Impact of Vision Impairment on Intensity of Occupational Therapy Utilization and Outcomes in Subacute Rehabilitation

Abstract

OBJECTIVE. To examine whether vision impairment is a predictor of intensity of occupational therapy utilization and outcomes in a sample of older adults ages ≥55 receiving subacute rehabilitation in a long-term care setting. METHOD. Data for this cohort study were collected by means of structured, in-person interviews with 100 older adult rehabilitation patients at admission to a subacute unit in a long-term care facility and by medical chart review after discharge. RESULTS. Regression analyses indicated that after controlling for sociodemographic, health, and social support variables, worse contrast sensitivity was a significant predictor of decreased time in occupational therapy, and worse visual acuity was a significant predictor of higher functional dependency at discharge. CONCLUSION. Vision impairment may prevent full use of occupational therapy and hinder occupational therapy efficacy in subacute care settings. Study findings underscore the importance of developing low vision rehabilitation interventions that can be delivered in conjunction with more traditional subacute rehabilitation.

Identifying community-dwelling older adults’ vision loss during mobility assessments: A scoping review

“…One challenge, however, is that older adults generally reported a lower incidence of vision problems in questionnaires or screening questions than was found when the vision loss was identified by testing. Older adults reported vision loss at a rate of 14% in the study by Simonsick et al (1999) and 21% in the Demura et al (2014) study, whereas testing of this age group showed significantly decreased visual skills in approximately 25% (Tiedemann et al, 2005;Roche et al, 2014) to 32% of similar populations (Cimarolli et al, 2012). The Perlmutter et al (2010) study noted that only 15% of their subjects self-reported limited vision; however, 40% of the same subjects tested as having significant vision loss.…”

“…Other questionnaires were designed to screen for any loss in visual skills, including those associated with age-related eye conditions. The Vision Screening Questionnaire for Older People (Horowitz, Teresi, & Cassels, 1991) was used for self-report of vision loss prior to screening of vision skills in the study by Cimarolli et al (2012). The Visual Impairment Screening Questionnaire was translated and adapted from the Vision Screening Questionnaire by Horowitz et al (1991) and was used by home health care providers to recognize suspected vision loss as part of an initiative to identify individuals at risk of falls (McGraw, Dery, & Wittich, 2011).…”

“…They suggested lower-contrast visual acuity test charts were more sensitive in detecting functionally relevant changes, as the everyday environment has varying levels of contrast. Lighting in the community environment was a significant factor in administering the vision-screening tests and was measured in degree of luminance or otherwise reported in each study (see Alexander et al, 2014aAlexander et al, , 2014bCimarolli et al, 2012;Laitinen et al, 2007;Perlmutter et al, 2010;Roche et al, 2010). The context for vision testing and for mobilityaid trials can be complicated or compromised by poor lighting.…”

“…The major age-related eye conditions are macular degeneration (also known as age-related macular degeneration, or ARMD), glaucoma, cataract, and diabetic retinopathy. The onset is usually gradual; chronic deterioration occurs, yet total blindness is rare (Cimarolli, Morse, Horowitz, & Reinhardt, 2012). The rate of comorbidity of vision and mobility challenges is demonstrated in numerous population-based studies, such as the Rotterdam study, in which 76.8% of 1,856 women over 85 years of age had motor impairments, 24.5% of whom also had visual impairments (Odding, Valkenburg, Stam, & Hofman, 2001).…”

Assessment of the Visual Status of Older Adults on an Orthopedic Unit

“…The presence of vision impairment in an older adult client receiving rehabilitation may affect the outcome of the occupational therapy intervention. Cimarolli, Morse, Horowitz, and Reinhardt (2012) reported that vision impairment negatively affected the use of occupational therapy services and predicted higher functional dependence at discharge in older adults in a subacute rehabilitation setting. Similarly, vision impairment was shown to reduce the effectiveness of rehabilitation after a hip fracture (Lieberman, Friger, & Lieberman, 2004).…”