Monday, May 16, 2011

Impact of Low Vision on Health Care and Personal Care of Elderly

Health Care Aspects

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Low vision affects both the business aspect of health care and the medical aspect of health care for the elderly. While age-related cognitive declines will affect the ability of the elderly to understand the business issues concerning their health care, low vision can seriously impair the ability to understand as well. Medicare and insurance companies send out large amounts of information to the elderly, but most is in small font and is difficult for senior citizens to read without help. In many cases, large print material is available, but many elderly do not know this. Rather than seek assistance, it is common for the elderly to ignore the information sent to them, leaving them frustrated at not understanding their benefits.

Lowered acuity and difficulty reading also affect the business aspect of senior citizens' health care when the elderly are required to complete forms for Medicare, insurance companies, and doctor's offices. Difficulties in accurately reading forms may result in dangerously inaccurate information being given. This is especially true in the case of medical history forms, where doctors may base treatment plans on inaccurate information.

The medical aspect of health care is also impacted by age-related vision loss. Reduced acuity means that the elderly may have a difficult time or a total inability to read medicine labels or treatment directions from doctors. Without being able to read this information, the elderly may set their own dosage or ignore the drugs and treatment recommendations entirely. Senior citizens may also find it difficult to read the pharmacy information given to them with prescription drugs, meaning they may not understand side effects, warnings, or interactions with other substances.

Poor color discrimination makes pill organization a challenge. Many pills come in the same size, color, and shape. While all have markings that make them distinguishable from other pills, these markings are usually etched into the pill (meaning there is no color or luminance contrast) or printed in fine print. In either case, these markings do not serve to help the elderly in distinguishing one pill from another. Even when pills are slightly different colors, the poor color discrimination that comes with age prevents the elderly from being able to distinguish the pills. This can lead to extremely dangerous mismanagement of medications.

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Poor color discrimination may also impair senior citizens' ability to notice changes in their bodies. Changes in skin color may be harder for the elderly to detect than for younger people. This can result in bruises, rashes, changed moles, or small lesions that go unnoticed and untreated.

Low-vision also impedes good health care by limiting the driving activities of the elderly. Many senior citizens prefer to ignore recommendations to see medical professionals rather than drive to their appointment or seek alternate transportation.

Personal Self-Care Aspects

Self-care refers to daily living activities, such as, bathing, moving about within the home, eating, dressing, and grooming. Ideally, the elderly would be capable of performing these tasks independently, but these tasks are commonly impaired by normal, age-related vision loss. The self-care task with the highest physical risk involved may be bathing. This risk is compounded by physical impairments that prevent the elderly from functioning safely. Poor depth perception can prevent the elderly from accurately judging the depth of the bathtub. Poor contrast sensitivity can prevent the elderly from accurately judging the edges and the contours of the bathtub. Both of these impairments can cause serious injuries in senior citizens. Young and older people alike have experienced the injuries caused from misjudging the distance of a stair step. For the elderly, this is even more dangerous because the step into a bath tubs typically deeper than the average stair step and also because the bones of the elderly are more brittle and more susceptible to injury. Bathtub transfer benches, walk-in showers, and caregiver assistance can all reduce the risk of injury during bathing.

Mobility within the home is also a major part of self-care and also involves some physical risk. Studies have shown that the elderly are more confident and less likely to fall in the familiarity of the home than in unfamiliar environments, but too many senior citizens still experience falls at home. While these falls often result from physical ailments and disabilities, age-related vision loss can certainly increase the risk. Poor contrast sensitivity and poor color discrimination combine to limit the ability of the elderly to determine edges. Examples of edges that are important to detect are the edges of stair steps or edges between two surface types, like carpet and tile. Detecting edges is important when the elderly are moving about because the individual who can detect a change in the surface they are walking on, such as from carpet to slick tile, can be prepared for the change and continue moving safely.

Poor contrast sensitivity and poor color discrimination can also limit the ability to perceive obstacles in their path. Modifying the environment to meet low-vision senior citizens' needs can reduce these risks.

Senior citizens may also find planning and preparing meals becomes more challenging with older age. Because of age-related health problems, doctors often prescribe special diets that limit substances such as sodium, sugar, and cholesterol. Many elderly may also have food allergies for which they must plan. While the ingredients of food products are required to be printed in a standard format on all product labels, this information can be inaccessible to the elderly with poor acuity. Poor contrast sensitivity affects the ability to read this small print when the labels are printed in low-contrast colors. Glare can also impair senior citizens' ability to read food labels on products with plastic or shiny labels. Unfortunately, the marketing industry produces product labels designed with younger, healthier eyes in mind.

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After planning a healthy diet and shopping for the right products, the elderly must face the challenges of low vision while cooking. Acuity and poor contrast sensitivity may impact the ability of the elderly to do their own cooking. For example, stove and oven knobs are often printed in smaller print and sometimes in low contrast. The same is true for cooking instructions on product packaging. Poor color discrimination can make it difficult for the elderly to determine when their food is done. For example, the younger person's may be able to look through the oven glass to see that bread has turned a golden color; older individuals may not be able to discriminate the change between the colors of unbaked bread.

Although senior citizens may be physically capable of dressing independently, choosing clothes that are both attractive to the individual wearing them and socially acceptable can be a challenging. This is the result of poor color discrimination caused by changes in the variable lens. For clothing to appear attractive to the individual the colors should be bright enough and bold enough that the older person wearing them can distinguish the colors. To be socially acceptable, the different pieces of clothing should match. Elderly persons with poor color discrimination may need assistance when choosing clothing to wear outside the home.

Personal grooming, including hair and makeup, can be challenging to senior citizens also. The phrase "blue haired" is not as farfetched as some think. Senior citizens who color their hair may end up with strangely tinted hair, and do not notice it, especially if the hairdresser is also older or if they color their own hair at home. This is because of age-related impairments in color discrimination. The yellowing of the variable lens filters out much of the color information taken in, so the elderly eye sees the tintas gray.

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Cosmetics also challenge elderly women when grooming. As the eye ages, it requires more stimulation for a given response. This means that the older eye needs greater intensities of color for perception to occur. This need for increased intensities may mean elderly women will wear too much make-up, because they cannot perceive less make-up or more appropriate colors. Poor color discrimination adds to the problem, because elderly women may choose colors that do not match each other, resulting in an unusual look. Greater amounts of light would normally help in these tasks, but this type of activity in this type of environment make greater amounts of light more harmful than good. For the elderly, large amounts of light should be aimed at the task at hand, not at the eyes, but when the task involves the face, aiming light at the eyes may be difficult to avoid. Extra light aimed at the face will cause glare, which will only make the task harder. Mirrors and porcelain bathtubs and toilets make extra light problematic as well. Reflection of light from mirrors and shiny porcelain surfaces will add to temporarily blinding glare. While blue hair and unusual makeup will not put senior citizens in any physical danger, it can affect the way people interact with them. Poor interactions can only serve to further the social isolation that senior citizens already feel.

While cosmetics and blue hair involve mostly elderly women, elderly men face challenges in grooming as well. Elderly men may shave less frequently than expected because it may be difficult to see the stubble growing on the face, especially if facial hair is a light shade of gray or white on light skin or if facial hair is dark on dark skin. This is due to a number of age-related changes combined, including poor acuity, poor color discrimination, and poor contrast sensitivity.

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