Experiences and perceptions of unrecognised vision loss in the lives of community-dwelling older adults in Denmark: a qualitative study

Timely detection of vision loss and eye disease is essential, as impaired vision can challenge everyday life and independence, particularly in later life. Nonetheless, vision loss frequently remains unrecognised and underdiagnosed. While novel home-based detection initiatives may offer a promising approach, little is known about how older adults themselves perceive their vision. The aim of this study is to explore the meaning of vision loss in the context of biography and everyday life among older adults aged ≥ 75 years who had lived with unrecognised vision loss.

A qualitative study using ethnographic methods was conducted among older adults receiving home care services who were identified with vision loss during a novel home-based detection initiative in a Danish provincial area. Participants detected with vision loss (Snellen decimal visual acuity ≤ 0.63) were subsequently invited to hospital-based ophthalmic assessment. Participant observations during clinical encounters (n = 13) and in-depth home-based interviews (n = 15) were conducted with 15 consecutively recruited older adults and six relatives. Interviews were audio-recorded, transcribed verbatim, and analysed using a narrative-thematic approach.

Although all participants were clinically identified with vision loss, often related to underlying eye disease, their subjective experiences did not necessarily align with ophthalmic assessments. Narratives of the past, present, and envisioned future revealed that vision was embedded within participants’ biographies. Past and present complex life circumstances, including accumulated hardships, declining health, and urgent health- or caregiving-related demands, shaped how participants made sense of their vision and, consequently, whether they recognised, prioritised, or responded to their vision loss.

Older adults’ perceptions of vision are deeply connected to their biographies. To ensure person-centred and tailored eye care for more care-dependent older adults, this study highlights the importance of considering not only biomedical aspects when designing initiatives to detect and address vision loss, but also biographical dimensions that may otherwise overshadow vision-related challenges.