Acquisition and Integration of Low Vision Assistive Devices: Understanding the Decision-Making Process of Older Adults With Low Vision

Abstract

The purpose of this study was to describe how older adults with low vision make decisions to use low vision assistive devices (LVADs). Analysis of participants' narratives, from both group and individual interviews, revealed three topic areas affecting device use. Two are discussed in this paper: Experiences and Characteristics Leading to Successful LVAD Use Decision Making and Challenges to Successful LVAD Use Decision Making. The third, Adjustment to Low Vision Disability, is briefly discussed. Of particular importance to occupational therapy practitioners in the growing field of low vision rehabilitation was the value placed on low vision rehabilitation services to assist with acquiring devices and integrating them into daily routines. Occupational therapy services were highly regarded. Participants demonstrated the importance of becoming a part of a supportive network of people with low vision to gain access to information about resources. They emphasized the need for systems and policy changes to reduce barriers to making informed decisions about LVAD use. Results indicate that occupational therapists working in low vision can support clients by facilitating development of a support network, acting as liaisons between clients and other health practitioners, especially ophthalmologists, and encouraging policy development that supports barrier-free LVAD acquisition and use. These topics should be incorporated into continuing and entry-level education to prepare practitioners for leadership in the field of low vision rehabilitation.

Factors That Influence the Occupational Engagement of Older Adults with Low Vision: A Scoping Review

“…Owsley et al (2001) aimed to identify those IADLs whose completion time was associated with visual function in a sample (n = 342) of older adults aged 56-86 years. After controlling for age, education, depression and general health, results indicated West et al (1997) 2520 Quantitative; population study Age Wahl et al (1999) 84 Quantitative; experimental with control group Physical environment Brennan et al (2001) 593 Qualitative; narrative data examined from three Fear, emotional response to vision loss previous quantitative studies Moore (2000) 8 Qualitative; phenomenology; interviews Fear, emotional response to vision loss, refusing/ delaying rehabilitation services Moore and Miller (2003) 8 Qualitative; phenomenology; interviews Fear, emotional response to vision loss, refusing/ delaying rehabilitation services Stevens-Ratchford and Krause (2004) 2 Qualitative; interviews Physical environment Wong et al (2004) 15 Qualitative; grounded theory; interviews Degree of vision loss, social environment Copolillo and Teitelman (2005) 15 Qualitative; applied ethnography; interviews Refusing/delaying rehabilitation services Teitelman and Copolillo (2005) 15 that poorer scores on visual acuity, contrast sensitivity and useful field of view were associated with longer visual IADL completion time, such as reading ingredients on a food can. In addition, Wong et al (2004) carried out a qualitative grounded theory study that aimed to describe the impact of age-related macular degeneration among 15 older adults (60-85 years).…”

An examination of the pairing between narrative and occupational science

“…Within occupational science narrative data can range from addressing the lifespan of one individual (30,40) to brief incidents recounted by many individuals (67,68). For instance, life stories refer to information that can either cover an entire lifetime or pertain to specific aspects or periods within a lifetime (69)(70)(71)(72).…”

“…Unfortunately, there has not been a consistent application of this terminology in occupational science. The terms analysis of narrative (84,85), thematic analysis (68,74), and "paradigmatic-type narrative analysis to produce categories" (80) have all been used by diverse researchers to describe similar analytic structures.…”

Characterization of the Living Environments of End-Stage Glaucoma Patients and Use of Low-Vision Care Services: A Physician Survey Study

“…A study by Copolillo et al examined the factors that impact the decision to use low vision assistive devices and low-vision care services among older adults with low vision. 18 Eight of 15 participants in the study described situations in which physicians did not discuss low-vision care services or assistive devices, even when no other medical treatments were available. Both of these studies show a potentially low referral rate of patients with end-stage glaucoma or low vision to low-vision care services.…”

“…The severity of end-stage glaucoma is associated with increased levels of medical resource consumption 16 and the importance of low-vision care services in increasing quality of life and functional status has been established. 8,9,17−19 Since few studies have evaluated the factors that influence physician and patient use of these services, 18 the objective of this study was to characterize the living environments of end-stage glaucoma patients as described by ophthalmologists and identify key factors that may influence practicing ophthalmologists' referral patterns for low-vision care services.…”