A Needs Assessment of Persons with Visual Impairments: Implications for Older Adults

The present study was designed to document the demographic characteristics of a sample of persons with visual disabilities and provide an index of their self-reported needs. An additional purpose was to determine whether the needs of the geriatric blind or severely visually impaired (over 70 years) differed in comparison to younger persons with visual disabilities. A needs assessment survey was administered to a sample of persons living in a metropolitan area who were visually impaired. The total sample was partitioned into four age groups, those less than 30 years, 30-49 years, 50-69 years, over 70 years. The results are discussed in terms of the special areas of need for persons with visual disabilities, in general and for older persons who are blind or visually impaired in particular. Implications for working with older persons with visual impairments are also suggested. Article: Persons who are blind or have severe visual impairments, as a special disability group, are a focus of concern. In general, the allocation of federal, state and local funds for services for persons who are blind or severely visually impaired underscores a societal awareness of the importance of the needs of this special population (Goodman, 1985; Gross, 1979). One immediate implication for the general public is the cost associated with rehabilitation and social service systems designed for persons with visual impairments. Thus, policy analysts and service agencies must carefully weigh the characteristics and self-expressed needs of the visually impaired to ensure optimum service provision and utilization. From a demographic perspective, older adults have considerably higher incidence of visual impairment than do younger persons (Lowman & Kirchner, 1979). This is not surprising, given that the various causes of blindness, such as diabetes, macular degeneration, glaucoma and cataracts, are concomitants of biological aging (Worden, 1976). There are an estimated 4.5 million blind or severely visually impaired elderly adults in the United States at present (Select Committee on Aging, 1985). Moreover, the demographic projections for the year 2000 indicate a disproportionate increase in the number of legally blind and severely visually impaired persons over age 65, relative to other age groups (Kirchner, 1985; Lowman & Kirchner, 1979). In light of these trends, it is essential to understand the service needs and characteristics of a constituency that is both visually impaired and aged. Given the fact that persons over age 65 presently constitute the largest segment of the visually impaired population and are growing in number (Goodman, 1985), one important question is whether their service needs differ in comparison to younger persons. Both clinical as well as empirical research and literature suggest that impaired vision in later life can have consequences in various spheres of social, emotional, mental and physical well-being and functioning (Gillman, Simmel & Simon, 1986; Grieg, West & Overbury, 1986; Havlik, 1986; Soroka & Newcomb 1981.) In addition to blindness, older persons may be coping with other physical deficits, such as deafness, arthritis, and general infirmities of old age, thus it is reasonable to expect that their service needs are different from younger persons with visual impairments. Moreover, having a visual impairment may be a new experience for older adults, thus additional needs associated with the adjustment to blindness in later life might be expected (Rosenbloom, 1982; Wineburg, 1982). Addressing the service needs of older persons with visual disabilities depends in part upon the adequacy of current information regarding their special needs and characteristics. There have been relatively few needs assessment endeavors directed toward older persons with visual disabilities. Love (1982) surveyed the orientation and mobility (OM) needs of older blind persons, from the perspective of the OM instructors. The results of Love's survey indicated that most of the elderly respondents used support canes and were mobile, although persons using walkers and crutches evidenced greater mobility difficulty. It is instructive to note that most of the OM instructors in Love's study reported needing more information as to how to work with the geriatric blind since they are likely to need additional devices, such as canes or wheelchairs to enable them to travel. Given the scarcity of needs assessments designed for persons with blindness and severe visual impairments, the present survey was undertaken to provide an empirical description of the needs of this special population. Documenting the self-perceived needs of persons with blindness or severe visual impairments is essential, not only to ensure optimal service, but for the general goal of developing a more efficient and cost effective state service network. The present study was unique in its resolve to provide a broad and integrative picture of the needs of a large sample of persons with visual impairments. A second unique aspect of the study concerned the wide age range of the participants surveyed (3 to 98 years). Given the broad age span, it was possible to partition the total sample into four separate age groups to compare the needs of older persons who are blind or severely visually impaired (over age 70) relative to the other age groups (those under 30, 30-49, 50-69). The needs of elderly adults with severe visual impairments are poorly understood (Branch, 1989; Dinner & Raftary, 1984; Goodman, 1985; Worden, 1976), therefore it seemed important to determine whether older persons' pattern of responses to the needs assessment survey differed from those of other ages. The discussion is organized as follows. The administrative and methodological aspects of the survey are highlighted first; then the demographic characteristics and self-expressed needs of the sample are discussed. In the final section, special areas of need for the geriatric blind are emphasized and some general implications for older adults and service providers are suggested. THE SURVEY Origin and Design. The Georgia Department of Human Resources, Division of Rehabilitation Services (DRS), contracted with the University of Georgia to conduct a needs assessment project. The DRS, a state and federally funded agency, sponsors a variety of programs and services designed to foster self-sufficiency in persons with disabilities. A task force of professionals and visually impaired consumers from the University and the DRS designed and piloted the needs assessment questionnaire. The survey questions were designed to gain information relevant to three DRS programs, i.e., the Employment, Independent Living, and Disability Adjudication programs. Thus, there were a total of five dimensions assessed in the survey, including demographic characteristics, disability adjudication, independent living skills, mobility and transportation needs, and interest in employment. Data Collection and Scoring. Survey participants were contacted through a collaborative effort involving state service providers, rehabilitation counselors, ophthalmologists, optometrists, hospitals, school systems, nursing homes, news media and advocacy groups. The various referral agents informed potential survey participants about the needs assessment project and these persons then self-selected to participate.' All referrals were pursued by the project coordinator who ensured that all prospective participants were screened for degree of blindness, which was defined as (a) central visual acuity of 20/200 or less in the better eye even with the use of corrective lenses, (b) field of vision is limited to 20 degrees or less, or (c) inability to read ordinary newsprint with use of corrective lens. Blindness was operationally defined as (a) lack of light perception, (b) inability to see to the side without turning the head, (c) inability to read ordinary newsprint with glasses, and (d) inability to see the number of fingers held at arm's length. All persons were telephone interviewed by volunteers who were trained prior to the administration of the survey. All respondents self-selected to participate in the study and the data collected was self reported by the respondents. Data summary and analysis followed. Comparisons were made by entering the responses into contingency tables which expressed response frequency by age group for each question in the survey. The chi square statistic was used to determine whether the patterns of expressed need and age group membership were independent. Where there was evidence of a statistical association between age and the frequency of response (p < .05), the chi square values are reported. To identify the source of the significant differences within each table, standardized residuals were computed for each question. Standardized residuals which exceed the criterion value indicate which cell or cells of the contingency table contribute to the overall significance of the chi square statistic (Hayes, 1988), and thus aid in the interpretation of significant age group by response frequency associations. DEMOGRAPHIC CHARACTERISTICS Survey Participants. A total of 303 persons from eight Atlanta area counties participated in the study (range = 3 to 98 years, mean age (M) = 59.3). These persons lived in city/town areas (.76), the suburbs (.09), and in rural areas (.15). Participants' protocols were partitioned into four age groups for data summary and analysis. Although the criterion for age group inclusion was somewhat arbitrary with respect to the more typical conventions (e.g., 65 + , 85 + ), the present divisions were employed to ensure that sample sizes within each group were proportional. The first age group was comprised of persons who were less than 30 years of age (M = 19.7 years, SD = 7.5 years). The second group included persons between the ages of 30 and 49 (M = 40.1, SD-5.7), the third group were between 50 and 69 (M = 60.2, SD=5.3), and the fourth group were over age 70 (M 80.3, SD = 6.7). There were 59, 96, 75 and 73 respondents in each of the four age groups, respectively. Visual Impairments. The types and frequency of reported visual impairments did not statistically differ among the age groups. Most persons had an inability to read newsprint with glasses (.83), others could not see the number of fingers held at arms length (.49), or could not see to the side without turning the head (.63), and others (.20) could not see light. The relationship between age of onset and chronological age was