Date Presented Accepted for AOTA INSPIRE 2021 but unable to be presented due to online event limitations. National guidelines for promoting health literacy do not consider the needs of people with low vision. This study explored consumer perceptions of a patient handout that was simplified for people with low health literacy and low vision. The simplified handout elicited statistically significant improvement in readability, suitability, and comprehensibility. This is the first study to examine the readability of patient handouts designed for people with low health literacy and low vision. Primary Author and Speaker: Jennifer Fortuna Contributing Authors: Anne Riddering, Cassie Lopez-Jeng, and Linda Shuster

Date Presented Accepted for AOTA INSPIRE 2021 but unable to be presented due to online event limitations. This study explored how older adults with visual impairment participate in physical activity. Research shows that older adults with visual impairment benefit from engaging in physical activity. The themes of exercise to enhance health and well-being, occupations as activity, loss of participation, adaptation to vision loss, and motivation to stay healthy emerged from the study. Physical activity is an important component to promote health and wellness in older adults with visual impairment. Primary Author and Speaker: Julie Ann Nastasi Additional Authors and Speakers: Kayley Carnes, Kaitlin Kenyon, Gabriela Lins, Alicia Lipinski, Meghan Murtha, Megan Neary, Elizabeth Neilan, Devon Tirney

Date Presented 04/13/21 This study explored associations between health literacy and severity of visual impairment in older adults with age-related macular degeneration (AMD). The Short Test of Functional Health Literacy in Adults was used to assess health literacy for timed and untimed testing conditions. A one-way analysis of variance was used for analysis. Timed, 73% of participants had inadequate health literacy. Untimed, 100% of participants had adequate health literacy. All scores improved with the time limit removed. Time may be underrecognized factor of reading performance in older adults with AMD. Primary Author and Speaker: Jennifer Fortuna Contributing Authors: Tina Fletcher, Catherine Candler, and Karen Dunlap

Importance: Evidence supports interventions for social participation for older adults with low vision. Objective: This systematic review examined the evidence for interventions within the scope of occupational therapy practice to maintain, restore, and improve performance and quality of life in leisure and social participation for older adults with low vision. Data Sources: MEDLINE, PsycINFO, CINAHL, OTseeker, and the Cochrane Database of Systematic Reviews were searched for articles published from January 2010 to March 2017 that described interventions within the scope of occupational therapy practice for older adults with low vision (mean age 55+). Study Selection and Data Collection: Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA–P) guidelines were followed and applied for this review. Exclusion criteria included publications outside of the period of the study, participants with mean age <55 yr, and interventions outside the occupational therapy scope of practice. Findings: The search yielded 455 articles, of which 3 Level III studies met the inclusion criteria. Low evidence with high risk of bias was found for interventions supporting social participation. Group therapy, more hours of direct service over a shorter duration, and fitting with low vision devices resulted in improvements in social participation and other outcomes. Conclusion and Relevance: Little evidence exists to support occupational therapy interventions in the areas of leisure and social participation. More research is needed in these areas. What This Article Adds: There continues to be a need for research studies in the areas of leisure and social participation.

Importance: Low vision affects many older adults and is expected to significantly increase over the next several decades. It has a significant impact on all aspects of daily life, including the reading required for participation in occupations. Objective: To determine the effectiveness of interventions within the scope of occupational therapy to improve reading required for the performance of occupations by older adults with low vision. Data Sources: We conducted a systematic review of literature published in the Cochrane Database of Systematic Reviews, MEDLINE, PsycINFO, CINAHL, and OTseeker databases from 2010 through 2016. The references of retrieved articles were also hand searched. Study Selection and Data Collection: Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were used to abstract and assess data quality and validity. This review followed the established methodology of the American Occupational Therapy Association Evidence-Based Practice Project. Findings: Sixteen articles met the inclusion criteria and were categorized into three themes: (1) technology, (2) visual skills training, and (3) multicomponent interventions. Moderate evidence supports stand-based electronic magnification and eccentric viewing training to improve reading outcomes. Strong evidence supports multicomponent interventions. Conclusions and Relevance: Occupational therapy practitioners working with older adults with low vision are strongly encouraged to integrate stand-based electronic magnification, eccentric viewing training, and comprehensive low vision services into routine care. Further research with larger sample sizes and functional reading outcome measures is needed. What This Article Adds: This review provides additional support for the use of select occupational therapy interventions (stand-based electronic magnification, eccentric viewing training, and comprehensive low vision services) to support the reading required for occupational performance for older adults with low vision. The findings provide guidance to occupational therapy practitioners for selection and implementation of evidence-based interventions for reading.

Importance: The prevalence of low vision increases with age. Low vision has detrimental effects on older adults’ independence. Objective: To identify the effectiveness of interventions within the scope of occupational therapy practice to maintain, restore, and improve performance in daily activities for older adults with low vision. Data Sources: Literature published between 2010 and 2017 was searched in CINAHL, Cochrane Databases, MEDLINE, OTseeker, and PsycINFO. Study Selection and Data Collection: The authors screened and appraised studies following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) protocol. Studies were eligible if the participants’ mean age was 55 yr or older, the level of evidence was Level III or higher, the intervention was within the scope of occupational therapy practice, and the outcome measures assessed the performance of daily activities. Findings: Fourteen studies met the review criteria. Three intervention themes were identified: low vision rehabilitation services (n = 6), self-management approach (n = 6), and tango (n = 2). Moderate evidence was found for low vision rehabilitation services. Low evidence was found for using the self-management approach or adding the self-management approach to existing low vision rehabilitation services. Low evidence was found for tango. Conclusion and Relevance: This systematic review supports the use of low vision rehabilitation services as an effective approach. Occupational therapy practitioners are encouraged to be part of multidisciplinary teams that offer comprehensive low vision evaluations and multicomponent services. What This Article Adds: Low vision rehabilitation that offers multidisciplinary services, including occupational therapy, is effective in promoting independence among older adults with low vision.

The special section in this issue advances research for occupational therapy interventions for people with low vision. Three systematic reviews provide evidence for occupational therapy interventions in the areas of activities of daily living, instrumental activities of daily living, leisure and social participation, and reading. In addition, the special section addresses oculomotor treatment in traumatic brain injury, normative data for the Dynavision, and properties of a ScanCourse.

OBJECTIVE. We describe the development and content validation of the revised Self-Report Assessment of Functional Visual Performance (R–SRAFVP). METHOD. The content validation process consisted of three stages: (1) three occupational therapy experts in low vision rehabilitation revised items on the 38-item SRAFVP via written feedback and semistructured interview, (2) eight occupational therapy low vision experts evaluated items for relevance and provided feedback on the rating scale, and (3) five adults with low vision provided feedback on item clarity via cognitive interviewing. RESULTS. In Stage 1 review, 21 items were added, totaling 59 items. In Stage 2 evaluation, 9 items were eliminated, resulting in the 50-item R–SRAFVP with a 4-point scale. The scale content validity index of the R–SRAFVP was .9. Stage 3 cognitive interviewing provided no substantive changes in content. CONCLUSION. R–SRAFVP content was relevant to evaluate the ability of adults with low vision to complete vision-dependent daily tasks and was understandable by these participants.

OBJECTIVE. Our objective was to validate the construct of the Revised Self-Report Assessment of Functional Visual Performance (R–SRAFVP) for older adults with low vision resulting from age-related eye disease. METHOD. The 50-item draft of the R–SRAFVP was administered to 87 older adults with low vision. Construct validation included principal-components analysis and the known-groups method. RESULTS. Principal-components analysis revealed nine components (comprising 33 items): Personal Care, Oral Care, Meal/Laundry Preparation, Financial Management, Telephone Usage, Personal Preference Activities, Reading, Writing, and Functional Mobility. Cronbach’s α ranged from .72 to .84 for individual components and was .92 overall. Known-groups comparisons showed that participants with moderate to profound acuity loss or contrast sensitivity deficits reported significantly greater difficulty completing tasks on the R–SRAFVP than those with milder acuity loss or normal contrast sensitivity. CONCLUSION. The 33-item R–SRAFVP demonstrates adequate evidence of reliability and validity to evaluate the ability of older adults with low vision to complete vision-dependent activities of daily living.

OBJECTIVE. In this study, we investigated whether older adults with low vision (LV) from age-related macular degeneration (AMD) demonstrated lower functional health literacy than older adults without LV. METHOD. Fifty adults with AMD were matched with adults without LV on age, gender, education, and income. We measured visual acuity, contrast sensitivity, and reading speed and administered the Test of Functional Health Literacy in Adults (TOFHLA) using two test time conditions, standard and unlimited, to measure health literacy levels. RESULTS. The group with LV had considerably lower TOFHLA scores for both time conditions (p < .001) and took notably longer to complete the test (p < .001). Poorer acuity correlated with lower TOFHLA scores in the group with LV. CONCLUSION. Older adults with LV may take longer to read and understand health information, which has important implications for providing health education to support self-management. Modifying components of the reading task may facilitate reading performance and understanding of health education materials.

OBJECTIVE. We sought to identify factors that facilitate and inhibit readiness for low vision interventions in people with vision loss, conceptualized as readiness for change in the way they perform daily activities. METHOD. We conducted 10 semistructured interviews with older adults with low vision and analyzed the results using grounded theory concepts. RESULTS. Themes involving factors that facilitated change included desire to maintain or regain independence, positive attitude, and presence of formal social support. Themes related to barriers to change included limited knowledge of options and activity not a priority. Themes that acted as both barriers and facilitators were informal social support and community resources. CONCLUSION. This study provides insight into readiness to make changes in behavior and environment in older adults with vision loss. Study findings can help occupational therapy practitioners practice client-centered care more effectively and promote safe and satisfying daily living activity performance in this population.

If occupational therapy is to advance in conjunction with the health care system to achieve the triple aim, evidence must be used to pave the way to new roles and areas of practice.

PURPOSE. To examine the visual status of a cohort of older adults on an orthopedic unit to determine their level of available vision to complete everyday activities in the hospital setting. METHOD. A convenience sample of 50 people was recruited. A visual history was obtained, and participants’ glasses were inspected. Distance acuity, reading acuity, and contrast sensitivity were assessed using standardized screening charts. RESULTS. Of participants, 26% did not have their glasses with them until prompted, and 85% had glasses in poor condition. When tested wearing their habitual correction, 6% had low vision, 2% were blind, 41% had reading acuities worse than 20/25, and 28% had contrast sensitivity deficits. CONCLUSION. Visual impairment is prevalent in older adults, yet visual function is not routinely screened in hospitals. Occupational therapists should routinely inquire about patients’ visual status, inspect their glasses, and encourage regular eye examinations. Failure to address vision could lead to inaccurate evaluation results.

Vision impairment is common in the first year after traumatic brain injury (TBI), including among service members whose brain injuries occurred during deployment in Iraq and Afghanistan. Occupational therapy practitioners provide routine vision screening to inform treatment planning and referral to vision specialists, but existing methods are lacking because many tests were developed for children and do not screen for vision dysfunction typical of TBI. An expert panel was charged with specifying the composition of a vision screening protocol for servicemembers with TBI. A modified nominal group technique fostered discussion and objective determinations of consensus. After considering 29 vision tests, the panel recommended a nine-test vision screening that examines functional performance, self-reported problems, far–near acuity, reading, accommodation, convergence, eye alignment and binocular vision, saccades, pursuits, and visual fields. Research is needed to develop reliable, valid, and clinically feasible vision screening protocols to identify TBI-related vision disorders in adults.

This issue of AJOT adds to the growing and evolving understanding of the effectiveness of occupational therapy interventions to meet the needs of older adults living with low vision; additional high-quality research is needed.

Systematic reviews of the literature relevant to older adults with low vision are important to the practice of occupational therapy. This article describes the four questions that served as the focus for the systematic reviews of the effectiveness of occupational therapy interventions for older adults with low vision. We describe the background for the reviews; the process followed for each question, including search terms and search strategy; the databases searched; and the methods used to summarize and critically appraise the literature. In addition, we present the final number of articles included in each systematic review; a summary of the results, strengths, and limitations of the findings; and implications for practice, education, and research.

A systematic literature review was conducted to evaluate the effectiveness of interventions within the scope of occupational therapy practice to improve or maintain the driving performance and community mobility of older adults with low vision. The results of this review identified a limited number of articles—eight—that met the inclusion criteria. Identified intervention strategies included the use of bioptics or prisms, multidisciplinary vision rehabilitation for community mobility, driving simulator training, driver education programs, and orientation and mobility training. Evidence is insufficient for the effectiveness of these interventions in improving or maintaining the driving performance or community mobility of older adults with low vision. Key study limitations included heterogeneity of sample characteristics (age, type of vision impairment), lack of standardization of interventions (device type, time, intensity duration), and lack of standardized assessments to measure driving and community mobility. This evidence-based review is informative for discussion of practice, education, and research implications.

The impact of age-related vision loss on older adults’ independence at home is profound. The purpose of this systematic review was to identify the effectiveness of interventions within the scope of occupational therapy practice to maintain, restore, and improve performance in daily activities at home for older adults with low vision. We searched and screened abstracts from multiple electronic databases and identified 17 studies that fulfilled our inclusion and exclusion criteria. Three themes in intervention approaches emerged: multicomponent intervention, single-component intervention, and multidisciplinary intervention. Strong evidence of effectiveness was found in studies that applied a multicomponent approach; these interventions involved teaching knowledge and skills that older adults with low vision need to help overcome the disablement process. Evidence also suggests that multiple sessions of training with low vision devices and special viewing skills to compensate for vision loss are necessary to have a positive effect on daily activities. Finally, multidisciplinary intervention that focused on personal goals yielded greater positive outcomes than interventions that were not personalized.