Expert series blog: Sight loss, dementia, and the built environment

Posted: 
6 June 2014

Jo Lawson, Independent Living Manager at RNIB Cymru discusses how people with dementia and sight loss can be helped to live as independently and safely as possible

It’s a fact that the population is ageing. 10 million people in the UK are over 65 years old.  It is projected that there will be five and a half million more elderly people in 20 years time and the number will have nearly doubled to around 19 million by 2050.

Some more facts: sight loss affects people of all ages but especially older people, one in nine people over the age of 60 and one in three people over the age of 85 are living with sight loss. The number of people living with sight loss is set to double over the next 25 years. Over a fifth of people with sight loss live in social housing. Ensuring their safety, independence, and equality is paramount to the work my team and I do.

I head up the Independent Living Team at RNIB Cymru. This includes our Welfare Rights team, award winning digital inclusion team, Vision Support Officer based with RCT Homes, and of course our Visibly Better and housing and access consultancy team. Visibly Better Cymru is an accreditation scheme for supported housing and other public spaces. Organisations work towards six standards, which focus on different aspects of accessibility, and receive Bronze, Silver, Gold and Platinum levels of accreditation as they progress through the standards. Visibly Better accreditation is a hallmark of good practice, recognised by Welsh Government, which organisations can use in marketing materials to attract new clients and to include in tenders for contracts.

Dementia is an increasingly common disability in older people and there are around 45,000 people in Wales who have it. In addition over 1 in 3 people with dementia will have a significant sight loss, with a large proportion of the rest having deteriorating vision through ageing.

People with dementia often have other health needs and conditions which tend to increase as people with dementia age. The combination of both dementia and sight loss can have a large and often dramatic effect on a person’s ability to cope with the symptoms of dementia.

Sight loss can also be caused by dementia itself. People with dementia often experience changes in visual functioning or visual perception due to neurological impairments, including problems with depth perception, glare and visual mistakes, or misrepresentations. Visual mistakes can take the form of illusions, misperceptions, misidentifications, and sometimes even hallucinations. These changes in vision can further be exacerbated by natural age-related changes to the eye and/or sight conditions.

To summarise, someone who has both dementia and sight loss will be in one of three situations:

  • A person with dementia whose visual functioning is affected by brain changes caused by the dementia but who does not have a separate eye condition; the brain cannot interpret and process the information from the eyes which are healthy.
  • A person with dementia who does not have impairment of the brain functions associated with vision but has an eye condition such as macular degeneration or cataract.
  • A person who has a combination of the above.

Our Senior Housing and Access Consultant Antonia John has written “Homes for people with dementia and sight loss: a guide to designing and providing safe and accessible environments”. The aim of this guidance is to support organisations and individuals when designing, refurbishing, and maintaining new and existing accommodation and other public spaces. It is based on the principles of providing a fully inclusive environment that supports people with dementia and sight loss to live as independently and safely as possible.

Housing associations from across Wales have told RNIB Cymru that some existing information and advice from the dementia field contradicts other best practice guidance; especially relating to meeting the needs of people with sight loss. There is also currently no definitive guidance on building EMI (Elderly Mentally Ill) wings or Extra Care homes linking in with sight loss and dementia requirements. This publication seeks to address this.

Due to the nature of dementia and the wide and varied symptoms that people experience when they have both sight loss and dementia there is not a “one size fits all” set of recommendations that will meet everyone’s needs. Similarly as dementia progresses someone’s needs may change and further adaptations may be necessary, as what worked previously to support a person’s independence may not continue to support them. There are however key principles that can be incorporated when designing and refurbishing housing for people with dementia and sight loss and these are detailed in this publication.

“Homes for people with dementia and sight loss” is for everyone involved in the design, development, and management of housing or other related disciplines. The guide is particularly aimed at organisations which are designing, refurbishing or maintaining existing sheltered housing stock and those building and designing new Extra Care housing and care homes. It will also be a valuable resource for managers of sheltered housing, Extra Care schemes, and care homes.

For more information, or to order your free copy of the publication, please email Jo Lawson, RNIB Cymru's Independent Living Manager Joanne.Lawson@rnib.org.uk

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