When You Have Older ClientsÖWho Have Difficulty Seeing
Poor vision or being legally blind is relatively common among older clients. [See also "Vision Loss" under Health.]
How Common Is It?
At least one in twelve seniors over the age of seventy five has low vision. That term does not mean that they are completely blind, but it does mean they have a serious condition that canít be fixed by wearing eyeglasses.
One of the most common forms of vision loss is called macular degeneration (it is more common among seniors than cataracts and glaucoma combined). People who have diabetes (a common health problem among older adults) may develop diabetic retinopathy.
What Are the Signs?
Upshaw Institute for the Blind has a list of Ten Signs of Vision Loss, some of which will be obvious with clients. There are many other signs.
1. Bumping into objects.
2. Moving hesitantly or walking close to the wall.
3. Groping for objects or touching them in an uncertain way.
4. Squinting or tilting the head to see.
5. Requesting additional or different kinds of lighting.
6. Holding books or other reading material close to the face.
7. Dropping food or utensils at mealtimes.
8. Showing difficulty in making out faces or the numbers of rooms or floors.
9. Looking ungroomed or sloppy, with stains on clothing, mismatched clothing, or uncombed hair.
10. Acting confused or disoriented, for example, walking into someone else's room by mistake.
Often you may not realize in the beginning that the person has difficulty seeing. They may seem aloof (ignoring you) when they simply donít see you. Many older people may feel uncomfortable letting others know about their vision loss, because it makes them feel vulnerable. Others are not aware of the slow deterioration of their sight.
Some Practical Tips for Helping
Most of these tips apply whether or not the person has difficulty seeing, but they are particularly helpful for people who do.
1. Identify Yourself and Say Hello
Take the initiative to say hello and identify yourself. And donít always assume that seniors can see you.
Donít assume because the person has low vision that they are not capable and do not foster that assumption in them. But occasionally ask if they could use any help. Let them decide.
3. Watch for Depression
Losing their vision is extremely hard on most people, and many people experiencing vision loss can become depressed.
Any of these can be signs of depression:
if the client seems excessively worried,
has bouts of crying,
is pessimistic, or snippy.
So are these:
if the person starts to withdraw socially,
refuses to communicate or
takes an excessively stiff upper lip,
mopes, or acts helpless.
You can help by treating the person respectfully. Donít isolate them further by avoiding them or excluding them from program activities, but recognize that you may need to adapt the activities so they can participate. Ask if theyíd like to be involved and what they need to do that.
Meeting Clients' Needs
People who work with older clients have learned quite a few good strategies that are helpful for all types of clients, but are particularly useful for clients with vision difficulties. Here are some of the "tried and true":
1. On the Phone
a. Your Message System
Your agency's or organization's phone system is often the first point of contact for seniors. Why not make it more suited to their needs. More seniors give up before they even start because of systems that seem to meet everyone else's needs but theirs.
In an article titled " How Call Centers Can Relate To An Aging Population", the author Barry Spiegelman points out the challenges for seniors and notes "A helpful voice at the end of the phone line is comforting to people of all ages." If you are stuck with voice mail etc., at least make it simple to make it user-tolerable.
"Phone protocols" with added digits, layers of calling "services," and multiple lines are hard for most people. However people with diminished vision and mobility face even more obstacles when dialing, following phone prompts, and writing or reading notes.
b. Voice Mail
Keep it short, and leave enough taping time for client to speak, hesitation and all. Identify yourself and your agency, so people know they dialed the right number.
c. Talking on the Phone (Leaving messages)
For all clients, give your name and phone number at the beginning of the message to them and repeat it again towards the end. Do not speak quickly, especially if giving a phone number, date or person's name.
2. Finding You
Where You Work: How easy is it for people to find you? Are the address numbers on the building and the agency name, floor and room numbers LARGE and in an easy to see location?
What about the signs that identify where you are located? Is there another prominent sign in the elevator (if you have one) that says where your office is.
Business Cards: If your business card has small printing, have your name and phone number stamped in LARGE on the back of it.
Letters: If there is important information, contact the person directly, as opposed to writing. They may not see or be able to read your letter.
Notices on Doors (Meeting locations, etc): Use large print (at least 1Ē tall). Use
black letters on white background, and
an easy to read letter style (for example, ďArialĒ) with no fancy curly-Qs.
If you want to attract attention to the notice, put the white paper on a larger coloured paper. If you have changed your regular meeting space or this is the first time for a client, have someone near the front door to help redirect people or provide them with information.
3. When Speaking
Face the person when speaking. Speak clearly and in a moderate tone. Always identify yourself to the person, especially if you are someplace that the person might not expect to see you.
In a group of people (such as at a Board of Directors, Advisory Committee or a group meeting), let the person know who else is present, but in a way that does not draw attention to them.
4. At Support Group Meetings
Include the visually-impaired person in the discussions to get their opinion, join in, and add to the group. Donít draw attention to the person and their disability, but donít ignore the person either. Treating the person ďnormallyĒ goes a long way to preventing feelings of isolation. Being blind or visually impaired is just part of who a person is.
5. Give Clear Directions
If you are giving directions, be specific; donít say "over there" or "over here". Instead say "on your left or right" or "immediately behind" or "in front of you, and to the right".
Donít assume the person can read your face expressions or gestures. Say everything in words that you want to convey.
Teach the receptionist or information person how to give clear, easy to understand directions to your agency, or to any location you want the client to attend.
Do what you can to eliminate any physical obstacles in your building.
1. Keep the Environment Predictable
This makes a big difference for a person with low vision. Many people can compensate for less vision by relying on their knowledge of your building and the area around it. Keep your building or meeting place as predictable as possible. Try not to change things too much, or if you do, let the person know.
Location of steps can be difficult for a person with low vision to gauge, leading to falls. Steps that have high contrast edges are easier to distinguish.
2. Common Areas
Make sure you have good lighting not only in your office, but also in the elevator and reception area. Watch out for glare.
Donít Believe the Myths
People who have vision loss or are blind do not have special senses. Their other senses (hearing, smell, touch) do not become keener. They have to rely on their other senses more, but thatís about it.
This unfortunate myth is perpetrated in liquor and faucet ads, and sometimes even by blind organizations who should know better. There is no credible research to back up the myth.
Where to Go For More Information
The Canadian National Institute for the Blind (CNIB) has service centres in many Canadian communities. Telephones numbers for CNIB can be found in the WHITE PAGES. They sell technical and independence aids for people.
See also America Foundation for the Blind.
Sources of Information Used Here:
Prepared by Charmaine Spencer, for Seeking Solutions. Part of this information has been adapted from
Tips of the Trade, BCCEAS (c) 2002, New Westminster, B.C.
Lylas G. Mogyk & Marja Mogyk (1999) Macular Degeneration: The Complete Guide to Saving and Maximizing Your Eyesight (Ballantines: New York);
Living with Vision Loss: A Handbook for Caregivers, published by the Canadian National Institute for the Blind.
Last updated July 20, 2002. Webmaster: firstname.lastname@example.org