Making her morning coffee was painful for 70-year-old Mrs. Cowel.* Diabetic retinopathy made it nearly impossible for her to distinguish the contrast between the color of the coffee and the color of her dark mug. Because she couldn’t determine when to stop pouring, she frequently spilled the hot liquid and burned her fingers. But giving up this daily chore would mean surrendering one more piece of independent living.
Taking his daily prescription medications was dangerous for 75-year-old Mr. Thomas.* Low vision prevented him from seeing the directions on the pill bottles and increased his risk for taking the wrong medicine at the wrong time.
Cowel and Thomas are part of the escalating numbers of seniors with vision problems that threaten their health and quality of life. To counter these problems, Lighthouse International, in partnership with Senator Martin J. Golden, then-chairman of the New York State Senate Aging Committee, launched New York City’s first homebound elderly nurse practitioner program for people with vision impairment.
Aging Up, Vision Down
As people age, their chances of contracting chronic illnesses such as diabetes and macular degeneration increases.
“We project that there will be close to one million elderly with some type of significant vision loss in the New York City area by 2015,” says Noreen Brennan, RN, MA, vice president of Clinical Services of Lighthouse International, a 103-year-old, nonprofit organization dedicated to fight, preserve, and prevent loss of vision. Vision loss leads to health and safety issues, to isolation, and to becoming homebound, especially for those in rural communities who can no longer drive, she says.
The Homebound Nurse Practitioner Program, under the leadership of Andrea Zaldivar, MS, ANP-BC, CDE, director of Geriatrics and Diabetes, will provide seniors with an opportunity to obtain inhome vision assessments and recommendations for follow-up care.
Eye SupportU.S. Senator Martin J. Golden with Program NPs Sylvia Simmons, MSN, GNP (left) and Alma Mesquita, MS, FNP-BC.
The Homebound Nurse Practitioner Program began in October as a pilot in Brooklyn to serve homebound elderly from ages 70 to 85 with vision problems. Geriatric nurse practitioners work in the patients’ homes in collaboration with an ophthalmologist or optometrist who performs refraction assessments.
Special training at Weill Cornell Medical Center Departments of Ophthalmology and Internal Medicine, ensure that the NPs put the medical and visual pieces together to focus on the whole person, says Brennan.
NPs perform eye and health assessments to rule out comorbid conditions like diabetes or hypertension that are caused by changes visualized in the retina or optic nerve.
The program fills the gap that often occurs when eye assessments are not included as part of the physical assessment, says Brennan. “The eyes are the windows to the body for seeing, but also for taking visual cues from the environment and helping to prevent falls,” she says. “Twenty percent of hip fractures caused by falls are related to vision impairment.” The service overcomes the barrier faced by the legally blind, who cannot get out to obtain the designation they need to qualify for state-provided eye services, says Brennan.
The nurses help clients maintain a safe home environment by making suggestions on how to improve lighting or remove dangerous objects such as throw rugs, and ascertain whether clients can exit their homes safely in case of emergency. They also facilitate acquirement of special devices to help them manage their daily living more effectively.
The pilot program is currently offered free of charge. As it develops, the program will accept Medicare, Medicaid, and private insurance.
Continuity of Care
The NPs provide continuity of care to help seniors manage their everyday lives. For example, they provided Mrs. Cowel with a coffee mug with a white center so she could see the coffee, and a liquid level indicator that sits on top of the cup and beeps when the coffee comes within an inch of the cup’s top. To prevent Mr. Thomas’ risk of medication errors, they telephoned the pharmacy and requested that labels with larger written instructions and better contrast be used on his medication bottles.
“The solutions to everyday problems sound small, but they are so important for seniors with low vision in their everyday lives,” says Brennan. “There are things that can be done to help seniors with low vision maintain a good quality of life,” she says.