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Assessing dementia and sight loss

This article discusses the effects of age on sight, the impact of dementia on visual functioning, assessing dementia and sight loss, diagnosing dementia and sight loss, and recognizing sight loss in people with dementia. It also introduces the PAL checklist for activity planning and the concept of person-centered care in managing dementia and sight loss.

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Assessing dementia and sight loss

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  1. Assessing dementia and sight loss • Penny Redwood • Redwood Training

  2. Effects of age on sight • percentage of light entering the eye reduces • speed and efficiency are compromised • visual acuity reduced • depth perception may also be reduced • decreased contrast sensitivity

  3. macular degeneration (AMD)

  4. glaucoma

  5. cataract

  6. stroke

  7. diabetic retinopathy

  8. Visual functioning • depends on the integration of many elements to enable us to acquire, assimilate and utilise knowledge and information about our environment • dementia has been described as a visuoperceptual and cognitive illness (Jones et al 2006) • people with dementia experience significant numbers of ‘visual mistakes’

  9. Assessing dementia & sight loss • Full functional assessment that identifies remaining abilities as well as difficulties • Mistaken or incomplete assessment possible if sensory impairments not recognised • Diagnosis of dementia tends to rely on visual testing • Person may have difficulty describing problems

  10. Diagnosing dementia and sight loss • Rules out other conditions • Provides an understanding of the reasons for confusion & difficulties • Enables appropriate treatment and care planning • Provides relevant information in order to make choices and plan

  11. Recognising sight loss in people with dementia • difficulties with: • identifying objects or familiar faces • needing more light for reading and other activities; holding material very close to eyes • coping with glare • watching TV - sitting close or given up watching altogether

  12. Recognising eating & drinking problems • does the person: • spill food/drink or knock over cups? • lack interest in food? • seem to ‘play’ with their food on a plate? • use fingers to search for food? • eat food from only one side of the plate? • seem confused about what is on their plate?

  13. The PAL checklist Jackie Pool Associates defined the ‘Pool Activity Level’ (PAL) instrument to measure activity. See: http://www.jackie-pool-associates.co.uk/index.php?option=com_content&view=article&id=126:activity-planning&catid=38:dementia-courses&Itemid=144

  14. Using PAL: • Eats independently & appropriately using the correct cutlery P • Eats using a spoon &/or needs food to be cut up into small pieces E • Only uses fingers to eat food S • Relies on others to be fed R

  15. Person Centred Care: the Kitwood equation • Tom Kitwood described the mutual contribution of biomedical and social/psychological on the development of dementia as a ‘dialectical process’ and expressed it as an equation: • D= NI +PH + B + MSP • D = Dementia • NI = Neurological impairment • PH = Physical health • B = Biography • MSP = Malignant social psychology

  16. Extending Kitwood’s equation: experience of sight loss S = C + H + B + P + SP + E S = experience of visual impairment (sight loss) C = sight condition H = health and physical fitness B = biography P = personality SP = social psychology E = environmental factors Penny Redwood 2009

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