Promoting and maintaining health of people with sight loss: A scoping study

This study was undertaken in response to a request by the Thomas Pocklington Trust to identify and explore the following issues: • The needs and concerns regarding immediate risks to health and safety related to sight loss; • Additional risks arising from sight loss for those who are also managing a long term disease; • The difficulties in maintaining and promoting health; • Whether or not health promotion activities and policies sufficiently address perceived needs. Findings pertaining to these objectives have been generated from data collected in Leeds, UK, a city where innovative programming for sight loss has either been planned or is being incorporated into health planning and a review of the literature. Findings related to the last two issues indicate that gaps exist in service provision for maintaining health and emphasise the need for more explicitly targeted health promotion initiatives that could address current weaknesses. - A review of the literature; - Focus group discussions with a range of people who had experienced sight loss; - Interviews with professional practitioners engaged in service provision to this population; - An expert hearing with four professional practitioners, one of whom had sight loss, and two service users with sight loss. Most participants were from the West Yorkshire region and the services described in the study are largely located in Leeds. Evidence from the literature review suggests that people with visual impairment have increased risk of accidents within the home and that ensuing consequences include injuries incurred and decreased confidence. Rates of depression among people who are blind or partially sighted are far higher than in the wider population and the likelihood of depression increases with age, although psycho-social interventions and technological assistance can be successfully implemented to improve quality of life. Sight loss together with other long term health conditions exacerbates the impact of other health conditions and has particularly severe impact on the wellbeing of older people insofar as it may affect their mobility, which in turn increases their risk of falls and depression. The nature and level of support available to people is variable but it is clear that access both to the right information at the right time and to appropriate services is a critical issue. Focus group discussions, interviews and the expert hearing corroborated and extended the themes noted in the literature and discuss the differential impact of different risks to health and the difficulties of coping with these at different times in a person’s life. A simple typology was defined using two dimensions of experience (‘stage of life’ and ‘early/late onset of sight loss’) as a means of organizing findings and providing a means of making further distinctions in interpreting the data. Potentially, this scheme can allow health promotion initiatives to be targeted more effectively to stages at which people with sight loss are more likely to encounter specific difficulties in managing and maintaining their health. There was a clear consensus throughout the study that interventions to meet the needs of people with sight loss must be tailored to meet the specific needs of individuals: people with sight loss are not a homogeneous group and the way in which each person experiences the challenges of sight loss and of managing their health will inevitably vary from person to person. Recommendations generated by this study include: • The scope for more pro-active services and need for closer collaboration between service providers; • The need for provision and promotion of targeted information; • The need for greater awareness of the needs of people with visual impairments among generic service providers; and • Further research that explores the usefulness of the typology with a larger sample more representative of population demographics such as BME communities that are more likely to slip through the cracks of service provision

Challenges in Developing Applications for Aging Populations

Elderly individuals can greatly benefit from the use of computer applications, which can assist in monitoring health conditions, staying in contact with friends and family, and even learning new things. However, developing accessible applications for an elderly user can be a daunting task for developers. Since the advent of the personal computer, the benefits and challenges of developing applications for older adults have been a hot topic of discussion. In this chapter, the authors discuss the various challenges developers who wish to create applications for the elderly computer user face, including age-related impairments, generational differences in computer use, and the hardware constraints mobile devices pose for application developers. Although these challenges are concerning, each can be overcome after being properly identified

Psychological principles of successful aging technologies: A mini-review

Based on resource-oriented conceptions of successful life-span development, we propose three principles for evaluating assistive technology: (a) net resource release; (b) person specificity, and (c) proximal versus distal frames of evaluation. We discuss how these general principles can aid the design and evaluation of assistive technology in adulthood and old age, and propose two technological strategies, one targeting sensorimotor and the other cognitive functioning. The sensorimotor strategy aims at releasing cognitive resources such as attention and working memory by reducing the cognitive demands of sensory or sensorimotor aspects of performance. The cognitive strategy attempts to provide adaptive and individualized cuing structures orienting the individual in time and space by providing prompts that connect properties of the environment to the individual's action goals. We argue that intelligent assistive technology continuously adjusts the balance between `environmental support' and `self-initiated processing' in person-specific and aging-sensitive ways, leading to enhanced allocation of cognitive resources. Furthermore, intelligent assistive technology may foster the generation of formerly latent cognitive resources by activating developmental reserves (plasticity). We conclude that `lifespan technology', if co-constructed by behavioral scientists, engineers, and aging individuals, offers great promise for improving both the transition from middle adulthood to old age and the degree of autonomy in old age in present and future generations. Copyright (C) 2008 S. Karger AG, Basel

Surveying Persons with Disabilities: A Source Guide (Version 1)

As a collaborator with the Cornell Rehabilitation Research and Training Center on Disability Demographics and Statistics, Mathematica Policy Research, Inc. has been working on a project that identifies the strengths and limitations in existing disability data collection in both content and data collection methodology. The intended outcomes of this project include expanding and synthesizing knowledge of best practices and the extent existing data use those practices, informing the development of data enhancement options, and contributing to a more informed use of existing data. In an effort to provide the public with an up-to-date and easily accessible source of research on the methodological issues associated with surveying persons with disabilities, MPR has prepared a Source Guide of material related to this topic. The Source Guide contains 150 abstracts, summaries, and references, followed by a Subject Index, which cross references the sources from the Reference List under various subjects. The Source Guide is viewed as a “living document,” and will be periodically updated

A framework for accessible m-government implementation

The great popularity and rapid diffusion of mobile technologies at worldwide level has also been recognised by the public sector, leading to the creation of m-government. A major challenge for m-government is accessibility – the provision of an equal service to all citizens irrespective of their psychical, mental or technical capabilities. This paper sketches the profiles of six citizen groups: Visually Impaired, Hearing Impaired, Motor Impaired, Speech Impaired, Cognitive Impaired and Elderly. M-government examples that target the aforementioned groups are discussed and a framework for accessible m-government implementation with reference to the W3C Mobile Web Best Practices is proposed

European Union policy on older adult learning : a critical commentary

This critical commentary discusses the strengths and lacunae in the European Union’s policy on older adult learning. Late-life learning is deemed as a productive investment on the basis that it not only engenders positive returns of economic growth but also improves the quality of life and social development of older persons. This article argues that although European Union policy on lifelong learning does hold some promise toward more optimum levels of physical, psychological, and social well-being in later life, it remains characterized by a range of limitations ranging from mindless activism, to economic bias, to ageism.peer-reviewe

A Profile of Canadians Over the Age of 65 Years Living with Coexisting Vision and Mobility Impairments: A Sequential Mixed Method Analysis

The purpose of this dissertation was (i) to investigate the prevalence of older Canadian adults living with coexisting vision and mobility impairments, and (ii) to describe how disability associated with both impairments relate to health status, activities of daily living, physical activity participation, assistive technology use, and health care services. These goals were achieved by using mixed methodology approach. The first manuscript was based on secondary analyses of the 2006/2007 National Population Health Survey (NPHS). The results of the secondary analysis of the NPHS revealed that approximately 3% of the Canadian population over the age of 65 was living with coexisting vision and mobility impairments. Also, older adults with both conditions required more assistance with activities of daily living and they reported the lowest levels of physical activity participation compared to those living with one or no impairment. The second part of the core component was based on secondary analyses of the 2006 Participation and Activity Limitations Survey (PALS). The PALS was specifically designed for individuals who reported they were living with a disability. As a result, a greater proportion of respondents indicated the presence of both target conditions – approximately 15% of older Canadians who reported having a disability were living with coexisting vision and mobility impairments. The analysis of the PALS data revealed that older adults with both impairments required more assistance with activities of daily living and they reported a higher use of assistive technology; however, there was a higher level of unmet needs for vision related assistive technology. The final manuscript consisted of in-depth interviews conducted to add the personal perspective of older adults with both impairments, and to expand and clarify the quantitative findings. The analyses of the transcripts revealed four main themes among participants: (i) the meaning behind vision, mobility, and coexisting impairments; (ii) adaptation of desired activities; (iii) external support for engaging in activity; and (iv) internal support for engaging in activity. The results of this dissertation contribute knowledge about living with coexisting vision and mobility impairments and offer a starting point to guide rehabilitation services for clients with multiple impairments

Report on current and future older adult services for people with sight loss in Ireland: National Council for the Blind of Ireland

Research was conducted after issues needing research in the Republic of Ireland (Ireland) for Older Adults who developed sight loss were identified by the National Council for the Blind of Ireland. The research was conducted using grounded methodology in three phases. The first phase found NCBI’s Current Services for older adults relate to five elements of what is referred to as inclusive capital. According to the 2016 Irish Census, physical impairments and a large number of cognitive impairments increase in old age, and the likelihood of becoming disabled rises exponentially after the age of 80. The second phase found larger jurisdictions and jurisdictions with older associations have multiple overlapping agencies, leading to confusion in service provision. Services for all jurisdictions are related to what are felt to be traditional demographics, however most jurisdictions surveyed had specialist services based on unique political or cultural backgrounds. The third phase studied academic literature on services for older adults, and found literature fell into categories mostly reflecting the five elements of inclusive capital. The study concludes there is a need to consider physical and mental health, multiple impairments, Significantly Older Adults’ social needs and end-of-life care

How a Diverse Research Ecosystem Has Generated New Rehabilitation Technologies: Review of NIDILRR’s Rehabilitation Engineering Research Centers

Over 50 million United States citizens (1 in 6 people in the US) have a developmental, acquired, or degenerative disability. The average US citizen can expect to live 20% of his or her life with a disability. Rehabilitation technologies play a major role in improving the quality of life for people with a disability, yet widespread and highly challenging needs remain. Within the US, a major effort aimed at the creation and evaluation of rehabilitation technology has been the Rehabilitation Engineering Research Centers (RERCs) sponsored by the National Institute on Disability, Independent Living, and Rehabilitation Research. As envisioned at their conception by a panel of the National Academy of Science in 1970, these centers were intended to take a “total approach to rehabilitation”, combining medicine, engineering, and related science, to improve the quality of life of individuals with a disability. Here, we review the scope, achievements, and ongoing projects of an unbiased sample of 19 currently active or recently terminated RERCs. Specifically, for each center, we briefly explain the needs it targets, summarize key historical advances, identify emerging innovations, and consider future directions. Our assessment from this review is that the RERC program indeed involves a multidisciplinary approach, with 36 professional fields involved, although 70% of research and development staff are in engineering fields, 23% in clinical fields, and only 7% in basic science fields; significantly, 11% of the professional staff have a disability related to their research. We observe that the RERC program has substantially diversified the scope of its work since the 1970’s, addressing more types of disabilities using more technologies, and, in particular, often now focusing on information technologies. RERC work also now often views users as integrated into an interdependent society through technologies that both people with and without disabilities co-use (such as the internet, wireless communication, and architecture). In addition, RERC research has evolved to view users as able at improving outcomes through learning, exercise, and plasticity (rather than being static), which can be optimally timed. We provide examples of rehabilitation technology innovation produced by the RERCs that illustrate this increasingly diversifying scope and evolving perspective. We conclude by discussing growth opportunities and possible future directions of the RERC program

Factors related to braille acquisition among adult and senior learners : establishing evidence-based practice

Les difficultés de lecture sont les raisons les plus fréquentes pour lesquelles des personnes sont orientées vers un service de réadaptation visuelle. Bien qu’il existe une base historique solide à propos de l’enseignement du braille chez les enfants aveugles, il existe très peu de données probantes concernant l’apprentissage du braille chez les personnes en âge de travailler et les personnes âgées. De surcroît, bien qu’il soit clair que le vieillissement est associé à un déclin des capacités tactiles, motrices et cognitives, on sait peu de choses sur la manière dont ces variables peuvent influencer les résultats de la lecture du braille. Pour examiner cette problématique, une étude en quatre phases a été conceptualisée. Dans la première phase, une étude de la portée a été menée afin de synthétiser les connaissances existantes concernant la relation entre le déclin des capacités lié au vieillissement et la performance de la lecture en braille. La seconde a voulu étudier les obstacles et les facilitateurs rencontrés par les adultes qui suivent une formation en braille. La troisième a exploré les variables qui sont en corrélation avec la performance de lecture en braille à l’âge adulte. Enfin, la dernière phase a voulu se pencher sur l’influence du support de lecture sur la performance de lecture des adultes ayant une sensibilité tactile réduite. Les preuves antérieures concernant le braille et le vieillissement restent rares. Il existe une variété de facteurs personnels, sociaux et institutionnels qui façonnent le processus d’apprentissage du braille chez les adultes, incluant la stigmatisation envers le braille et le vieillissement perçue par certains praticiens, des services inadéquats et des difficultés à l’accès aux équipements brailles. Des données soulignent la nécessité de commencer l’apprentissage du braille le plus tôt possible, d’évaluer des mesures objectives de l’acuité tactile tout en considérant le rôle de la fonction du toucher, de fournir une formation accrue en matière de perception tactile et d’envisager une plus grande intégration d’appareils braille. Les résultats font également ressortir la nécessité d’augmenter le financement et les services ; de définir des critères d’éligibilité qui tiennent compte des réalités uniques des clients âgés et l’accès au braille ; et d’étudier plus avant le rôle de la stigmatisation vis-à-vis du braille et du vieillissement. En somme, tous ces éléments réunis peuvent influencer à la fois les décisions cliniques et les résultats d’apprentissage.Reading difficulties are the most common reasons for referral to vision rehabilitation. Though there is a strong historical basis for the provision of braille instruction among blind children, there is little evidence-based research on the needs of working-age and older adults. Aging is associated with declines in tactile, motor and cognitive capacities. Moreover, learning in adulthood is distinct from childhood learning, owing to differences in cortical plasticity and development. Little is known about how these variables may influence braille reading outcomes, but such knowledge is needed to inform the design of evidence-based strategies. For example, low-cost braille devices incorporate dots of greater height and density, but the extent to which such approaches may enhance reading performance for older adults with reduced tactile sensitivity remains unexplored. These questions are especially imperative as the prevalence of age-related vision loss continues to increase. A four-phase study was devised to synthesize prior evidence on the interrelationship between factors known to decline with age and braille reading performance; to investigate the barriers and facilitators encountered by working-age and older adults who pursue braille training; to identify variables that correlate with braille reading performance in adulthood; and to explore the influence of reading medium on the reading performance of adults with reduced tactile sensitivity. This thesis confirms that prior evidence on braille and aging remains scant, heightening the imperative for further research in this domain. Moreover, there are a variety of personal, social and institutional factors which shape the adult braille learning process, including perceived stigma towards braille and aging among some practitioners, inadequate services and access to braille devices. Braille learning age, frequency of usage, and measures of active tactile acuity emerged as significant correlates of braille reading speed. Preliminary evidence suggests that using braille displays with greater dot height enhances performance for those with reduced tactile sensitivity, while also enabling immediate access to relevant reading content. Collectively, these findings point to the need for rehabilitation practitioners to introduce braille as early as possible, evaluate objective measures of tactile acuity while also considering the role of functional touch, provide increased training in tactile perception, and consider a wider integration of braille devices. Findings also highlight the need for increased funding and services, eligibility criteria which takes into account the unique realities of older braille clients, and the need to further explore the role of stigma towards braille and aging which may influence both clinical decisions and learning outcomes