Marianne Coleman, Bao Nguyen, Lynette Joubert, Allison McKendrick

Australian College of Optometry, University of Melbourne, University of Western Australia

Being able to see well matters to people living with dementia. In our study, we interviewed people living with dementia and carers, and found many activities enjoyed by people living with dementia are visual, such as gardening, seeing friends and family, and arts/crafts. The 2022 World Alzheimer’s Report highlights that looking after sensory health, such as vision and hearing, is really important to help people living with dementia maintain their independence, and to create environments/opportunities for them to be and do what they value.  

While people living with dementia at home and in aged care facilities are not any more likely to develop sight-threatening eye diseases than people without dementia, they are at greater risk of experiencing preventable sight loss. A UK study sent mobile optometrists to assess over 700 people living with dementia at home and in residential aged care facilities. They found one in three people with dementia had reduced eyesight, often due to addressable issues such as cataract or outdated glasses.  

Poor eyesight makes living with dementia harder.  It can increase risk of falls and make it more difficult to engage in tailored activities and programmes to enhance wellbeing.  Therefore, preventing sight loss for people with dementia is important, and regular eye tests considered as part of primary preventive care. Unfortunately, people living with dementia can experience barriers to accessing routine eyecare.  

We wanted to share some key messages from our research about dementia-friendly eyecare with the aged care sector: 

1. Good eyesight is important for people living with dementia.  Regular eye tests should be part of the post-diagnosis care pathway and continue  even when care needs have escalated, such as transitioning to residential aged care, or if glasses are no longer being worn.  Support people with dementia to get their eyes tested once a year with a dementia-friendly optometrist. For people with younger onset dementia, this would be every three years, or more often if the person has an eye condition. We have developed information booklets about eye tests for people with dementia which are available online and can be printed for your use.  
2. Many parts of the routine eye examination can be successfully performed for people with dementia, with adaptations to accommodate communication difficulties and cognitive impairment. Simply telling the optometrist about a dementia diagnosis in advance is a huge help. Useful information about visual function can be obtained even from simple tests, and any vision impairments can be documented for the benefit of other care professionals, to inform person-centred care, rehabilitation or reablement across settings. Examples include visual field defects, reading difficulties, or poor contrast vision due to cataract. 
3. Optometrists can perform eye tests in residential aged care or at home using portable equipment. If you are worried about the eyesight of someone under your care, or their glasses are damaged, broken or missing, an optometrist can perform a check, and this is usually billed under Medicare.  You can use search functions on Optometry Australia to find optometrists servicing aged care, doing home visits or who are dementia friendly. 

You can download the information booklet about eye test for people living with dementia video (3 mins) or  watch the 20 seconds silent video on YouTube. You can also read more about why everybody living with dementia needs regular eye tests on Melbourne University website.

*The views and opinions expressed in Knowledge Blogs are those of the authors and do not necessarily reflect those of ARIIA, Flinders University and/or the Australian Government Department of Health and Aged Care.

Bethany Kings (National Program Manager), Marie Alford (Head of Dementia Professional Services)

DSA Dementia Support Australia

They say change is inevitable, and also that change can be slow. That is, until there is a crisis. We have seen how the impetus of a pandemic and aged care reform has challenged the pace of change and has pushed us to creatively adapt processes, communication channels, systems and funding mechanisms to meet the immediate health demands.

Dementia Support Australia (DSA) is not immune to this change as we seek to support a sector in flux. One strength of the service is our ability to pivot in response to the surrounding landscape. Whilst our core business is to support people living with dementia where behaviour impacts care, the way this is undertaken has evolved since the inception of DSA in 2016.

At the beginning of COVID-19, access to residential care homes was limited. However, with a cocktail of reduced visitation, changed routines, staff in masks, goggles, gowns and gloves, and constantly changing staff, the need for DSA support only grew. Out of this came the Dementia Engagement Modelling Program (DEMP) and greater utilisation of our brokerage services. Engagement continues to be a core focus within our work.

With the implementation of Royal Commission recommendations came the strengthening of behaviour support plans and an overdue focus on reducing restrictive practices. The sector needed guidance but, more importantly, support. With our expertise in non-pharmacological approaches to behaviour management, DSA sought to understand the regulations and published our Behaviour Support Plan resources to help providers build their plans and bring them to life. We consider this a work in progress, with care providers facing previously unseen workforce challenges.

Our focus has been drawn more recently to the outcome of increased regulation and workforce issues further impacting care transitions, particularly from the hospital. We have been piloting the Acute to Residential Care Transition program, designed to understand some of the complex factors that lead to ‘bed block’ and offer policy and practice development. DSA has been supporting General Practitioners who care for people with behaviours and psychological symptoms of dementia through the GP Advice Service, offering opportunities to talk with our medical specialists about prescribing and de-prescribing, and introducing Dementia Support Coaches in response to feedback that on the ground modelling of behaviour support is the most effective way to effect change.

With the current aged care workforce shortages, the aging population, rising costs and continuing reforms, we are working to make our recommendation reports more streamlined and accessible to front-line staff, taking it to single concepts, using different mechanisms to deliver interventions. But we need your help to ensure this meets the diverse needs of the sector. We have a strong and stable vision focussing on holistic, seamless, borderless support consistently delivered with respect to local geographic context. Knowing the person is the foundation of everything we do as we build recommendations and interventions in partnership with those who provide care.

Funded by the Australian Government, call DSA on 1800 699 799 or head to the DSA website; we are here to help.

*The views and opinions expressed in Knowledge Blogs are those of the authors and do not necessarily reflect those of ARIIA, Flinders University and/or the Australian Government Department of Health and Aged Care.