Nora Griffin-Shirley, PhD, Texas Tech University, n.griffin-shirley@ttu.edu

1. O&M for Life: Orientation and Mobility for Older Individuals with Visual ImpairmentAER International Orientation & Mobility Conference 2013 Nora Griffin-Shirley, PhD, Texas Tech University, n.griffin-shirley@ttu.edu Laura Bozeman, PhD, University of Massachusetts Boston, Laura.bozeman@umb.edu Anita Page, MEd, Texas Tech University, anita.page@ttu.edu

3. Objectives • Participants will learn strategies to work with older clients (55+) in the provision of O&M instruction. • Participants will explore issues commonly experienced by older O&M clients. • Participants will have a simulation activity after which a dialogue will ensue concerning their experiences and solutions for effective instructional strategies.

4. Today’s Agenda • Short Presentation • Simulation Activity • Dialogue

5. Issues Commonly Experienced by Older O&M Clients Other Than Visual Impairment • Health • Psychological – depression, isolation, dementia, lack of self-confidence & self-esteem, unavailable informal supports (family, friends), cumulative effect of many losses & inadequate coping skills (Brennan & Bally, 2007) • Physical – hearing; orthopedic; diminished touch, taste & smell; other conditions (e.g., high blood pressure, diabetes, heart disease, etc.)

6. Issues……. • Financial – longer hospital stays, increase in doctor’s visits, poverty • Falls • Non-driving concerns • Older adult’s attitude toward blindness (Brennan, Horowitz & Reinhardt, 2004) • Strong sense of spirituality (Brennan & Bally, 2007) • Impact of deafblindness

7. GROUP ACTIVITY What are some issues you have noticed when providing O&M services to this population?

8. Simulation Activity • Pair with a partner • Go to all stations & complete activities • Note concerns you had completing the activities & what you did to successfully accomplish the task or cope • Jot down items for discussion

9. Discussion • What concerns did you have when completing the activities? • What did you do to successfully accomplish the task or cope with it?

10. Strategies for Providing O&M Training to Older Adults

11. Exercise Tips • Increase physical activity on a daily basis • Get seniors involved in a regular exercise program such as walking or Tai Chi after their physicians have given permission for starting an exercise program (Griffin-Shirley & Welsh, 2010)

12. Discuss with personal trainers and exercise program instructors how they can modify their teaching to include verbal cueing and assisted movement, if needed, for students to be successful. • Have seniors try new recreational activities with a friend and discover what modifications may need to be made with the actual recreational skills and the environment

13. Access transportation and routes to a fitness facility, and advocate for familiarization to this facility and access to educational materials distributed by the facility • Have seniors journal their thoughts and feelings while they are starting an exercise program to document the effects it has on their lives and the impact on their orientation and mobility

14. Have seniors initiate social interactions with friends and others to make them feel comfortable about exercising together • Have seniors experiment with their low vision devices during recreation activities to understand what works best and how to care for these aids (Griffin-Shirley & Welsh, 2010)

15. O&M Tips • Use an andragogical approach • Schedule lessons at the most appropriate time of day to maximize a senior’s learning based on her functional abilities • Plan the duration of a lesson to accommodate for a senior’s health condition and stamina (Griffin-Shirley & Welsh, 2010)

16. Choose the locations and content of lessons that are going to contribute to meeting the most immediate O&M goals of a senior • Adjust the delivery of a lesson’s content to facilitate a senior’s comprehension

17. Share with the senior observations of her performance and her evaluation reports • Discuss O&M goals with the senior and her family members as well as their feelings about independent travel and how it fits into their lifestyles (Griffin-Shirley & Welsh, 2010)

18. Provide initial objectives that are meaningful but readily attainable & lead to successful experiences relevant to attainment of the senior’s orientation and mobility goal • Create teaching materials that enhance the senior’s comprehension of lesson content, involve a multi-sensory approach, and tap into the senior’s preferred intelligences (Griffin-Shirley & Welsh, 2010)

19. Make sure the older adult does not think you are overprotecting her due to her age because the senior’s perception of overprotectiveness could interfere with her desire to become an independent traveler (Cimarolli, Reinhardt & Hororwitz, 2006). • Choose highly motivating routes to teach seniors (Griffin-Shirley & Welsh, 2010)

20. Choose the most appropriate environmental modifications for the senior’s home to maximize safety and travel efficiency • Use memory techniques and devices if the senior has memory problems • Respond promptly to senior’s who are crying or extremely emotional during lessons • When appropriate, include caregivers in your lessons, teaching them ways to support the senior’s independence and safety (Griffin-Shirley & Welsh, 2010)

21. Recognize that senior’s may use a variety of mobility tools and orientation aids • Become well versed in the use and maintenance of tools and aids and how to train the senior’s to use them • Use a team approach (Griffin-Shirley & Welsh, 2010)

22. Collaboration with Other Team Members When Serving Older Clients • Needed for communication, respect and joint decision-making on behalf of senior • COMS defines what independence resembles for senior (Pogrund & Griffin-Shirley, 2011) • Teams in assisted living facilities, hospitals, nursing homes, VA BRCs, low vision clinics representing various professionals • Different models – What model do you see used most often?

23. References • Brennan, M. & Bally, S.J. (2007). Psychosocial adaptations to dual sensory loss in middle and late adulthood. Trends in Amplification, 11(4), 281-300. • Brennan, M., Horowitz, A., & Reinhardt, J.P. (2004). Understanding older Americans attitudes, knowledge, and fears about vision loss and aging. Journal of Social Work in Disability & Rehabilitation, 3(3), 17-38. • Cimarolli, V.R., Reinhardt, J.P. & Horowitz, A. (2006). Perceived overprotection: Support gone bad? The Journals of Gerontology Series B: Psychological Sciences and Social Sciences, 61, 18-23. • Pogrund, R. & Griffin-Shirley, N. Collaboration in providing orientation and mobility to the older adult. In N. Griffin-Shirley & L. Bozeman, O&M for Life. Unpublished manuscript. • Griffin-Shirley, N., & Welsh, R. L. (2010). Teaching orientation and mobility to older adults. In W.R. Weiner, & R.L. Welsh, Blasch, B.B., (Eds.) Foundations of Orientation and Mobility (3rd edition, p. 286-314). New York: AFB Press. • U.S. Department of Health and Human Services, Center for Disease Control & Prevention, (2010). Summary of Health Statistics for U.S. Adults: National Health Interview Survey, 2009. (CDC No. Number 362.1’0973’021s—dc21) Retrieved http://www.cdc.gov/nchs/nhis/new_nhis.htm