Assessing dementia and sight loss

Penny RedwoodRedwood Training

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

macular degeneration (AMD)

glaucoma

cataract

stroke

diabetic retinopathy

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’

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

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

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

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?

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

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

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

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 factorsPenny Redwood 2009