“Alone we can do so little; together we can do so much.” — Helen Keller
A senior patient might tell her nurse that her well-lit room is too dark; a radiology technician might notice his senior patient tilting his head at an odd angle while reading a consent form; or a dental hygienist might see her patient wince from the bright overhead light. While these healthcare professionals may not examine their patients’ vision, they and many others are in a unique position to screen vision-impaired senior patients and steer them toward the help they need.
Common Senior Eye Disorders
Loss of eyesight is a growing concern. More than six million American adults over the age of 65 have a severe visual impairment, according to the American Federation for the Blind (AFB). The U.S. Census Bureau predicts that the population of Americans over age 65 will more than double between 2010 and 2050, and the AFB states that severe visual loss rates are expected to double along with the aging population.
Although aging does not cause most eye problems, the risk of vision impairment does increase with age. The AFB lists more than 50 eye conditions that impair vision. These conditions can negatively impact senior health, ranging from annoyances to total blindness. Some eye disorders more common among older adults include:
- Presbyopia, in which the lens loses flexibility and the eye’s ability to focus on nearby objects decreases. Not to be confused with farsightedness, this condition occurs over time, often becoming noticeable after age 40. Reading glasses are a common solution for restoring close-up vision.
- Cataracts, which also form slowly over time. Cataracts cloud the eye’s lens, causing increased glare, blurred vision, and distorted colors. If troublesome, they can be surgically removed.
- Retinal diseases, which include several disorders. Macular degeneration causes a gradual loss of central vision. Another retinal disease, called diabetic retinopathy, can lead to total blindness if the disease remains uncontrolled.
- Glaucoma is a group of disorders of the optic nerve that can lead to blindness if left untreated. Symptoms include painful swelling of the eye and loss of peripheral vision.
Complications for Vision-Impaired Seniors
Loss of visual acuity can negatively impact senior health in a variety of ways. Depression is a common issue among seniors, for example, and an estimated one third of vision-impaired seniors report symptoms of depression. For a variety of reasons, many seniors are at risk for falls, and not seeing well can make them more vulnerable. According to the Centers for Disease Control and Prevention, falls increase the chance of a senior needing admittance to a hospital or nursing facility for a serious injury. This in turn could mean a loss of independence.
In addition to the physical effects of losing one’s vision, simple activities of daily living can become more difficult. Those with poor vision, for instance, may make a serious error when taking medication.
Whether from diseases, medications, treatment side effects, or environmental factors, it is not uncommon for seniors to experience more than one sensory deprivation — typically hearing and vision loss combined. Other seniors may cope with varying degrees of loss to their senses of taste, touch, and smell.
Identifying Vision Problems
Early detection can in many cases prevent, treat, or even reverse the effects of vision problems. Because the onset of common senior eye conditions is often gradual, your senior patients may be unaware of any problems. Others may believe that their eye problems are a normal part of aging, or they may be too shy or embarrassed to seek help. Finances are an important issue for many, as Medicare typically does not pay for eyeglasses unless they are needed after intraocular lens cataract surgery. Seniors may be unaware of different resources that could defray the costs of vision treatment.
Only qualified practitioners diagnose and treat eye diseases. Nevertheless, practitioners across the healthcare spectrum who work with older adults have an important role to play. When a healthcare provider learns to recognize the cues, her casual observation may be able to detect a patient’s low vision or other issues with eyesight. Clues that professionals should look and listen for among their patients include:
- Reports of visual distortions such as seeing double, spots and floaters, or halos around lights
- Appearing not to notice obstacles in front of them
- Complaints of eye pain or related sensations such as a sense of pressure
- Preferring to walk near walls or moving uncertainly
- Wearing mismatched or stained clothing
- Asking for brighter lighting
- Expressing difficulty with seeing at night or reacting strongly to glare
- Reports of frequent headaches
- Squinting during conversations or not seeming properly focused
- Frequently dropping objects
Great care should be taken before mentioning vision problems to a senior or his caregiver. In addition, healthcare professionals can adapt their work habits and environments to make them friendlier to those with vision impairment. Adaptations might include:
- Having a patient with both vision and hearing loss repeat information and instructions
- Using large fonts on printed materials
- Offering to read necessary forms
- Removing rugs, cords, and other tripping hazards
- Installing brighter lights
- Using contrasting colors to delineate baseboards, walls, and doors
- Ensuring the visibility of glass doors
- Hanging signage at eye level
- Using blinds to eliminate glare
- Installing handrails along hallways
- Ensuring that emergency exits are visible
How a healthcare worker interacts with a visually impaired senior is important for both his confidence and his safety. It is especially important not to patronize him. For example, ask the senior if he would like help before providing it. Do not leave him in the examination room alone without first informing him, and provide precise instructions. If he has a guide dog, make sure it is not distracted, and be mindful that the use of a white cane does not necessarily mean total blindness. When leading the patient, he should be kept apprised of obstacles but allowed to otherwise lead — unless he asks for help. However, that does not mean allowing him to make risky maneuvers.
Help for Vision-Impaired Seniors
Sharing your knowledge, even if it is just a quick tip, could help busy family caregivers and make a huge difference in your patient’s life. Practical ideas to enhance or simplify day-to-day living can be especially useful. Here are a few suggestions from the AFB and other sources:
- Designate a specific area for keys, remote controls, and other frequently lost items.
- Cover glare-producing glass tables.
- Use non-skid flooring when practical.
- Make sure all flammable items are kept away from the stove.
- Purchase long oven mitts and colored cutting boards to help prevent kitchen accidents.
- Full-spectrum incandescent bulbs are best for close-up work, while fluorescent lights produce less glare. Both are more effective when suspended directly overhead or behind the senior.
- Mark hot water settings on faucets and set lower water temperatures.
- Label thermostat and washer and dryer settings.
- Clearly label all cleaning products and other potentially harmful substances.
- Develop a filing system for household business.
- Use large-print calendars and color coding to keep up with important dates.
- Have a system to keep medications clearly labeled and organized; an automatic pill dispenser is one such solution.
- Develop a system for storing specific types of clothing in designated parts of the closet or drawers.
From Braille printers and GPS tracking systems to digital talking books and magnified screen readers, many types of tools are available to help those who are visually impaired. The AFB maintains and updates lists of these products and technologies. Additionally, a HomeSafe Alert System, which automatically calls for help in the event of a fall, can bring peace of mind to seniors living independently at home and to their caregivers.
In addition to national and private resources, every state has an agency for the blind.
Other important resources include:
- American Association of the Deaf-Blind — (301) 563-9064
- American Foundation for the Blind — (212) 502-7600
- Blinded Veterans Association — (800) 669-7079
- The Carroll Center for the Blind — (800) 852-3131
- Lions Clubs International — (630) 571-5466
- National Eye Institute — (301) 496-5248
- Prevent Blindness America — (800)-331-2020
- VisionAware — firstname.lastname@example.org
Healthcare professionals can also become directly involved by contacting the AFB and asking what they can do to help. Petition drives, literature distribution, advocacy efforts, vision-screening fairs, and monetary donations are a sampling of the many opportunities for improving senior health.
Promising Treatment Research
Scientific research is making significant advances in understanding and treating eye diseases. A recent study published in Science, for example, suggests that age-related macular degeneration may respond well to drugs used to treat HIV. What makes this news especially significant is that these drugs are already FDA-approved.
In addition, while a cornea transplant can restore vision to someone with damage to the dome-shaped film that protects the eye, some may need to wait years to receive a replacement. To mitigate this issue, scientists are developing a means to manufacture replacement corneas using stem cells from a patient’s healthy eye.
The role of a healthcare provider fosters compassion, knowledge, and a sense of trust that puts you in a unique position to help patients with more than just your area of expertise. By learning to recognize the signs of vision problems and referring your patients to the appropriate resources, you’ll greatly benefit your patients as a member of their caregiving team.
When advising senior patients experiencing vision impairments or other conditions associated with increased fall risk, also consider referring them for a medical alert system.