Low Vision Rehabilitation in a Nursing Home Population: The SEEING Study

Visual impairment (that is, blindness or low vision) increases dramatically with age, such that an estimated 250,000 new cases are reported annually among persons aged 65 and older in the United States (Massof, 2002). Furthermore, in the United States, the prevalence of individuals with a visual acuity of worse than 20/40 is 2.76%, with increasing prevalence with age (Eye Diseases Prevalence Group, 2004). Individuals who are blind or have low vision encounter increased difficulty maintaining their independence in a variety of areas, including activities of daily living (ADLs) and mobility (Rubin, Roche, Prasada-Rao, & Fried, 1994; Watson, 2001). Although low vision is not correctable, rehabilitation services can improve functioning in those who have it. These services are not mandated by law, despite the great need. However, the increased prevalence of vision loss and the need for low vision rehabilitation prompted the U.S. National Institutes of Health (2000) to include low vision rehabilitation services as one of its goals for its program Healthy People 2010, which is a national health promotion and disease prevention initiative that challenges individuals, communities, and professionals to take specific steps to ensure increased quality and years of healthy life and eliminate health disparities among people in the United States. If a community does not have low vision specialists, access to low vision rehabilitation is difficult for that community's older persons who may have to travel great distances for treatment. As the population ages and the number of nursing home residents with low vision rises, the rehabilitation needs of this population will increase (Horowitz, 1994; Mitchell, Hayes, & Wang, 1997). Federally funded programs, such as the Aid to the Independent Elderly Blind, which is intended to maintain the independence of elderly people in their current living situations, specifically exclude nursing home facilities. Services that do exist for nursing home residents with low vision are limited. An example of such a service is the Talking Book program of the National Library Service for the Blind and Physically Handicapped, Library of Congress, which some nursing home facilities use. Services may not be based on an assessment of the residents’ level of function and the tasks for which vision is needed. The literature on the prevalence of low vision and the associated deficit of performance on ADLs by institutionalized adults describes the impact of low vision (De Winter, Hoyng, Froeling, Meulendijks, & Van der Wilt, 2004; Marx, Werner, Cohen-Mansfield, & Feldman, 1992). De Winter et al. compared the function of elderly nursing home residents who had low vision devices and those who did not have low vision devices, but the sample was too small to detect significant differences. Marx et al. surveyed 103 nursing home residents with good cognition and found that a significantly greater proportion of residents with low vision than of those with good vision were dependent on caregivers for performing ADLs. No age adjustment was done in this sample, and it was unclear whether the residents had received any rehabilitation as part of the study. In the context of a clinical trial of vision restoration and rehabilitation services for nursing home residents, we provided low vision services to residents in randomly selected nursing homes. The low vision specialist for this study, the first author, has a master's degree in rehabilitation of persons who are visually impaired and is a certified low vision therapist. The low vision intervention presented in this article was a component of a larger intervention, the Salisbury Eye Evaluation in Nursing Home Groups (SEEING) Study, that included ophthalmologic screening, examination, refraction, and cataract surgery when appropriate; this process was described in more detail in an earlier publication (West et al., 2003). This article describes the characteristics of residents in 28 nursing homes on the Eastern Shore of Maryland and Delaware who were found to have low vision, the proportion of these residents who agreed to low vision rehabilitation or other types of intervention, and the residents’ need for and goals of low vision rehabilitation.