A Study Exploring Occupational Therapists’ Current Knowledge and Awareness of Visual Impairment in Older Adults and Potential Interventions which Aim to

Improve their Quality of Life

Gail Fish

MSc Occupational Therapy (Pre-Registration)

Dissertation Presentation (2011)

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Background•2 million visually impaired people in UK (RNIB, 2009)

•Ageing population will increase demand for vision-related services

•Services currently provided by opticians, ophthalmologists, local authority visual impairment teams / rehabilitation officers

•Emerging field of occupational therapy practice in UK (Campion et al, 2010)

•Occupational therapists are in a prime position to work in this area (Rosenfeld, 2011; Warren, 2011)

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What is Visual Impairment?

•“a limitation in one or more functions of

the eye or visual system” (Access

Economics, 2009, p.2).

•Normal age-related structural changes

•Generally correctable using glasses

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What is Low Vision?•Uncorrectable sight loss caused by age-related eye diseases

•Up to 90% retain some useful residual sight – potential for vision rehabilitation (Lamoureux et al, 2007)

•An older person with low vision is therefore described as someone who,

“…has impairment of visual functioning even after treatment and/or standard refractive

correction…but who uses, or is potentially able to use, vision for the planning and/or execution of a

task” (World Health Organisation, 1996, p.4).

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Age-related Eye Diseases

Cataracts Age-related macular degenerationAdapted from: City and County of San Francisco: SFGOV. 2009, Common causes of low vision

[online]. City and County of San Francisco: SFGOV, San Francisco. Available at: http://sfarchive.org/sfgov/mainpages/www.sfgov.org/site/accessibility_indexd269.html?id=79571 [Accessed 6 June 2011]. 5

Age-related Eye Diseases

Glaucoma Diabetic RetinopathyAdapted from: City and County of San Francisco: SFGOV. 2009, Common causes of low vision [online]. City and County of San Francisco: SFGOV, San Francisco. Available at: http://sfarchive.org/sfgov/mainpages/www.sfgov.org/site/accessibility_indexd269.html?id=79571 [Accessed 6 June 2011]. 6

Previous ResearchCampion et al (2010) – Carried out survey with members of two COT Specialist Sections to investigate training needs of OTs in relation to sight loss- Also explored pre-registration education in this area, and best ways to deliver post-registration training

Copolillo et al (2007)- Conducted survey of OTs working in low vision rehabilitation in USA, to investigate their role

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Aim

To investigate occupational therapists’ current knowledge and awareness of visual impairment in older adults and potential interventions which aim to

improve their quality of life

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Methods•Brief literature search

•Contacted four COT Specialist Sections by email (Older People, Housing, Trauma & Orthopaedics, Rheumatology)

•Developed survey → piloted → published online

•1043 members invited to participate by email

•Survey available to participants for four weeks

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Demographic Results•Response rate = 25% (265 /

1043)

•92% (n = 242) worked with clients aged 65+

•52% (n = 135) had practised for >16 years

•21% (n = 54) had practised for 6-10 years

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1. Knowledge of Common Causes of Low Vision in Older

Adults

•Majority (80%) reported ‘fair’ or ‘good‘ knowledge

•< 10% = ‘very good’ knowledge of any eye condition

•< 1% = ‘excellent’ knowledge of any eye condition

•Poorest knowledge of diabetic retinopathy (23%)

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2. Awareness of Available Vision-Related Services

• 77% (n = 201) would refer client to VI team if visual impairment was identified Housing (87%) > Trauma & Orthopaedics (37%) (Χ2 = 33.85, df = 3, p = 0.00)

• 81% (n = 213) aware of LA VI services Housing (92%) > Trauma & Orthopaedics (56%) (Χ2 = 35.87, df = 6, p = 0.00)

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3. Awareness and Use of a Range of Relevant

Interventions•Participants most aware of and had most frequently used interventions within ‘traditional’ domain of occupational therapy

•96% (n = 251) aware of ‘use of optical devices in daily activities’, but only 58% (n = 153) had used this intervention in practice

INTERVENTION PREVIOUSLY USED WITH VISUALLY IMPAIRED OLDER ADULT

NUMBER OF RESPONSES

%

Basic ADL interventions 223 85.1

Indoor functional mobility 204 77.9

Environmental modifications 202 77.1

Instrumental ADL interventions 202 77.1

Use of nonoptical assistive devices / compensatory strategies

187 71.4

Use of optical devices in daily activities 153 58.4

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4. Occupational Therapy and Low Vision

•81% (n = 211) = practice would be enhanced by learning more about visual impairment1-5 years (91%) > 16+ years of practice (73%) (rs = 0.21, p = 0.001, n = 262)

•87% (n = 228) = OTs could have important future role in this area

•50% (n = 131) might want to work in this area in future

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* Awareness of conditions associated with VI: falls (84%), stroke (80%), fractures (63%), depression (63%), dementia (45%)

* 65% indicated awareness that anyone with a visual impairment

could access services provided by LA VI team, registered or not

* 69% unfamiliar with Light for Sight guidelines; 87% unaware of Progress in Sight best practice guidelines

Additional Findings

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Implications for Practice

Occupational therapists have skills to work in low vision, but knowledge should be developed:

•Broaden existing knowledge of eye diseases•Training on suitable low vision interventions•Visual impairment should be a core subject in undergraduate & postgraduate programmes•Need for post-registration education•Embrace opportunities! (Withers & Shann, 2008)

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Study Limitations• Relatively low response rate (25%), although comparable to

previous studies mentioned in slide 7

• Technical issue with one question may have lowered response rate

• Not generalisable – four specialist groups were chosen deliberately due to their interest in older adults

• Voluntary participation may have reduced the study’s representativeness

• The survey was created solely by the researcher, thus its validity and reliability are not proven

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Future Research?

Further high quality research to

evaluate and establish an

evidence-base for the effectiveness of

occupational therapy-led low vision interventions

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Thank You…I want to sincerely thank you all again for taking the time to participate in my study and for making it possible!

In due course, I hope to try to have it published in the BJOT with my supervisor, Dr Dawn Skelton.

If you would like to contact me with any comments or queries, my email address is gfish11@caledonian.ac.uk

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References•Access Economics. 2009, Future sight loss UK 1: the economic impact of partial sight and blindness in the UK adult population, [internet], London, RNIB. Available at: http://www.rnib.org.uk/aboutus/Research/reports/2009andearlier/FSUK_Report.pdf [Accessed 22 January 2011].

•Adams, O.F. 2007a, “Rehabilitation services.” in: Low vision manual, eds. A.J. Jackson & J.S. Wolffsohn, Butterworth Heinemann, Edinburgh, pp. 291-307.

•Campion, C., Awang, D. & Ward, G. 2010, “Broadening the vision: the education and training needs of occupational therapists working with people with sight loss”, British Journal of Occupational Therapy, Vol. 73, no. 9, pp. 413-421.

•City and County of San Francisco: SFGOV. 2009, Common causes of low vision [online]. City and County of San Francisco: SFGOV, San Francisco. Available at: http://sfarchive.org/sfgov/mainpages/www.sfgov.org/site/accessibility_indexd269.html?id=79571 [Accessed 6 June 2011].

•Copolillo, A., Warren, M. & Teitelman, J.L. 2007, “Results from a survey of occupational therapy practitioners in low vision rehabilitation”, Occupational Therapy in Health Care, Vol. 21, no. 4, pp. 19-37.

• Diabetes UK. 2011, Diabetes in the UK 2011-2012: key statistics on diabetes, [internet], London, Diabetes UK. Available at: http://www.diabetes.org.uk/Documents/Reports/Diabetes-in-the-UK-2011-12.pdf [Accessed 2nd March 2012].

•Evans, J.R. & Mathur, A. 2005, “The value of online surveys”, Internet Research, Vol. 15, no. 2, pp. 195-219.

•Lamoureux, E.L., Pallant, J.F., Pesudovs, K., Rees, G., Hassell, J.B. & Keeffe, J.E. 2007, “The effectiveness of low-vision rehabilitation on participation in daily living and quality of life”, Investigative Ophthalmology and Visual Science, Vol. 48, no. 4, pp. 1476-1482.

•Lord, S., Sherrington, C., Menz, H. & Close, J. 2007, Falls in Older People, 2nd edn, Cambridge University Press, Cambridge. 22

References (cont…)

•Macular Disease Society. 2011, Registering as severely sight impaired/blind or sight impaired/partially sighted [online]. The Macular Disease Society, Andover. Available at: http://www.maculardisease.org/page.asp?section=239&sectionTitle=Registration [Accessed 14 June 2011].

* Rosenfeld, S. 2011, “Vision and occupational therapy: terminology, tips, and trends”, OT Practice, Vol. 16, no. 15, pp. 7-11.

•Royal National Institute of Blind People. 2010a, The benefits of registering as blind or partially sighted, RNIB and Royal College of Ophthalmologists, London.

•Royal National Institute of Blind People. 2010b, Community care: support for people with sight problems, RNIB and Royal College of Ophthalmologists, London.

•Royal National Institute of Blind People. 2009, Sight problems, RNIB, London.

•Scheiman, M., Scheiman, M. & Whittaker, S.G. 2007, Low vision rehabilitation: a practical guide for occupational therapists, SLACK Incorporated, Thorofare.

•Schonlau, M., Fricker, R.D. & Elliott, M.N. 2002, Conducting research surveys via e-mail and the web, Rand, Santa Monica.

•Stuen, C. & Offner, R. 1999, “A key to aging in place: vision rehabilitation for older adults”, Physical & Occupational Therapy in Geriatrics, Vol. 16, no. 3/4, pp.59-77.

•Warren, M. 2011, “Extending occupational therapy boundaries to assist people with low vision”, British Journal of Occupational Therapy, Vol. 74, no. 1, pp. 1.

•Withers, C. & Shann, S. 2008, “Embracing opportunities: stepping out of the box”, British Journal of Occupational Therapy, Vol. 71, no. 3, pp. 122-124.

•World Health Organisation. 1996, Low vision care for the elderly, [internet], Geneva, World Health Organisation. Available at: http://www.who.int/ncd/vision2020_actionplan/documents/WHO_PBL_96.57.pdf [Acccessed 26 February 2011].

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