Effectiveness of Occupational Therapy Interventions for Older Adults Living With Low Vision

Sue Berger, PhD, OTR/L, BCG, FAOTA, is Clinical Associate Professor, Department of Occupational Therapy, Boston University College of Health and Rehabilitation Sciences: Sargent College, 635 Commonwealth Avenue, Boston, MA 02215; sueb@bu.edu An 85-yr-old woman with macular degeneration struggles to read the daily newspaper, an important part of her morning routine. A 78-yr-old man with glaucoma recently gave up attending his weekly bowling league. These two older adults, along with millions of other older adults, are trying to adapt to a life with vision loss. Recent data have shown that 1 in 6 Americans older than age 70 are living with low vision (Dillon, Gu, Hoffman, & Ko, 2010), and that number is expected to double by 2030 (Congdon et al., 2004). According to an American Occupational Therapy Association (AOTA; 2010) workforce study, more than 35% of occupational therapy practitioners work in acute care hospitals, long-term care environments, and home health, settings that meet the needs of clients ages 65 or older. All occupational therapy practitioners working with older adults, not just those who choose to specialize in low vision rehabilitation, must understand the influence of visual impairment on participation. Impairments at the body structure and body function level often cause a decrease in occupational performance. Similar to weakness or paralysis, a decrease in vision can significantly influence one’s ability to engage in desired occupations. Just as occupational therapy practitioners provide various interventions to facilitate participation for people experiencing occupational loss after a stroke, they also support people unable to engage in occupations because of vision loss by focusing on person factors (e.g., teaching strategies to use remaining vision), adapting the environment (e.g., improving lighting),oraltering the occupation (e.g., using talking books). Some of the specific interventions occupational therapy practitioners use to improve occupational performance may be unique to clients with vision loss (e.g., optical devices), just as the interventions used to improve occupational performance may be unique to those living with stroke (e.g., constraintinduced movement therapy) or any other impairment. Whether intervening with people with a mental health condition, loss of a limb, injury to the back, or decreased vision, the central goal of occupational therapy is to promote health and participation through engagement in occupations (AOTA, 2008). Before the 1990s, the primary professionals working to address the challenges associated with visual impairment were optometrists and vision rehabilitation professionals, including certified vision rehabilitation therapists, certified orientation and mobility specialists, and certified low vision therapists. Traditional services were delivered using an educational model with reimbursement provided through federal monies, state funds, and private charities (Mogk & Goodrich, 2004; Orr & Rogers, 2001; Stelmack, 2005; Warren, 2011). A series of policy changes has made it possible for occupational therapy practitioners to provide rehabilitation services to older adults with low vision. In 1991, the SueBerger,PhD,OTR/L,BCG,FAOTA