Improving later life for people with sight loss

Contents

4 Welcome

6 Sight loss in an ageing society

10 The lived experience of people with sight loss Dedicated to the memory of Alan Suttie, 20 The policy environment a former Trustee of RNIB who passed away in 2014. Alan 22 Ways forward and dedicated his life to recommendations improving the lives of blind and partially sighted people, 28 Agenda for action championing the cause of older people. 29 References

3 Welcome

On 22 June 2015, The learning from the more older people are Age UK and RNIB seminar will be used by able to look after their RNIB and Age UK to set an sight for themselves held a joint seminar agenda for positive action and are enabled to live ‘Improving later in order to empower and independently, with real life for people with support older people with choice and control over sight loss to shape their their lives. sight loss’. The own futures. seminar drew on the Our seminar concluded expertise of older Almost two million people that when people in the UK have significant experiencing sight loss people with sight sight loss. They are succeed in finding the right loss. We considered predominantly older people advice and support, this the latest research and, as more of us live can have a transformative evidence and longer, these numbers are impact on their lives. set to increase. With this However, at present there current policy demographic shift come is no universal safety net landscape. Our aim new challenges: more older or signposting to services. was to understand people needing support Such advice and support the implications to live with sight loss, is usually provided by and more experiencing voluntary and community of sight loss in an sight loss alongside groups and organisations, ageing society for other challenges often whose funding is often public policy and the associated with ageing, fragile and whose outreach including the need to capacity is inevitably provision of services manage multiple long constrained. and support. term conditions, lower income, reduced social We know that all blind and networks and experience partially sighted people, of bereavement. In this and all older people, are context, we need to ensure different. We need to

4 recognise and respond to people’s individual strengths, interests, wishes and needs – offering a range of advice, information and joined-up options that provide choice and enable older people with sight loss to live life as they wish.

We are determined that our organisations will Fazilet Hadi Caroline Abrahams lead by example, working together with people in later life to meet the challenge of sight loss in an ageing society.

This report, and the seminar on which it is based, marks the start of our efforts to do this. We look forward to “ We are determined that our working with partners and colleagues across organisations will lead by example, the voluntary, statutory working together with people in later and private sectors, as life to meet the challenge of sight well as with many older loss in an ageing society.” people, in the weeks and months ahead.

5 Sight loss in an ageing society

Society is ageing – in the UK and across the world. The scale and significance of this longevity revolution is frequently underestimated. The last thirty years have seen an increase of one third in the proportion of the UK population aged 65 and over [1] and a three- fold increase in the proportion aged 90 or over [2].

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0 1983 1987 1991 1995 1999 2003 2007 2011

People age 90+ per 100,000

Figure 1: Growth in UK population aged 90 plus

6 The number of people in the UK aged 65+ is projected to 50% rise by nearly 50% (48.6%) in the next 20 years

Figure 1 is a bar chart These figures are glasses. These people are depicting the number of significant because all living with significant people aged 90 plus per the prevalence of sight sight loss. At least one- 100,000 of the population loss increases with age. third has irreversible sight by year between 1983 Currently almost 1.5 million loss and some have vision and 2011. The chart people aged 65-84, and a that is equivalent to people demonstrates a rising further 580,000 aged 85 who are registered as trend from approximately and over, are living with partially sighted or blind. 300 people aged 90 plus sight loss in the UK [9]. And these numbers are per 100,000 population in That’s one in five people set to grow. 1983 to 800 per 100,000 aged 75 or over, and one by 2011 [3]. in two people aged 90 and The leading causes of over living with sight loss sight loss in the UK are Today, there are 11.4 [10]. These figures include uncorrected refractive million people in the UK the circa 25,000 people error, age-related macular aged 65 or over and three annually who are certified degeneration, cataract, million are aged 80 or by an ophthalmologist as glaucoma and diabetic over [4]. Life expectancy severely sight impaired or retinopathy. The evidence estimates at age 65 are sight impaired and who clearly shows just how 86.1 years for women are added to the registers common eye conditions are and 83.6 years for men of around 350,000 blind in later life, for example the [5] compared to 83.0 for and partially sighted majority of women aged women and 79.0 for men people maintained by 85 and over has at least in 1985 [6]. The revolution local authorities, as well as one eye condition [11]. is set to continue. The those whose sight is just Furthermore this has a real number of people in the UK better than the levels which effect on daily lives, with aged 65+ is projected to qualify for certification. only half of women aged 85 rise by nearly 50% (48.6%) It also includes people and over reporting that they in the next 20 years (from who are awaiting or are able to read newsprint 2015) to over 17 million [7]. having treatment such at arm’s-length, even when The population aged 85 as eye injections, laser wearing glasses [12]. and above is expected to treatment or surgery that The evidence also treble in the next 30 years may improve their sight. demonstrates that sight [7]. A baby born in 2011 is And it includes people loss in later life is often almost eight times more whose vision loss could experienced alongside likely to reach 100 than be improved by wearing other challenges. one born in 1931 [8]. correctly prescribed

7 Those in the poorest fifth of the population had an almost 80% higher risk 80% of developing severe visual impairment than those from the wealthiest fifth

Compared with the general • Are more likely to position in society to be older population, older experience falls low. Those in the poorest people with sight loss: fifth of the population had • Are more likely to an almost 80% higher risk • Are more likely to have be disabled of developing severe visual other health conditions impairment than those from • Are more likely to report the wealthiest fifth [13]. • Are more likely to have having poor quality social difficulty accessing health relationships Furthermore, older people services who develop sight loss in • Are more likely to have later life are more likely • Are more likely to live negative views of their than those who do not in poverty neighbourhood. to experience:

• Are less likely to be And the evidence suggests • A fall in quality of life; able to shop for every that sight loss may be both day necessities without a cause and consequence • A decline in social assistance of these other engagement; and disadvantages: people • Are less likely to play in the highest income • A fall in income. [13] as much sport as they groups are significantly would like to more likely than those in Taken together, this the lowest income groups evidence demonstrates • Are more likely to to retain their sight in later a clear need for action to experience chronic pain life – so there is a clear address the issues faced by older people with sight • Are more likely to have link to the wider health inequalities agenda [13]. loss. Given the prevalence problems with mobility of sight loss, it is clear outside the home Research has that our wider ambitions • Have greater need for demonstrated that the to promote healthy, active services risks of developing both later lives will not be moderate and severe realised if people with sight • Are more likely to live in vision loss are significantly loss are not able full to poor quality housing greater among people from take part in daily activities poorer backgrounds and and contribute to their those who perceived their communities.

8 9 The lived experience of people with sight loss

People in later life John Thomas is a retired are heterogeneous, RNIB’s Panel of university lecturer, radio the Third Age presenter and consultant, varying widely in RNIB has established and is a member of health, housing, the self titled “Panel P3A. He has Retinitis economic of the Third Age” or Pigmentosa (RP) which circumstances, P3A to ensure that was first diagnosed when the perspectives of he was in his 20s. He is interests, blind and partially now in his late 70s. He has aspirations, needs sighted people experienced a range of and a host of other in later life are forms of sight loss – from characteristics. fully represented night blindness, through in its work. The tunnel vision, to finally However, whatever group adopts a co- losing his sight in his early their circumstances, production approach 60s. He describes himself most want to remain to its work across as fortunate, explaining: “I have had nearly 60 years independent, the organisation, drawing on panellists’ of learning to cope with taking control of own experience as sight loss.” their situations and well as insights from John describes formal research and having access to retaining mobility and personal stories. real choice in how communication as vital they decide to live to his quality of life. He uses a long cane to get their lives. Working around, having started with older people out with a symbol cane in living with sight his 50s when his tunnel loss is one of the vision had started to cause accidents. He believes he most effective ways was fortunate to have been in which we can able to develop mobility learn how best to skills gradually. He says: empower them to “In my view, developing these mobility skills so that live well . I am able to get out in my local area, and having the

10 “ I’m sorry but you won’t be able to drive back home, because I have to register you as blind”. That came down as a wall of bricks on me.” Padma Cheriyan

confidence to do so, has voluntary sector. Thinking Padma Cheriyan is a been vitally important.” about his experience of volunteer and campaigner sight loss, he says: “There for RNIB, a member of John has used a range of are three things that I P3A and a self-confessed technologies to support believe have helped me: “angry old woman,” his communication because, she explains, “I over the years. He now • Life is a lot easier if feel that I need not have uses screen reader you have a partner or suffered the trauma I technology to support a supportive family suffered, after I lost my his continued use of ICT, network. sight, if I had been offered which was recommended support and information at • Life is a lot easier if you by a consultant he heard the right time.” Padma had are reasonably well off. about at a peer support always been short-sighted My wife and I aren’t rich group. He says: “These and had regular eye tests but we have enough to technologies have given with the same optician. afford the technology I me an enormous amount of Her sight was deteriorating, need to communicate and communicative freedom”. but despite getting to live independently. stronger lenses, nothing John believes the skills seemed to help. he developed in mobility • Finally, life is a lot easier if you are reasonably and communication were Padma had a busy life at assertive and persuasive. vital to enabling him to work, and as “the typical You need a certain continue working until he glorified taxi driver” for her amount of charm to get was nearly 60 and, beyond family. However, eventually by as a blind person.” that, to remain active in the her sight issues started

11 12 to cause her problems me. I thought I was being loss are to remain active at work and, after a “near pushed into a dungeon and and independent [9]. To be miss” in the car, her family the keys thrown away, but most effective, this support insisted she saw another she was excellent. Without must be informed by, and optician. The optician her support I don’t think I co-produced with, older recommended she should could have done what I do people with sight loss; it see a specialist and her now. She gave me mobility must be personalised; it GP made the referral. training and introduced must address sight loss me to other people in the and functional vision She explains: “The blind association. I was together with other needs specialist did some tests very lucky to see the rehab and aspirations in a joined- and then asked me how I worker, and I don’t think up way; and it must be got to the hospital. When I that would happen now. available and accessible. told him I had driven myself However, in all the years he said, “I’m sorry but you since there has never been Too often people struggle won’t be able to drive back any follow up or further to access appropriate home, because I have to support. There is still a rehabilitation and support register you as blind”. That lot to do.” services. A recent Thomas came down as a wall of Pocklington Trust study bricks on me.” Throughout the seminar, based on discussions with P3A members and other a group of older people Padma was not offered any participants reinforced with sight loss over a three support at the hospital in these messages and year period concluded that coming to terms with this highlighted the following the priority needs of older diagnosis, nor was she themes and comments people were: made aware of sources in their feedback as of support. we explored the state • Easy access to services of current provision of and the ability to re- Fortunately, though, within services and support access services after a week of her diagnosis for older people with initial contact; Padma received a call sight loss. from a rehab officer. She • Integrated services explains: “Initially I didn’t 1. Ensuring easy with smooth referrals want to see her at all, I said access to services between different parts “I don’t want anybody to of the system; come here and feel sorry and support for people for me” but she insisted. with sight loss • Community based I am glad I eventually Effective rehabilitation facilitators to support said, “Yes” because she and support are vital if people in accessing really put life back into older people with sight services;

13 In the year after registration, only 23 per cent of people 23% who lost their sight say they were offered mobility training

• Improved awareness appropriate aids and reduction in social care among GPs of sight adaptations and/or services: the number of loss issues to improve ongoing social care blind and partially sighted identification and provision; people receiving social referrals; and care fell by 35% between • Information and advice 2008 and 2013 [16]; and • Support groups [14]. on accessing financial support and housing • Older people with 2. Making services options; sight loss have been accessible disproportionately • Emotional support; and Older people with sight affected by the loss in community based loss, and particularly • Information on support services [17]. those whose sight loss is available from the diagnosed during later life, voluntary sector, including The resulting unmet are likely to need access peer support groups. need has considerable to a range of services and consequences for wider support, including: Unfortunately, the evidence health and wellbeing, for shows that too many older example people with sight • Information about their people are not able to loss are twice as likely to diagnosis and prognosis access these services, fall as sighted peers and to help them understand and many do not even they have a higher risk their condition; receive support with their of injury [18]. most immediate needs. • Where applicable, support Research shows: in being registered blind 3. Delivering or partially sighted as • In the year after integrated services a route to social service registration, less than Services for people assessment, rehabilitation a quarter (23 per cent) with sight loss are often and other statutory of people who lost their fragmented, provided by provision; sight say they were multiple agencies including offered mobility training health, social care, • Practical support to help them get around voluntary and community – for example, help independently [15]; organisations and the with mobility and private sector. From an communication through • People with sight loss individual’s perspective, rehabilitation training have experienced this complexity is etc, the provision of a disproportionate frustrating and hard to

14 The number of blind and partially sighted people 35% receiving social care fell by 35% between 2008 and 2013

navigate. From a service 4. Improving Across specialist services delivery perspective, it is professional working largely with older highly inefficient; the fact awareness people, research shows that different organisations that lack of awareness Sight loss in later life often ask the individual the among professionals as to goes alongside other long same questions underlines how to meet the needs of term conditions. So it is the lack of service co- people with sight loss is a vital that professionals ordination. Older people serious issue. For example: across the health and need access to support care system are able to which is joined-up, and • A study looking at meet the needs of blind which responds to their Occupational Therapy and partially sighted wider needs and goals. services found serious people, and that eye-care Age UK has pioneered gaps in staff training on professionals are equipped integrated approaches for sight loss [22]. to work with people with older people with long term other conditions, including • Only 46% of stroke conditions, which start diabetes and dementia. professionals responding from a person’s strengths, Sadly the evidence shows to a national survey interests, wishes and we have a long way to go: reported using a care needs, to build tailored pathway for vision care packages of support [19]. • One in two people living for stroke survivors [23]. in care homes have some The NHS Five Year Forward degree of sight loss, and • Research on dementia View emphasises this type yet the vast majority of and sight loss concluded, of co-ordinated approach, homes are not dealing “A common experience and, increasingly, policy with this appropriately [20]. is that of one set and guidance specify a of dementia/visual joined-up approach to sight • Blind and partially sighted impairment needs being loss. However, too many people have been found addressed, rather than older people with sight loss to have been involved both being taken into still encounter fragmented in some of the most account” [24]. services. There are a disturbing cases of poor number of systemic and home care provision, and • A study of vision cultural barriers to better few home care service rehabilitation services integration that have yet to specifications recognise found that staff felt that be overcome, including lack the issue of sight loss [21]. their work was not widely of professional awareness understood by other across disciplines. professionals [25].

15 5. Facilitated access forward in the provision voluntary sector worker, Providing a single point of facilitated support [14]. they are able to plug that of contact within the Unfortunately, only around individual into the full system, who can support one third of eye hospitals range of support from individuals to access offer a sight loss adviser across the voluntary and services which meet their service at present. statutory sector [26]. In needs, is increasingly other areas, Community “First Contact” schemes recognised as an important Navigator schemes such offer a practical way of way forward. For blind as Village Agents and ensuring that, no matter and partially sighted older Wayfinders work with which local professional people, the introduction older people to identify makes “first contact” with of sight loss advisers and access appropriate an older person, be it the has marked a step support that will meet GP, a social worker or a their individual needs.

Who are sight loss advisers? A sight loss adviser – also known as an Eye Clinic Liaison Officer (ECLO) or Vision Support Officer – works directly with people with low vision, deteriorating vision, sight loss or impending sight loss, and their families. The support is both practical and emotional, is for all ages and is extended to parents, family members and carers. Sight loss advisers provide timely one- to-one support and quality information and advice, emotional support and access to other statutory and voluntary services. They connect people with the support they need to understand their diagnosis, deal with their sight loss and maintain their independence. The sight loss adviser gives dedicated time to people following their diagnosis, so they can discuss the impact their condition will have on their life.

16 6. Empowerment and peer support Information and advice can be vital tools in empowering older people to take steps to protect their sight and in enabling blind and partially sighted older people to access the support they need to maintain a good quality of life. However, too often older people report that they lack the information they need [27]. Peer support groups can act as an important source of practical information and emotional support for older people with sight loss, as well as a means of making new friends. The evidence on the statutory and accessible peer support clearly demonstrates the voluntary sectors have options for people with value of emotional support left some groups sight loss including digital, and social connections struggling to continue. face to face and telephone [28]. However, access to based peer support peer support is patchy, RNIB and Action for Blind groups. For example, and funding pressures People provide a range of the RNIB Talk and Support

17 ‘Time to Talk’ project, supported by Nesta, A word about technology offers older people Undoubtedly technology can, and already does, play affected by sight loss an enormous role in enriching and enabling the lives the opportunity to share of older people with sight loss [9]. However, it can and discuss their feelings also be costly and often confusing. For some older and experiences of living people with sight loss, the march of digitalisation and with sight loss with peers the shift of services from telephone-based to online as part of a short series provision have proved challenging [29]. The digital of telephone discussion divide between younger and older generations is groups. During the significant, and many people developing sight loss sessions, participants in later life will lack the skills and equipment needed receive signposting to to make the most of assistive technologies. Older key sources of information people with sight loss need access to affordable, and support. Contact appropriate technology and to the support they with peers encourages need to use it day-to-day. The best way to ensure participants to consider that technology is appropriate to meet the needs of their own needs and blind and partially sighted older people is to involve situation and to take them in its design and implementation. Both RNIB positive action to and Age UK provide digital inclusion services to access support. older people. For example, Online Today is a new Big Lottery funded project led by RNIB, delivered in partnership, to help people with sensory loss across the UK to get online.

18 19 The policy environment

The current Over-stretched Squeeze on social economic and health budgets care budgets policy environment An ageing population and The impacts of austerity on the requirement to find £22 care and support services offers little to cheer billion of efficiency savings for adults are already those seeking to mean that the NHS is under clear, with a real-terms improve support great pressure and this reduction of 31% in social for older people is expected to continue care budgets between or even intensify over the 2010-11 and 2015-16 and with sight loss. The next few years. There are further cuts expected [33]. commitment to already serious capacity This has led to tightening deficit reduction issues in eye care services eligibility criteria and cut means pressure across the NHS, and the backs in services including RNIB has intervened in vision rehabilitation. on health and care a number of areas in services. Further which treatments such In June 2015, Age UK cuts across wider as cataract surgeries published new statistics and wet AMD treatments highlighting the escalating public sector were being rationed [30]. social care crisis and provision will demonstrating how the continue to impact Voluntary sector failure to invest sufficient organisations including resources in social care the lives of blind Age UK and RNIB have was leading to costly and partially sighted been working with the additional burdens on older people. Key NHS to improve patient health services [34]. pressure points experiences: developing new eye care pathways The new health and social in the system in [31] and integrated care care integration agenda the months services [32]. However, presents an opportunity ahead include moving these innovations to address these issues but, with budgets stretched, the following. into mainstream practice can be challenging, in part there is a risk that the full because most clinicians potential of integration and health managers are may not be realised. running to stand still and The Care Act 2014 [35] so lack the time to bring in helpfully places renewed new ways of working, even emphasis on prevention, when they know that they rehabilitation and would improve outcomes maintaining wellbeing, for their patients. 20 Real-terms reduction in social care budgets 31% between 2010-11 and 2015-16

and has given people new fuel payment, will provide rights to information and some protection. However, advice, assessment and the impact of these cuts on support. However, once disability benefits, which again, lack of funding many older people with threatens to undermine sight loss rely on to cover the process of putting the their increased costs of good intentions of this living, remains unclear. legislation into practice. Wider public Cuts in welfare service cuts spending As austerity continues, we The government has are likely to see continued promised to make cuts cuts in the wider provision in welfare expenditure upon which many older totalling £12 billion a year. people with sight loss rely The commitments it has to maintain their wellbeing. made to the ‘triple lock’ on These services include the basic state pension and libraries, public transport to the so-called pensioner and leisure services. benefits, including the winter 21 Ways forward and recommendations

Intensive cross- Empowering older Recommendation: sector discussion people with sight loss Empower older people to look after their sight, at the seminar Most older people would prefer to look after and to remain independent highlighted a their own sight, and to with sight loss, by number of key manage their sight loss improving awareness recommendations. independently. To do this, and access to information they need access to the about what to do, who right information at the can help and rights and right time. entitlements, including entitlements under the Care Act 2014.

The Age UK website includes information on sight tests, choosing glasses, the importance of good quality lighting and practical aids for daily living. It also contains information on how to register as blind or partially sighted [36].

22 Ensuring the voices of Improving meet the needs of older older people with sight professional blind and partially sighted loss are represented awareness people with multiple conditions. The same Older people with sight loss We need improved is true of care providers, are themselves best placed awareness among primary both in residential settings to present their views and care practitioners and and in the community. to make choices about the specialists who are services and support they regularly in contact with Recommendation: want and need to live well. older people, so that Improve professional Their voices need to be they can better support awareness of eye health heard at the forefront the identification of people and sight loss across of service, policy and with sight loss and better health and social care. strategic developments.

Recommendation: Ensure older people are actively engaged and involved Thomas Pocklington Trust and the College of in the co-production Occupational Therapists (COT), along with of services, policy and universities training OTs and partners in sight loss strategic development organisations, are working together to encourage in way that is both and educate OTs to ‘Think Sight’, especially when accessible and relevant working with older people. The scheme provides to their interests. continuing professional development resources to OTs and:

RNIB’s Panel of the • Sharing ideas and good practice and highlighting Third Age (P3A) sources of support for OTs. brings together • Running information stands and presentations at older people with key OT events. sight loss to inform and co-produce • Distributing the ‘Eyes Right’ toolkit to enable OTs to screen for sight loss. the work and priorities of RNIB • Building a network of OTs who want to improve policy, strategy their support for people with sight loss. and services.

23 Improving access to advisers.We need to people can access help support at diagnosis ensure that older people to navigate the system, and beyond can transition seamlessly with seamless transitions between services and between specialist and We must ensure that we do providers as this improves general services and not miss the opportunity to outcomes for individuals across sectors including use the point of diagnosis and saves time and money. health, social care and to connect with older voluntary and community people with sight loss, Recommendation: Ensure organisations. offering them information, blind and partially sighted advice and access to the agencies that can offer support.

Recommendation: Improve availability of, and access to, sight loss Partnership working works Since April 2011, Age UK Lincoln has hosted an Independent Living Co-ordinator from Action for Blind People. Both organisations promote the partnership Investment in Sight through products, materials and events. The Action loss advisor for Blind People staff member sits within Age UK An RNIB Social Return Lincoln’s advice team and Age UK Lincoln staff on Investment study members have received training on visual awareness. showed that the Sight Through this partnership, older people with sight loss adviser service in loss can be directed to specialist support for their one area could deliver sight loss and to wider support available to older a return on investment people in the area. Both organisations report that of £10.57 for every the partnership delivers a higher quality service to £1 spent [37]. individuals than either could deliver alone.

24 We need to ensure a more joined-up response to the individual needs of Integrated care older people with sight Integrated care pathways are a way of ensuring loss, recognising their that health and social care services are co-ordinated social, emotional, practical around people’s needs. Age UK’s pathway brings and medical needs by together local NHS health teams, social care delivering personalised, organisations and the voluntary sector to help put integrated services. older people living with long-term conditions in control of their health and wellbeing, independence Recommendation: and quality of life. Local organisations and individual Improve access to person- older people co-design and co-produce a tailored centred wrap-around programme of medical and non-medical support packages of support for that draws out the goals that the older person blind and partially sighted identifies as most important to them. Through the older people. scheme, local Age UK staff and volunteers become members of primary care led multi-disciplinary teams, providing care and support in and through the local community [32].

25 Peer support and emotional support With support from the Big Lottery Fund, RNIB worked Individuals need more with Staffordshire Fire and Rescue Service, Age UK than clinical and practical Stafford and District, Action for Blind People and York support to cope with Blind and Partially Sighted Society to co-design an sight loss in later life. Peer integrated pathway in Stafford and York that enabled support can be invaluable older people, especially those with or at risk of sight in meeting these needs; it loss, to manage the changes they encounter in later gives access to emotional life and reduce isolation. support, advice and new social connections. Together, partners identified older people with or at risk of sight loss and referred them to appropriate Recommendation: support through a range of local services, and Improve access to, supported them to run: and support to develop, peer support groups • Peer-support programmes – sharing practical and services. knowledge and experience, and providing emotional support to each other.

• Volunteer ‘buddying’ schemes - providing practical support on transport, hobbies, shopping and other daily tasks that can be challenging for vulnerable older people.

• ‘Change Exchange’ self-advocacy groups – campaigning for improvements in local services and facilities, demonstrating that older people can change the way society views older people and sight loss.

Learning from this project is now being applied to the co-design of integrated pathways across Yorkshire and Lincolnshire [38].

26 Ready for ageing and sight loss Housing sight Ensuring that older people In 2003, the Welsh Government funded Housing Sight: with sight loss are able A guide to designing accessible housing for people to live healthy and active with sight loss [39]. In 2005, it published new lives is not just a matter of Development Quality Requirements that reference providing the right services. this guidance in setting standards for housing It requires a whole-system associations in Wales. This has been an important response from policy driver for change in Wales; as a consequence, many makers, commissioners housing associations have worked in partnership with and practitioners to make RNIB and other agencies to ensure that their housing communities ready for is up to standard. ageing with sight loss.

Programmes such as those for Age Friendly and Dementia Friendly communities may point the way forward in ensuring our neighbourhoods, villages, towns and cities are great places to grow older with sight loss.

Recommendation: Learn from age friendly and dementia friendly community programmes to support people and groups to take responsibility to prepare for the growing numbers of people ageing with sight loss.

27 Agenda for action

While the challenges Business as usual is not an We need: an ageing society option because the number of older people with sight • Real leadership from present to our loss is large and growing, political leaders, senior health and care future cuts will impact vital actors within health systems are services and incomes and, and social care, and the even in less austere times, voluntary and private increasingly working separately has not sectors too, recognising understood, it brought success. that sight loss in older is clear that the people is a major and Our new approach must mainstream issue. specific issues start from the enormous relating to ageing strength and resource of • Real engagement with sight loss older people with sight with older people with have yet to be fully loss, ensuring that their sight loss, so that their voices are heard and their strengths, wishes, appreciated by skills are put to use in needs and aspirations those who are in reconfiguring and renewing enrich, inform and shape a position to make the available provision so everything we do. that it meets their needs the big decisions • Real empowerment of more effectively. affecting older older people with sight people. Age UK We need to learn from loss, giving them genuine choice and control, with and the RNIB are the best innovations from around the country and good access to the determined to internationally to deliver information they need to put this right. maximum value for people identify and make use of with sight loss. However, the support that they want, we know that it won’t be in the ways they want. enough to simply identify • Real openness in the sight good practice and hope loss sector, the ageing it will be replicated. sector and beyond, challenging and being challenged, and working in partnership and sharing expertise, to improve outcomes for older people with sight loss.

28 References

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