Psychosocial adjustment to age-related vision loss

Both the number and proportion of the elderly and people with chronic disability are increasing as a proportion of the entire population, particularly in the over 80 years age range. The most common cause of chronic visual disability in the elderly is age-related maculopathy (ARM). Chronic visual disability, manifested as functional limitations of activities of daily living, often results in psychosocial handicap due to ineffective coping skills. Both low vision services and low vision research have previously been oriented toward functional adjustment to disability, rather than psychosocial aspects of vision loss. Previous disability research has sought to explain psychosocial adjustment in terms of mediators of stress, such as involved in "stress and coping" theory. Recent research interest in measures of rehabilitation outcome have used psychosocial factors as key indicators of adjustment. This study investigates both mediators and measures of psychosocial adjustment to chronic vision loss using a modified stress and coping model.

The study consisted of two groups: thirty elderly people with vision loss due to age-related maculopathy (ARM), and thirty elderly people (controls), age-matched and sex-matched to the ARM group but with normal vision. Data were collected, in an interview format in subjects' homes, on four psychosocial scales (life satisfaction, daily hassles, social support, and self-esteem) and a measure of self-care. In addition, information on history of visual impairment, use of optical devices, use of rehabilitation resources, distance and near visual acuity, and demographic factors were also collected.

In terms of the model presented, psychosocial results confirmed several, but not all relationships defined within the model and it appears to serve as a useful framework with which to understand the mediating factors in psychosocial adjustment to age-related vision loss. The results tend to suggest that people with chronic age-related vision loss report poorer psychosocial adjustment (as indicated by significantly poorer life satisfaction and greater stress) than age- and sex-matched controls, perhaps as a result of poorer perceptions of social support, despite rehabilitative attention.

Several results have implications for the functional rehabilitation of ARM. ARM subjects were found to have significantly poorer mobility and fewer daily activities than control subjects. Reading, recognised as important for both survival and recreational activities for many people with ARM, requires regular follow-up, as indicated by results showing gradual deterioration in vision in the ARM group being associated with poor satisfaction with prescribed reading devices, despite the majority of subjects still using the device daily. People with ARM would therefore seem to prefer to persevere with a coping strategy that is unsatisfactory in order to retain some independence in functioning.

Despite several of the individual psychosocial measures used demonstrating their usefulness as measures of psychosocial adjustment, the validity of each of the measures used is questioned. Although the methodology herein does not allow interpretation as to predictors of psychosocial adjustment following onset of vision loss (or indeed following rehabilitation services), interpretation can be made regarding factors important in the adjustment process and inter-relationships between factors. From a clinical perspective therefore, results indicate that effective low vision rehabilitation should include programs that incorporate both psychosocial adjustment and functional adjustment services. Future research is recommended to develop new measures of psychosocial adjustment to age-related vision loss.