Vision & Aging VISIONS © Greenwich St. 3rd Floor

Part 1 Vision Impairment
(10 minutes for this section)

Vision Impairment Among persons age 65 and older, an estimated 21% report some form of vision impairment, representing 7.3 million persons. According to the American Community Survey of 2009, nearly 3 million people age 65 years and older 7.1 % of the senior population report blindness or severe vision loss. Vision rehabilitation services for older adults are largely underutilized despite the documented need and benefit of such services. Among persons age 65 and older, an estimated 21% report some form of vision impairment, representing 7.3 million persons. ~ (Lighthouse International Survey, 1995) Vision rehabilitation services for older adults are largely underutilized despite the documented need and benefit of such services. ~ (Lighthouse Research Institute, 1995)

Fear of Losing Vision 71% of Americans age 45 and older fear being blind more than being deaf. 76% fear blindness more than having to use a wheelchair. 70% fear blindness more than losing a limb. 41% fear blindness more than having a mental or emotional illness. Results of the Lighthouse National Survey on Vision Loss (The Lighthouse Inc.,1995) indicated that there is great fear and limited knowledge about vision loss and aging among middle aged and older adults:

Vision changes are a natural part of aging

8 Common Occurrences in the Aging Eye
Difficulty focusing up close Slight loss of side (peripheral) vision Need for more illumination especially task lighting (ex. Direct lighting on a book) Eyes take longer to adjust when moving between light and dark areas

8 Common Occurrences in the Aging Eye
Glare may be bothersome Contrast between similar colors, such as blue and black, become hard to distinguish Dry eyes or excessive tears Floaters: small pieces amoeba like that “float across the visual field”

Part 2 Four Major Eye Diseases

Macular Degeneration Age-related macular degeneration (AMD):
Leading cause of blindness in older people. Affects a tiny area in the middle of the retina called the macula, the part of the eye that allows you to see fine detail. Causes no pain. Gradually destroys sharp, central vision needed for seeing straight-ahead activities such as reading, sewing, and driving. The greatest risk factor is age. A large study found that people in middle-age have about a 2 % risk of getting AMD, the risk increased to nearly 30 % in those over 75 Other risk factors include: Gender—Women tend to be at greater risk than men. Race—Whites are much more likely to lose vision from AMD than Blacks. Smoking—Smoking may increase the risk of AMD. Family History—Those with immediate family members who have AMD are at higher risk of developing the disease.

Some Signs of Central Vision Loss
A gradual loss of ability to see objects clearly in the center of the visual field. May be reading a paper or watching TV and not see all or parts of words or pictures

Distorted vision Straight edges appear wavy or have wavy lines such as the edge of a counter top or table

A gradual loss of color vision The most common sign of macular degeneration is a dark or empty area appearing in the center of vision May experience this as having a blind spot in their vision

Person may tilt their head in order to use their remaining peripheral vision or appear to be looking at the side of a person’s face; inability to recognize a familiar person. This is a common sign of a vision problem.

Who Is At High Risk? Smokers Heredity predisposition
People with High blood pressure People who are obese and inactive People with Lighter eye color ex. Blue, Gray Can be related to a drug side effect

Treatment Wet Only Laser Surgery Photodynamic therapy Injections

Glaucoma Glaucoma: Glaucoma is treated with medication, lasers, and surgery. Glaucoma is an eye disease in which the normal fluid pressure inside the eyes slowly rises damaging the optic nerve, leading to vision loss—or blindness. At first, there are no symptoms. Vision stays normal, and there is no pain. As the disease progresses, a person with glaucoma may notice his or her side vision gradually failing. Objects in front may still be seen clearly, but objects to the side may be missed. In addition, depth perception is often impaired. As the disease worsens, the field of vision narrows and blindness results. Risk factors: Blacks over the age of 40. Studies show that glaucoma is: 5X more likely to occur in Blacks than in Whites. 4X more likely to cause blindness in Blacks than in Whites. Anyone over the age of 60. People with a family history of glaucoma.

Signs of Glaucoma Moving the head hesitantly while walking or walking close to or reaching for the wall Bumping into objects that are off to the side, near the head, or at foot level Trouble reading, writing, or doing activities in a dimly lit room

Who Is At High Risk? African Americans over the age 40
Everyone over age 60 People with a family history of glaucoma Former NYS Governor David A. Paterson has glaucoma. He had an attack in May 2008 requiring surgery to reduce the pressure in his eyes.

Treatment Eye Doctor prescribes drops or pills to reduce and control pressure and flow Laser trabeculoplasty Conventional eye surgery -drops to cause the eye to make less fluid, lower eye pressure -laser: drains fluid out of the eye. Laser makes severl evenly spaced burns that stretch drainage holes -conventional: makes a new opening for the fluid-remove piece of tissue to create new channel

Cataracts Cataracts A clouding of the eye’s lens that causes loss of vision. Age-related cataract is the most common type. The lens focuses light onto the retina at the back of the eye The lens is made of mostly water and protein. As we age, some of the protein may clump together and start to cloud a small area of the lens. This is a cataract. Over time, the cataract may grow larger and cloud more of the lens, making it harder to see. Lights such headlights or sunlight cause more problems with glare than before. Colors may not appear as bright to you as they once did. People can have an age-related cataract in their 40s and 50s. But during middle age, most cataracts are small and don’t affect vision. It is after age 60 that most cataracts cause a decrease in vision. Excessive exposure to ultraviolet radiation in sunlight, cigarette smoking or the use of certain medications are also risk factors for the development of cataracts. If a cataract develops to the point that it affects daily activities, surgery may be recommend. During the surgery, the eye's natural lens is removed and usually replaced with a plastic artificial lens. Problems with other parts of the eye may prevent any improvement in vision after cataract surgery. If improvement in vision is unlikely, cataract removal may not be recommended.

Signs & Symptoms of Cataracts
Blurred or hazy, cloudy vision that makes it difficult to tell time, read, watch TV, see food on a plate, and travel safely The appearance of spots in front of the eyes Increased sensitivity to glare

The feeling of having a film over the eyes A temporary improvement in near vision may also indicate formation of a cataract

Cataracts that are so advanced and pronounced that you can actually see the film over the eye This must be treated immediately and should be considered an emergency

Who Is At High Risk? People with Diabetes
Smokers and people who excessively consume alcohol Prolonged exposure to sunlight without UV protection

Treatment The symptoms of early cataract may be improved with new eyeglasses, brighter lighting, anti-glare sunglasses, or magnifying lenses Surgery involves removing the cloudy lens and replacing it with an artificial lens. This surgery is very effective.

Diabetic Retinopathy Blurred central or side vision (left) or a blind spot in central vision (right) may indicate diabetic retinopathy

Diabetic Retinopathy The early stages of diabetic retinopathy may cause blurred vision, or it may produce no visual symptoms at all Vision may change from day to day or even from morning to evening

Diabetic Retinopathy This “changeable vision” may interfere with all activities. As the disease progresses, diabetics may notice a cloudiness of vision, blind spots or an unusual amount of floaters.

What are the Risks & Symptoms?
Risks: People with Type 1 & 2 diabetes. Often there are no symptoms in the early stages of the disease, nor is there any pain. Blurred vision may occur. If new blood vessels grow on the surface of the retina, they can bleed into the eye and impair vision.

Treatment Control blood sugar, blood pressure and blood cholesterol.
Laser treatment. Laser treatment shrink abnormal blood vessels can save rest of site

Part 3: Legal Blindness vs. Low Vision

Low Vision vs. Legally Blind Legal Blindness is an arbitrary definition created for the purpose of benefits (not a clinically, evidence based measure) This is the cut point for Legally Blind (20/200 with correction) Anyone in this range can be said to have low vision. The definition of low vision varies by state. (20/40 to 20/200 with correction) "Legal blindness" represents an artificial distinction and has little value for rehabilitation, but it is significant in that it determines eligibility for certain disability benefits from the Federal Government. In the United States, it is typically defined as visual acuity with best correction in the better eye worse than or equal to 20/200 or a visual field extent of less than 20 degrees in diameter. These overly simple criteria for visual impairment are far from comprehensive in defining the visual function deficits that can cause difficulties for daily living tasks. Normal Vision (20/20 with correction) Better than 20/20 vision

How Do I Know If My Client Has A Vision Problem?

Common Signs of Vision Loss
Bumping into objects Moving hesitantly or walking close to a wall Groping for objects or touching in tentative ways Squinting or tilting one’s head to see Requesting additional or different kinds of lighting Difficulty recognizing faces Difficulty reading regular size print Difficulty reading papers with poor contrast

Common Signs of Vision Loss
Holding books or other reading materials close to one’s face Spilling liquids or pushing food off the plate Becoming withdrawn and hesitant to leave the house A physical alteration to the eyes including excessive tearing, swelling or color change.

Part 4: Prevention of Vision Loss

Prevention of Vision Loss
What can you do to protect against vision loss? Wear sunglasses (from childhood on) w/ UV protection and/or a brimmed hat in all seasons. Eat a balanced diet rich in green leafy veggies & fish Stop smoking Manage your diabetes if you have been diagnosed Get tested for diabetes Get an annual dilated eye exam with pressure of eye checked by an Optometrist or Ophthalmologist

What else can you do? Early diagnosis is very important, so treatment can begin Avoid tobacco & drink alcohol in moderation Keep tight blood sugar control Urge family members and friends to get regular dilated eye exams

What else can you do? Learn the warning signs of eye diseases Learn your family history and determine if you are at high risk

Important for to be a self-advocate Questions for Your Eye Care Professional
When you call to make an appointment Be prepared to describe any vision problem(s) you are having even if they are minor . Ask how much the exam will cost. Ask if your health insurance will cover the cost. Ask if you need to pay at the time of the exam or will you be billed.

Questions for the Eye Care Professional
Before you go to your exam, make a list of the following: Signs and symptoms of eye problems you have noticed Eye injuries or eye surgery you have had and the approximate dates, hospitals where treated All prescription and over-the-counter drugs you are taking Questions you have about vision General health condition Family history of eye problems

Take along the following: Your eyeglasses and/or contact lenses A list of your prescriptions and any over-the-counter drugs or vitamins you are taking Medical/Health Insurance card A list of any current or past medical conditions

List of questions to ask your eye care professional What is my diagnosis? Will I need treatment of any kind? What changes if any can I expect in my vision? Will my vision get worse or stay the same as now? If I will lose any vision, how quickly? Will regular eyeglasses improve my vision? What medical/surgical treatments are available for my condition? Is there more than one treatment option? When do you recommend for treatment start? What are the treatment risks and side effects? If my treatment includes medication(s), what should I do if I miss a dose?

List of questions to ask your eye care professional (continued) Should I watch for any particular symptoms? What can I do to protect or improve my vision? Will diet, exercise, or lifestyle changes help? Do I have “low” vision (impaired vision)? Is a “low vision” exam from a “low vision” specialist recommended? If my vision can’t be corrected with regular glasses, can you refer me to a low vision specialist? Would I benefit from low-vision optical aids? Where can I get vision rehabilitation services to manage better with my vision loss?

Part 5 Vision Rehabilitation Services
(13 Minutes) Mebane will Turn it back over to Diane

Vision Rehabilitation Services
There are 18 vision rehabilitation agencies in New York State serving every county. They offer individualized services. Services may be offered in the home, at the agency or both. Vision rehabilitation agencies help people of all ages to lead independent and active lives despite vision loss. The agencies especially help seniors where vision loss is most prevalent.

What are Vision Rehabilitation Services?
Vision rehabilitation professionals utilize a team approach Vision Rehabilitation Therapist (VRT) University-trained professionals who address the skills needed to live independently at home, to obtain employment and to participate in community life. You may learn Braille or other alternative forms of communication. Orientation and Mobility (O&M) Specialist University-trained professionals who help individuals use their remaining vision and other senses to determine their position within the environment and to use techniques for safe movement from one place to another, crossing streets or using public transportation. You may be prescribed a long red and white cane. Diane: Vision Rehabilitation Therapist (VRT) Vision Rehabilitation Therapists provide instruction in adaptive independent living skills, to help people who are blind and visually impaired to confidently carry out their daily activities, such as: Evaluation of needs in the home, community, and work environments; Teaching adaptive independent living skills; Indoor mobility training VRT combines adaptive rehabilitation and adult education in the following areas: home management, personal management, communication skills, activities of daily living, leisure activities, and indoor travel skills." Orientation & Mobility (O&M) Certified Orientation and Mobility Specialists teach how to use remaining senses to determine position within the environment, and techniques for safe travel from one place to another, outdoors. Training might include use of a long red and white cane and independent use of public transportation. If multi-handicapped or have partial vision may need to learn to use your vision more efficiently. Goals might include getting around in your building or home, your immediate neighborhood, to work, to shopping areas or to medical appointments.

Intake worker/Licensed Social Worker/Case Worker The initial point of contact for people seeking services is called “intake”. The worker will familiarize you with available services, and inform you about available entitlements and assist with access to benefits. Licensed social workers provide supportive counseling to help in the process of adjusting to vision loss for seniors and their families. Occupational Therapist (OT)* You may also meet with an occupational therapist when: an additional functional limitation exists or a physical condition or disability affects the individual with vision loss. When the person is recovering or in rehabilitation from a stroke, experiences multiple sclerosis or other sensory, muscle or neurological conditions. When a person with multiple impairments ages and develops a functional vision impairment. Diane: Average units/ cost for equipment. .

Low Vision Services/Low Vision Eye Clinic Low vision services help seniors maximize the use of their remaining vision through the use of optical aids, equipment, devices and special lighting. In a low vision exam the emphasis is on assessment and evaluation and improving how a person with vision loss performs routine daily tasks. Refraction using specially prescribed lenses, to better focus and use the remaining vision, is an important part of the low vision exam. Diane: Average units/ cost for equipment. .

Vision Rehabilitation Services Seniors Often Receive
Vision Rehabilitation Therapy (VRT) Meal Management Communication Skills including Braille Home Management Financial Management Personal Management Indoor Mobility Low Vision Medication and clothing labeling Orientation and Mobility (O&M) Independent Street Crossing Outdoor and Sidewalk Travel Emergency Exiting Use of Public Transportation Navigating in unfamiliar environments Development of other senses to substitute for or supplement function with vision loss Preparation for dog guide training Diane: Average units/ cost for equipment. .

Other Vision Rehabilitation Services
Employment Skills to remain in or return to work Adaptations used in the workplace Career exploration and communicating with other blind seniors who are working Coaching, resume writing and preparing for a job interview Blindline® A toll free number to access information about products and services for people with vision loss in NYS Toll free call center Mon-Fri 9am-5pm Website Blindline toll free number fo products and services for everyone

VISIONS/Services for the Blind and Visually Impaired is one of the vision rehabilitation agencies
VISIONS/VCB VISIONS Center on Blindness in Rockland County Overnight vision rehabilitation and social programs for youth, adults, seniors and families; overnight respite for caregivers. VISIONS at SELIS MANOR Adapted learning environment and meeting place for people with vision loss of all ages 14 to 100+. VISIONS Center on Aging senior center, support groups, computer training, adapted classes, fitness center, library, ceramics, photography, bowling, benefits help and social work counseling.

VISIONS Intergenerational Volunteer Program
High school teens assist seniors at home and at Selis Manor Reading, shopping, escorting, computer help, friendly visiting Reduces isolation

What if seniors are resistant to a referral to Vision Rehabilitation Services?
Must Overcome Language/Culture barriers Fear or denial of vision loss Belief that nothing can be done Depression leading to isolation Work with Medical Professionals who know the senior Get MD or OD or OT or PT to prescribe or recommend vision rehabilitation services Get Nurse or social worker to recommend vision rehabilitation services Address Limited Resources Basic vision rehabilitation services for “legally blind” seniors In NYS are free of charge and funded by the NYS Commission for the Blind and Visually Handicapped. Some agencies charge co-pays or sliding scale charges for other services; some agencies like VISIONS in NYC do not charge for services and all services are provided free for the senior with no billing of insurance. Jackie/Mebane Ongoing Outreach/Follow-up – Continuous outreach to service professionals, as well as education of seniors in community settings regarding eye health and vision rehabilitation services. Addressing Barriers Knowledge/Acceptance of referral No memory of referral discussion with case manager Lack of comprehension when services explained by case manager Hesitancy to identify as visually impaired (cultural and/or emotional origin) Fear of impact on other services, such as home attendant Multiple health issues - Individual may be coping with numerous health issues, with vision loss not a primary concern and/or does not have the stamina to actively participate in training Diane: Working with medical professionals Difficulty obtaining information, especially in regards to completing eye report forms (not reimbursed) Particular difficulty in hospitals and other clinic settings – client may see a different doctor each time as well as high turnover rate Many seniors have not seen an eye care professional either recently or at all Limited resources Lack of adequate funding for services to seniors / little or no funding for individuals who are not legally blind Insufficient number of vision rehabilitation professions to meet the demand, bilingual professionals particularly scarce

Who pays for Vision Rehabilitation Services?
Vision rehabilitation services for people over age 55 who do not intend to enter or reenter the work force are generally funded by the state rehabilitation agency NYS CBVH under a program, known as Independent Living Services for Older Individuals Who Are Blind. Vocational Rehabilitation Services are for individuals of all ages interested in returning to work also funded by the state rehabilitation agency NYS CBVH. The Veterans Administration provides low vision and vision rehabilitation services for qualified veterans. Children’s Services: early intervention services for blind babies and toddlers is paid for through the Department of Health and vision rehabilitation services for blind and visually impaired school aged children may be paid for by the local school district or the state rehabilitation agency CBVH. Diane:

Part 6 Disability Etiquette

Things to know about disability etiquette:
Remember that the person is not the condition. Avoid words like victim, suffers from, and afflicted by. It is okay to say “John is a person with a vision problem.” Many people who meet the legal definition of blindness, do have some remaining sight or perception of light.

Introductions Introduce yourself. Identify who you are and what your job role is. “Hi! I’m John the Social Worker, how can I help you?” Speak to a person who is blind the same way you would to anyone else. Don’t shout or speak slower than usual. When you move, or leave a room, let the person who is blind know. “I’m going to get a pen. I’ll be back in a few minutes.”

Never touch a person who is blind without asking.
Assisting If you encounter a person who is blind and seems to need help, offer help. Just ask if they need assistance. Never touch a person who is blind without asking. Allow the person who is blind to take your arm. Let them control their movements. This is known as Human Guide Technique.

Giving Directions Be specific “Walk about 5 feet and enter at the second door on your left.” Be descriptive as you walk If the person takes your arm, stay a step ahead of them.

Giving Directions Put the person’s hand on the back or side of a chair. “The chair is facing away from you and has no handles.” During meals help the person locate food on the plate by using a clock system: “Potatoes are at 2 o’clock and meat is at 10 o’clock.”

Dog Guides A dog guide is a working dog.
Get permission before interacting with or petting someone’s dog guide. Even better, don’t touch/talk to the dog. Don’t give commands Ex. “Rover, come over here!”

Part 7 Home Safety and Maintaining Independence with Vision Loss

Home Safety Lighting is critical. Make sure there is:
Proper, Ample, Even Lighting  Lighting in hallways, stairwells and work areas  A light switch, table lamp or automatic nightlight by bedroom door (nightlights in hallways, bathrooms, bedroom)  Blinds or sheer curtains to reduce glare  the right wattage for light bulbs. Don’t use 60 watts if you need 100 watt bulbs for proper lighting.

Color Contrast & Texture
Paint, wall paper or carpet in contrast colors to make doors, stairs and room borders easier to see Mark edges of steps and ramps with paint or tape in a high contrast color. Use texture changes as markers: Velcro, rubber bands, raised dots on bottles, cans

Color Contrast Tips-cont’d
Examples: Install handrail with color different from background wall color Mark edges of stairs with bright paint, yellow or red Place a strip of Velcro at the end of handrail to identify when at the bottom step Paint or install door handles in contrast to door Add bright tape or paint on light switches and keyholes Use brightly colored non-skid tub mat Color contrast grab bars and towels from background wall Add bright tape to outline rim of tub, edges of counter or vanity, kitchen countertops Use different textured markers for medicine bottles Use a different color cutting board from the counter and the food being prepared

Furnishings Move furniture out of main walkway areas
Keep doors/cabinets fully closed or fully open Keep chairs, desks pushed in and in the same place Mark common settings on appliances (i.e. on/off, 375) Color contrast of floors from sofas/chairs Avoid upholstery with patterns Do not move anything without letting the person know

Flooring-Reduce Risk of Falls
Replace torn carpets, remove area carpets or throw rugs Always use non-skid padding or mats Remove electrical cords from pathways Use non-shiny finishes on floor-no polish or wax Remove doorsills Remember to pick up any items that you could trip over

Communication Systems to Consider
Telephones with large print keypads or dials Telephone color that contrasts with the color of the bedside table Voice Dialing or Phone that Announces the Numbers Telephone/Emergency Numbers in Large Print that are readily available or pre-programmed into the phone

Signage Note where emergency exits are located and make sure they are clearly readable Use heavy black felt tip pen on white, off white on non-glossy background or paper when making signs Immediately report or replace any lights out on building signs or signs that can no longer be read easily

Magnifiers Use an illuminating magnifier in any area when reading or taking medications It is preferable to have a low vision doctor prescribe a magnifier with the proper lighting for a particular eye condition

Emergency Preparedness
Always keep a cane or walker in the same place near the door or with a wallet or hand bag. Keep a “Go Bag” with extra medicine, tooth brush, toothpaste, water, proper identification, emergency contacts. Decide on a place to meet family or friends Practice an emergency evacuation drill locating a go bag, safely exiting building using stairwell, crossing street to a set meeting place If you must remain indoors, have emergency food and supplies in place

Part 8 Impact of Vision Rehabilitation Services on Quality of Life
Demonstration Project ( ) NYC Department for the Aging and VISIONS/Services for the Blind and Visually Impaired (13 Minutes) Diane can turn it back over to Mebane

Quality of life issues include:
Purpose of Research To measure the impact of vision rehabilitation services on frail and homebound seniors. Quality of life issues include: Functional Ability Depression Coping Skills Overall Health Face-to-face interviews were conducted and included the following sections: I. Sociodemographics II. Health & functional vision status III. Quality of Life

Baseline Sociodemographics
Close to three-fourth (74%) were female. Over two-thirds (68%) were age 75 and older. Over two-thirds (71%) identified themselves as African-American. Close to one-sixth (16%) identified themselves as being of Latino descent. Slightly over half (51%) were widowed. Slightly over two-fifths (42%) had an educational level less than a High School Diploma or GED. A little over one-third (34%) live in poverty. About three-fourths were female (74%). As you can see, and as was expected based on data we have from out case management agencies, the total case management agency population is typically three-fourths female and one fourth male and thus we had a true representative sample. A little over two-thirds were aged 75 and older (68%). Also, we know that this population tends to be older than the population that attends our senior centers and again, we found the same finding in our research where little over two-thirds were aged 75 and older (68%). Again, this matches the demographic data we have on our case management agencies, where the mean age is also 80 and three-fourths of the population is 75+. A little over two-thirds self-identified as African-American (67%). About one-fifth identified themselves as Latino (16.1%). In terms of race and ethnicity, for the purpose of this study African/Americans and Latinos were targeted. As you can see from the graph, a little over two-thirds self-identified as African-American (67%) and about one-fifth identified themselves as Latino (16.1%). Due to the nature of targeting certain populations, these numbers cannot be compared to case management agencies in general. In terms of marital status: A little over half were widowed (51%). And only 11% were married at the time of the interview. Education Almost two-fifths had less than a high-school education (42%) Annual Income: In terms of poverty, we looked at how many people lived in the household and the reported annual income range and found that out of 130 people who answered both questions 44 (34%) lived below the 2006 poverty guidelines.

Profile of Participants
Number of Participants That Report Having Each of the Four Common Eye Diseases N = 140 As you can see from this slide, 52% report having glaucoma and 40% report cataracts with 19% reporting MD and 19% reporting DR. As we discussed earlier we would expect to see a higher percentage of people reporting glaucoma and cataracts. One of the main reasons for the high percent reporting cataracts is that many of our clients, as previously mentioned, suffer from multiple health issues, including diabetes that may not make them good candidates for cataract surgery. Also note that the percentages add up to more than 100 because some people reported having more than one eye disease. 57 people (41%) reported some combination of the four with the most common combination being glaucoma and cataracts (14%) 9 people (6%) reported one of the four and an “other specific” eye disease. 13 people (9%) reported that they did not know which of the four eye disease they had and did not report an “other specific” eye disease. 10 (7.1%) reported none of the four but did report an “other specific” eye disease. 12 (8.6%) reported cataracts. 5 (3.6%) reported diabetic retinopathy. 23 (16.4%) reported glaucoma. 5 (3.6%) reported macular degeneration. 6 (4.3%) reported no eye disease but did report having vision problems.

Mean CES-D Score* The higher the score the greater the depressive symptomology Range When we measure depressive symptomology we asked the person how often they have felt a certain way during the past week. If they report they felt this rarely or none of the time then they got a score of zero for that item. There are 20 items to this scale that include questions such as: The literature has shown that a score of 16 or higher indicates high depressive symptomology. As you can see, prior to the receipt of VR services, people reported, on average, as having high depressive symptomology, whereas after VR services the average score dropped below Indicating an alleviation of some of the symptoms. In fact 42% of the sample (54 people) reported a score of 16 or higher, were as after services it dropped to 23%. HOW OFTEN YOU HAVE FELT THIS WAY DURING THE PAST WEEK Rarely or None of the time(<1 day) Some or a little of the time(1-2 days) Occasionally or a moderate amount of time (3-4 days) Most or all the time(5-7 days) I was bothered by things that usually don't bother me. 2. I did not feel like eating; my appetite was poor. 3. I felt that I could not shake off the blues even with help from my family or friends. 4. I felt that I was just as good as other people .5. I had trouble keeping my mind on what I was doing. 6. I felt depressed. 7. I felt that everything I did was an effort. 8. I felt hopeful about the future. 9. I thought my life had been a failure. 10. I felt fearful. 11. My sleep was restless. 12. I was happy. 13. I talked less than usual. 14. I felt lonely. 15. People were unfriendly. 16. I enjoyed life. 17. I had crying spells. 18. I felt sad. 19. I felt that people disliked me. 20. I could not “get going” *p < .05 A Score > = 16 indicates High Depressive Symptomology

Mean Adaptation to Vision Loss (AVL) Score The higher the score the better the adaptation Range The adaptation to vision loss score measures psychosocial adaptation to age-related vision loss, defined as encompassing elements of realistic acceptance of the vision loss, positive attitudes towards rehabilitation potential, and continuing relationships with family and friends (Horowitz & Reinhardt, 1998) Participants reported an increase in their ability to adapt to vision loss as a result of vision rehabilitation. Although not a statistically significant increase, the increase after the receipt of vision rehabilitation services indicates that clients have a more positive attitude after receiving vision rehabilitation services. In terms of realistic acceptance of their vision loss, prior to the receipt of vision rehabilitation services 36.4% of the respondents indicated that they strongly agreed with the statement, “vision impairment is the cause of all my problems,” whereas at the completion of vision rehabilitation services only 13.6% strongly agreed with the statement.

Number of Participants That Report Using Each Type of Adaptive Aid N = 22 We asked participants if they currently used any of the following: As you can see in most cases the number of seniors using each type of adaptive aid, such as HSG, SL, MC, LPRM more than doubled. And the use of LPT and TWC also greatly increased. On average use of adaptive aids increased from 2 to 4.

Findings/Conclusions Baseline to 3 Months after Services
Analysis of Quality of life issues for all seniors indicate: Coping skills, functional ability and depression were all inter-related. There was a significant difference in function and attitude after vision rehabilitation services. Significantly less functional disability. Reduction in depressive symptoms. Increased psychosocial ability to adapt to vision loss. Increased Life Satisfaction. Increase in use of Adaptive Aids. Increased life satisfaction. When participants were asked to rate their “satisfaction with life these days”, prior to receipt of services almost one-fourth reported they were “not at all satisfied” (23.8%). After the receipt of vision rehabilitation services there was a decrease in the number of participants reporting they were “not at all satisfied.” Immediately after completion, 11.4% stated they were “not at all satisfied.” The decrease in negative outlook can be considered an indicator of the positive impact of vision rehabilitation services on quality of life.

Part 9 Other Resources (10 minutes for this section)

Mebane - future research & ongoing training
V. Conclusion/Recommendations: Future Research – Trends found in this study were that Spanish-speaking seniors reported feeling less able to cope with their vision impairment and experienced more depressive symptoms and greater functional disability than English-speaking seniors. More research needs to be conducted with the Spanish-speaking population to ascertain if the trends found in this study continue to be found in a larger Spanish speaking population. While acculturation factors were not examined in this study, one reason for the finding may be that Spanish-speaking seniors feel less able to access resources, and more isolated due to not being fluent in English. Ongoing Training – Case managers at additional agencies, as well as other aging services professionals can benefit from receiving training about the four common eye diseases, how vision rehabilitation services can improve the quality of life and independence of an elder and where and how to make a referral. Additionally, due to the high turnover rate in case management agencies, it would be advisable to periodically return to agencies where training has already occurred. Diane: Ongoing follow-up/outreach, Addressing Barriers. Ongoing Outreach/Follow-up – Continuous outreach to service professionals, as well as education of seniors in community settings regarding eye health and vision rehabilitation services. Addressing Barriers Knowledge/Acceptance of referral No memory of referral discussion with case manager Lack of comprehension when services explained by case manager Hesitancy to identify as visually impaired (cultural and/or emotional origin) Fear of impact on other services, such as home attendant Multiple health issues - Individual may be coping with numerous health issues, with vision loss not a primary concern and/or does not have the stamina to actively participate in training Working with medical professionals Difficulty obtaining information, especially in regards to completing eye report forms (not reimbursed) Particular difficulty in hospitals and other clinic settings – client may see a different doctor each time as well as high turnover rate Many seniors have not seen an eye care professional either recently or at all Limited resources Lack of adequate funding for services to seniors / little or no funding for individuals who are not legally blind Insufficient number of vision rehabilitation professions to meet the demand, bilingual professionals particularly scarce

Resources NYS Commission for the Blind and Visually Handicapped CBVH
2. National Eye Institute Website 3. American Foundation for the Blind VISIONS/Services for the Blind and Visually Impaired

CONTACT INFORMATION VISIONS/Services for the Blind and Visually Impaired Nancy D. Miller, LMSW Executive Director x117

Vision & Aging VISIONS © Greenwich St. 3rd Floor

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