This scoping review aimed to map those factors which have been found to influence the occupational engagement of older adults with low vision. As a profession focused on enabling participation in meaningful occupation,
occupational therapy is particularly well suited to provide low vision rehabilitation services for seniors experiencing vision loss. The results of this scoping review, however, may be used to further define and expand the role of occupational therapy in low vision rehabilitation.
For example, in both occupational therapy and low vision rehabilitation, growing attention has been given to self-management approaches (Packer, 2011; Rees, Saw, Lamoureux, & Keeffe, 2007). A self-management approach both
incorporates and moves beyond the more traditional approaches to vision
rehabilitation, which generally involves the provision of visual aids and training in order to encourage older adults to use their residual vision (Rees et al., 2007). In contrast, self-management, involves teaching individuals with chronic conditions the skills to problem solve and manage the “practical, social and emotional consequences of their condition” (Rees et al., 2007, p. 40). In relation to the results of this review, self-management programs could be designed by occupational therapists in ways that assist clients in developing the problem solving skills needed to deal with the impact of emotional, behavioural, and environmental factors on their engagement in meaningful occupation. The
efficacy of self-management interventions have already been assessed for older adults with macular degeneration with results suggesting positive outcomes in relation to improved functioning, self-efficacy and reduced emotional distress (Birk et al., 2004; Brody, Roch-Levecq, Thomas, Kaplan, & Brown, 2005; Eklund, Sonn, & Dahlin-Ivanoff, 2004).
The quantitative research included within this scoping review, largely explored how the occupational engagement of older adults with ARVL related to age and degree of vision loss. The qualitative research added further insight regarding the influence of emotional and behavioural factors on occupational engagement and also provided initial findings regarding the importance of the physical and social environment. Thus, the findings from this scoping review highlight the need for low vision rehabilitation to go beyond addressing the influence of personal factors on occupational engagement to include a broader consideration of the influence of the environment on the occupational engagement of seniors with vision loss. Given the body of knowledge regarding environmental influences on occupation, as well as the range of strategies occupational therapists employ to address environmental influences on occupation (Letts, Rigby & Stewart, 2003), this is an area where occupational therapists can contribute to the development and
enhancement of low vision rehabilitation services.
At the same time, given the limited amount of studies found that addressed environmental influences on the occupational engagement of older adults with ARVL, it is apparent that further research is required to elucidate the complex ways in which various environmental features support and detract from
occupational engagement. As well, beyond considerations of physical and social aspects of the environment, critically informed social aging theories point to how more macro-level aspects of the environment, including political, cultural and institutional, influence the health and activities of aging individuals (Estes, Biggs & Phillipson, 2003). Thus, to fully understand what leads to occupational
restriction among seniors with low vision and to design policies, programs, and advocacy efforts that optimally enable occupational engagement for seniors with ARVL, there is a significant need for research that focuses on environmental influences that spans the various types of environments. There is also a practical and political role for occupational therapy in advocating for inclusive spaces, policies, and programs that promote the physical and social engagement of older adults with vision loss. Such a focus will raise awareness of how different
occupational engagement of seniors with age-related vision loss. By taking the lead in addressing this current research gap and linking findings to practice, occupational therapy will be well positioned to expand its contributions to LVRS and optimize the occupational engagement of the growing number of seniors who experience age-related vision loss.
2.5 Conclusion
Given population aging trends and the chronic nature of ARVL, occupational therapists will be increasingly likely to encounter clients with low vision in a variety of practice settings. As a profession focused on enabling participation in meaningful occupation, it is important that occupational therapists understand the factors which influence the occupational engagement of older adults with ARVL. To date, most of the research in the ARVL field has focused on the impact of low vision but not on understanding the various factors that influence the
occupational engagement of older adults with ARVL. Research that has
examined influences on these occupational challenges has largely focused on person-related factors, although there are some findings which address physical and social environmental components. Further research regarding the factors that shape and perpetuate the negative impact of ARVL on occupational
engagement, particularly research which more broadly considers environmental influences, is needed to advance evidence-based occupational therapy practice in this practice area.
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Table 2.1: Study Descriptive Characteristics
Authors N= Article type Factors addressed by
results West, Munoz, Rubin,
Schein, Roche, Zeger, German & Fried (1997)
2520 Quantitative; population study
Age
Wahl, Oswald & Zimprich (1999) 84 Quantitative; experimental with control group Physical environment Brennan, Horowitz,
Reinhardt, Cimarolli, Benn & Leonard (2001)
593 Qualitative; narrative data examined from three previous quantitative studies
Fear, emotional
response to vision loss
Moore (2000) 8 Qualitative;
phenomenology; interviews
Fear, emotional
response to vision loss, refusing/ delaying rehabilitation services
Moore & Miller (2003) 8 Qualitative;
phenomenology; interviews
Fear, emotional
response to vision loss, refusing/ delaying rehabilitation services Stevens-Ratchford &
Krause (2004) 2 Qualitative; interviews Physical environment
Wong, Guymer, Hassell & Keeffe (2004)
15 Qualitative; grounded
theory; interviews
Degree of vision loss, social environment Copolillo & Teitelman
(2005) 15 Qualitative; applied ethnography; interviews Refusing/delaying rehabilitation services Teitelman & Copolillo
(2005)
15 Qualitative; focus
groups and interviews
Emotional response to vision loss, social environment MacLachlan, Laliberte
Rudman & Klinger (2007)
4 Qualitative;
phenomenology; interview
Fear, emotional
response to vision loss, refusing/ delaying rehabilitation services, accepting risk, physical environment
Laitinen, Sainio, Koskinen, Rudanko, Laatikainen & Aromaa (2007)
3439 Quantitative; cross sectional survey
Degree of vision loss
Girdler, Packer & Boldy (2008)
22 Qualitative; focus
groups
Fear, emotional
response to vision loss, refusing/delaying
rehabilitation services, social environment
Wang & Boerner (2008) 58 Qualitative; cross
sectional
Social environment
Grue et al., (2008) 770 Quantitative;
observational Degree of vision loss
Laliberte Rudman & Durdle
(2008) 34 Qualitative; phenomenology;
interviews
Fear, social environment
Laliberte Rudman, Huot, Klinger, Leipert & Spafford (2010) 34 Qualitative; phenomenology; interviews Refusing/delaying rehabilitation services, accepting risk, physical environment, social environment
Boerner & Wang (2010) 151 Quantitative;
interviews Age
Alma, Van Der Mei, Melis- Dankers, Van Tilburg, Groothoff & Suurmeijer (2011)
173 Quantitative; cross
sectional study
Age, degree of vision loss
Horowitz, Brennan, Reinhardt & MacMillan (2006)
584 Quantitative; before and after with follow up
Refusing/delaying rehabilitation services Owsley, McGwin, Sloane,
Stalvey & Wells (2001)
342 Quantitative;
observational
Degree of vision loss Spafford, Laliberte
Rudman, Leipert, Klinger & Huot (2010)
34 Qualitative; interviews Refusing/delaying rehabilitation services
Weber & Wong (2010) 30 Qualitative; survey Emotional response to
2.7 Addendum to Chapter (completed 5/18/2014)