As I was driving to my Whitwick practice this morning, I was listening to a report on the radio about today being World Alzheimers day, and it got me thinking about the number of my patients that had been affected by this dreadful condition, and what that effect had been.
The Alzheimers Society say that nearly two thirds of people with dementia experience loneliness and almost half report losing friends after their diagnosis. A survey found that stigma is a major barrier to improving care and support for people with the condition, and that three quarters of people with dementia and nearly two thirds of family carers believe that people with dementia face stigma, including fear and avoidance, from others. All too often, dementia is wrongly dismissed as a sign of ageing or the subject is brushed under the carpet. Most adults say they would find it difficult to have a conversation about dementia.
But what does this mean in practice, and what should we be thinking about when we talk about eyecare and helping my patients?
Firstly just because someone is showing signs of dementia (or confusion as it is often referred to), eyecare and vision is still so important. It is all too easy to put everything down to dementia, but some unusual behaviour may simply be a reaction to sight loss or attempts to make the most of useful vision. Someone may be becoming withdrawn or uncommunicative, being clumsy or falling more, reporting visual hallucinations, holding things up close, being confused and disorientated. They can sometimes be startled by noises or people approaching. But if someone can’t see properly, these things will happen. If you can’t see well enough to recognise someone’s face, you can stop acknowledging them. You are much more likely to trip and bump into things. If a cataract is coming on, then glare and shadows become much more challenging. If someone loves reading and then they can’t, they will inevitably get more and more frustrated. It may be that dementia is having an effect, but it is important to have their sight tested as sight loss could be contributing to increased confusion.
Sight loss is not always obvious in people with dementia because the signs can be difficult to separate. One condition may mask or be mistaken for the effects of the other and lead to inaction. If you are caring for someone with dementia you might want to consider whether the person is having difficulty with reading, recognising people, coping with bright light, low light or both. They might struggle to find things, react differently whilst avoiding obstacles, experience difficulty locating food on their plate, or just not seeing well enough with their existing glasses. Unfortunately if someone has dementia, they are not always able to explain what is happening to them, and they have to endure even greater suffering. They can still have a cataract, their vision may be affected by a stroke, they may be developing macular degeneration or they could have discomfort from dry eyes. They just can’t explain it effectively.
People with dementia can also have visual difficulties caused by the brain but still have healthy eyes. They can often have problems perceiving what they see rather than how sharply they see it. This can mean that when they try to read, they can read the words easily, but they don’t know what they mean. This does not mean that their close work vision should be ignored; many other close visual tasks still need clear vision, for example seeing food on the plate.
How does all this relate to an eyetest at our practice? It may seem obvious, but it helps if we know. With patients that we have known for years we often will recognise the changes ourselves, but for newer patients we won’t know without being told.
We can always test someone, we can use different methods and techniques that don’t rely on answers or choices. We don’t always need to know “what’s better, one or two!”
It is often better if the patient with dementia has someone with them. This helps in so many ways: the patient is usually much more relaxed and happier, we can get a lot more background information about the health, condition and needs of the patient and there is more than one pair of ears so that advice can be passed on and help put in place.
It can sometimes be better to visit a dementia sufferer at their own home, as this can feel much more comfortable and relaxed. We are always happy to do this. It is important in this situation that there is someone with the patient that they know well, and can help out with any questions that may come up. Regrettably, the Health Service will not always fully fund the visit, as their rules say that the patient must be unable to leave home. The NHS rules do not consider that someone’s peace of mind or comfort is sufficient reason. However, we are always happy to use the basic NHS funding as part payment if it is possible.
If you have any questions about dementia, vision and eyes or testing someone that is affected, please contact a member of our friendly team. Spondon is on 01332 666 760,Whitwick is on 01530 832769, email firstname.lastname@example.org or call in and see us anytime.
Dispensing Optician and Owner