precisely
  • brushes against wall or bumps into objects
  • goes up and down stairs slowly and cautiously
  • experiences difficulties such as spilling food or knocking over liquids during mealtime

Residents experiencing some of the common indicators of vision loss should receive a thorough eye examination from an optometrist or opthamologist. Many times, surgical procedures, corrective eye-wear, medications, and adaptive devices can alleviate or correct a resident's vision problems.

Forms of Corrective Eye-Wear

Many types of corrective eye-wear can help visually impaired residents. Possibilities include powerful regular and bifocal eyeglass lenses hand-held, mounted, or wearable magnifying lenses and telescopic lenses that mount on to a section of one's eyeglasses. inexpensive magnifying lenses and sheets can be used during reading, and binoculars can be used outdoors. Of course, these optical aides are useless unless they are kept clean and are used with proper lighting.

Residents face many challenges in obtaining and keeping corrective eye-wear, eyeglasses in nursing homes are commonly lost, misplaced or broken Facilities experience difficulty and a lot of red tape from the state to obtain a replacement pair. Sometimes, residents will walk off with another resident's eyeglasses. Residents may wear another person's eyeglasses without the resident, family, or staff noticing.

Unfortunately, many residents never have their vision checked by eye professionals. With the residents' more obvious medical or nursing concerns, staff members may not recognize that some residents are experiencing vision problems, And yet vision problems in many cases may be an underlying cause of a resident's functional decline, loss of independence, fearfulness and anxiety. Because vision has such a vital impact on resident well-being, every effort should be made to have residents' eyes checked and to help them obtain corrective eye-wear.

Taking Advantage of Adaptive Devices and Materials

Many companies offer a variety of products for the visually impaired. Among the available products include large print watches, telephones with large numbers, self-threading sewing needles, TV screen enlargers, talking clocks and calculators, and large print playing card s and games.

Libraries are a wonderful resource in finding materials for the visually impaired. They offer large print reading materials, audio cassettes, and talking books (books which are read and recorded on cassette) Both the Readers Digest and the New York Times offer large-print editions for the visually impaired and are available by mail. Residents can also use tape cassettes to send "voice letters" to family and 

In some cities, there are radio reading services for the visually impaired, These services usually read the local newspapers as well as some national newspapers, magazines, and community reports. Of course having volunteers or staff members read for visually impaired residents can provide much enjoyment.