Anxiety is a feeling of fear, panic, worry, or unease about future events, and can be linked to a fear reaction around current events. When felt unusually intensely or for prolonged periods it can develop into a debilitating anxiety disorder that impacts on a person’s quality of life and their ability to respond appropriately to life events. Anxiety and Depression is almost three times as likely to occur in older people with sight loss than people with good vision.

Anxiety is a broad term that encompasses many underlying disorders and phobias, including:

• Generalised anxiety disorder (GAD): This is characterised by constant worrying, feeling on edge and being unable to relax, which prevents pleasure in day-to-day life.
• Panic disorder: This is characterised by repeated, unexpected bouts of severe anxiety, often accompanied by physical symptoms such as a fast heart rate and shakiness. With time, anxiety becomes more continuous, and the fear of having a panic attack can become embedded.
• Social anxiety disorder: This form of anxiety is typified by a debilitating fear that other people will think badly of the individual. It often has roots in being very shy as a child and can make it hard to develop friendships or a fulfilling social life. It can also affect how people perform in public.

Bipolar disorder, formerly known as manic depression, is a mental illness that has prolonged periods of depression and periods of abnormally elevated moods. These are seen to swing from one extreme to another, giving periods of depression and periods of elevated moods; If the elevated mood is significant it is known as mania or hypomania depending on its severity or whether symptoms of psychosis are present

There are several different types of personality disorder. However, BPD is characterised by a person thinking, feeling and relating to others differently from the average person. This is shown through their patterns of behaviour, varying moods, and unusual self-image.

Depression is a common and serious medical illness that negatively affects how the person feels, the way they think and how they act. There are several types, which are classified based on the impact that they have on individuals and the symptoms that are experienced. It causes feelings of sadness and/ or a loss of interest in activities once enjoyed and can lead to a variety of emotional and physical problems, decreasing a person’s ability to function effectively. Women are more likely to seek depression help and treatment than men. However, it is treatable.

Most common Treatments for depression include:

• Cognitive Behavioural Therapy (CBT). This is a type of psychotherapy that aims to tackle the negative thoughts that are associated with depression. CBT helps people to think in a more balanced way and challenges their negative assumptions about their lives. It aims to identify and change aspects of behaviour that may cause or prolong symptoms of depression.
• Antidepressant Medication. This is typically used alongside CBT to complement the psychotherapy and act as an additional buffer against depression. Antidepressant medication will be the first line of treatment for depression if:
  • It is severe or comes and goes
  • The person has responded well to medication in the past
  • The person has not responded well to psychotherapy in the past

There is a history of familial depression

Dissociation is one way the mind copes with too much stress, such as during a traumatic event. For many people, dissociation is a natural response to trauma that they can’t control, and it can be a response to a one-off traumatic event or to ongoing trauma and abuse. It usually describes an experience where the person feels disconnected in some way from the world around them or from them self and if the frequency and duration of a dissociative event becomes greater, then a dissociative disorder may develop.

Dissociation can be a symptom of a mental health problem such as schizophrenia, bipolar disorder, borderline personality disorder or post-traumatic stress disorder; or it can occur as a side effect of some drugs, medication, or coming off some medication and alcohol.

Emotionally Unstable Personality Disorder (also ADHD) is a brain disorder causing a group of behavioural symptoms that include inattentiveness, hyperactivity and impulsiveness that interfere with functioning or development. These are usually noticed at an early age often becoming more apparent at the start of schooling but can continue into adulthood.

OCD is associated with repetitive unwanted thoughts or behaviours which are often related to issues concerning safety, contamination or harm. The behaviours associated with OCD can seem impossible to stop or control and can become extremely time consuming, affecting the individual’s ability to conduct normal life.

These are common and involve unrealistic fears of specific objects, situations or events. Examples may include fears of snakes, spiders, flying or heights. However, if extremely the anxiety induced by the phobia can impact on the person’s ability to lead a normal life.

PTSD is a specific form of anxiety disorder characterised as a persisting anxiety state related to having had a traumatising experience that was highly stressful, frightening or distressing events; the resultant stress can continue long after the initial triggering events have ended.

A desire to have an excessive fluid intake in the absence of a physiological need or requirement to drink, i.e. not as a result of the thirst stimulus.

Psychosis is a symptom, of a mental illness such as schizophrenia and can be caused by mental or physical illness, substance abuse, or extreme stress or trauma. Young people are especially vulnerable for reasons that are not fully understand.

Drug induced psychosis has been associated with suicidal thoughts, dangerous and violent behaviour, hospitalisation and criminal behaviour that can lead to arrests.

Schizophrenia is a psychotic disorder; it is a severe long-term mental health condition that causes a range of different psychological symptoms. These can include:

• Hallucinations – characterised by hearing or seeing things that others do not.
• Delusions – holding unusual or false beliefs that are not based on reality.
• Muddled thoughts – unclear and confused thinking resulting from hallucinations or delusions
• Changes in behaviour patterns/ Abnormal social behaviour or reluctant social interaction and lack of motivation

If a person experiences a combination of schizophrenia symptoms such as hallucinations or delusions and mood disorder symptoms such as depression or mania and deregulated emotions, they are described as having Schizoaffective Disorder.

The phrase ‘self-harm’ is used to describe a wide range of behaviours. Self-harm is often understood to be a physical response to an emotional pain of some kind, and results when a person intends to hurt themselves physically; it can be an addictive behaviour. Some forms of self-harm are quite well known, such as cutting, burning or pinching, but it also includes abusing drugs and alcohol or having an eating disorder.

Substance misuse is the harmful use of substances (like drugs and alcohol) for non-medical purposes. The term “substance misuse” often refers to illegal drugs and is a patterned use of a drug in which the users consume the substance in amounts or with methods, which are harmful to themselves or others.

However, legal substances can also be misused, such as alcohol, prescription medications, caffeine, nicotine and volatile substances.

Addiction results when there is a physical and/ or psychological need for a substance, due to regular, continued use. Some substances are highly addictive, others are less addictive. However, the symptoms of addiction are similar no matter which substance is used. Typical signs of substance misuse or addiction include:

• Neglecting responsibilities and activities you used to enjoy
• Loss of interest in usual personal care and concern for own well-being

Suicidal thoughts can be triggered by

• depression or anxiety
• feeling useless and unwanted or needed by anyone
• feeling hopeless about the future or powerless to be able to do or say anything to bring about change
• blaming oneself for things that have happened in their life, and
• that it would be easier for others if they weren’t here

Dementia is a term used to describe a group of symptoms associated with a decline in memory or other thinking skills that is severe enough to reduce a person’s ability to perform everyday activities. It can incorrectly be referred to as “senility” or “senile dementia,” which reflects an incorrect belief that serious mental decline is a normal part of aging.

Alzheimer’s Disease is the most common type of dementia and symptoms include: Difficulties with language, Trouble finding words; and Frequent repetition.

People may become agitated or depressed and the disease changes how a person makes decisions or solves problems.

Vascular Dementia, which can occur after a stroke, is the second most common dementia type and is caused by damage to the brain’s blood supply. It results in the person having difficulties with everyday living skills, and attention and memory problems.

Frontotemporal dementia is characterised by changes in behaviour and personality, where behaviours become obsessive or repetitive, and the person shows a loss of empathy

Some conditions that can cause symptoms of dementia include ones that are reversible, such as thyroid problems and vitamin deficiencies.

DES is characterised by of a group of symptoms, usually resulting from brain damage, that fall into cognitive, behavioural and emotional categories and tend to occur together.

The term describes a common pattern of poor function in regard to e.g. planning, abstract thinking, flexibility and behavioural control. It was once known as Frontal Lobe Syndrome, which characterised a location rather than the actual pattern of deficits that are exhibited.

This is the second most common type of progressive dementia after Alzheimer’s disease dementia. Protein deposits, called Lewy bodies, develop in nerve cells in the brain regions involved in thinking, memory and movement (motor control).

Lewy body dementia causes a progressive decline in mental abilities, and people with Lewy body dementia may experience visual hallucinations, and changes in alertness and attention.

Other effects include Parkinson’s disease-like symptoms such as rigid muscles, slow movement and tremors

This is a neurodegenerative disorder that affects predominately dopamine-producing cells in a specific area of the brain. It is most common in the over 60’s, and more common in men. It has a small genetic component and there are indications that environmental factors may also contribute to its onset later in life. Incidents of brain injury with loss of consciousness are also known to be higher amongst those who go on to develop Parkinson’s Disease.

Korsakoff syndrome is a chronic memory disorder caused by severe deficiency of thiamine (vitamin B-1). It is most commonly caused by alcohol misuse, but certain other conditions also can cause the syndrome.

Osteoarthritis is the most common chronic condition of the joints, sometimes called degenerative joint disease or degenerative arthritis. It can affect any joint, but occurs most often in knees, hips, lower back and neck, small joints of the fingers and the bases of the thumb and big toe. It results from a breakdown of the cartilage cushion that normally covers the ends of the bones making up the joints.

Although it can occur in people of all ages, osteoarthritis is most common in people older than 65. Common risk factors include increasing age, obesity, previous joint injury, overuse of the joint, weak thigh muscles, and genetics.

Sensory loss can occur due to a minor nick or lesion on the spinal cord. This creates problems with the nervous system that can lead to loss of smell, taste, touch, sight and hearing.

Sensory losses can be from birth, arising during pregnancy if e.g. an infection such as measles is contracted, or can be caused from degenerative illnesses, including those experienced in old age. Persons with Cerebral Palsy may also have sensory loss, depending on which part of their brain is affected.

The term ‘Sensory Impairment’ is also used to refer to people with either visual or hearing impairments or both – the extent of those impairments will vary from person to person.

There is a high prevalence rate of sight loss amongst adults with learning disabilities, with this group being 10 times more likely to be blind or partially sighted than the general population.

There is also a significantly higher risk of falls and therefore fall injuries amongst those who have impaired sight.

Visual Impairments: An ophthalmologist can assess an individual and issue a Certificate of Vision Impairment (CVI), which is used to identify them as being ‘sight impaired’ or ‘severely sight impaired’.

• Sight impaired: This term is used for someone who is “substantially and permanently handicapped by defective vision caused by congenital (present at birth) defect, illness or injury.”
• Severely sight impaired: This term is used for someone who is “so blind as to be unable to perform any work for which eyesight is essential.“

Conditions leading to Visual Impairment

• Age-related macular degeneration (AMD): AMD commonly affects people over the age of 50 and is the leading cause of blindness in people over the age of 65. There is also a strong link between smoking and Age-related macular degeneration (AMD), with the risks being equivalent to developing lung cancer. Obesity has also been linked to several eye conditions including development of cataracts and AMD.Wet AMD (neovascular or exudative AMD) can develop quickly affecting central vision in a short period of time. Early identification and treatment of wet AMD is vital. Treatment can halt the further development of scarring but lost sight cannot be restored.Dry AMD (atrophic) can develop slowly and take a long time to progress. There is currently no treatment for dry AMD, and it does impact upon a person daily life.

• Glaucoma: A group of eye conditions in which the optic nerve is damaged commonly, but not always, due to changes in eye pressure. Damage to sight can usually be minimised by early diagnosis in conjunction with careful regular observation and treatment.Many glaucoma patients will attend regular appointments and take eye drops for the rest of their lives to prevent deterioration of vision. Some forms of glaucoma can be treated with laser surgery and surgery.The risk of developing glaucoma is higher in African and African-Caribbean populations
• Cataracts: A common eye condition that is prevalent in older people. The lens becomes less transparent and turns misty or cloudy. Cataracts over time can get worse and impact upon vision. A straightforward operation replaces the lens with an artificial one. A number of studies have demonstrated the cost benefits of cataracts surgery in improving life quality and reducing the number of falls in the elderly. Evidence also shows that people from the Asian population are at a higher risk

Speech sound disorders are shown by an inability to correctly form the sounds of words. These include Articulation Disorder, Disfluency, Phonological Disorder and Voice Disorders.

Diabetes mellitus refers to a group of diseases that affect how the body uses blood sugar (glucose). Hyperglycaemia, (elevated blood sugar), that is persistent and/ or occurring often, can lead to serious health problems. Hypoglycaemia (low blood sugar), usually resulting from incorrect use of medication in relation to food intake, can also lead to coma.

Chronic diabetes conditions can be Type 1 or Type 2.

Type 1 results from loss of effective Insulin production by the Pancreas. It usually starts in childhood or adolescence. It is also referred to as Insulin dependent diabetes as treatment requires regular injections of Insulin at correct dose and time to correspond with food intake.

Type 2 occurs as a result of the failure of the body’s cells to process the sugar in the blood correctly, and at least in the early stages can usually be managed through diet, exercise and tablets. It generally occurs in those who are obese and the over 40’s.

Symptoms: The following symptoms of diabetes are typical. However, some people with type 2 diabetes have symptoms so mild that they can go unnoticed.

• Urinating frequently and urgently
• Feeling very thirsty – regardless of fluid intake
• Feeling very hungry – even though you are eating
• Extreme fatigue
• Blurry vision
• Cuts/bruises that are slow to heal
• Weight loss – even though you are eating more
• Tingling, pain, or numbness in the hands/feet (type 2)

There is a risk of developing complications that arise from long-term and/or poorly managed Diabetes, so early detection and effectively managed treatment are essential to reduce these risks.

• Diabetic retinopathy: This is a common complication of diabetes. It occurs when high blood sugar levels damage the cells at the back of the eye, known as the retina. If it is not treated, it can lead to blindness. Diabetes also increases the risk of other serious vision conditions, such as cataracts and glaucoma.Evidence shows that people from the African, African-Caribbean and Asian populations are at a higher risk of developing diabetic eye disease, and that smoking can make diabetes-related sight problems worse. Smoking has also been linked to the development of cataracts.

• Cardiovascular disease: Diabetes dramatically increases the risk of various cardiovascular problems, including coronary artery disease with chest pain (angina), heart attack, stroke and narrowing of arteries (atherosclerosis). People with diabetes, are more likely to have heart disease or stroke.

• Nerve damage (neuropathy): Excess sugar can injure the walls of the tiny blood vessels (capillaries) that nourish nerves, especially in the legs. This can cause tingling, numbness, burning or pain that usually begins at the tips of the toes or fingers and gradually spreads upward. Left untreated, all sense of feeling in the affected limbs can be lost. Damage to the nerves related to digestion can also cause problems with nausea, vomiting, diarrhoea or constipation.Nerve damage in the feet or poor blood flow to the feet increases the risk of various foot complications. Left untreated, cuts and blisters can develop serious infections, which often heal poorly. These infections may ultimately require toe, foot or leg amputation.
• Kidney damage (nephropathy): The kidneys contain millions of tiny blood vessel clusters (glomeruli) that filter waste from your blood. Diabetes can damage this delicate filtering system. Severe damage can lead to kidney failure or irreversible end-stage kidney disease, which may require dialysis or a kidney transplant.
• Skin conditions. Diabetes may leave you more susceptible to skin problems, including bacterial and fungal infections.
• Hearing impairment. Hearing problems are more common in people with diabetes.
• Alzheimer’s disease. Type 2 diabetes may increase the risk of dementia, such as Alzheimer’s disease. The poorer your blood sugar control, the greater the risk appears to be.
• Depression. Depression symptoms are common in people with type 1 and type 2 diabetes. Depression can affect diabetes management.

Dysphagia is the medical term for swallowing difficulties, including shallow swallowing reflex. Some people with dysphagia have problems swallowing certain foods or liquids, while others cannot swallow at all.

Signs of Dysphagia include:

• Coughing or choking when eating or drinking
• Bringing food back up, sometimes through the nose (reflux)
• A sensation that food is stuck in the throat or chest
• Persistent drooling of saliva
• Being unable to chew food properly
• A ‘gurgly’ wet sounding voice when eating or drinking

Complications of Dysphagia: Over time can also cause symptoms such as weight loss and repeated chest infections.

Epilepsy is one of the most common conditions affecting the brain. It is not a learning disability but, according to Mencap statistics, 30% of people with a learning disability also have epilepsy.

Seizures are bursts of electrical activity in the brain that temporarily affect how it works. These can be triggered by e.g. flashing light, but for others the seizure occurs out of the blue.

People with epilepsy have seizures when the way their brain works becomes disrupted. Most seizures are sudden and short-lived, lasting a matter of seconds or minutes, and aren’t dangerous to the person having them, providing they are in a safe location when they occur.

Seizure signs and symptoms may include:

• Temporary confusion
• A staring spell
• Uncontrollable jerking movements of the arms and legs
• Loss of consciousness or awareness
• Psychic symptoms such as fear, anxiety or deja vu

Symptoms vary depending on the type of seizure, however, in most cases, a person with epilepsy will tend to have the same type of seizure each time, so the symptoms will be similar from episode to episode.

Medication and Treatment

Most people with epilepsy can become seizure-free by taking anti-seizure (anti-epileptic) medication.

Ensuring that the wishes of the individual are recorded so that in the event of sudden, unexpected or known end of life, these wishes and those of any significant others in their lives can be sensitively and appropriately acted upon.

Palliative care is also commissioned from appropriate external agencies should it become necessary to ensure that an individual can continue to be cared for and live in their Home for as long as is practically possible

Hypertension means High Blood pressure. In addition to increasing the risk of stroke, uncontrolled high blood pressure increases the risk of both retinal vein and retinal artery occlusion. Both conditions can cause sudden loss of vision in one eye and can lead to further complications.

Asthma is a chronic (long-term) lung disease that inflames and narrows the airways. Asthma causes recurring periods of wheezing (a whistling sound when you breathe), chest tightness, shortness of breath, and coughing. The coughing often occurs at night or early in the morning. Asthma triggers, can include outdoor allergens, such as pollens from grass, trees and weeds, and indoor allergens, such as pet dander, dust mites and mould. Certain drugs and food additives and irritants in the air, such as smoke, chemical fumes and strong odours. Colds, the flu or other respiratory tract illnesses, can cause the airways to become narrow and inflamed, leading to asthma symptoms.

Chronic obstructive pulmonary disease (COPD): This is a common lung disease which makes it hard to breathe.

There are two main forms of COPD: Chronic bronchitis, which involves a long-term cough with mucus; and Emphysema, which involves damage to the lungs over time, e.g. as a result of long-term smoking.

Eczema: This is a term for a group of medical conditions that cause the skin to become inflamed or irritated. The most common type of eczema is known as atopic dermatitis, or atopic eczema. Atopic refers to a group of diseases with an often-inherited tendency to develop other allergic conditions, such as asthma and hay fever.

Paraesthesia: This is an abnormal sensation such as tingling, tickling, pricking, numbness or burning of a person’s skin with no apparent physical cause. The occurrence of a paraesthesia may be short-lived or chronic and can have any of dozens of possible underlying causes. The most familiar kind of paraesthesia is the sensation known as “pins and needles” or of a limb “falling asleep”. A less well-known and uncommon but important paraesthesia is formication – the sensation of bugs crawling underneath the skin.

Photosensitivity: This describes an oversensitivity of skin to light. The term is principally used for abnormal reactions of the skin, and two types are distinguished, photo allergy and phototoxicity. A photo allergy is an immune system reaction to sunlight, most often, an itchy red rash. The most common locations include the “V” of the neck

Photosensitivity can also be a side effect of medications or result from diseases, such as lupus.

Treatment depends on the severity of the reaction and the cause. Photosensitivity can be prevented by avoiding skin exposure to strong sunlight (ultraviolet) light

A stoma is an opening in the body, created as a result of surgery to either the intestine and/ or bowel or the urinary tract. The purpose is to collect waste in a pouch or bag rather than allow its normal passage through the body. A colostomy and an ileostomy may be carried out as temporary measures (while, for example, another area of the bowel is being allowed to heal), or as a permanent measure, whereas a urostomy is usually carried out as a permanent measure.

With all types of stoma, the patient has no control over the output and has to wear the pouch or bag on their abdomen to collect either faeces (colostomies and ileostomies) or urine (urostomy). These have to be regularly emptied and the stoma (actual opening) has to be cared for.

The three main types of stoma are

• Colostomy – a stoma formed in the colon (large intestine or bowel).
• Ileostomy – a stoma formed in the ileum (small intestine or bowel).
• Nephrostomy/Urostomy – different from the other two types of stoma because it is not formed in the digestive system but in the urinary tract

Common reasons for having a stoma include:

• Obstruction or blockage of the bowel/bladder
• Perforation of the bowel
• Removal of severely diseased bowel or bladder

Common conditions which may require a stoma include:

• Bowel or bladder cancer
• Diverticular disease
• Ulcerative colitis
• Crohn’s disease

A stroke is a medical condition in which poor blood flow to the brain results in cell death.

There are two main types of stroke: ischemic, due to lack of blood flow, and haemorrhagic, due to bleeding, however, both result in part of the brain not functioning properly.

Around 60% of stroke survivors have some sort of visual dysfunction following a stroke, due to damage to the visual pathway of the eyes resulting in visual field loss, blurry vision, double vision and moving images. The most common condition is homonymous hemianopia, a loss of half a person’s visual field, which occurs in 30% of all stroke survivors.

Stroke is also a leading cause of epilepsy in adults older than age 35.

Thyroid disease is a medical condition that affects the production of Thyroid hormone by the thyroid gland, found at the front of the neck. The symptoms of thyroid disease vary depending on the type.

There are four general types:

• Hypothyroidism (low function) caused by not having enough thyroid hormones
• Hyperthyroidism (high function) caused by having too much thyroid hormones;
• Structural abnormalities, most commonly an enlargement of the thyroid gland; and
• Tumours which can be benign or cancerous.

Common hypothyroid symptoms include fatigue, low energy, weight gain, inability to tolerate the cold, slow heart rate, dry skin and constipation.

Common hyperthyroid symptoms include irritability, weight loss, fast heartbeat, heat intolerance, diarrhoea, and enlargement of the thyroid.

In both hypothyroidism and hyperthyroidism, there may be swelling of a part of the neck, which is also known as goitre.