Optometry

Alfred A. Rosenbloom Jr.

People are living longer. In 1970, the average life expectancy at birth was 70.8 years; in 2000, it was 76.9 years; and by 2030, it is estimated that the number of those 85 and older will be growing four times faster than any other segment of the population. This group of “oldest-old” could comprise up to 10 million people. Aging, however, no longer necessarily means physical decline and illness. In the last 2 decades, the rate of disability among older people has declined dramatically.

The National Institutes on Aging (NIA), part of the federal government’s National Institutes of Health, investigates ways to support healthy aging and prevent or delay the onset of dis­eases that disproportionately affect people as they age. These studies may not only increase longevity, but also may promote what is known as “active life expectancy”— the time of advancing years free of disability.

The founding director of the NIA was Robert N. Butler, MD, a distinguished national leader in health promotion and successful aging. As we mourn his recent death, we can honor his unparalleled professional and personal legacy; there was no greater champion for older people and for the research and policies that could im­prove their lives.

Mental wellness vs. mental illness

Dr. Butler wrote in his book, Aging and Mental Health, “Older people need freedom – encouragement to move on in new directions. Autonomy and independence are precious commodities for them; physical, social, cultural and economic aspects of people’s lives are all intricately woven into their psychological well being.”

Dr. Butler emphasized mental wellness rather than the traditional concepts of mental illness such as anxiety dis­orders, dementia and paranoia. Dr. Butler’s approach considered the influence of such factors as physical health, medical care, personality, social support, cultural/ethnic heritage and life experiences. Intangible factors also emerged that are the hallmarks of mental wellness: competence, control, meaningful living, life satisfaction and self-worth.

Various investigators have reviewed the literature on life satisfaction and affirm that the majority of people older than 65 describe themselves as satisfied or very satisfied with their lives. These findings contradict the myth that older adults always become bitter, unhappy or senile. Professional providers need to shed negative views and recognize that this time of life can be a time of growth, change, contentment and happiness.

Results from NIA-sponsored and other studies are likely to improve our understanding of the benefits and risks of antioxidants, calorie restriction, hormone supplements and other interventions to promote healthy aging with emphasis on healthy eating and physical activity.

The aging population represents an unparalleled but urgent policy and program challenge. Both public and private organizations should ensure that the needs of older persons and their human resource potential are adequately addressed. The American Optometric Association has passed resolutions such as 1934, which endorsed the United Nations 1999 International Year of Older Persons, and promotes healthy aging on its website for both practitioners and patients, but there remain significant challenges to be addressed.

Challenge one: Using the talents of senior ODs

Optometry’s senior practitioners and leaders constitute an untapped resource. Active, healthy, vigorous, retired or semi-retired colleagues seek meaningful ways to use their time and talents.

The AOA, state associations and schools of optometry should initiate mentoring programs. The mentors could encourage high school or undergraduate students to consider becoming optometrists, provide support for current optometry students and advise optometrists beginning their careers or seeking career renewal.

Challenge two: Expanding services to older patients

The former AOA Geriatrics and Nursing Facility Committee prepared a curriculum entitled “Geriatric Optometry for the Primary Care Practice.” The guidelines were widely disseminated but now could be updated.

Colleges of optometry should incorporate more geriatrics into their curriculum, and the schools and associations should provide more continuing education programs concerning the needs of older patients.

Challenge three: Maximizing comprehensive care for older patients:

The focus for the future must encompass both research and development. There is an urgent need for expanded research into the visual performance characteristics of the conditions that cause vision loss. As research progresses, new procedures can be developed to alleviate diseases such as age-related macular degeneration.

Managed care also has become a challenge, for it becomes increasingly essential that we conduct studies concerning its impact. These studies should include: quantity of care, patient eligibility, delivery of service and funding.

Longer lives require planning to distribute available economic and human resources to maintain and enhance quality of life. Optometry – as well as the rest of society – must recognize and aggressively prepare for sharing its human resources in new and creative ways. Ultimately, society will be better served, the potential for professional growth greatly strengthened and senior optometrists’ sense of self-worth enhanced.

It is my earnest hope that our profession will actively encourage many more senior colleagues to share in the opportunities to actively contribute their knowledge and commitment to the advancement of our great profession.

Reference:

• Butler RN, Lewis MI, Sutherland T. Aging and Mental Health: Positive Psychosocial and Biomedical Approaches, 5th ed. Boston: Allyn & Bacon, 1998.

• Alfred A. Rosenbloom Jr., OD, MA, DOS, FAAO, is former dean and president of the Illinois College of Optometry, current Donald Krumrey Endowed Chair Emeritus of the Chicago Lighthouse and a Primary Care Optometry News Editorial Board member. He can be reached at 1850 West Roosevelt Rd., Chicago, IL 60608-1298; (312) 997-3688; fax: (312) 997-3663; aarlvpro@sbcglobal.net.