|Helping Residents with 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
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
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
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
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
- 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
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.