Low vision service models in Alberta: innovation, collaboration, and future opportunities

The impact of combined age-related vision loss and dementia on the participation of older adults: A scoping review

INTRODUCTION

There are a growing number of older adults with combined age-related vision loss (ARVL) and dementia. Existing literature shows the pervasive impact that both diagnoses have separately on the participation of older adults, however, little is known about the societal participation of older adults with both conditions. As such, the aim of this scoping review was to explore the combined impact of ARVL and dementia on the participation of older adults, with a specific focus on highlighting strategies that help mitigate the impact of ARVL and dementia on participation.

METHODS

This study utilized a scoping review, informed by the framework by Arksey and O'Malley [1]. Two researchers independently ran a total of 62 search terms across four categories in six databases (PubMed, CINAHL, Scopus, Embase, Medline, PsycINFO), with an initial yield of 2,053 articles. Grey literature was also included in this scoping review and was retrieved from organizational websites, brochures, conference proceedings, and a Google Scholar search. The application of study inclusion criteria resulted in a final yield of 13 empirical studies and 10 grey literature sources.

RESULTS

Following detailed thematic analysis of the empirical and grey literature sources, four themes emerged regarding the impact of combined ARVL and dementia on the participation of older adults including: 1) Managing the pragmatic aspects of a dual diagnosis; 2) Diverse approaches to risk assessment and management; 3) Adopting a multi-disciplinary approach to facilitate care and; 4) Using compensatory strategies to facilitate participation.

CONCLUSIONS

The four themes highlight the challenges older adults with these combined diagnoses experience, which limit their opportunities for meaningful participation. Given the scarcity of research on this topic, future research should identify the type of ARVL and dementia diagnoses of study participants, conduct qualitative research about the lived experiences of older adults with a dual diagnosis, and broaden the geographic scope of research.

Essential components of rehabilitation services provided to visually impaired people

CLINICAL RELEVANCE

This study was conducted to determine the essential components in the delivery of vision rehabilitation services. The findings could be useful in the planning of vision rehabilitation services by optometrists or health managers.

BACKGROUND

Appropriate models of delivering vision rehabilitation services are a challenge for service providers worldwide. Studies have not revealed the key characteristics of a suitable model for delivering vision rehabilitation services. This study investigated the viewpoints of the key informants for identifying the most important components of a suitable model for delivering vision rehabilitation services.

METHODS

Semi-structured in-depth interviews were conducted with 19 participants including managers and service providers in Iran. All the interviews were recorded and transcribed verbatim. An inductive framework analysis approach was used to analyse the data. Qualitative analysis was done using the MAXQDA 10 software.

RESULTS

Four main themes emerged from the data, including creating maximum access (three subcategories: screening for visual impairment, creating a stepped-model for service delivery, and public and professional awareness of vision rehabilitation services), early intervention (two sub-categories: timely identification of people at the onset of disability and starting off with counselling services), need for financial support (two subcategories: providing affordable visual aid equipment and insurance coverage), and informed and skilled personnel (two subcategories: training vision rehabilitation specialists and familiarity of the rehabilitation staff with the rehabilitation program).

CONCLUSION

This study identified the key features of an appropriate model for providing vision rehabilitation services to blind and visually impaired people from the viewpoints of key informants who were experienced in providing vision rehabilitation services. The findings have valuable implications for policy-making and planning for vision rehabilitation services by the health system.

A Proposed Model for Integrated Low-Vision Rehabilitation Services in Canada

PURPOSE

The provision and funding of low-vision rehabilitation (LVR) are very variable across Canada. Quebec is well served by 14 government-funded rehabilitation centers. In most provinces, there are no such multidisciplinary services-optometrists offer LVR from their offices to a greater or lesser degree or undertake assessments in centers run by CNIB (formerly Canadian National Institute for the Blind). No integrated model for LVR exists across Canada. This document proposes such a model, which focuses on the profession of optometry, but may also be applicable to ophthalmology.

METHODS

This article describes different models of LV provision, the evidence for their relative effectiveness, the current situation in Canada, including the variability between areas and the need to increase referrals to LVR, and the current international consensus for LV provision. With the projected increase in people with LV, a generally accepted LV model for Canada is required to improve patient care.

RESULTS

It has become recognized in the global community that a tiered system may be required to provide for patients who range in their visual rehabilitation needs and geographic locations. The proposed LVR model includes three levels: 1. Screening/recognition of a potential patient with LV followed by appropriate triage. All optometrists should be involved at this level. 2. Management of the patient with minimum visual impairment/disability. This level of LVR can take place in a local optometry office with a minimal of extra equipment or devices. Level 3: Comprehensive LVR for patients with more vision loss and greater disabilities. Level 3 requires collaboration with other professionals, and three mechanisms are proposed by this which may take place.

CONCLUSIONS

The proposed model is expected to be useful for future education, policy decisions, and collaboration in Canada, and it may also be of interest for the development of LV services in other countries.

Disparities in awareness and use of low-vision rehabilitation

OBJECTIVE

To describe the demographic, visual, health, and psychological variables associated with awareness and use of low-vision rehabilitation services in Montreal, Que.

STUDY DESIGN

Hospital-based cross-sectional study.

PARTICIPANTS

Four hundred forty-eight patients with best-corrected visual acuity worse than 20/70 in their better eye recruited from 4 ophthalmology departments.

METHODS

Patients answered questions about their awareness and use of low-vision services. Visual acuity was recorded and patients answered the Brief Cope and Center for Epidemiologic Studies - Depression Scale questionnaires and provided information on demographics and health status. Multiple logistic regression was used to identify independent predictors of awareness and use of low-vision rehabilitation services.

RESULTS

A majority of patients in the sample (71%) were aware of low-vision rehabilitation. Of those who were aware, 81% reported participating in low-vision rehabilitation. Black patients, those whose first language was French, those with less severe visual acuity loss, and those who reported less acceptance on the Brief Cope questionnaire were less likely to know about low-vision services (p < 0.05). Of those who knew about low-vision services, those with less severe visual acuity loss were less likely to have participated in low-vision services (p < 0.05).

CONCLUSIONS

It is important that all those who qualify for low-vision rehabilitation services can access them. Although the patients in this Montreal area study showed a high rate of awareness and use of low-vision rehabilitation, awareness and use could be improved in certain demographic populations and in those with less severe vision loss.