Pearls from Recent Studies on Low Vision Rehabilitation and Psychosocial Issues
Research of interest to the AMD Community as presented at Vision 2008, Montreal, Canada
Selected and Summarized by Dan Roberts, Director, MD Support
These findings are derived by the referenced authors based solely upon the results of their respective studies. In every case, more research is recommended before final conclusions can be drawn.
Cultural factors unique to current senior adults have a significant influence on their perceptions of visual impairment, disability, and aging. These impact their self-perception and response to their own vision loss, and may impact their participation in rehabilitation.
The difference age makes: Cultural factors shaping older adults’ experience of and responses to vision loss from age-related macular degeneration (Mogk M., Lutheran University, Humanities/ English, Thousand Oaks ,California, United States)
Walking with safety and confidence and enjoying hobbies and leisure activities contribute to the quality of life among the senior low vision population. Self-esteem explains a nearly equal amount of variance in quality of life, specifically, ability to help with chores around the house, using remaining vision effectively, and often leaving the property and walking without help.
The impact of activities of daily living and self-esteem on quality of life among older persons with vision impairment (La Grow S., University, School of Health and Social Services, Palmerston North, New Zealand)
Vision impairment is associated with a reduction in activity in the areas of work and leisure, but not in domestic areas of daily living. Vision impairment is associated with a reduction in all areas of independence. People with impaired vision are least satisfied with independence in quiet recreation, and sighted people are the least satisfied with independence in active recreation.
Activity and independence: A comparison study of older people with and without impaired vision (Good G.A., La Grow S., Alpass F., University, School of Health and Social Services, Palmerston North, New Zealand, Massey University, School of Psychology, Palmerston North, New Zealand)
Older adults with visual impairment and severe depressive symptoms are most likely to be current smokers, to be obese (BMI>30), to be physically inactive, to have fair/poor health, to have difficulties with activities of daily living and to use special equipment to navigate the environment.
Older adults with both visual impairment and depressive symptoms experience the greatest health disparities except alcohol use. Without timely intervention, older adults with visual impairment who also experience depressive symptoms are vulnerable to health decline and further disablement.
Effects of depression on health and functional status among older adults with visual impairment (Jones G.C., Crews J., Danielson M., Center for Disease Control and Prevention, National Center on Birth Defects and Developmental Disabilities, Atlanta, United States)
The majority of daily activities (such as nutrition, fitness, personal care, communication and mobility) and social roles (such as responsibility, community life and leisure) are compromised by visual impairment. Furthermore, nearly 1/3 of the visually impaired population has depressive symptoms. The most important services are Activities of Daily Living followed by Orientation and Mobility, Optometry and Adapted Computer. Psychological services are among the least provided activities.
Waiting for services from a vision rehabilitation center: Are services related to the needs of elderly clients? (Témisjian K., Wanet-Defalque M.-C., Gresset J., Desrosiers J., Rousseau J., Dubois M.-F., Vincent C., Carignan M., Renaud J., Overbury O., Institut Nazareth et Louis-Braille, CRIR, Longueuil, Canada, Institut Nazareth et Louis-Braille, Université de Montréal École d'Optométrie, CRIR, Longueuil, Canada, Université de Montréal, École d'Optométrie, Montréal, Canada, Université de Sherbrooke, École de Réadaptation, Sherbrooke, Canada, Université de Montréal, Institut Universitaire de Gériatrie de Montréal, École de Réadaptation, Montréal, Canada, Université de Sherbrooke, Sherbrooke, Canada, Université Laval, Québec, Canada, Université de Montréal, Montréal, Canada, Université de Sherbrooke, Université de Montréal, Montréal, Canada, Université de Montréal, McGill University, École d'Optométrie, Montréal, Canada)
Increased age results in a greater number of relinquished activities for those with good sight, but not for those with impaired vision. Poor vision, poor hearing and lack of transport are reasons given by the visually impaired for stopping activity. In comparison, physical difficulties, lack of interest and lack of time are reasons given by normally-sighted people. Relinquished activities which most strongly correlate with a lower level of life satisfaction include dancing, sex and shopping for those with impaired vision and gardening, social activities and travel for those with sight.
Activities relinquished by older people with impaired vision: Why are they relinquished and what is the impact on life satisfaction? (Good G.A., Massey University, School of Health and Social Services, Palmerston North, New Zealand)
It does not appear that, with the exception of the number of friends and family identified, psychosocial factors are a significant influence on quality of life. Use of magnifiers does appear to influence the quality of life domains which relate to near vision tasks.
Psychosocial aspects of quality of life - A pilot study (Dickinson C.M., Hernandez Trillo A., University of Manchester, Faculty of Life Sciences, Manchester, United Kingdom)
Overall social participation of people with visual impairment is significantly lower than that of people without visual impairment. The groups also differ on all social participation domains except housing and interpersonal relationships. Depressive symptoms and perceived quality of distance vision together explain more than 60% of the variance in the level of social participation of the group with visual impairment.
Social participation and visual impairment in older adults (Desrosiers J., Wanet-Defalque M.-C., Gresset J., Témisjian, K., Dubois M.-F., Renaud J., Overbury O., Vincent C., Carignan M., Université de Sherbrooke, Rehabilitation, Sherbrooke, Canada, Institut Nazareth et Louis Braille, Université de Montréal, Montréal, Canada, Université de Montréal, Montréal, Canada, Institut Nazareth et Louis-Braille, Longueuil, Canada, Université de Sherbrooke, Sherbrooke, Canada, Université de Sherbrooke, Longueuil, Canada, Université Laval, Québec, Canada)
Quality of Life Index (QLI) scores globally suggest good quality of life of those with visual impairment—similar to those without visual impairment. The mean score for the “Health and functioning” domain of the QLI was the lowest , while the “Family” domain was the highest. Fewer depressive symptoms, greater satisfaction with participation in social roles and with social support, and fewer secondary health problems best explained better quality of life.
Subjective quality of life of older adults having visual impairment (Levasseur M., Renaud J., Gresset J., Overbury O., Desrosiers J., Wanet-Defalque M.-C., Dubois M.-F., Rousseau J., Témisjian K., Vincent C., Carignan M., Université de Sherbrooke, Sherbrooke, Canada, Université de Montréal, Montréal, Canada, Institut Nazareth et Louis Braille, Longueuil, Canada, Université Laval, Québec, Canada)