Addressing sight loss in dementia

Aug 24, 2020

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Addressing sight loss in dementia

Addressing sight loss in dementia

Posted in : Dementia Care on by : Pooja Jain

Accessing professional Support 

When you start to notice that the person with dementia is having problems with their vision, it is important to first rule out other conditions. As mentioned in the previous blog, Causes of sight loss in Dementia, there are various eye conditions and health problems that can impact vision. Since most of them are treatable, the first step is to book an appointment for an eye test with an opthamologist as well as time with your physician. 

Generally, it is a good practice to have yearly eye appointments and regular health checkups even if they don’t experience any problems with their vision.

Optometrist

An eye test will check eye health, helping to identify any eye conditions. If the person with dementia can’t get to the optometrist, there may be a local optometrist that can provide an eye examination at your home. The NHS provides free eye tests, even at home, for those over the age of 60. It is possible to qualify for financial support with the cost of glasses. For more information you call the Royal National Institute of Blind People (RNIB) helpline on 0303 123 9999. 

Our ability to understand our environment is driven significantly by our sight. Therefore, identifying eye conditions and intervening early enough can help prevent sight loss and save both of you the challenges that come with it. You can help optometrists with early diagnosis of these conditions, by letting them know that the person has dementia, their list of medication, if they wear glasses, or have any family history of eye problems. 

Tip:

If the person with dementia needs or already uses glasses, it is worth having a conversation with the optometrist about it. Have them suggest an appropriate pair of glasses and check in with the person with dementia if it fits well and is comfortable. Wearing glasses that are wrong for them can cause confusion and they could trip or fall. Understanding the cleaning regime for the glasses is also important. If the person needs more than one pair of glasses for different purposes, then getting different coloured frames can help i.e. red frame glasses for reading and the green frame for walking in the park. 

General Physician

A normal health checkup with your doctor can help understand if there is anything else going on that’s impacting their vision, such as medication side effects, nutritional deficits or the onset of other comorbidities. 

If the person you are caring for has some level of permanent sight loss, the following two services can provide support.

Low vision services 

Your ophthalmologist or doctor can refer to these services. Specialist optometrists assess  vision and provide supporting advice and techniques. This could range from providing a magnifier to advice on lighting and reading techniques. These services are typically located in hospitals but if needed, they can also be provided at home. 

Vision rehabilitation services 

Local service providers or voluntary organisations can refer you to these services to help with poor sight. Visual rehabilitation workers or occupational therapists provide assistance with adaptive equipment like using a symbol or mobility cane, environmental modifications to staying safe and supporting with being confident when going out. 

Communication techniques

Non-verbal communication, which includes your facial expressions and body language, can play a significant role when speaking to someone. However, as the person you are caring for struggles to see, they are likely to miss the non-verbal cues. You’ll also need to slightly change how and what you say. To improve communication, you can:

  • Address the person using their name so they know you are talking to them 
  • Ask guests to introduce themselves when approaching them, and where appropriate using touch to let the person know they are there
  • Let the person know when you are done speaking with them and are leaving their presence or the room 
  • If you are supporting the person with dementia with a task, say what you are going to do before you do it and as you go through each step of the task 
  • Ask if there is a place in the house where you can be better seen and heard  
  • Use words and phrases in context that is familiar to them ie. Instead of saying ‘your clothes are over there’, you can say ‘your clothes are on your bed on your left where you normally keep them while getting read’. 
  • Make written information more accessible by using bigger and clearer fonts, supplement written information with images, having the messages written on a notice board, and/or having an audio version accessible. 

Environmental modifications

Making things in the environment bigger, brighter and bolder can help with sight loss: 

  • Visibility – Use objects such as clocks and telephones with large numbers. It can help them identify and use those objects much easier. 
  • Lighting – Improve the lighting in a room. It increases the contrast and clarity, making it easier for the person with dementia to carry out tasks. Check out RNIB’s article, Lighting, which provides hints and tips on how to improve lighting in your home effectively. 
  • Contrast & Colour – Use contrasting colours between objects and their background i.e. walls and doors, furniture and walls, tablecloth and crockery, and door and it’s signage. It makes it less likely to misidentify objects in their environment.  
  • Declutter – Keep the spaces physically and visually clear. Cluttered rooms can be safety issues as it increases the likelihood of falls and other injuries. 
  • Reduce glare – Be mindful of lamps and blinds that could create a glare as it can cause confusion. 
  • Sensory stimulation – Use other senses like sound, smell, and touch to help the person with orientation or wayfinding ie. cooking with aromatic spices or brewing coffee in the kitchen, playing music in the living room, guiding them with a simple touch on their arm.  
  • Familiarity – Keep furniture and other objects in familiar places. Make sure the furniture has a good grip without any sharp edges. 

Try to avoid things like highly patterned wallpaper, carpets and furnishings, as well as reflective surfaces to minimise confusion. 

Assistive products 

There are products, beyond glasses, that can support people with dementia and sight loss with daily tasks: 

  • Technology and equipment, such as automatic lights or audio labels
  • Easy to see telephones like Doro PhotoEasy, which has three large memory buttons that can hold a label or a photo
  • A liquid level indicator on the side of a cup/mug beeps when the liquid is almost near the brim 
  • Radio controlled talking watch reads out the time simply with the press of a button 
  • Signature guide is a durable plastic device to help the person write their signature on legal documents, forms and letters
  • Bumpons are self-adhesive tactile rubber shapes that highlight settings on cookers, microwaves, thermostats and remote controls.

Sources

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