Title: A preventative approach to ensuring Access to a Sustainable, whole System pathway for older people with vISion impairmenT (ASSIST)
Funder: Health and Care Research Wales (Welsh Government)

Abstract: The project addresses the need for more sustainable care and support for older people with vision impairment (VI) to help them live happier and more fulfilling lives. BACKGROUND: VI affects ~1.93M people in the UK, approximately 3% of its population. Of these, 1.5M are over 65 years. VI is one of the most common disabling conditions in older adults, impacting on everyday life and social connections regardless of its severity, with profound consequences on health and wellbeing, and increased risk of falls in the community. Social services, third sector and health care support can help older people maintain independence and social connections, when VI requires major lifestyle adjustments. Welsh policy guidance on social care support for older adults with VI is comprehensive, but access and navigation of the support can be a problem for many. The extent of the problem is unclear. Third sector/voluntary social services are evolving, which can be difficult for older people and clinicians to keep up to date with. Social Prescribing is a way of “connecting people to community support to better manage their health and wellbeing”, in which professionals based in the third sector, local authority, primary care and housing can refer people to community services and activities. Older adults with VI in Wales may be unaware of how to access the social prescribing pathway. Although databases of assets (services) exist, they lack maintenance and there is disconnect between resources. A clear pathway for people to navigate and access the available support is needed. AIMS: The project aims to investigate the current provision of care and support for older people with VI. Identification of gaps in access and areas of best practice will allow improvement and sustainable ‘joined up’ solutions to be identified, with a focus on strengthening preventative approaches. QUESTION: What is the current provision of support for older people (over 65 years) with VI, whom does it benefit and how can we improve the system to better engage s ustainable ‘joined up’ solutions? PLAN: Three cycles of Realist Inquiry will be undertaken: 1) Rapid Realist Review to build a ‘Programme Theory’ 2) Survey and series of interviews with people with VI and their carers to understand their complex experiences 3) Focus groups and interviews with health and social care professionals, directorate management and third sector & social services providing relevant support, to gain their perspective and refine the Programme Theory. Health economic modelling will be used to explore the existing access to social services, provision of interventions and solutions and their impact on outcomes and how change in provision may change outcomes. Best practice examples will be identified to show the linking of individuals with appropriate services/solutions; this may include (but is not limited to) social prescribing within the services used. BENEFITS: This project will identify how and why the current system is failing older people living with VI. We will develop a better system, designed from the outset to be sustainable in the long- term. This will provide a pathway for service users and their carers to access and navigate individualised support. Feedback from our project will inform database/resource managers on organisational improvements. The findings will inform a targeted goal-driven approach to implementing sustainable improvements.

Lay abstract: The project addresses the need for more sustainable care and support for older people with vision impairment (VI) to help them live happier and more fulfilling lives. Nearly 2 million people in the UK have a VI and of these, 1.5 million are over 65 years old. VI is one of the most common disabling conditions in older people and affects their everyday lives, including their relationships and social connections. It has been linked to people feeling isolated and depressed, and also to poorer health and wellbeing, including being more at risk of having a serious fall. When people need to make big changes to their lifestyle because of their VI, the voluntary sector, social and health services can help them to keep their independence. Although there are clear Welsh policies on social care support for older people with VI, the problem for many people can be getting access to the support and finding the right type of support for their individual needs. Currently, we don’t know the extent of the problem, but as voluntary sector and social services are evolving, it can be difficult for people and their care teams to keep up to date with the changes. Social Prescribing means “connecting people to community support to better manage their health and wellbeing”, in which professionals (e.g. doctors, optometrists, social workers, housing officers) can refer people to community services and activities. Many older people with VI in Wales may be unaware of how to access the social prescribing pathway. This is because national databases of services lack maintenance and resources are not joined up. A clear pathway for people to navigate and access the available support is needed. The project aims to find out what the current provision of care and support for older people with VI is, to uncover gaps in access and identify areas of best practice. We will recommend how improvements can be made to support better, joined up working and more efficient ways of using existing resources. We will review the literature on existing support, then we will survey older people with VI and their carers, before interviewing a range of people involved in the whole system about their experiences of the existing system, including older people with VI and their carers, professionals working in health and social care, healthcare managers & providers and administrative staff and voluntary sector workers who provide relevant support. This will help us to find out about the current support and whether the needs of these people are being met. We will find out what works well and what doesn’t and what the possible solutions and improvements should be, as well as the economic impact of such improvements. Public involvement is at the forefront of our research and the contribution of a visually impaired lay member of the research team to the planning of the research proposal will continue and extend to involvement in decisions about the running of the project, reviewing results and preparing and presenting findings. We will also have a Project Advisory Group which includes lay members who will meet at key milestones to oversee and consult on the project. The findings of the project will be summarised for a general audience, in accessible formats including written, audio and video formats. The researchers and lay member will co-present the findings in a series of presentations to stakeholders.

Research activity codes: 8.1 ORGANISATION AND DELIVERY OF SERVICES;8.2 HEALTH AND WELFARE ECONOMICS
Health categories: EYE