Therapists and caregivers working with the elderly in the long term care setting must assess the impact poor vision has on functional performance. Often, it is an area that is placed low on the totem pole by the interdisciplinary team but can have a dramatic impact on safety, including falls, balance deficits, nutrition (ability to feed self and “see” food), cognition (may actually present as a cognitive deficit), and overall quality of life. As we age, it is inevitable that our bodies change and for the institutionalized elderly with multiple co-morbidities, declining vision can become a key factor in maintaining independent task performance in mobility and self-care.
The three most common eye problems that the elderly face are cataracts, glaucoma, and macular degeneration. All of these can be improved by recognizing that the deficit is present and instituting appropriate treatment. Often, there can be a change in vision for a resident who wears glasses and if the resident has not had a recent eye exam the glasses they are wearing are no longer addressing the visual deficit. Many of our elderly residents have a diabetes diagnosis, a prominent co-morbidity in, which makes them particularly susceptible to macular degeneration, a condition in which the “macula” (the section in the center of the eye that helps us see fine details in the center of our visual field) which results in “blind spots” as well as blurry or fuzzy vision. This will significantly reduce the mobility and place them at higher risk of falls.
There are certainly best practices that can facilitate a healthier and safer lifestyle for these residents. Frequent (quarterly) visual assessments to ensure there have not been significant changes in their visual status as well as appropriate and timely referral to the optometrist/ophthalmologist are needed to ensure that a visual deficit is not contributing to an overall decline in functional performance. The interdisciplinary team must recognize that poor vision can have a significant impact on safety as well and make accurate visual assessment part of the quarterly screening process.

Cherie Rowell
Director of Clinical Services
Functional Pathways