Poor Vision in the Elderly can lead to physical and cognitive decline

Science Daily reports a study out of Germany published in the Journal of the American Geriatric Society demonstrating what we all already know.  When people (Especially older people) lose vision their ability to participate in meaningful mental and physical activity declines.  This of course effects the quality of life and their ability to care for their other medical issues.

The Problem

Why is it important to prevent visual loss and restore blindness in the elderly? After all, they may not have too many more years to benefit from expensive interventions. The study quoted in the attached link demonstrates that elderly individuals who develop significant visual loss (20%) also have significantly more physical and cognitive problems. It stands to reason. If you cannot take care of yourself – Drive to appointments, read instructions and prescriptions, etc it is going to be hard to do the necessary activities to provide adequate healthcare to themselves. Further, the simple act of doing these tasks are probably helpful in preserving physician and mental fitness.

Suggestion

We need to examine how extending additional care to the visually impaired will reduce other disparities in the health care so that these patients can lead more productive and meaningful lives. This would involve earlier diagnosis of diseases that lead to visual loss but have little early symptoms – such as glaucoma. We also need to find more accessible treatment options for those with treatable visual loss such as macular degeneration. Possibly bringing this service to the patient in terms of more accessible delivery. visual restoration with innovations and better use of existing technology to restore functional vision. Medicare will pay tens of thousands of dollars for surgical rehabilitation with such devices as a Intraocular Minature Telescopic Implant or a Retinal Prosthesis but will not pay a fraction of that for more conventional treatments and devices that have a greater chance of success.

 

Communities for the Visually Impaired Elderly

Communities for the visually impaired would allow the concentration and focus of needed resources resources including vision and health care facilities and transportation. In addition, the housing could be specially designed for the visually impaired to make their day to day living less difficult and stressful.

I believe such efforts would be cost effective but even more beneficial in improving quality of life for our most experienced patients.

Trying to Make a Sustainable Impact

Eye Care in Ghana

Obtaining access to eye care in Ghana is a challenge for many reasons.

  • There are only about 300 ophthalmologists and Optometrists for the 23 million populations
  • Most of the providers are clustered in the larger cities.
  • Travel to and from providers offices is difficult
  • Access to expensive medications and treatment is impossible for most of the population to obtain.
  • Training and continuing education is scarce

 

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For these and many other reasons there is a large reservoir of untreated eye disease in Ghana. One would think that if someone would just set up a clinic with free care there would be a line of desperate individuals for treatment. This is usually not the case. Communication is not easy in Ghana however it is improving. Transportation is also slow and unreliable.   There are understandable fears of undergoing invasive treatment but a foreign doctor who they do not know.

The keys to a successful intervention are therefore contingent on developing effective relationships with the local leadership and health care community:

  • Local village leaderships/ Chiefs
  • Engagement of local and regional Ophthalmologists and Optometrists
  • Effective communication with local heath administrators / ministers
  • Understanding the role of religious leaders in the health care decisions of the local citizens.

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In the final analysis, we need to decide if the trip we are planning is really just a work vacation for us. However, valuable and laudable it is to spend a week or so in a developing country this must be weighed against the negative fall out from a trip that disrupts long-term operations and relationships without replacing them with something better and sustainable.