Keeping Older Adults with Vision Loss Safe: Chronic Conditions and Comorbidities that Influence Functional Mobility.

Age-related macular degeneration (AMD) is a leading of cause of vision loss in Americans aged 60 and older. The loss of central vision from AMD can decrease visual acuity, contrast sensitivity, glare sensitivity, color discrimination, and the ability to adapt to changes in lighting conditions. Older adults with vision loss often have other chronic, comorbid conditions that cause some level of difficulty with mobility tasks. Many express a fear of falling or other anxieties about walking outdoors or in unfamiliar settings (Nelson, Aspinall, & O'Brien, 1999) and hear from family members and friends that it is not safe for them to walk alone outdoors. A stumble, trip, or fall may cause some older adults to stop participating in an activity, such as working in the yard, walking in the neighborhood, shopping, and attending church services or senior center events. Withdrawal from activities of daily living and social events may lead to isolation and depression as an older adult's routines are interrupted (Tolman, Hill, Kleinschmidt, & Gregg, 2005). As an older adult gives up favorite activities, his or her self-confidence declines and begins to affect all activities of daily living, including mobility. All professionals who are involved in the vision rehabilitation process should be aware of the impact of these chronic, comorbid conditions on the mobility of older adults. Orientation and mobility (O&M) instructors are familiar with the unique mobility needs of older adults and the impact of other conditions, but older adults may not seek their services. Other health care professionals may not be aware of the impact of comorbid conditions combined with visual impairment on the mobility of older adults, the value of O&M services for older adults, or even that O&M services exist (Casten, Maloney, & Rovner, 2005). This article explores, from the author's experience, key conditions that influence functional mobility and how these limitations affect the safety of older adults. The focus is not on the visual impairment, but on the chronic, comorbid conditions that affect the mobility of older adults. Since functional vision may change throughout the day and under different weather and environmental conditions, functional assessments should identify unsafe practices in all types of situations. Training should incorporate the recognition of factors that influence vision and the implementation of compensatory strategies to maximize safe travel. VISION LOSS AND COMORBID CONDITIONS Independent mobility is a physically demanding task requiring one's body parts to work together in response to visual, auditory, and tactile input from the environment. Crews, Jones, and Kim (2006) noted the following difficulties with mobility tasks that were reported by older adult participants with vision loss and another comorbid condition: * Vision loss and joint problems: 41% reported difficulty walking a quarter mile, and 38% had difficulty climbing 10 steps. * Vision loss and stroke: 65% reported difficulty walking a quarter mile, and 54% had difficulty climbing 10 steps. * Vision loss and heart problems: 51% had difficulty walking a quarter mile, and 42% had difficulty climbing 10 steps. Visual impairment and other health conditions, such as cardiovascular disease, arthritis, strokes, breathing problems, and peripheral neuropathies, have a significant impact on the mobility of older adults, affecting their range of motion, strength, balance, and endurance. Decreases in range of motion and strength may limit older adults' ability to maintain their balance when recovering from a stumble or a bump into an obstacle. Balance deficits in older adults increase the risk of falls. Over time, gradual withdrawal from daily activities, social events, and outings may have an effect on endurance. Success in accomplishing mobility tasks requires addressing many visual, psychosocial, cognitive, and physical factors, especially in older adults who have a number of chronic conditions. …