Abstract
In the summer of 2016, I returned to New York City after living and working for the previous 15 years in California. A few dozen visits back east during that period kept the environment etched in memory. In that time, I went from a 47-year-old blind person to a 63-year-old one. As I recommenced life in my hometown, I noticed that I had grown more hesitant and less sure of myself.
I am part of an emerging cohort of “experienced” blind baby boomers who, due to the combined effects of aging and blindness, may be encountering more difficulty functioning than we are used to. An experienced blind person, by my own definition, is one who has lived and learned to function well with one’s own blindness or low vision for at least a decade so that accomplishing everyday activities is more or less routine. I propose that these effects, although subtle, are impactful, both on the blind individuals who are growing older and potentially on the service-delivery system. What are some of the things that happen to people who are blind who are growing older? Can the current rehabilitation service-delivery system help? Is it even the appropriate venue? Or, given the methodologies used and the capacity of the rehabilitation system, what alternatives might blind persons who are growing older use in order to continue to function well?
The Effects of Aging on Blind People
The sometimes-subtle effects of being blind and growing older include slight decreases in hearing acuity, which can reduce confidence in travel skills or in the ability to hear or attend to conversations or audible outputs from appliances or computers. Individuals may experience reduction in physical abilities such as strength, stamina, balance, agility, and reflexes. These deficits can lead to slower walking speeds, more difficulty climbing stairs, and less confidence in tripping-recovery, leading to surprise when falls occur. Finally, there may be psychological effects, such as subtle increases in anxiety and slowing of memory and thinking, mastery of which historically has been a staple of how blind people function well.
Just as impactful for many older people who are blind are difficulties in keeping up with the latest technological advances (e.g., smartphones, newer versions of computer operating systems, and redesigned websites) that are necessary to manage the demands of contemporary society.
As this commentary is being written, the world has been immersed for two years in a pandemic that has made home-based information-processing a must, including the potentially life-saving tasks of obtaining food and vaccination appointments (not to mention getting to those appointments). Adding to the burden are the tasks of maintaining contact with friends, family and business associates via virtual meeting software, all in the backdrop of the loss of a lifetime of personal contact and proximal assistance.
The U.S. Census Bureau (2019) estimated that 73 million baby boomers would reside in the United States by 2020, with the oldest having reached the age of 74 years and the youngest 65 years. By 2030, all baby boomers will have exceeded the age of 74 years. Assuming they experience the usual effects of aging and no serious secondary disabilities or health conditions, the phenomenon I am describing will exist. Thus, I hope that blindness professionals will look out for, become aware of, and report the difficulties incurred by experienced blind persons who are growing older.
Who Will Meet The Needs of Experienced Older Blind People?
Is the current service-delivery system capable of helping experienced older blind people? In the United States, the principle mechanism for serving blind persons over age 55 years is the Older Individuals Who Are Blind (OIB) program. Through grants to states, private agencies for the blind provide the majority of program-related independent living services such as vision rehabilitation therapy (daily living skills), orientation and mobility, low vision services, assistive technology, and counseling and referral. Over the years, and, as the incidences of blindness among older persons has increased, severely stretched OIB programs have had to evolve to include ways to prioritize who will receive services first. Factors for prioritization include, but are not limited to, safety concerns, potential imminent institutionalization, severity of visual impairment, availability of personal support, transition in living conditions (from home to a nursing home or to the homes of adult children), and the amount of time spent waiting for services. Management strategies for controlling costs (e.g., for assistive devices) and a variety of strategies such as group training to maximize staff time also have evolved. With their needs paling in comparison to those of newly blinded older persons, it will be important to develop a strategy to deal with the potentially large cohort of experienced blind persons who are growing older.
How Can the Service-Delivery System Help Experienced Blind People?
As alluded to above, the new cohort may respond best to a simple and on-demand process that involves a small amount of time from rehabilitation professionals and self-help connections to other experienced blind persons who are growing older. Is the OIB program the appropriate venue for this kind of help? I hypothesize that the typical experienced blind person who is growing older will neither desire nor need a rigorous and formal rehabilitation program. Of course, those with more serious concerns can still request services from the OIB program and, in the case of those who are still employed, from the vocational rehabilitation system.
For the needs of experienced blind people to be met, professional action is needed. Blindness professionals are in the best position to solicit observations from their experienced blind colleagues who are growing older. They can hold focus groups with current or former OIB consumers to further illuminate the needs of this cohort. If they suggest or offer services, professionals should gauge the reaction to such offers. I, for one, might not feel the need to engage the rehabilitation system, including the OIB program per se, but I might want a quick assessment and some advice from a rehabilitation professional in specific areas where my own skills are “shaky.” I also might want to talk with others in similar situations. Many of these needs could be met by group services and discussions, which hopefully could be conducted in an accessible manner. Finally, professionals need to tabulate their findings on the needs of older experienced blind people and share them with their supervisors and administrators. It will be incumbent upon the service-delivery system to figure out what to do next for people like me, and I am hopeful organizations like the Vision Serve Alliance (2021) will embrace the challenge.
Footnotes
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding
The author(s) received no financial support for the research, authorship, and/or publication of this article.