Assessing Older Adults' Functional Visual Performance Using the Performance Quality Rating Scale.

Visual impairment has distinct impacts on the activities of older adults. Quantifying the functional impact of visual loss would facilitate targeted rehabilitation. The objectives of this study were to: (1) develop an observational assessment of the functional visual performance of older adults using the Performance Quality Rating Scale (PQRS); (2) test the feasibility and inter-rater agreement in a pilot sample of older adults with visual impairment. A convenience sample of older adults with vision loss (N = 20) performed seven pre-selected activities. Performance was videoed (N = 126 videos) and rated by two raters using specific operational definitions. All participants completed the seven activities with the given resources and 90% of videos were successfully rated using the developed PQRS. Inter-rater agreement was substantial (weighted Kappa = 0.71; 95% confidence interval [CI] = [0.64, 0.79]) for all activities. The developed PQRS for functional vision is feasible, with substantial inter-rater agreement, to assess functional vision of older adults in an outpatient setting.

Assessing older adults' use of vision using the Performance Quality Rating Scale.Visual impairment has different impacts on the everyday activities of older adults. Assessing the specific impact would help therapists to provide rehabilitation targeting their daily challenges. The objectives of this study were (1) to develop an assessment of how older adults use their vision using the Performance Quality Rating Scale (PQRS); (2) to test the possibility of using, and the agreement of using this tool between two raters in a pilot sample. Twenty older adults with vision loss performed seven activities in an outpatient clinic. In total, 126 videos of their performances were rated by two raters using the PQRS. 90% of the videos were successfully rated using the developed PQRS with good agreement between the raters. The developed PQRS can possibly be used to assess how older adults use their vision for daily activities in an outpatient setting.

The impact of low vision on activities, participation, and goals among older adults: a scoping review.

PURPOSE: Participation is a key outcome of rehabilitation. However, no reviews have investigated the impact of low vision on the activities, participation, and goals of older adults. This paper aims to review and synthesize available literature on how low vision impacts the activity and participation of older adults. METHOD: A scoping review was conducted. The key findings were extracted from 30 full-text articles that met the selection criteria. The International Classification of Functioning, Disability and Health was used to frame the findings at the activity and participation levels. RESULTS: At the activity level, the categories of Walking, Moving around in different locations, and Reading were commonly impacted by low vision. The main domains impacted at the participation level were Community, social and civic life and Interpersonal interaction and relationships. Only one study addressed the goals of older adults with low vision. CONCLUSION: Low vision impacts reading, walking, and moving around in different locations. Rehabilitation therapists should be aware of and consider assessing these activities. Further research is needed on the impact of low vision on other functional activities, participation, and self-identified goals of older adults to guide clinical practice.Implications for rehabilitationLow vision has an impact on the activity level of older adults, consistently identified in the areas of walking and moving around in different locations and reading for knowledge and leisure.At the participation level, the impact of low vision is less frequently identified compared to the areas identified at the activity level, in the areas of leisure, social interactions and basic and instrumental ADL.Rehabilitation therapists working with older adults with low vision should assess clients' performance of moving around in different locations, in addition to walking, and include screening questions on the impact of low vision on driving.Rehabilitation therapists working with older adults with low vision should determine clients' reading needs and acquire competence in assessing clients' reading ability and providing intervention for different types of reading to enable them to continue participating in various life situations that require the performance of reading.

Classifying Types of Visual Loss Linked With Function to Inform Referral to Vision Rehabilitation for Older Adults in Singapore.

Objective: Visual impairment restricts performance in activities of daily living. The aim of this study was to classify types of visual loss associated with function in older adults based on clinical data and World Health Organization (WHO) acuity and visual field criteria. Methods: Seven hundred retrospective medical records of older adults seen at the outpatient ophthalmology clinics of a Singapore hospital were reviewed. Extracted data was mapped to the WHO low vision criteria. A flow chart was developed to classify the main types of visual loss aligned with function. Results: The flow chart developed describes four major types of visual loss: (1) full visual field with decreased visual acuity, (2) any visual field loss with greater than ten degrees of available field, (3) peripheral field loss with less than 10° of available field, and (4) any visual field loss due to a cortical event. Within each major type, sub-categories were identified reflecting the complexity of the visual impact of the eye conditions. Conclusion: The flow chart can be applied to outpatient records to identify older adults with different types of visual loss to inform targeted rehabilitation linked with function.

Butterflies and black lacy patterns: the prevalence and characteristics of Charles Bonnet hallucinations in an Australian population.

BACKGROUND: Charles Bonnet Syndrome (CBS) is characterized by vivid, elaborate and recurrent visual hallucinations in psychologically normal people. It most often occurs in older, visually impaired persons. The prevalence of the syndrome has been reported at 1-40% in Asia, Europe and North America. The aim of this study was to examine the prevalence and characteristics of CBS in the older aged, visually impaired population in Australia. METHODS: Two hundred consecutive patients attending ophthalmology clinics aged more than 60 years with best-corrected visual acuity of 6/12 or less were screened for CBS. Those who reported experiencing visual hallucinations were asked to participate in the project. They were then interviewed and asked demographic, general health and visual hallucination-related questions. A group of 30 non-hallucinating participants was chosen for comparison of demographic data. RESULTS: The prevalence was found to be 17.5%. Participants experiencing hallucinations were predominantly female with a mean age of 77.7 years. Correlations were found between the living situation, level of education and characteristics of the hallucinations such as the duration, length of time the participant had been experiencing them and their frequency. CONCLUSION: The prevalence of CBS in the older-aged, low-vision population is 17.5%. Several demographic and syndrome-specific characteristics were found to be consistent enabling a profile of a CBS sufferer in this group of participants to be compiled.

Therapeutic Argentine Tango Dancing for People with Mild Parkinson's Disease: A Feasibility Study.

BACKGROUND: Individuals living with Parkinson's disease (PD) can experience a range of movement disorders that affect mobility and balance and increase the risk of falls. Low health-related quality of life, depression, and anxiety are more common in people with PD than age-matched comparisons. Therapeutic dance is a form of physical activity believed to facilitate movement and therapy uptake. As well as being enjoyable, dancing is thought to improve mobility, balance, and well-being in some people living with PD. The primary objective of this study was to evaluate the feasibility and safety of a 4-week Argentine tango dance program for people with PD. METHODS: Six community dwelling individuals with mild to moderate PD were recruited from Parkinson's support groups, movement disorder clinics, and the PD association in Australia. To minimize falls risk, participants were required to be <75 years of age and physically independent (Hoehn and Yahr stages I-III). They were also required to speak English. Participants attended a 1-hour dance class at a dance studio twice per week for 4 weeks. A professional dance instructor led and choreographed the Argentine tango dance classes. Physiotherapists were present to assist participants during the class and served as dance partners as necessary. The primary outcome was feasibility, which was determined by measures of recruitment, adherence, attrition, safety (falls, near misses and adverse events), and resource requirements. Secondary measures included the Beck Depression Inventory and the Euroqol-5D, administered at baseline and post intervention. Therapy outcomes pre- and post-intervention were analyzed descriptively as medians and interquartile ranges and using Wilcoxon matched pair signed-rank tests. RESULTS: The Argentine tango dance intervention was shown to be safe, with no adverse events. Adherence to the dance program was 89%. Depression scores improved after intervention (p = 0.04). Some challenges were associated with the need to quickly recruit participants and physiotherapists to act as dance partners during classes and to monitor participants. CONCLUSION: The 4-week, twice weekly Argentine tango dancing program was shown to be feasible and safe for people with mild-to-moderately severe PD.

Latency and accuracy of saccades to somatosensory targets.

PURPOSE: To examine the accuracy and latency of reflexive saccades to vibratory stimulation of the fingertips made by normal human subjects and to compare the findings to those of visually guided saccades. METHODS: Eye movements were recorded using infrared oculography. Stimuli were presented via an array of audiometric bone vibrator transducers driven at 250 Hz and positioned at eye level in a darkened room. Target locations were at 0 and +/-5, 10, and 15 deg. Visual stimuli were green LEDs. Saccades were analysed interactively off-line and latency and amplitude measured for both types of saccade. RESULTS: Saccades to tactile stimuli had longer latencies and showed less accurate final eye positions than those to equivalent visual targets; they were unaffected by subject age. Error magnitude for the tactile saccades increased monotonically with increasing target eccentricity; because the fingers remained in a fixed position throughout the testing, this also meant that error was lowest for the thumb and increased with progression outwards towards the ring finger. Visually guided refixations were accurate and differed less than 0.2 deg across target locations. Subject age had no effect on performance. CONCLUSIONS: Human subjects may make relatively accurate refixations to tactile targets in the absence of visual cues, but only to certain locations/fingers; others were localised very poorly. Further studies are needed to determine whether finger selection or target location is the primary determinant of accuracy in this task.