1 2017 TAER Conference O&M for Older Adults with Vision LossNora Griffin-Shirley, PhD, Texas Tech University, Anita Page, COMS, Texas Tech University,
2 Participants will identify:O&M challenges older adults with vision loss face. Instructional strategies to use when teaching O&M skills to older adults with vision loss.
3 Agenda Simulation Activity Dialogue Presentation
4 Group Activity Pair with a partner & listen to instructionsGo to all stations & complete activities Note concerns you had completing the activities & what you did to successfully accomplish the task or cope What concerns did you have when completing the activities? What did you do to successfully accomplish the task or cope with it?
5 Group Activity - Discussion
6 Demographics By 2030, the baby boomer population will increase by 7% from 13% in (Brandon, ). Number of persons who are visually impaired over 55 years – million (U.S. Census Bureau, 2016)
7 Challenges
8 Challenges Financial – longer hospital stays, increase in doctor’s visits, poverty Falls - Your 85 year old consumers are times more likely to fall than your 65 year olds (CDC report, 2010) Non-driving concerns Changes in physical status
9 Challenges Older adult’s attitude toward blindness (Brennan, Horowitz & Reinhardt, 2004) Strong sense of spirituality (Brennan & Bally, 2007) Impact of deafblindness
10 Changes in Living OptionsOlder adult’s house Independent living Assisted living Nursing care Continuing care retirement communities (CCRC) Home care (Types of senior housing and senior care, 2014)
11 Living Options Adult day care Alzheimer's or memory careLow income affordable care Respite care - short term stay
12 Changes in Support SystemsCaregivers can experience grief, depression & fatigue. Spouses’ emotional well-being can be compromised (Brennan & Bally, 2007). Families tend to be overprotective of a family member with vision loss, thus facilitating more dependence. Caregivers report a fairly high level of self-esteem although they may feel a mild burden when caring for a loved one with vision loss. (Silva-Smith, Theune, & Spaid, 2007)
13 Psychological Effects of Vision Loss on Older AdultsLess likely to socialize with friends & participate in community activities Reduced informal supports such as family members and friends Decline in mental health (e.g., depression, frustration, helplessness, loss of confidence, insecurity, reduced self-esteem) (Griffin-Shirley & Bozeman, 2016)
14 Psychological EffectsFear of blindness Negative stereotypes of persons with visual impairment Strain on caregivers Compromised communication for those having both vision & hearing loss (Griffin-Shirley & Bozeman, 2016)
15 Falls & Prevention 2.8 million older adults annually are treated for fall injuries in emergency rooms (CDC report, 2016).
16 Falls Look at side effects of drugs – some anti-depressants cause balance issues Encourage exercise Conduct home safety and modification programs (Couturier, 2010)
17 Assessment of Risk for FallsRange of motion Balance Reflexes Neuropathy Health conditions that cause a potential fall – dizziness, weakness
18 Importance of Physical FitnessTo improve overall health To increase older adults’ balance, endurance, strength, & flexibility To reduce falls To support mobility (Bozeman & Zhang, 2016)
19 O&M specialists need to promote exercise of older adults with vision loss to help them maintain or regain strength, thus reducing falls.
20 Home/environmental Safety EvaluationDocument falls & alert doctor of results of fall screening/PT referral? Does senior have: Balances issues? Difficulty standing from chair? Does he/she shuffle? (Riddening, 2011) Are steps symmetrical or equal in length? Stand with his/her heels close together? Does student clear the floor when walking with feet? Are arms of favorite chair worn?
21 Fall Prevention Teach eccentric viewing/scanningDiscourage use of: unsafe footwear, bare feet, throw rugs Use non-skid strips, grab bars Use high contrast material to mark raised thresholds; apron pockets, rolling carts, backpacks, bags with long straps, bath & tub seats, walker baskets
22 If Fall Occurs Check for dizziness & injuriesIf uninjured, have senior roll on all fours Crawl to heavy piece of furniture Pull up and sit Reassess injury & call for assistance
23 Exercise Increase physical activity on a daily basisGet seniors involved in a regular exercise program such as walking or Tai Chi after their physicians have given permission to start an exercise program. (Griffin-Shirley & Welsh, 2010)
24 Exercise - 2 Discuss with personal trainers and exercise program instructors how they can modify their teaching to include verbal cueing and assisted movement, if needed, for students to be successful. Have individuals try new recreational activities with a friend and discover what modifications may need to be made with the actual recreational skills and the environment.
25 Exercise - 3 Have older adults initiate social interactions with friends and others to feel comfortable about exercising together. Have older adults experiment with their low vision devices during recreation activities to understand what works best and how to care for these aids.
26 Exercise - 4 Access transportation and routes to a fitness facility. Advocate for familiarization to this facility and access to educational materials distributed by the facility. Have older adults journal their thoughts and feelings when starting an exercise program to document the effects it has on their lives and the resulting impact on their orientation and mobility.
27 Assessment for Older Adults with Vision LossTake the whole person into account Two parts: background assessment & functional assessment Determine the older person’s goals for the development, implementation, & evaluation of an efficacious O&M program (Bozeman & Bozeman, 2016)
28 O&M Instructional Strategies - 1Use an andragogical approach Schedule lessons at the most appropriate time of day to maximize the older adult’s learning based on her functional abilities Plan the duration of a lesson to accommodate for an older adult’s health condition and stamina
29 O&M Instructional Strategies - 2Choose the locations and content of lessons that are going to contribute to meeting the most immediate O&M goals of older adult Adjust the delivery of a lesson’s content to facilitate an older adult’s comprehension
30 O&M Instructional Strategies - 3Share with the older adult observations of her performance and her evaluation reports. Discuss O&M goals with the older adult and her family members as well as their feelings about independent travel and how it fits into their lifestyles. (Griffin-Shirley & Welsh, 2010)
31 O&M Instructional Strategies - 4Modifications “may be used to address balance problems, physical weakness, hearing or cognitive issues” (Page & Bozeman, 2016, p. 46). When making modifications stress performance and safety. When using guide techniques, more communication may needed than with younger people with vision loss. Guide technique modifications. (Page & Bozeman, 2016, pp. 50, 51)
32 O&M Instructional Strategies - 5Provide initial objectives that are meaningful but readily attainable & lead to successful experiences relevant to attainment of the older adult’s orientation and mobility goal. Create teaching materials that enhance the older adult’s comprehension of lesson content, involve a multi-sensory approach, and tap into the older adult’s preferred intelligences.
33 O&M Instructional Strategies - 6Make sure the older adult does not think you are overprotecting him, due to his age. This perception of overprotectiveness could interfere with the older adult’s desire to become an independent traveler (Cimarolli, Reinhardt & Horowitz, 2006). Choose highly motivating routes to teach older adults (Griffin-Shirley & Welsh, 2010)
34 O&M Instructional Strategies - 7Choose the most appropriate environmental modifications for the older adult’s home to maximize safety and travel efficiency. Use memory techniques and devices if the older adult has memory problems. Respond promptly to an older adult who is crying or extremely emotional during lessons. When appropriate, include caregivers in your lessons, teaching them ways to support the older adult’s independence and safety.
35 O&M Instructional Strategies - 8Recognize that older adults may use a variety of mobility tools (e.g. reverse walker) and orientation aids (Crawford, 2016). Become well versed in the use and maintenance of tools and aids and how to train the older adults to use them. Use a team approach – transdisciplinary vs. interdisciplinary.
36 O&M Instructional Strategies - 9Break a complex route into small, logically contained sections that are taught successively. The routes can also be stored mentally; written in Braille; recorded on audiotape, MP3 player or iPhone. Teach older adults how to solicit aid and to know when they need to travel with a guide.
37 References Bozeman, L., & Bozeman, K. (2016). Sensory changes with age: Assessment strategies for older adults with visual impairment. In N. Griffin-Shirley & L. Bozeman (Eds.), O&M for independent living: Strategies for teaching orientation and mobility to older adults. (pp ). NY: AFB Press. Bozeman, L., & Zhang, H. (2016). Importance of exercise for orientation and mobility for older adults with visual impairments. In N. Griffin-Shirley & L. Bozeman (Eds.), O&M for independent living: Strategies for teaching orientation and mobility to older adults. (pp ). NY: AFB Press. Brandon, E. (2014, June 16). The youngest turned 50. U.S. News and World Report. youngest-baby-boomers-turn-50 Brennan, M. & Bally, S.J. (2007). Psychosocial adaptations to dual sensory loss in middle and late adulthood. Trends in Amplification, 11, Brennan, M., Horowitz, A., & Reinhardt, J. P. (2004). Understanding older Americans’ attitudes, knowledge, and fears about vision loss and aging. Journal of Social Work in Disability and Rehabilitation, 3 (3),
38 References Centers for Disease Control and Prevention. The State of Aging and Health in America Atlanta, GA: Centers for Disease Control and Prevention, US Department of Health and Human Services; 2013. Centers for Disease Control and Prevention, National Center for Injury Prevention and Control. Web–based Injury Statistics Query and Reporting System (WISQARS) [online]. Accessed August 5, 2016. Cimarolli, V.R., Reinhardt, J.P. & Horowitz, A. (2006). Perceived overprotection: Support gone bad? The Journals of Gerontology Series B: Psychological Sciences and Social Sciences, 61, Couturier, J.A. (2010). Falling: Prevalence, risk factors, and interventions. In W.R. Weiner, & R.L. Welsh, Blasch, B.B., (Eds.) Foundations of Orientation and Mobility (3rd edition, Appendix 10A). New York: AFB Press. Crawford, J, S. (2016). Orientation and mobility tolls and techniques. In N. Griffin-Shirley & L. Bozeman (Eds.), O&M for independent living: Strategies for teaching orientation and mobility to older adults. (pp ). NY: AFB Press.
39 References Griffin-Shirley, N. & Bozeman, L. (2016). Vision loss and older adults: Considerations for the orientation and mobility professional. In N. Griffin-Shirley & L. Bozeman (Eds.),. O&M for independent living: Strategies for teaching orientation and mobility to older adults. (pp.1-21). NY: AFB Press. Griffin-Shirley, N., & Welsh, R. L. (2010). Teaching orientation and mobility to older adults. In W.R. Weiner, R.L. Welsh, & Blasch, B.B., (Eds.) Foundations of Orientation and Mobility (3rd edition) (pp ). New York: AFB Press. Page, A. & Bozeman, L. (2016). Modifying orientation and mobility techniques for older adults with visual impairments. . In N. Griffin-Shirley & L. Bozeman (Eds.), O&M for independent living: Strategies for teaching orientation and mobility to older adults. (pp ). NY: AFB Press. Silva-Smith, A.L., Theune, T.W., & Spaid, P.E. (2007). Primary support persons for individuals who are visually impaired: Who they are and the support they provide. Journal of Visual Impairment & Blindness, 101, Types of senior housing and senior care. SeniorHousingNet.com. (2014). Retrieved from types/index.aspx?source=web
40 References Page, A. & Bozeman, L. (2016). Modifying orientation and mobility techniques for older adults with visual impairments. . In N. Griffin-Shirley & L. Bozeman (Eds.), O&M for independent living: Strategies for teaching orientation and mobility to older adults. (pp ). NY: AFB Press. Silva-Smith, A.L., Theune, T.W., & Spaid, P.E. (2007). Primary support persons for individuals who are visually impaired: Who they are and the support they provide. Journal of Visual Impairment & Blindness, 101, Types of senior housing and senior care. SeniorHousingNet.com. (2014). Retrieved from types/index.aspx?source=web U.S. Census Bureau. (2016). American Community Survey, PUMS Data, Year Averages. Data Tabulated by National Strategic Planning & Analysis Research Center, Mississippi State University.