Supervised by Dr. Lauren
Scharff
Stephen F. Austin State University
This entire paper contains several sections: Introduction, Changes in Vision and Their Effects, Impact of Low Vision, Available Services, Obstacles to Services, the Need for Additional Services and an Interdisciplinary Approach, and References.
Although a wide variety of services are available to meet the needs of the low-vision elderly, many senior citizens are not receiving the assistance they need to maintain satisfying and independent lifestyles. There are a number of obstacles that prevent the elderly from receiving these services.
One of the most obvious obstacles preventing the elderly from seeking assistance is the financial cost. Many senior citizens receive a fixed income, which must be used to cover all financial costs of living. A fixed income may not allow for additional expenses to be added to the senior citizen's budget, especially with the added cost of lost wages and increased medical care due to age-related vision loss (Padula, 1982, p. 320; Wagner, 2000). Additionally, the financial cost of many of these services, such as custodial care providers, low vision aides and training, and rehabilitation services, is very expensive and typically not covered under Medicare or insurance benefits (E. Davidson, personal communication, July 1, 2002). Medicare and insurance companies make the problem worse by disallowing referrals to rehabilitation specialists, leaving the patient to pay for services out-of-pocket (Oberlink, 1997).
Utilizing specialized professionals as opposed to general service providers can be a difficult decision for the elderly because only some agencies are publicly funded. Restructuring of government-funded service providers has resulted in agencies that provide services for a wide variety of disabilities rather than for specific disabilities (E. Davidson, personal communication, July 1, 2002; American, 2000b). These legislative changes in the roles of publicly funded agencies can have a huge impact on the quality of services provided (Scott & Rogers, 1992). Service providers at these agencies may be trained in the basics of the most common disabilities but do not receive the specific low-vision education needed to effectively assist the low-vision elderly. The choice for senior citizens then becomes a cost-benefit analysis. Which is more desirable: inadequately trained "specialists" available at a lower cost through publicly funded agencies, or highly trained rehabilitation specialists who cost significantly more financially through private agencies?
Another obstacle in receiving services is simply the lack of services in some areas of the country. Rural and semi-rural areas often have very little available to assist low-vision senior citizens. Even transportation services, typically available from local government agencies, are often lacking in these areas. This is a larger problem than it first appears because of the number of senior citizens who retire to quiet but semi-rural areas. While the peaceful environment is enjoyable in the earlier years of old age, the lack of services in the later years can be very problematic and relocating can be physically taxing as well as financially expensive.
Lack of knowledge about available services is also an obstacle that senior citizens must overcome to receive the most effective assistance. Many services go unadvertised and consequently go underutilized. The elderly and their caregivers should seek out the types of services available in their areas. Several sources of information are available, from search engines on the Internet to local organizations who publish catalogues of information and services for the area. If these resources are unavailable, general physicians, optometrists, and ophthalmologists should be able to refer the elderly and their caregivers to several service providers.
Senior citizens and their caregivers also have a lack of knowledge concerning what vision changes are normal. In many cases, the elderly do not know what types of vision changes are the result of normal aging and what types of vision changes are the result of ocular disease (Silverstone, 1993). For example, an older individual may think that losing vision in the periphery (the sides) of their field of vision is part of normal aging, when it may actually be a symptom of glaucoma. In other cases, the elderly expect visual loss with age and do no know that modifications and assistance can help maintain independent lifestyles (Abdulrazzak, 1997). An elderly individual may notice that reading fine print has become much more difficult to read, but may not realize that bifocals or closed-circuit televisions can help. These are also the elderly who often ignore suggestions to seek regular examinations from optometrists and ophthalmologists.
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