Dementia and A&E waits: Why good eyesight matters more than you might think

Dementia affects more than memory: it can affect how we see the world

When we think about dementia, memory loss is often the first symptom that comes to mind.

However, dementia can also affect how the brain interprets visual information.

Seeing involves more than the eyes. Our eyes capture information, but our brain must interpret what that information means.

For example, when we look at a staircase, our brain helps us recognise the edges of the steps, judge their depth and decide where to place our feet.

Someone living with dementia may experience difficulties with visual perception even when their eyes are relatively healthy.

Depending on the type and stage of dementia, these difficulties can include:

• Depth perception: Judging distances, steps and the position of objects.
• Contrast sensitivity: Distinguishing objects from backgrounds with similar colours.
• Object recognition: Understanding what familiar objects are.
• Visual attention: Finding important information in a busy environment.
• Spatial awareness: Navigating unfamiliar rooms, corridors and doorways.

Imagine walking into a hospital corridor with a highly patterned floor. What appears to one person as an ordinary pattern might be difficult for someone with dementia to interpret.

Now imagine that person also has an outdated glasses prescription or an untreated cataract.

They may be dealing with two separate challenges: changes in how their brain processes visual information and reduced clarity of vision from an eye problem.

This is why eyesight should not be overlooked when supporting someone with dementia.

Research suggests many people with dementia have sight problems that could be improved

A major UK research project, the PrOVIDe study, examined the eyesight of 708 people living with dementia aged between 60 and 89.

Researchers found that approximately 32.5% of participants whose visual acuity could be measured had vision worse than 6/12 while wearing their existing glasses, where applicable.

Importantly, 44% of those with this level of visual impairment could achieve vision better than 6/12 with an updated glasses prescription.

Among participants whose vision could not be adequately corrected with glasses, cataract accounted for almost half of the remaining impairment.

The study also found a higher prevalence of uncorrected or undercorrected vision problems among care home residents.

These findings highlight something important.

Not every difficulty experienced by someone with dementia is necessarily caused by dementia itself.

Some difficulties may be made worse by treatable eye conditions, an outdated prescription or glasses that are no longer being worn correctly.

Correcting these issues cannot reverse dementia-related changes in the brain. However, clearer vision may make certain daily activities easier and more comfortable.

Source: Bowen et al., The PrOVIDe study, NIHR Health Services and Delivery Research, 2016.

Why poor eyesight can make hospital visits more challenging

Hospitals can be difficult environments for anyone.

There may be unfamiliar faces, bright lighting, background noise, moving equipment, confusing signs and long periods of waiting.

For someone living with dementia, these surroundings can be particularly overwhelming.

Reduced eyesight can introduce additional difficulties.

1. Recognising people and understanding surroundings

If someone cannot clearly see a healthcare professional's face, name badge or gestures, communication may become more difficult.

They may also struggle to identify where they are or recognise familiar people approaching them.

Ensuring their usual glasses are available, clean and correctly fitted may help with visual clarity.

2. Moving safely through unfamiliar environments

Hospital corridors often contain changes in flooring, reflective surfaces, furniture and equipment.

Reduced vision can make obstacles more difficult to identify, while dementia-related visual processing difficulties may affect how someone interprets them.

Supporting safe mobility requires more than glasses alone, but identifying visual problems is one useful part of a wider approach.

3. Understanding written information

Signs, appointment letters, menus and written instructions can be difficult to read when vision is reduced.

For some people, larger print, clear contrast and verbal explanations may help.

4. Distress and sudden confusion

People with dementia are at increased risk of delirium, a sudden change in mental state that can occur during illness or hospital admission.

Delirium may involve increased confusion, changes in attention, agitation, drowsiness or altered awareness.

Poor eyesight or hearing can make communication and orientation more difficult, although delirium has multiple possible causes, including acute illness and medication effects.

Sudden confusion should always be assessed medically and must not simply be attributed to dementia or poor eyesight.

Could better eyesight help reduce falls?

Falls are a significant concern for many older adults, including people living with dementia.

Vision plays an important role in balance, movement and recognising obstacles.

Someone with reduced eyesight may have difficulty identifying a step, noticing an object on the floor or judging the distance to a chair.

However, falls rarely have a single cause.

Muscle weakness, medication, balance problems, footwear, cognitive impairment and environmental hazards can all contribute.

An eye examination can help identify whether reduced vision is one of the factors involved.

It would be misleading to suggest that new glasses alone will prevent falls. In some circumstances, adapting to a changed prescription can itself require care, particularly when walking on stairs.

For anyone experiencing repeated falls, a wider assessment by an appropriate healthcare professional is important.

Seven signs that someone with dementia may be struggling with their eyesight

People living with dementia may not always be able to explain that their vision has changed.

Instead, relatives and carers may notice changes in behaviour.

Look out for:

1. Difficulty recognising faces: They may recognise someone only after hearing their voice.
2. Hesitation around steps or doorways: They may appear uncertain about changes in floor level.
3. Reaching inaccurately: They may miss a cup, handle or other object.
4. Losing interest in familiar activities: Reading, television, puzzles or hobbies may become less enjoyable.
5. Bumping into furniture: Objects that were previously easy to navigate may become obstacles.
6. Problems with glasses: Glasses may be damaged, missing, incorrectly fitted or unsuitable for the task.
7. Changes in visual behaviour: Increased squinting, moving closer to objects or difficulty in dim lighting.

These signs do not prove that someone has an eye condition. Some can result from dementia-related visual processing difficulties or other medical problems.

Nevertheless, they provide good reasons to arrange an appropriate assessment.

Practical changes families can make at home

An eye test is important, but there are also everyday changes that may make the home easier to navigate.

Improve lighting

Ensure frequently used areas have adequate, even lighting.

Pay particular attention to staircases, hallways, bathrooms and places where the person reads or eats.

Reduce glare where possible and consider night lighting along routes to the bathroom.

Use colour contrast

Objects may be easier to identify when they contrast with their surroundings.

For example, a dark-coloured plate on a light table may be easier to distinguish than a white plate on a white tablecloth.

Contrast can also help people identify handrails, furniture and important household objects.

Reduce confusing patterns

Highly patterned carpets, rugs and flooring may be difficult for some people with dementia to interpret.

Plain, non-reflective surfaces can sometimes make environments easier to understand.

Loose rugs can also present a trip hazard.

Keep familiar objects in consistent places

Regularly moving furniture or everyday items can make navigating the home more difficult.

Keeping important belongings in familiar locations may support independence.

Make glasses part of the daily routine

Check that glasses are clean, comfortable and being used for the correct purpose.

Some people have different prescriptions for reading and distance vision.

A carer can help establish a routine for storing and finding glasses without unnecessarily taking over tasks the person can still manage.

These changes should be adapted to the individual. What helps one person may not help another.

What happens during an eye test for someone with dementia?

One concern we often encounter is whether someone with dementia will be able to participate in an eye examination.

Families may worry that their relative will not understand the instructions, remember what to do or be able to read the letters on an eye chart.

Fortunately, an eye examination can be adapted to the person's abilities.

At First Care Optical, our approach is to make the examination as comfortable and manageable as possible.

A familiar environment

Where appropriate, a home eye test allows the person to remain in familiar surroundings, avoiding the need to travel to an unfamiliar practice.

Clear, simple communication

We can explain individual steps using straightforward language, allowing time for the person to respond.

Flexible testing

Not every patient can complete every standard test in the usual way.

Optometrists can adapt testing methods and use objective techniques where appropriate, although some results may be less precise or certain tests may not be possible.

Involvement of relatives and carers

A familiar person may help provide relevant history, explain how the person's vision affects daily life and offer reassurance.

Respecting the person's wishes

A dementia diagnosis does not automatically mean someone cannot consent to an examination.

The optometrist must consider the person's ability to make the relevant decision and follow appropriate consent and capacity procedures.

The aim is to obtain as much useful clinical information as possible while respecting the person's comfort, dignity and individual needs.

Learn more about home eye tests for patients with dementia.

When should someone with dementia have an eye test?

NICE recommends encouraging people living with dementia to have an eye test soon after diagnosis if they have not had one recently, and then every two years.

An optometrist may recommend a different interval depending on the person's clinical needs.

An earlier assessment may also be appropriate if relatives or carers notice a change in visual behaviour.

Importantly, sudden loss of vision, new severe eye pain or sudden neurological symptoms require urgent medical assessment, rather than waiting for a routine appointment.

What if the person cannot travel to an optician?

For some families, arranging an appointment is not the difficult part.

The real challenge is getting there.

Someone with dementia may find travelling, unfamiliar surroundings or waiting rooms distressing. Physical mobility difficulties may create additional barriers.

A domiciliary eye examination can allow eligible patients to receive eye care in their own home or care setting.

In England, NHS-funded domiciliary sight tests are available to people who meet the NHS sight-test eligibility requirements and cannot leave home unaccompanied because of physical or mental illness or disability.

A dementia diagnosis does not automatically establish eligibility.

Where NHS funding does not apply, private options may be available.

First Care Optical provides home eye tests across its service areas, including Coventry and Warwickshire, and can advise families about appointment arrangements and eligibility.

• Check NHS eligibility
• Read our guide to booking for a relative
• Find out about home eye test costs

A simple checklist before a hospital visit

If someone living with dementia needs hospital treatment, a little preparation may help make the experience more manageable.

• Pack their usual glasses in a clearly labelled protective case.
• Include any hearing aids and necessary accessories.
• Tell healthcare staff whether glasses are for distance, reading or both.
• Bring a short written summary of the person's usual communication needs and routines.
• Consider using the Alzheimer's Society's This is me document to share information about the person.
• Make staff aware of any known visual impairment or difficulties interpreting surroundings.
• Where appropriate, ask whether a relative or familiar carer can remain with the person.

These steps cannot remove the challenges of an emergency department, but they may help staff understand the person's individual needs.

When to seek urgent medical advice

Not every change in behaviour or visual ability should be attributed to dementia.

Seek urgent medical advice if someone develops sudden confusion, an abrupt deterioration in their usual functioning or new visual symptoms.

Sudden severe visual loss, stroke-like symptoms or a significant change in consciousness may require emergency assistance through 999.

For other urgent concerns, NHS 111 can help direct families to the appropriate service.

Routine eye examinations are valuable, but they are not a substitute for emergency medical assessment.

Supporting people with dementia means looking at the whole person

The proposed Wait Well initiative in Coventry highlights an important principle: healthcare should consider not only a person's medical condition but also how their environment affects their experience.

For someone living with dementia, small adjustments can make everyday situations more manageable.

Better communication, familiar surroundings, appropriate lighting and support from carers all have a role to play.

So does eyesight.

An eye test will not treat dementia, prevent every fall or eliminate the need for hospital care.

But identifying a correctable visual problem may help someone see familiar faces more clearly, engage with activities they enjoy or navigate their surroundings with greater confidence.

And for a person living with dementia, those everyday experiences matter.

Home eye tests for people living with dementia

If you care for someone with dementia and are concerned about their eyesight, First Care Optical can help you understand the options for an eye examination at home.

We can discuss their individual circumstances, explain NHS eligibility and help arrange an appropriate appointment.

Call 07458 693608 or use our online booking form.