Rethinking the experiences and entitlements of people with dementia: Taking vision into account

Bartlett, Ruth and McKeefry, Declan (2011) Rethinking the experiences and entitlements of people with dementia: Taking vision into account. Journal of Care Services Management, 5 (2), 105-114. (doi:10.1179/175016811X12966389037637).

Abstract

A large proportion of people with dementia will have some kind of problem with their vision. Such problems may be the result of disturbances to low-level visual functions such as contrast sensitivity, colour vision, or visual acuity, for example. In addition, dementia can have detrimental effects on higher cognitive aspects of visual function such as visual attention, spatial localization, object recognition, facial recognition, and visual memory. The underlying cause of these visual problems is likely to be a result of a combination of a number of different factors (it is recognized that medication can also affect vision, but this will not be discussed here): (1) the direct patho-physiological effects of dementia on the brain and visual system, (2) the losses in visual function that occur as part and parcel of the normal ageing process, and (3) the losses in visual function that are a consequence of ocular diseases, such as age-related macular degeneration, glaucoma, or cataracts, which are more common in older people.

In this article, the likely prevalence of visual problems among people with dementia is highlighted and the ways in which dementia, ageing, and common eye conditions affect a person's vision are briefly described. The main aim of this article is to increase knowledge of visual issues and, in particular, eye health, and to argue that people with dementia are entitled to have their visual experiences and sight problems fully recognized and eye sight routinely tested.

A second aim of this article is to report on the findings of a small-scale scoping study commissioned by Thomas Pocklington Trust - a charity for people with sight loss. Drawing on work completed for this study, the article explores the extent to which existing models of dementia care, such as Kitwood's enriched model, and best practice guidelines take account of the visual experiences and problems that people with dementia have. Some of the shortcomings of these models are identified and the general lack of awareness in the best practice literature is highlighted. Reporting on this study provides further context for arguing that vision must be taken into account when working with people with dementia. Finally, the article concludes with some recommendations for practice development, including a call for the development of an online practice development network.

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Contributors

Author: Ruth Bartlett

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