It’s not always immediately clear when someone with dementia enters the practice, but ELAINE GRISDALE and MARIANNE COLEMAN outline some potential scenarios and how to respond.
Following our previous article about dementia, part two answers some key questions for optical dispensers to enhance the quality-of-life of people living with dementia.
Signs someone has dementia
Knowing about a dementia diagnosis ahead of an eye appointment can be the exception, rather than the rule.
This can hamper efforts of eyecare practitioners who want to deliver the best in patient-centred care.
Why might people with dementia or carers/supporters choose not to disclose a dementia diagnosis?
They may be unsure of the benefits of disclosure in the eyecare context, perhaps after experiencing stigma at other healthcare appointments. The person may not have a diagnosis yet, or may not have come to terms with it.
“The most important thing any eyecare professional can do is look beyond the label of dementia and see the person.”
Whatever the reasoning, we have regular contact with our clients and are in a privileged position to support them, whether they have a diagnosis or not.
Some giveaways that a dementia diagnosis may be in the mix include having someone else making the appointment, mix-ups with appointments, or requests to change primary contact details for reminders and billing.
Helpful tips when people with dementia visit my practice
Dementia does not affect everyone in the same way, so it can be difficult to know what to expect.
However, the most important thing any eyecare professional can do is look beyond the label of dementia, and see the person. Respecting the personhood of a person living with dementia gives them purpose, status and value in society (Kitwood, 1998), and people with dementia wish to express their aesthetic preferences when choosing frames, so be sure to.
Many people with dementia can give consent (Shah et al., 2017), and where capacity may be in question, making decisions can still be a partnership between you, the person with dementia and their carer/supporter.
Some simple strategies can take an eyecare experience from good to great for people with dementia and their carers supporters:
1. Be mindful that “we see with our brain”. Some types of dementia can affect visual processing, and an ordinary dispensary layout can become difficult to navigate for some people with dementia. (Crutch, Yong and Shakespeare, 2016).
2. Assume nothing. Some people with dementia may rise to the occasion of an eye test, or shopping for frames, and can seemingly navigate openings of conversation easily. Signs of dementia may only start to emerge as the conversation progresses. Similarly, assume nothing about the glasses they may have brought along.
3. Think about your environment. Noisy or distracting environments can trigger behaviours such as agitation or anxiety, especially if a person is also experiencing hearing loss. Can you turn off background music? Is there somewhere quieter to wait for the appointment, or to have frames fitted? Having items to fiddle with (even a lens cloth to fold), or something soft to touch, such as a stuffed toy or blanket, can help with anxiety and agitation.
4. Be patient and flexible; appointments can always be continued another time.
5. Communicate clearly,andfocus on the person with dementia first and foremost, involving their carer/ supporter where needed.
6. Encourage a partnership.Smile, introduce yourself and keep the patient informed of what you are doing. A lanyard with your name, photo and role is useful.
Dementia-friendly dispensing tips
1. Beware the “tyranny of choice” – some people may find the array of options on offer at a frame bar off-putting or even distressing. Ask the right questions regarding preferences, then bring over up to three frames to try at a time.
2. Spatial vision changes in some types of dementia can cause issues with glare or reflections, which may be helped by suitable lens coatings. Be able to justify any recommendations you make.
3. People with dementia can be at increased risk of falling (Allan et al., 2009). Wearing inappropriate or badly fitting spectacles can increase falls risk for spectacle wearers (Elliott, 2023). Single vision spectacles can be a safer option when outdoors, but avoid change for change’s sake if the person is using their existing glasses appropriately.
4. Sparepairs,brightlycolouredcasesand glasses chains can help reduce loss and address perception problems.
There are many helpful resources eyecare professionals can turn to, to learn about dementia care in Australia.
For starters, there’s the ODA Dementia-friendly dispensing webinar – available from the Optical Dispensers Australia webinar library.
‘Understanding Dementia’ is also a free online course from the University of Tasmania. Also, check out Dementia Australia’s dedicated guide about dementia and eye health, which includes an information sheet about eye tests for people with dementia and carers, and a tip sheet for eyecare professionals.
ABOUT THE AUTHORS: Marianne Coleman works within the National Centre for Healthy Ageing at Monash University & Peninsula Health. Elaine Grisdale is the director of development at the International Opticians Association and scientific director of the SILMO Academy.
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