title: Low Vision Rehabilitation, Age-Related Vision Loss, and Risk: A Critical Interpretive Synthesis.
abstract: Given the centrality of risk in geriatric rehabilitation, it is critically important to attend to how conceptualizations of risk shape research, policies, and rehabilitation practices. This paper presents a critical interpretive synthesis (CIS) of literature addressing risk and low vision rehabilitation for older adults with age-related vision loss (ARVL) to identify key guiding assumptions regarding risk and discuss implications for what gets attended to, and not attended to, within research and rehabilitation.
  
  
  
  This CIS combined guidelines proposed by Dixon-Woods and colleagues (2006-Conducting a critical interpretive synthesis of the literature on access to healthcare by vulnerable groups. BMC Medical Research Methodology, 6, 35) and Alvesson and Sandberg (2011-Generating research questions through problematization. Academy of Management Review, 36, 247-271; 2013-Constructing research questions: Doing interesting research. London: Sage). The iterative review process involved 3 steps: literature search and selection, data extraction, and syntheses to identify boundary assumptions. The dataset included 83 research and practice description articles.
  
  
  
  Older adults with ARVL were constructed as "at risk" for various adverse outcomes, particularly dependency and self-harm, and as posing risks to others. An epidemiological approach to risk based in assumptions aligned with a technico-scientific perspective was dominant, with risk conceptualized as an embodied, individual-level phenomenon that is to be determined and managed through objective screening and expert monitoring.
  
  
  
  Key concerns include a lack of: attention to the tensions created when rehabilitation research and practice attempt to promote independence while simultaneously reducing risk, incorporation of aging adults' perspectives on risk, and analysis of environmental factors that shape risks. Research that starts by valuing older adults' experiences and attends to context can inform rehabilitation practices that support health-promoting, risk-taking, and facilitate collaborative approaches to risk management.
authors.affiliation: School of Occupational Therapy & Graduate Program in Health and Rehabilitation Sciences, The University of Western Ontario, London, Canada. drudman@uwo.ca.
authors.forename: Debbie
authors.initials: D
authors.lastname: Laliberte Rudman
authors.affiliation: School of Rehabilitation Sciences, University of Ottawa, Ontario, Canada. Bruyère Research Institute, Ottawa, Ontario, Canada.
authors.forename: Mary Y
authors.initials: MY
authors.lastname: Egan
authors.affiliation: Graduate Program in Health and Rehabilitation Sciences, The University of Western Ontario, London, Canada.
authors.forename: Colleen E
authors.initials: CE
authors.lastname: McGrath
authors.affiliation: School of Rehabilitation Sciences, University of Ottawa, Ontario, Canada. Bruyère Research Institute, Ottawa, Ontario, Canada.
authors.forename: Dorothy
authors.initials: D
authors.lastname: Kessler
authors.affiliation: Health Sciences, Brock University, St. Catharines, Ontario, Canada. Bridgepoint Collaboratory for Research and Innovation, Bridgepoint Hospital, Toronto, Ontario, Canada.
authors.forename: Paula
authors.initials: P
authors.lastname: Gardner
authors.affiliation: Physiotherapy Program, School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Ontario, Canada.
authors.forename: Judy
authors.initials: J
authors.lastname: King
authors.affiliation: Faculty of Nursing, University of Alberta, Edmonton, Canada.
authors.forename: Christine
authors.initials: C
authors.lastname: Ceci
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000375:Aging; D004185:Disability Evaluation; D015577:Geriatric Assessment / Q000379:methods*; D006801:Humans; D012306:Risk; D018570:Risk Assessment; D015354:Vision, Low / Q000534:rehabilitation*
keywords: Access to and utilization of services; Rehabilitation; Vision-related conditions