Early identification of vision problems and timely treatment help support older adults’ functional ability and enable safe and independent living at home.
One key factor in older adults’ ability to live at home—yet often overlooked—is the role of the senses, particularly sensory impairments. A recent doctoral dissertation by Tiina Pesonen at the University of Oulu shows that even mild vision impairment affects the functional capacity of older adults. This finding is significant, as vision problems are often considered a natural part of ageing and may therefore receive insufficient attention in care and treatment.
Vision is a central component of safe mobility and everyday functioning. When vision declines, daily activities can become more difficult. Even small changes may accumulate over time, leading to reduced mobility, increased uncertainty and feelings of insecurity, and a growing need for assistance. Reduced mobility can also increase loneliness, as natural opportunities for social interaction diminish.
“Supporting vision is an essential part of supporting overall functional ability. From the perspective of living at home, a particularly challenging situation arises when impaired vision is combined with cognitive decline, as their combined effect significantly reduces the ability to manage basic daily activities and increases the need for support and services”, says Tiina Pesonen.
Poor vision increases falls and costs
Preventing falls is a critical issue for older adults living at home. Falls are one of the most common causes of injuries, hospitalizations, and loss of functional capacity among older people. In addition to human suffering, they generate considerable costs for healthcare systems. The earlier risk factors are identified, the better they can be minimized.
Traditionally, fall prevention has focused on factors such as muscle strength, balance, medication, and home accessibility. The importance of vision is often overlooked, even though it affects all of these factors.
In services for older adults, vision is regularly assessed using tools such as the RAI (Resident Assessment Instrument), which identifies moderate visual impairment reasonably well. Otherwise, vision is typically assessed in healthcare services based on the situation—for example, during appointments or when individuals themselves report vision-related difficulties.
However, Pesonen emphasizes that vision screening for older adults should be conducted more systematically in primary-level services, as declines in vision or other vision-related problems may easily go unnoticed or may be mistakenly considered a normal part of ageing.
“Beyond identification, another challenge is what happens after vision has been assessed as impaired. Development efforts should therefore pay special attention to follow-up measures, such as referral to treatment, rehabilitation, assistive devices, and counselling.”
This, in turn, requires commitment and investment from wellbeing services counties. In vision and eyecare, optometrists practically form the foundation for early detection. Integrating optometrists more closely into eye care services, along with effective national operating models and care pathways, would improve early identification and access to treatment for vision problems among older adults—and the population at large.
Appropriate support enables safe living at home
Sensory impairments should already be considered in service design, as early identification of declining vision and appropriate support and treatment have a broad impact on an individual’s quality of life. They can help prevent falls, maintain functional capacity, and support safe living at home.
Tiina Pesonen also highlights the broader societal impact of supporting functional ability: “Supporting functional capacity helps people maintain their independence and reduces the need for more intensive services. Especially for older adults, it enables longer living at home, which in turn reduces the costs of social and healthcare services.”
