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Vision UK 2014: Outcome 2, Oral Presentations
Presentation 1
Abstract title:
Living with dementia and sight loss: support that works well
Names and affiliations of authors:
Sarah Buchanan - Thomas Pocklington Trust
Karen Croucher and Mark Bevan - York University
Julie Barrett - Housing and Dementia Research Consortium
Andrea Innes, Samuel Nyman and Michelle Heward - Bournemouth University
Simon Evans and Jennifer Bray - Worcester University
Anna Clarke - Cambridge University.
Presenter:
Sarah Buchanan
[email protected]
Introduction/purpose:
Concurrent dementia and sight loss affects at least 125,000 people in the UK.
Sight loss among people with dementia may be caused by an eye condition,
dementia or ageing of the eye. Whatever the cause, living with sight loss is
exacerbated by dementia and vice versa. This presentation will share findings from
an NIHR funded research project that set out to assess how effective care and
support may be provided for people with concurrent dementia who are living in
different housing settings rather than care homes.
Methods:
The project described in this presentation ran for 18 months, drawing on
expertise in four university teams and two specialist voluntary organisations and
involved people personally affected by dementia and sight loss and professionals
providing care and support services. The research was placed in England.
Research methods involved a literature review, interviews with people with
dementia and visual impairment and their carers, focus groups and interviews
with a range of practitioners - including those with expertise in dementia, visual
impairment, and housing - a consensus event and an economic analysis of the
costs and impacts of different arrangements of care and support.
Impact:
A key output from the project is guidance for good practice in care and support. The
guidance was drawn from research findings and a consensus event that considered
key elements of good practice and priorities for implementation. That event involved
the research team and a range of participants from relevant organisations and
services, people personally affected by dementia and sight loss and professionals
offering care and support.
The research findings, and guidance arising, complement past and present research
about dementia and sight loss and the work of the Vision UK Dementia and Sight
Loss Interest Group.
Conclusion:
The primary output from the research project is good practice guidance that seeks to
improve the lives of people with sight loss who are also affected by dementia. This
will support implementation of the UK Vision Strategy and while addressing a
particular audience the guidance and the presentation about it is likely to have
resonance for the wider audience of people whose sight loss is exacerbated by
another health condition, and vice versa.
Discussion:
Vision UK 2014 offers an opportunity to share guidance and raise awareness of
the challenges facing people who have sight loss and dementia. The
presentation will summarise the guidance and support future distribution of
copies of the guidance.
References:
These cannot be supplied at this stage: the full research report to NIHR will be
completed by 31 March after which references will be available for this presentation.
Please note that this presentation will present independent research
commissioned/funded by the Department of Health's NIHR School for Social Care
Research. The views to be expressed in the presentation are those of the authors
and not necessarily those of the NIHR School for Social Care Research or the
Department of Health, NIHR, or NHS.
Presentation 2
Abstract title:
Effectiveness of service provision in reducing falls in people with visual impairment
Names and affiliations of authors:
Leon Robinson - Whiteabbey Hospital, Northern Health and Social Care Trust
Jackie Casey and Dr May Stinson – School of Health Sciences, University of Ulster
Adrienne Hull – RNIB Northern Ireland, Belfast
Dr Shelley Crawford, Muckamore Abbey Hospital, Belfast Health and Social Care
Trust
Presenter:
Leona Robinson
[email protected]
Introduction/purpose:
Older people with visual impairment (VI) are much more likely to fall than their
fully-sighted counterparts (Dhital et al 2010). Age-related macular degeneration
(ARMD) is the most common cause of VI in older adults and has been attributed
to an increase in falls risk (Szabo et al 2010). This collaborative study, between
the Royal National Institute for the Blind (RNIB) and Occupational Therapy (OT)
researchers, aimed to establish the effectiveness of an existing service, Eye
Care Liaison Officers (ECLOs), in reducing incidence of falls amongst older
adults with ARMD.
Methods:
A randomised control trial study design was used. Ethical approval was obtained
through the Office for Research Ethics NI and the Belfast HSC Trust. Consenting
participants were 65 years or older, diagnosed with ARMD, cognitively able and
attending the out-patient macular clinic. The intervention group (n= 33) received
condition- specific falls advice and literature alongside usual ECLO intervention. The
control group (n=29) received usual care only. Standardised assessments were used
to establish falls risk, confidence and perceived health status. For six months
following intervention, all participants completed falls calendars and received monthly
telephone calls to establish falls incidence. Data was analysed descriptively. Further
statistical analysis is ongoing to determine any differences between control and
intervention groups. These results will be fully presented at conference.
Impact:
Falls are a significant health problem for older people, with 30% of people over 65
years old experiencing a fall (National Institute for Clinical Excellence 2013). In this
study, falls were reported by over 60% of all participants, with 75% of these fallers
citing two or more falls. A substantial number of reported falls occurred around the
home, with falls on steps due to misjudging step distance frequently cited as the
cause. Conversations with participants highlighted that they tended not to associate
falling with their VI.
Conclusion:
Preliminary results evidence the high incidence of falls in individuals with ARMD.
Full results will be presented showing the falls incidence for each group and the
difference, if any, of the enhanced ECLO intervention.
Discussion:
The implications from this study for future service development are as follows:
1. ECLOs are an existing resource within eye clinics working with a high risk falls
group. With appropriate falls- specific training, the ECLO is well placed, to give
timely, relevant information regarding falls prevention.
The unexpected high incidence of falls stresses the importance of being visually
aware and understanding the link between VI and falls. A need exists for closer
working between established falls services and eye care services. This should
include clear referral pathways.
References:
Dhital A, Pey T, Stanford MR (2010) Visual loss and falls: a review. Eye (24),
1437–1446.
National Institute for Clinical Excellence (2013) Falls: assessment and
prevention of falls in older people [CG161]. London: NICE.
Szabo SM, Janssen PA, Khan K, Lord SR, Potter MJ (2010) Neovascular
AMD: an overlooked risk factor for injurious falls. Osteoporosis International,
21(5), 855-862.
Acknowledgement: This study was funded by RNIB.
Presentation 3
Abstract title:
A qualitative study of stakeholder views regarding participation in locally
commissioned enhanced optometric services
Names and affiliations of authors:
Evgenia Konstantakopoulou, David Edgar, John Lawrenson - Division of Optometry
and Visual Science, City University London
Robert Harper - Manchester Royal Eye Hospital, Central Manchester University
Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre
Presenter:
John Lawrenson
[email protected]
Introduction/purpose:
Purpose: to explore the views of optometrists, GPs and ophthalmologists
regarding the development and organisation of community-based enhanced
optometric services.
Methods:
Design: qualitative study using free-text questionnaires and telephone interviews
Setting: a Minor Eye Conditions Scheme (MECS) and a Glaucoma Referral
Refinement Scheme (GRRS) based in accredited community optometry
practices
Participants: 41 optometrists, 6 ophthalmologists and 25 GPs
Impact:
Results: the most common reason given by optometrists for participation in
enhanced schemes was to further their professional development; however as
providers of ‘for-profit’ healthcare, it was clear that participants had also considered
the impact of the schemes on their business. Lack of ‘fit’ with the retail business
model of optometry was a frequently given reason for non-participation. The
methods used for training and accreditation were generally thought to be
appropriate, and participating optometrists welcomed the opportunities for ongoing
training. The ophthalmologists involved in MECS and GRRS expressed very positive
views regarding the schemes and widely acknowledged that the new care pathways
would reduce unnecessary referrals and shorten patient waiting times. GPs involved
in MECS were also very supportive. They felt that the scheme provided an ‘expert’
local opinion that could potentially reduce the number of secondary care referrals.
Conclusion:
Conclusions: the results of this study demonstrated strong stakeholder support for
the development of community - based enhanced optometric services. Although
optometrists welcomed the opportunity to develop their professional skills and
knowledge, enhanced schemes must also provide a sufficient financial incentive so
as not to compromise the profitability of their business.
Discussion:
Optometrists represent a skilled primary care workforce that with further training
can provide effective referral refinement and ocular disease management in the
community through the provision of ESS. The present study identified that the
primary reason for participation in these schemes is the desire to develop
professional skills and knowledge. However, as ‘for-profit’ providers of healthcare
schemes have to provide sufficient financial incentives so as not to compromise
business profitability. Optometrists recognised the need for additional training
and viewed this favourably whether it was delivered online or face-to-face. ESS
were well received by GPs and by participating ophthalmologists working in
secondary care. Both professional groups recognised the advantages of
integrating community optometry into eye care pathways to provide an
appropriate delivery of care in a convenient High Street setting.
References:
Ratnarajan G, Newsom W, Vernon SA, Fenerty C, Henson D, Spencer F, Wang
Y, Harper R, McNaught A,
Collins L, Parker M, Lawrenson J, Hudson R, Khaw PT, Wormald R, GarwayHeath D, Bourne R.The effectiveness of schemes that refine referrals between
primary and secondary care--the UK experience with glaucoma referrals: the
Health Innovation & Education Cluster (HIEC) Glaucoma Pathways Project.
BMJ Open. 2013 Jul 21;3(7).
Sheen NJ1, Fone D, Phillips CJ, Sparrow JM, Pointer JS, Wild JM.Novel
optometrist-led all Wales primary eyecare services: evaluation of a
prospective case series. Br J Ophthalmol. 2009 Apr;93(4):435-8.