responsibilities rather than merely recipients of care, who should be grateful for whatever goodwill is handed to them. All EU countries have signed the UNCRPD: United Nations Convention on the Rights of Persons with Disabilities. The purpose of the Convention is to promote, protect and ensure the full and equal enjoyment of all human rights and fundamental freedoms by all persons with disabilities. It represents a significant change in approach: it treats disability as a human rights issue, rather than only as a social welfare matter. The concept of disability enshrined in the Convention refers to long-term physical, mental, intellectual or sensory impairments which, in interaction with various barriers, may hinder full and effective participation in society on an equal basis with others. Also VIOPs want to be able to use the latest smart phones, access the internet, connect with family abroad on Skype or email and, even where confidence and capacity to go out and about may be compromised, they want to be part of their chosen network of people, social connections and activities. Rehabilitation has therefore moved beyond, but still includes, traditional models of orientation and mobility and independent living to embrace new opportunities through technology while holding onto the values of peer support, group and one-on-one training and maximising potential. Rehabilitation outcomes for older people, which they have an input into defining, should be part of any rehabilitation service, and in particular for older people – many of whom, due to changing demographics in Europe and the current causes of most sight loss, are engaging with services for the first time in later life. Models of rehabilitation should be evaluated, reviewed and revised as an integral part of the rehabilitation process and continue to reflect the needs people seeking it and the evolution of the society of which people with impaired vision continue to contribute to as citizens. A structured approach to rehabilitation is the most important sense we possess in understanding our environment and any loss of sight has an impact on our quality of life although individuals may be slow to recognise such impact where the sight loss progresses slowly. It may be delayed because of a general acceptance of functional loss across sight, hearing and mobility as a natural accompaniment of age. Awareness may only become inescapable when an individual meets a situation where
their sight is inadequate; something as simple and everyday as reading the newspaper. It gradually presents an increasing impediment to a range of everyday activities as the condition progresses. Reading, driving or using a computer can all be made more difficult or impossible. At a more severe level of sight loss, independent mobility becomes a challenge. Dealing with obstacles needs external intervention in the form of equipment and training but the rehabilitation process in relation to older people is made more difficult by frailty and tiredness, lack of confidence, poor motivation and the degenerative nature of sight loss and memory loss; all potential accompaniments to the ageing process. The complex circumstances of progressive disability with age cannot be understood by using the simplistic dualism of medical and social models. They are no longer fit for purpose in an age when we are looking at joined up health and social care. The International Classification of Functioning, Disability and Health (ICF; WHO, 2001) offers a way forward but the complex taxonomy that it provides is difficult to use intuitively and although it is a valuable tool for exchange of information between professionals it is less suitable for informing relatively informal interviews in rehabilitation situations. ICF describes an individual’s type and severity of impairment, potential for, and actual level of social activity. It provides a shared terminology and structure that professionals can use to frame their perceptions of a person’s condition and how they function in the wider society, with the option of presenting this as a numerical code for the standardised exchange of information between professionals who may operate between different professional frames of reference. The ICF structure and terminology is complex and be difficult for a VIOP to follow in discussing their circumstances and possible rehabilitation options. It is not the normal language with which individuals talk about themselves. A more accessible presentation of ICF has been developed at Royal Dutch Visio which identifies the relationship between environmental factors and personal factors in determining an individual’s potential for increased engagement in activities and participation. Medical Functions