Normal Age-Related Vision Loss
and Related Services for the Elderly

by Donia E. Nolan

Supervised by Dr. LaurenScharff
Stephen F. Austin State University

This entire paper contains several sections: Introduction,Changes in Vision and TheirEffects, Impact of LowVision, Available Services,Obstacles to Services, theNeed for Additional Services and anInterdisciplinary Approach, and References.

Obstacles to Receiving Services

Although a wide variety of services are available to meet theneeds of the low-vision elderly, many senior citizens are notreceiving the assistance they need to maintain satisfying andindependent lifestyles. There are a number of obstacles that preventthe elderly from receiving these services.

One of the most obvious obstacles preventing the elderly fromseeking assistance is the financial cost. Many senior citizensreceive a fixed income, which must be used to cover all financialcosts of living. A fixed income may not allow for additional expensesto be added to the senior citizen's budget, especially with the addedcost of lost wages and increased medical care due to age-relatedvision loss (Padula, 1982, p. 320; Wagner, 2000). Additionally, thefinancial cost of many of these services, such as custodial careproviders, low vision aides and training, and rehabilitationservices, is very expensive and typically not covered under Medicareor insurance benefits (E. Davidson, personal communication, July 1,2002). Medicare and insurance companies make the problem worse bydisallowing referrals to rehabilitation specialists, leaving thepatient to pay for services out-of-pocket (Oberlink, 1997).

Utilizing specialized professionals as opposed to generalservice providers can be a difficult decision for the elderlybecause only some agencies are publicly funded. Restructuring ofgovernment-funded service providers has resulted in agencies thatprovide services for a wide variety of disabilities rather than forspecific disabilities (E. Davidson, personal communication, July 1,2002; American, 2000b). These legislative changes in the roles ofpublicly funded agencies can have a huge impact on the quality ofservices provided (Scott & Rogers, 1992). Service providers atthese agencies may be trained in the basics of the most commondisabilities but do not receive the specific low-vision educationneeded to effectively assist the low-vision elderly. The choice forsenior citizens then becomes a cost-benefit analysis. Which is moredesirable: inadequately trained "specialists" available at a lowercost through publicly funded agencies, or highly trainedrehabilitation specialists who cost significantly more financiallythrough private agencies?

Another obstacle in receiving services is simply the lack ofservices in some areas of the country. Rural and semi-rural areasoften have very little available to assist low-vision seniorcitizens. Even transportation services, typically available fromlocal government agencies, are often lacking in these areas. This isa larger problem than it first appears because of the number ofsenior citizens who retire to quiet but semi-rural areas. While thepeaceful environment is enjoyable in the earlier years of old age,the lack of services in the later years can be very problematic andrelocating can be physically taxing as well as financiallyexpensive.

Lack of knowledge about available services is also anobstacle that senior citizens must overcome to receive the mosteffective assistance. Many services go unadvertised and consequentlygo underutilized. The elderly and their caregivers should seek outthe types of services available in their areas. Several sources ofinformation are available, from search engines on the Internet tolocal organizations who publish catalogues of information andservices for the area. If these resources are unavailable, generalphysicians, optometrists, and ophthalmologists should be able torefer the elderly and their caregivers to several serviceproviders.

Senior citizens and their caregivers also have a lack ofknowledge concerning what vision changes are normal. In manycases, the elderly do not know what types of vision changes are theresult of normal aging and what types of vision changes are theresult of ocular disease (Silverstone, 1993). For example, an olderindividual may think that losing vision in the periphery (the sides)of their field of vision is part of normal aging, when it mayactually be a symptom of glaucoma. In other cases, the elderly expectvisual loss with age and do no know that modifications and assistancecan help maintain independent lifestyles (Abdulrazzak, 1997). Anelderly individual may notice that reading fine print has become muchmore difficult to read, but may not realize that bifocals orclosed-circuit televisions can help. These are also the elderly whooften ignore suggestions to seek regular examinations fromoptometrists and ophthalmologists.

Go to the next Section: The Need forAdditional Services and an Interdisciplinary Approach

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