OTR 532: Evaluations of Older Adults
July 1st, 2013
Case Report: Age-Related Macular Degeneration As a person ages their visual feedback can be affected by many factors. A specific condition that can interfere with an individuals occupational performance is age-related macular degeneration (AMD). Macular degeneration is a progressive physical breakdown of the macula, which is part of the retina. There are two forms of macular degeneration, “wet” and “dry”. Eighty to ninety percent of patients have the “dry” form. Both wet and dry AMD can drastically impact an individuals ability to maintain independence, complete daily ADL’s, IADL’s, and BADL’s.
The “dry” form involves deterioration of the macula, that is found in the center of the retina. This form is also associated with the formation of drusen (small yellow deposits) under the macula. The drusen build up leads to thinning and drying of the macula. This form typically progresses slower than the “wet” form. This type of AMD develops gradually, and symptoms can often be mistaken as typical aging. An individual may find they need increased lighting for reading, difficulty adapting to low light levels, increased blurriness, difficulty recognizing faces, and gradually increasing haziness of central vision (Coleman, Chan, Ferris & Chew, 2008).
The “wet” form of AMD effects approximately 10-15% of individuals with this condition. In this type there is abnormal blood vessel growth under the retina and macula. This abnormal growth of blood vessels is known as choroidal neovascularization, or CNV. These blood vessels can bleed and leak fluid, causing the macula to lift up from it’s naturally flat position. This form is more serious and progresses faster than the “dry” form. Severe distortion or destruction of central vision is often the result of this form. The “wet” form causes an individual to see a dark spot(s) in the center of their vision due to the accumulation of blood or fluid. Straight lines may appear wavy to the person because the macula is no longer smooth (Coleman, Chan, Ferris & Chew, 2008).
A person living with macular degeneration is typically able to remain living in their home independently, with proper modifications and supports in place. Decreased visual feedback increases the risk of falling in older adults. Functional mobility may also be affected by decreased balance due to poor visual perception. Functional mobility can be the most drastically impacted, because of a limited visual field it is difficult to maneuver around any clutter/tripping hazards, coffee tables, pets, or other items that may be in the way of navigating one’s own home or the community. A patient with AMD may also have difficulty with self-care ADL’s such as bathing, dressing, and feeding. Due to decreased central vision an individual may have difficulty seeing dangers in the shower, finding soap/shampoos, or adjust the tempature properly when completing bathing/showering tasks. Self-feeding involves setting up, arranging, and bringing food from plate to mouth. AMD can increase the difficultly of this because of the need for primarily central vision during these tasks. Other areas affected include IADL’s communication management, community mobility,health management, home management, meal preparation and cleanup, safety and emergency maintence, shopping, leisure participation, and social participation (Occupational therapy practice framework, 2008).
Three priority areas to address when treating a client with AMD are home safety, home modification/adaptations, and social/leisure participation. The first area to be address would be done so utilzing the HOME-FAST screening tool in the client’s home setting. Due to decreased central vision the client should have a home that is free of clutter or unnecassary dangers. By removing objects such as boxes, papers, unused items from living space and walkways the client