Kathryn Price, Trainee Geriatrician, Shreena Patel, Optometrist, Claudia Osei-Asibey, Optometrist, Sancy Low, Consultant Ophthalmologist, and Tania Kalsi, Consultant Geriatrician are all members in the Partnership Southwark Vision Together programme. Here they share their top tips for improving eyesight education in social care settings.
In the context of providing holistic care to residents in care homes, eye health is often overlooked despite its significant impact on overall well-being and quality of life. Pat, an 86-year-old resident with dementia and progressive frailty, exemplifies the challenges and transformative potential of accessible eye care services in such settings.
Pat was becoming increasingly depressed, reduced her engagement in activities and was beginning to stumble. Through a comprehensive assessment by a domiciliary optometrist, the identification and subsequent management of cataracts were achieved, involving collaborative decision-making with a multidisciplinary team, carers, and her family. This personalised approach not only addressed her physical health but also significantly improved her engagement and mental well-being.
In the context of providing holistic care to residents in care homes, eye health is often overlooked despite its significant impact on overall well-being and quality of life. Pat, an 86-year-old resident with dementia and progressive frailty, exemplifies the challenges and transformative potential of accessible eye care services in such settings.
Vision: through the eyes of the resident
Different eye conditions result in different changes in the way people can see. The most common sight threatening eye conditions are glaucoma, diabetic retinopathy, cataracts and Age-related macular degeneration (ARMD).
*Images courtesy and with permission from Outside Clinic
Eye symptoms, vision & dementia
Residents with advanced dementia may not be able to express specific eye symptoms. Visual loss may manifest in behavioural changes, reduced engagement in activities, low mood or social withdrawal. Eye pain may present with increased confusion (delirium).
Dementia not only affects memory, it affects vision as the brain needs to process and interpret signals seen by the eye. People with dementia can find it difficult to judge distances (e.g. cannot tell if an object is on top of a patterned rug or part of it), this increases the risk of falls. In Alzheimer’s dementia, peripheral vision is lost, vision is restricted to what is “right in front of them”. Carers need to consider this when delivering care, meals and activities. Processing difficulties can be supported by using high colour contrast. Brighter lights are needed and visual simplicity is beneficial as visual busy-ness can be difficult to interpret.
Compliance with eye drops can be difficult in advanced dementia. Where advance dementia precludes optimal eyedrop compliance, talk with clinicians about pragmatic eyecare plans that balance eyecare, vision and distress from treatment.
Severe visual impairment
Ensure residents eligible are registered as severely sight impaired. This is completed by a consultant eye doctor. They may be entitled to added benefits and be eligible to the local sensory impairment team support with adjuncts to aid independence.
Most people with sight loss need enhanced lighting. This should be considered in the care home environment in terms of bulb wattage, table and floor lamps. LED lights are on the cool end of the colour spectrum and can be brighter. Studies have shown that improved lighting improves quality of life as well as independence. Other helpful adjuncts include large-print remote controls for TVs, large-print playing cards, handheld magnifiers and ensuring glasses are contemporary to current vision.
Overcoming Barriers to Eye Care Services
Barriers to accessing eye care for residents include dementia particularly if associated with behavioural challenges and physical dependency. Residents need proactive and regular eyesight checks. Work with your health system strategic partners to advocate for residents to drive up change to service pathways to meet residents needs closer to home.
Take Home messages
Make numbers big
- Regular eyesight checks are crucial for care home residents for quality of life, function as well as well as for falls prevention
- Typical eye symptoms may be absent in those with advanced dementia, therefore care staff need to consider eyesight issues in those who seem to reduce activity engagement, fall, become low in mood as well when they have observable symptoms e.g. red eye
- Consider lighting, contrast, visual simplicity and other adjuncts in the environment to mitigate sight challenges related to both dementia as well as for severe sight impairment
- Ensure all those who are sight impaired or severely sight impaired are registered
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