However, essential optometric care for an aging population has issues
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
governments 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 peoples 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. Butlers 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
Optometrys 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
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
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
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.
- 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;