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“Out of sight, out of mind”: a qualitative study of visual impairment and dementia from three perspectives

Published online by Cambridge University Press:  06 March 2009

Vanessa Lawrence ,
Joanna Murray ,
Dominic ffytche  and
Sube Banerjee
Vanessa Lawrence
Affiliation:
Section of Mental Health and Ageing, Institute of Psychiatry, King's College London, U.K.
Joanna Murray
Affiliation:
Section of Mental Health and Ageing, Institute of Psychiatry, King's College London, U.K.
Dominic ffytche
Affiliation:
Section of Old Age Psychiatry and Centre for Neuroimaging Sciences, Institute of Psychiatry, King's College London, U.K.
Sube Banerjee*
Affiliation:
Section of Mental Health and Ageing, Institute of Psychiatry, King's College London, U.K.
*
Correspondence should be addressed to: Sube Banerjee, Professor of Mental Health and Ageing, PO26 Section of Mental Health and Ageing, De Crespigney Park, Institute of Psychiatry, King's College London, SE5 8AF, U.K. Phone: + 44 207 8480012; Fax + 44 207 848 5056. Email: s.banerjee@iop.kcl.ac.uk.
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Abstract

Background: Dementia and visual impairment are among the most common medical conditions in later life. Almost nothing is known about the experiences and needs of older adults with both conditions.

Method: In this qualitative study using in-depth individual interviews, multiple perspectives were sought through a case-study approach. Fifty-two interviews were conducted: 17 with older adults with visual impairment and dementia, 17 with family caregivers, and 18 with care professionals.

Results: Impaired memory and a lack of visual cues created profound disorientation and distress, which could be manifested in disruptive behavior. Visual hallucinations compounded older adults' disorientation, and caregivers were uncertain about how to manage them. Visual impairments reduced the ability of older adults to perform certain activities safely, while dementia impaired their ability to assess the risks accurately. Concerns about safety prompted family members to limit their relatives' activities even in early stages of dementia. Low-vision services perceived themselves to be ill equipped to manage dementia-related needs, while visual needs were accorded a low priority by dementia services. A lack of joint working by the two services led to an overcautious approach.

Conclusions: The research identified considerable unmet needs and opportunities to improve care. The provision of clear verbal communication and optimized visual inputs is likely to reduce disorientation, distress and agitated behavior, while one-to-one contact is needed to overcome feelings of isolation. Family caregivers require additional respite services and advice on managing hallucinations. Increased sharing of information and skills between mental health and low-vision professionals would help maximize older adults' independence.

Keywords

visual impairmentdementiaqualitative research
Type
Research Article
Information
International Psychogeriatrics , Volume 21 , Issue 3 , June 2009 , pp. 511 - 518
Copyright
Copyright © International Psychogeriatric Association 2009

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