How does eye care seeking behaviour change with increasing age and visual impairment? Intersectional analysis of older adults in the Indian Sundarbans

Debjani Barman,Manasee Mishra

doi:10.1186/s12877-020-1438-y

Abstract

BackgroundVisual impairment disproportionately affects people in the low-income countries. A high proportion of visual impairment can be prevented or cured. Yet, care seeking for eye health is restricted for women and older adults. This article uses the intersectionality approach to understand how eye care seeking behaviour changes in men and women with increase in age and visual impairment in a poor and underserved region of India. It brings forth the commonalities and differences between the various groups.MethodsThe article is based on qualitative data. Persons aged 50 years and more are categorized into young-old, middle-old and old-old. Men and women with low vision/ high visual impairment have been selected from each of the three age groups. In-depth interviews have been carried out with 24 study participants. Data saturation has been attained. The JHPIEGO Gender Analysis Framework underpins the study. The narrative data has been coded in NVivo 10 software.ResultsVarious symptoms are associated with visual impairment. The young-old with low vision do not report much difficulty due to visual impairment. Study participants with high visual impairment, and in the older age groups do. Difficulty in the discharge of regular chores due to visual impairment is rarely reported. Impaired vision is considered to be inevitable with advancing age. Care seeking is delayed for eye health. Typically, outpatient care from nearby health care facilities has been sought by men and women in every group. Inpatient care is limitedly sought, and mostly restricted to men. Eye care seeking behaviour changes among men with increase in age and visual impairment. Women consistently seek less care than men for both outpatient and inpatient eye care. Study participants of both genders become dependent with increasing age and visual impairment. Traditional patriarchal privileges enjoyed by men (such as mobility and economic independence) decrease with age. The vulnerability of women gets compounded with time.ConclusionsThe article presents a granulated understanding of eye care seeking behaviour among older adults in India. Such differentials need to be taken cognizance of in programmes promoting universal access to health care. Existing conceptualizations on access to health care need to be revisited.

Highlights

Visual impairment disproportionately affects people in the low-income countries
Visual impairment is believed to occur with advancement in age and does not concern the young-old
There is a sense of normalization of visual impairment among the older adults too

Summary

Introduction

Visual impairment disproportionately affects people in the low-income countries. A high proportion of visual impairment can be prevented or cured. This article uses the intersectionality approach to understand how eye care seeking behaviour changes in men and women with increase in age and visual impairment in a poor and underserved region of India. It brings forth the commonalities and differences between the various groups. 90.0% of the visually impaired in the world live in low-income settings and 82.0% of the people living in blindness are aged 50 years and more [2]. Uncorrected refractive errors are the main cause of moderate and severe visual impairment in the world and cataract is the leading cause of blindness in low- and middle- income countries (ibid). A recent survey in the country showed that 70.0% of the study population aged 50 years and more have impairments in either near or distance vision [5]

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