Sheila Roche, Laura Vogtle, Mary Warren, Kieran A. O’Connor; Assessment of the Visual Status of Older Adults on an Orthopedic Unit. Am J Occup Ther 2014;68(4):465-471. doi: 10.5014/ajot.2014.010231.
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PURPOSE. To examine the visual status of a cohort of older adults on an orthopedic unit to determine their level of available vision to complete everyday activities in the hospital setting.
METHOD. A convenience sample of 50 people was recruited. A visual history was obtained, and participants’ glasses were inspected. Distance acuity, reading acuity, and contrast sensitivity were assessed using standardized screening charts.
RESULTS. Of participants, 26% did not have their glasses with them until prompted, and 85% had glasses in poor condition. When tested wearing their habitual correction, 6% had low vision, 2% were blind, 41% had reading acuities worse than 20/25, and 28% had contrast sensitivity deficits.
CONCLUSION. Visual impairment is prevalent in older adults, yet visual function is not routinely screened in hospitals. Occupational therapists should routinely inquire about patients’ visual status, inspect their glasses, and encourage regular eye examinations. Failure to address vision could lead to inaccurate evaluation results.
Vision loss is a common comorbidity in older adults. Occupational therapy practitioners should have an understanding of normal age-related changes in vision and age-related eye disease, strategies to enhance the use of vision, and the procedure to obtain an optometry or ophthalmology consult.
Many clients leave their glasses at home when admitted to the hospital. It is imperative that clients wear their glasses when undergoing assessments. An absence of glasses should be noted and taken into account when interpreting the outcome of assessments that contain low contrast and small details.
The condition of clients’ glasses should be inspected regularly, and they should be cleaned appropriately to ensure optimal use of the glasses.
Occupational therapy practitioners should consider the available lighting for the client and supplement with task lighting, as needed, to ensure optimal lighting in both clinical settings and home environments.
Screening visual acuity and contrast sensitivity and inspecting clients’ glasses should be included in the occupational therapy evaluation of older adults. It is important to complete these assessments before administering cognitive or neuropsychological tests with visual details, and it should also be considered when assessing clients who have a history of falls. If screening assessments suggest vision impairment, the occupational therapist should refer the client to an eye care professional for diagnosis and treatment.
Acuity charts must be properly illuminated to obtain accurate results.
When visual deficits are noted, the occupational therapist should liaise directly with the members of the rehabilitation team, advising them of the implications of such deficits on assessments, interventions, ambulation, and ADLs.
Occupational therapy practitioners can play an important role as educators, informing other health care professionals of the issues relating to vision loss and encouraging clients to schedule regular eye examinations.
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