Depression in older people: visual impairment and subjective ratings of health

Factors associated with vision-related quality of life among the adult population living in Nagorno Karabagh

OBJECTIVES

Visual impairment and blindness are major public health problems causing significant suffering, disability, loss of productivity, and diminishing quality of life for millions of people. This study explored the factors associated with the overall vision-related quality of life (VRQoL) and its different domains in the adult population of Nagorno Karabakh and assessed the independent contribution of specific eye diseases to VRQoL.

STUDY DESIGN

A cross-sectional study.

METHODS

We conducted interviewer-administered survey along with free eye screenings among adult residents of Hadrut and Martuni regions of Nagorno Karabakh (Artsakh) in 2014-2015. The study questionnaire included questions about sociodemographic characteristics, non-communicable diseases, use of eye care services, visual acuity, eye diseases, and VRQoL. National Eye Institute Visual Functioning Questionnaire-25 (NEI VFQ-25) was used to assess VRQoL. In total, 531 adults participated in the study.

RESULTS

The mean age of participants was 60.1 years (standard deviation [SD] = 13.7), ranging from 18 to 90 years. The majority of participants were female (71.4%). The most frequently diagnosed eye disorder was cataract (33.8%). The prevalence of moderate and severe visual impairment was 7.0% and 0.8%, respectively. Almost 2.8% (15) of participants were blind. The mean global score of VFQ-25 in all study participants was 71.1 ± 19.28 (SD), whereas the mean global scores of VFQ-25 among not visually impaired, visually impaired, and blind participants were 74.0 ± 16.47 (SD), 51.7 ± 21.77 (SD), and 30.9 ± 20.2 (SD), respectively. In the adjusted linear regression model having moderate/severe visual impairment or blindness, age, socio-economic status, and having eye diseases such as glaucoma and cataract were significantly associated with VFQ-25 global score. The subscales of near vision, distance vision, peripheral vision, role difficulties, and mental health had significant associations with severe/moderate visual impairment in the adjusted analysis. After adjusting for visual impairment and demographic variables, participants with cataract and glaucoma were found to have statistically significant lower subscale scores than those without eye disease.

CONCLUSION

Our data suggest that visual impairment was associated with lower scores of VRQoL. The strength of that association correlated with the increase in the level of visual impairment (from moderate/severe impairment to blindness). VRQoL was also shown to be affected by age, socio-economic status, and having eye diseases such as glaucoma and cataract. Further actions of remediation of visual impairment in this population are warranted.

Vision-related Quality of Life in Glaucoma Suspect or Early Glaucoma Patients

PURPOSE

To determine the association of vision-related quality of life (QoL) to demographic factors and visual function in glaucoma suspect or early glaucoma patients.

MATERIALS AND METHODS

We administered the 25-item National Eye Institute Visual Function Questionnaire (VFQ-25) on the same day as a comprehensive ocular examination to participants either with glaucoma or at high risk for developing glaucoma. Regression models were used to determine the association between VFQ-25 composite and subscale scores, visual field status, logMAR equivalent visual acuity (VA), age, and sex. In all analyses we used data from the eye with the best mean deviation (MD), best pattern SD, and best VA.

RESULTS

Data from 198 participants were analyzed. The mean best MD (±SD) was 0.02±1.52 dB (range, -5.11 to 2.63 dB) and the mean best pattern SD was 1.75±1.03 dB (range, 0.91 to 8.36 dB). The mean VFQ-25 composite score was 91.6±6.7 (range, 54.5 to 100.0). Composite score and the Distance Activities, Color Vision subscale scores were associated with best MD (P≤0.05). The General Vision and Driving subscale scores were associated with best VA (P≤0.03). The composite score and the Distance Activities, Driving, and Color Vision subscale scores were associated with age (P≤0.05). Finally, the Distance Activities, Driving, and Peripheral Vision subscale scores were associated with sex (P≤0.04).

CONCLUSIONS

Vision-related QoL is associated with visual field status even in early and suspected glaucoma. It is also associated with VA, age, and sex. Particular decreases in QoL are related to distance activities, driving, and color vision.

Hallucinations in Healthy Older Adults: An Overview of the Literature and Perspectives for Future Research

KEY POINTS

➢ Studies suggest a substantial minority of healthy older adults have hallucinatory experiences, in line with existing evidence on hallucinations in other age groups, though it is still unclear if hallucination prevalence increases or declines with age in older cohorts.

➢ Stigma attached to both hallucinations and ageing leads to considerable under-reporting of these experiences in healthy older adults and may negatively bias how professionals, family members, and the public respond.

➢ Why and when hallucinations in healthy older adults remit, persist, or progress to other clinical disorders remains poorly understood.

➢ Current evidence points to a range of factors associated with hallucinations in older adults including decline in sensory or cognitive functioning, poor sleep, and psychosocial stressors (e.g., social isolation, loneliness, and bereavement), highlighting the need for accurate assessment and tailored interventions.

Hallucinations, though common in youth and younger adults, are not the preserve of these age groups. Accumulating evidence shows that hallucinatory experiences are also present at surprisingly high rates in healthy older adults in the general community. Furthermore, stigma and misunderstanding of hallucinations, together with ageism, may lead to under-reporting of these experiences by older adults, and misdiagnosis or mismanagement by health and mental health practitioners. Consequently, improved public and professional knowledge is needed about the nature and significance of hallucinations with advancing age. The purpose of this review is to provide a comprehensive overview, and critical analysis, of research on the prevalence, psychosocial, and neurobiological factors associated with hallucinations in people aged 60 years and over. To the best of our knowledge, this is the first review of its kind in the literature. The evidence supports a dynamic conceptualization of hallucinations, in which the emergence of hallucinations is viewed as a balance between the sensory, cognitive, or social impairments accompanying advancing age and the degree to which compensatory processes elicited by these impairments are successful. We briefly summarize the implications of the literature for aged care services and interventions, and stress that far more studies are needed in this important field of research.

Multisite prospective investigation of psychological outcomes following cataract surgery in Vietnam

Background

Cataract surgery is a low-cost and effective intervention. There is increasing evidence to suggest that cataract surgery is associated with improvements in mobility, overall functioning and reductions in psychological distress. Within low-income and middle-income countries, cataract surgery has also been documented to lead to reductions in psychological distress; however, differences in economic activity and engagement in paid and domestic work in these countries may moderate such reductions. We aimed to examine the psychological outcomes following cataract surgery among a diverse Vietnamese sample.

Methods

We report findings from the VISIONARY study, a 12-month multisite prospective study of cataract surgery outcomes conducted in Vietnam (N=462). Generalised estimating equations (GEEs) were used to identify the variables which were associated with reduced psychological distress.

Results

A high proportion of participants (56.6%) reported psychological distress before surgery and severity of psychological distress had decreased by 12 months following surgery (95% CI (4.13 to 4.95)). There were regional differences in the extent of improvement in psychological distress and change in paid and unpaid work. The extent of improvement in visual acuity, male gender, and increase in paid and unpaid work hours were significant predictors of reductions in psychological distress.

Conclusions

Cataract surgery appears to result in the greatest reductions in psychological distress in communities where work engagement is highest.

Funding

The VISIONARY study was funded by a grant provided by the Fred Hollows Foundation, Australia. During the course of this work, BME was in receipt of an Ian Potter Foundation Fellowship and a National Health and Medical Research Council (NHMRC) fellowship (1072148), SJ received an NHMRC Senior Research Fellowship, MLH was in receipt of a National Heart Foundation Future Leader Fellowship 100034.

The incidence and predictors of depressive and anxiety symptoms in older adults with vision impairment: a longitudinal prospective cohort study

PURPOSE

Depression and anxiety are highly prevalent in older adults with vision impairment. Because symptoms of depression and anxiety appear to fluctuate, it is important to identify patients who are at risk of developing these symptoms for early diagnosis and treatment. Therefore, the aim of this study was to determine the incidence of subthreshold depression and anxiety, and to investigate predictors of developing symptoms of depression and anxiety in older adults with vision impairment who had no subthreshold depression or anxiety at baseline.

METHODS

A longitudinal prospective cohort study with a follow-up of 24 months in 540 older adults with vision impairment (mean age 75 years, 56% female, 48% macular degeneration, 15% glaucoma) from outpatient low-vision rehabilitation organisations was performed. The cumulative incidences of subthreshold depression and anxiety were calculated and linear mixed models with maximum likelihood estimation were used to determine two prediction models. Main outcome measures were: fluctuations in (i) depressive symptoms (Center for Epidemiologic Studies Depression Scale, CES-D) and (ii) anxiety symptoms (Hospital Anxiety and Depression Scale-Anxiety subscale, HADS-A).

RESULTS

The annual cumulative incidences of subthreshold depression and anxiety were 21.3% (95% Confidence Interval (CI) 18.7-23.9%) and 9.5% (95% CI 7.4-11.6%), respectively. Risk factors for developing depressive symptoms were: living alone, having just enough money to cover expenses, having macular degeneration, having problems with adaptation to vision loss, reduced health related quality of life, and experiencing symptoms of anxiety. For developing anxiety symptoms, a relatively younger age, experiencing symptoms of depression, not living alone and experiencing hindrance at work proved to be risk factors.

CONCLUSIONS

This study shows that the incidence of subthreshold depression and anxiety in older adults with vision impairment is twice as high compared with older adults in general and confirms that depression and anxiety symptoms fluctuate over time. It is of great importance that low vision rehabilitation staff monitor older adults with vision impairment who are most vulnerable for developing these symptoms, based on the risk factors that were found in this study, to be able to offer early interventions to prevent and treat mental health problems in this population.

Depressive symptoms in older adults awaiting cataract surgery

BACKGROUND

To assess the prevalence and predictors of depressive symptoms in a cohort of older adults awaiting cataract surgery and establish threshold vision at which depressive symptoms may emerge.

DESIGN

Analysis of cross-sectional baseline data from a longitudinal cohort study of patients aged ≥65 years on Australian public hospital cataract surgery waiting lists.

PARTICIPANTS

We included 329 participants enrolled October 2013-August 2015.

METHODS

Participants completed assessment of depressive symptoms, visual disability, quality of life, social participation and exercise frequency at least one month prior to cataract surgery. High and low contrast habitual vision was examined and systemic comorbidities noted.

MAIN OUTCOME MEASURE

Depressive symptoms prior to first eye cataract surgery.

RESULTS

The prevalence of depressive symptoms was 28.6% (94/329). Univariate analysis identified that participants with poorer high contrast vision, reduced quality of life, greater patient-reported visual disability, higher comorbidity score and who were taking more medications were more likely to exhibit signs of depression. Greater patient-reported visual disability (P = 0.02), reduced quality of life (P = 0.003) and a higher comorbidity score (P = 0.02) remained significantly associated with depressive symptoms in the multivariable model. Depressive symptoms emerged at a visual acuity of 6/12.

CONCLUSIONS

These findings demonstrate a high prevalence of depressive symptoms in older persons with cataract, emerging at modest levels of vision loss. Efficient referral processes, timely surgical management, and improved screening and coordinated treatment of depressive symptoms during the surgical wait may minimize the negative psychological effects of cataract in this already vulnerable population.

A population study of correlates of social participation in older adults with age-related vision loss

OBJECTIVE

To examine personal characteristics, disease-related impairment variables, activity limitations, and environmental factors as correlates of social participation in older adults with vision loss guided by the World Health Organization's International Classification of Functioning, Disability and Health Model.

DESIGN

Baseline data of a larger longitudinal study.

SETTING

Community-based vision rehabilitation agency.

SUBJECTS

A total of 364 older adults with significant vision impairment due to age-related macular degeneration.

MAIN MEASURES

In-person interviews assessing social participation (i.e. frequency of social support contacts, social/leisure challenges faced due to vision loss, and of social support provided to others) and hypothesized correlates (e.g. visual acuity test, Functional Vision Screening Questionnaire, ratings of attachment to house and neighborhood, environmental modifications in home).

RESULTS

Regression analyses showed that indicators of physical, social, and mental functioning (e.g. better visual function, fewer difficulties with instrumental activities of daily living, fewer depressive symptoms) were positively related to social participation indicators (greater social contacts, less challenges in social/leisure domains, and providing more support to others). Environmental factors also emerged as independent correlates of social participation indicators when functional variables were controlled. That is, participants reporting higher attachment to their neighborhood and better income adequacy reported having more social contacts; and those implementing more environmental strategies were more likely to report greater challenges in social and leisure domains. Better income adequacy and living with more people were related to providing more social support to others.

CONCLUSION

Environmental variables may play a role in the social participation of older adults with age-related macular degeneration.

Anxiety and depression in patients with advanced macular degeneration: current perspectives

Age-related macular degeneration (AMD) - despite advances in prevention and medical treatment options - remains prevalent among older adults, often resulting in functional losses that negatively affect the mental health of older adults. In particular, the prevalence of both anxiety and depression in patients with AMD is high. Along with medical treatment options, low vision rehabilitation and AMD-specific behavioral and self-management programs have been developed and have demonstrated effectiveness in improving the mental health of AMD patients. This article reviews the prevalence of anxiety and depression in patients with advanced AMD, discusses potential mechanisms accounting for the development of depression and anxiety in AMD patients, presents the state-of the-art of available interventions for addressing anxiety and depression in AMD patients, and delineates recommendations for eye care professionals regarding how to screen for these two prevalent mental health problems and how to facilitate appropriate treatment for patients with AMD.

Estimation of depression prevalence in patients with Stargardt disease using PHQ-9 and Zung scores

PURPOSE

To evaluate the psychological impact and depression prevalence in patients with Stargardt disease.

METHODS

We conducted a case-control study including 39 patients with Stargardt disease and 32 age- and sex-matched healthy controls. All participants underwent a complete ophthalmologic examination and completed the Patient Health Questionnaire-9 (PHQ-9) and the Zung Depression Inventory questionnaire. Results were analyzed using IBM SPSS 22.0 software.

RESULTS

The patient group consisted of 19 men and 20 women with mean age of 36.9 ± 5.4 years and control group of 19 men and 13 women with mean age of 42.5 ± 10.1 years. The mean values of PHQ-9 and Zung scores for patients and healthy individuals were 10.9 ± 4.9, 46.7 ± 11.1, 6.7 ± 5.4, and 41.1 ± 8.5, respectively. There were statistically significant differences between the 2 groups in PHQ-9 scores (independent samples t test: p = 0.001), but not in Zung scores (Mann-Whitney test: p = 0.053). The PHQ-9 and Zung scores appeared to be moderately but significantly correlated (Pearson coefficient 0.44, p<0.0001). In addition, PHQ-9 score seems to be raised along with age, whereas both scores are low when best-corrected visual acuity is high.

CONCLUSIONS

Patients with Stargardt disease exhibited more depressive symptoms compared to healthy individuals according mainly to PHQ-9 scores. Moderate depression was significantly correlated visual function decline.

Visual impairment and depression among socially vulnerable older adults in Armenia

OBJECTIVES

Visual impairment in older adults is a major public health problem. Untreated visual impairment might negatively impact physical and psychological health. This study assessed the association between visual impairment and depression among socially vulnerable older adults (those aged 50 and above) in Armenia.

METHOD

The survey and eye screenings were carried out among 339 participants who were the residents of retirement homes and single older adults in the households. The study team used Golovin-Sivtsev chart and cycloplegic skiascopy to measure visual impairment and Center for Epidemiologic Studies Depression scale to measure depression.

RESULTS

The prevalence of visual impairment in the sample was 13.3%. Almost 24.0% of participants reported depression symptoms. Participants living in the retirement homes had substantially higher rates of visual impairment (21.5%) and depression (28.0%) than those living in households (9.3% and 15.0%, respectively). The odds of having depression were higher among those with visual impairment compared to those without after adjusting for confounders (OR = 2.75; 95% CI: 1.29-5.87). Having at least one non-communicable disease was associated with depression (OR = 2.47; 95% CI: 1.28-4.75). Living in the retirement home was marginally significantly associated with having depression. Other confounders included age, gender, education, physical activity, and smoking.

CONCLUSION

Visual impairment was significantly associated with depression in socially vulnerable older adults in Armenia. Timely eye screenings in similar population groups could lead to early detection of visual impairment and prevention of visual loss and associated mental health problems.

Watchful waiting for subthreshold depression and anxiety in visually impaired older adults

Purpose

Immediate treatment of depression and anxiety may not always be necessary in resilient patients. This study aimed to determine remission rates of subthreshold depression and anxiety, incidence rates of major depressive and anxiety disorders, and predictors of these remission and incidence rates in visually impaired older adults after a three-month ‘watchful waiting’ period.

Methods

A pretest–posttest study in 265 visually impaired older adults (mean age 74 years), from outpatient low-vision rehabilitation services, with subthreshold depression and/or anxiety was performed as part of a randomised controlled trial on the cost-effectiveness of a stepped-care intervention. An ordinal logistic regression analysis was conducted. Main outcome measures were: (1) subthreshold depression and anxiety measured with the Centre for Epidemiologic Studies Depression Scale (CES-D) and the anxiety subscale of the Hospital Anxiety and Depression Scale (HADS-A), and (2) depressive and anxiety disorders measured with the Mini International Neuropsychiatric Interview.

Results

After a three-month watchful waiting period, depression and anxiety decreased significantly by 3.8 (CES-D) and 1.4 points (HADS-A) (p < 0.001). Of all participants, 34 % recovered from subthreshold depression and/or anxiety and 18 % developed a depressive and/or anxiety disorder. Female gender [odds ratio (OR) 0.49, 95 % confidence interval (CI) 0.28–0.86], more problems with adjustment to vision loss at baseline (OR 1.02, 95 % CI 1.00–1.03), more symptoms of depression and anxiety at baseline (OR 1.06, 95 % CI 1.02–1.10), and a history of major depressive, dysthymic, and/or panic disorder (OR 2.28, 95 % CI 1.28–4.07) were associated with lower odds of remitting from subthreshold depression and/or anxiety and higher odds of developing a disorder after watchful waiting.

Conclusions

Watchful waiting can be an appropriate step in managing depression and anxiety in visually impaired older adults. However, female gender, problems with adjustment to vision loss, higher depression and anxiety symptoms, and a history of a depressive or anxiety disorder confer a disadvantage. Screening tools may be used to identify patients with these characteristics, who may benefit more from higher intensity treatment or a shorter period of watchful waiting.

Psychological Aspects and Depression in Patients with Retinitis Pigmentosa

Purpose

To assess the psychological impact and the potential relationship between depression and visual impairment in patients with retinitis pigmentosa (RP).

Methods

Our study included 34 patients with RP and 35 age- and sex-matched controls. All participants underwent a thorough ophthalmic examination including best-corrected visual acuity (BCVA), slit-lamp biomicroscopy, and dilated funduscopy, and they completed the Zung Depression Inventory questionnaire and the Patient Health Questionnaire-9 (PHQ-9). Questionnaires were rated according to specific guidelines. Statistical analysis was performed using SPSS 20.0 software.

Results

There was a statistically significant difference in PHQ-9 score and Zung score between patients with RP and controls. The BCVA differed significantly between the 2 groups as well. Older subjects presented significantly higher Zung score and PHQ-9 score, as well as worse BCVA in both eyes. Sex did not show any significant correlation as far as Zung score, PHQ-9 score, or BCVA. Zung score was correlated positively with PHQ-9 score, while both Zung and PHQ-9 score were positively correlated with BCVA.

Conclusions

Patients with RP seem to present mild to moderate depressive symptoms in comparison with healthy control subjects without visual impairment. These symptoms were found to be correlated with BCVA and age, suggesting that visual loss and older age in patients with RP could be predictive factors of their emotional status. Therefore, there is need for close monitoring and supportive management of this population, so as to detect depression and to treat it promptly.

Do problem-solving interventions improve psychosocial outcomes in vision impaired adults: a systematic review and meta-analysis

OBJECTIVE

To evaluate the effectiveness of problem-solving interventions on psychosocial outcomes in vision impaired adults.

METHODS

A systematic search of randomised controlled trials (RCTs), published between 1990 and 2013, that investigated the impact of problem-solving interventions on depressive symptoms, emotional distress, quality of life (QoL) and functioning was conducted. Two reviewers independently selected and appraised study quality. Data permitting, intervention effects were statistically pooled and meta-analyses were performed, otherwise summarised descriptively.

RESULTS

Eleven studies (reporting on eight trials) met inclusion criteria. Pooled analysis showed problem-solving interventions improved vision-related functioning (standardised mean change [SMC]: 0.15; 95% CI: 0.04-0.27) and emotional distress (SMC: -0.36; 95% CI: -0.54 to -0.19). There was no evidence to support improvements in depressive symptoms (SMC: -0.27, 95% CI: -0.66 to 0.12) and insufficient evidence to determine the effectiveness of problem-solving interventions on QoL.

CONCLUSION

The small number of well-designed studies and narrow inclusion criteria limit the conclusions drawn from this review. However, problem-solving skills may be important for nurturing daily functioning and reducing emotional distress for adults with vision impairment.

PRACTICE IMPLICATIONS

Given the empirical support for the importance of effective problem-solving skills in managing chronic illness, more well-designed RCTs are needed with diverse vision impaired samples.

Association between vision impairment and health among a national cohort of 87,134 Thai adults

To date, more than 300 million people worldwide live with low vision and blindness, imposing social and economic burdens on individuals and families. This study analyzes a cohort of 87 134 Thai adults, reporting odds ratios (ORs) and calculating population attributable fractions (PAFs). PAF estimates the proportion of the disease or condition that would not occur if no one in the population had the risk factor. Approximately 28% and 8% reported having refractive errors and vision impairment not correctable by visual aids. Both types of vision impairment were positively associated with poor self-assessed health (adjusted ORs = 1.23 to 2.03) and poor psychological health (adjusted ORs = 1.13 to 1.63). PAFs show that refractive errors explain 6.1% of poor self-assessed health, 3.5% of poor psychological health, and 2.2% of falls in the last year. PAFs for vision impairment not correctable by visual aids explain 7.5%, 4.7%, and 3.1%, respectively. Incorporating early detection and prevention of vision impairment at the primary health care level will contribute to promoting the health of Thais.

Visual ability of patients seeking outpatient low vision services in the United States

IMPORTANCE

Most patients with low vision are elderly and have functional limitations from other health problems that could add to the functional limitations caused by their visual impairments.

OBJECTIVE

To identify factors that contribute to visual ability measures in patients who present for outpatient low vision rehabilitation (LVR) services.

DESIGN, SETTING, AND PARTICIPANTS

As part of a prospective, observational study of new patients seeking outpatient LVR, 779 patients from 28 clinical centers in the United States were enrolled in the Low Vision Rehabilitation Outcomes Study (LVROS) from April 25, 2008, through May 2, 2011. The Activity Inventory (AI), an adaptive visual function questionnaire, was administered to measure overall visual ability and visual ability in 4 functional domains (reading, mobility, visual motor function, and visual information processing) at baseline before LVR. The Geriatric Depression Scale, Telephone Interview for Cognitive Status, and Medical Outcomes Study 36-Item Short-Form Health Survey physical functioning questionnaires were also administered to measure patients' psychological, cognitive, and physical health states, respectively.

MAIN OUTCOMES AND MEASURES

Predictors of visual ability and functional domains as measured by the AI.

RESULTS

Among the 779 patients in the LVROS sample, the mean age was 76.4 years, 33% were male, and the median logMAR visual acuity score was 0.60 (0.40-0.90 interquartile range). Correlations were observed between logMAR visual acuity and baseline visual ability overall (r = -0.42) and for all functional domains. Visual acuity was the strongest predictor of visual ability (P  < .001) and reading ability (P < .001) and had a significant independent effect on the other functional domains. Physical ability was independently associated with (P < .001) overall visual ability as well as mobility and visual motor function. Depression had a consistent independent effect (P < .001) on overall visual ability and on all functional domains, whereas cognition had an effect on only reading and mobility (P < .001).

CONCLUSIONS AND RELEVANCE

Visual ability is a multidimensional construct, with visual acuity, depression, physical ability, and cognition explaining more than one-third of the variance in visual ability as measured by the AI. The significant contributions of the nonvisual factors to visual ability measures and the rehabilitation potential (ie, ceiling) effects they may impose on LVR are important considerations when measuring baseline visual ability and ultimately LVR outcomes in ongoing clinical research.

Longitudinal observation, evaluation and interpretation of coping with mental (emotional) health in low vision rehabilitation using the Dutch ICF Activity Inventory

BACKGROUND

Since there is evidence that mental health aspects (such as depression) may inhibit an optimal rehabilitation outcome, there is growing interest in the psychosocial aspects of vision loss as part of rehabilitation. The purpose of this study is to provide more insight into the construct validity and (longitudinal) interpretation of goals related to 'Coping with mental (emotional) health aspects' which are part of the recently developed 'Dutch ICF Activity Inventory (D-AI). Moreover, the data allowed to provide some insight in the outcome in this domain in relation to rehabilitation programs followed in Dutch Multidisciplinary Rehabilitation Centers at baseline and follow-up.

METHODS

In a cohort of 241 visually impaired persons, the D-AI was assessed at baseline (enrollment), 4 and 12 months, The importance and difficulty of the D-AI goals 'Handle feelings', 'Acceptance', and 'Feeling fit' and difficulty scores of underlying tasks were further analyzed, together with similar or related standardized questionnaires. At baseline, Spearman correlations were determined between D-AI goals and task and additional questionnaires to investigate the construct validity. Corrected and uncorrected linear mixed models were used to determine longitudinal rehabilitation outcomes in relation to rehabilitation programs followed.

RESULTS

Baseline correlations indicated that the difficulty of tasks and the umbrella goal 'Acceptance' were not similar. Longitudinal analyses provided insight in some subtle differences in concepts measured at the goal and task level of the D-AI, as well as similar validated questionnaires. After correcting for confounding variables, none of the underlying task difficulty scales changed over time. For goal difficulty scores only 'Acceptance' was reported to be significantly less difficult at 4 and 12 months follow-up. Importance scores of goals were stable from baseline to follow-up.

CONCLUSION

With respect to the constructs measured, results support the formulation of the new goal question 'Emotional life' which replaces the goals 'Handle feelings' and 'Acceptance'. Results indicate that MRCs should pay more attention to problems related to mental health. They have started to use the D-AI as it seems a promising tool to investigate and evaluate rehabilitation needs (including those related to mental health) over time and to clearly define rehabilitation goals from the very start.

Vision Rehabilitation in Patients with Age-related Macular Degeneration

Background

The aim of this study was to investigate the rehabilitative process and visual rehabilitation outcomes in patients with central vision loss due to age-related macular degeneration (AMD).

Methods

Ninety-five subjects with AMD selected from the attendees of the National Centre of Services and Research for the Prevention of Blindness and Rehabilitation of Low Vision Patients—International Agency for Prevention of Blindness—IAPB Italia Onlus, were evaluated for this retrospective study. Low vision examination included psychological counseling, best corrected visual acuity (BCVA), near visual acuity, Pelli-Robson contrast sensitivity, and fixation stability analysis. Once the clinical assessment was completed, patients attended a low-vision rehabilitative pathway based on visual stimulation, devices training and, if needed, psychological support. Required magnification and reading speed were also evaluated.

Results

For the whole sample, the mean BCVA of the better eye was 0.7 (±0.2) LogMAR and of the worse eye was 1 (±0.2) LogMAR. Restoring reading ability was the most important focus for the patients examined as it was requested by 85% of the whole sample. Mean power of optical magnifying aids for near activities was 10.6 (±9.1) positive spherical diopters. Mean reading speed for the whole sample was 33.1 (±18.2) words per minute (wpm) before visual rehabilitation sessions and increased to 55.2 (±33.1) wpm after visual rehabilitation path. To cope with distance difficulties, 78 distance refractive correction, 10 Galilean telescopes, and 7 Keplerian telescopes were prescribed. For intermediate distance activities, 22 compensation lenses and 10 Galilean telescopes were suggested. Moreover, PC magnifier softwares were prescribed to nine patients. Sixty-five polarized medical filters were prescribed to reduce glare of sunlight. Because of unstable fixation in their better eye (32.3% (±19.7) within 2° circle and 54.8% (±22.9) within 4° circle) and visual acuity < 1.2 LogMAR in the fellow eye, 38 subjects, before starting the devices training sessions, attended a bio-feedback rehabilitation session with flickering pattern stimulus. In these subjects, fixation stability increased significantly to 75.6 (±14.9) within 2° and 89.4 (±19.5) within 4° ( P < 0.05), respectively.

Conclusions

Attending a customized low-vision intervention based on a multidisciplinary approach seems to be effective for improving visual functions in AMD. Both optical/electronic magnifiers and specific visual stimulation program can enhance visual performances.

Why visually impaired older adults often do not receive mental health services: the patient's perspective

PURPOSE

Older adults with a visual impairment are particularly vulnerable for increased depression and anxiety symptoms; however, they tend to underutilise mental health services. The present study aims to characterise the perceived need for and barriers to use mental health services in visually impaired older adults based on Andersen's behavioural model.

METHODS

A cross-sectional study in 871 visually impaired older adults (mean age 73 years) from outpatient low vision rehabilitation services was conducted. A multinomial logistic regression analysis was performed to assess potential-related factors to perceived need for mental health services, measured with the Perceived Need for Care Questionnaire (PNCQ).

RESULTS

About 35 % of the population had subthreshold depression and/or anxiety, and 13 % had a mood and/or anxiety disorder according to the DSM-IV. Almost 34 % of the participants with an actual disorder did not receive mental health services, even though 57 % perceived to be in need of these services. Participants who had more severe depression and/or anxiety, comorbid depression and anxiety, no history of major depressive disorder, a lower perceived health status and a younger age were more likely to be in need of mental health services. Barriers to receive these services were lack of knowledge and self-reliance.

CONCLUSIONS

Findings support the implementation of counselling methods, instead of medication, and patient empowerment to reduce an unmet need of mental health services in visually impaired older adults, for which extensive research is warranted.

Visual impairment and multimorbidity in a representative sample of the Spanish population

BACKGROUND

In the context of population aging, visual impairment has emerged as a growing concern in public health. However, there is a need for further research into the relationship between visual impairment and chronic medical conditions in the elderly. The aim of our study was to examine the relationship between visual impairment and three main types of co-morbidity: chronic physical conditions (both at an independent and additive level), mental health and cognitive functioning.

METHODS

Data were collected from the COURAGE in Europe project, a cross-sectional study. A total of 4,583 participants from Spain were included. Diagnosis of chronic medical conditions included self-reported medical diagnosis and symptomatic algorithms. Depression and anxiety were assessed using CIDI algorithms. Visual assessment included objective distance/near visual acuity and subjective visual performance. Descriptive analyses included the whole sample (n = 4,583). Statistical analyses included participants aged over 50 years (n = 3,625; mean age = 66.45 years) since they have a significant prevalence of chronic conditions and visual impairment. Crude and adjusted binary logistic regressions were performed to identify independent associations between visual impairment and chronic medical conditions, physical multimorbidity and mental conditions. Covariates included age, gender, marital status, education level, employment status and urbanicity.

RESULTS

The number of chronic physical conditions was found to be associated with poorer results in both distance and near visual acuity [OR 1.75 (CI 1.38-2.23); OR 1.69 (CI 1.27-2.24)]. At an independent level, arthritis, stroke and diabetes were associated with poorer distance visual acuity results after adjusting for covariates [OR 1.79 (CI 1.46-2.21); OR 1.59 (CI 1.05-2.42); OR 1.27 (1.01-1.60)]. Only stroke was associated with near visual impairment [OR 3.01 (CI 1.86-4.87)]. With regard to mental health, poor subjective visual acuity was associated with depression [OR 1.61 (CI 1.14-2.27); OR 1.48 (CI 1.03-2.13)]. Both objective and subjective poor distance and near visual acuity were associated with worse cognitive functioning.

CONCLUSIONS

Arthritis, stroke and the co-occurrence of various chronic physical diseases are associated with higher prevalence of visual impairment. Visual impairment is associated with higher prevalence of depression and poorer cognitive function results. There is a need to implement patient-centered care involving special visual assessment in these cases.

Depressive symptoms among the visually disabled in Wuhan: an epidemiological survey

Background

There are no representative studies on the mental health status of persons with disabilities in China.

Objective

Estimate the prevalence of depressive symptoms and identify the factors associated with depressive symptoms in a representative sample of individuals with serious visually disabilities in Wuhan, China.

Methods

A multi-stage stratified cluster sampling method was used to identify 1200 visually disabled individuals from among the 22,000 persons with serious visual disabilities who were registered with the Wuhan Disabled Persons' Federation. Identified individuals were administered the Center for Epidemiological Studies Depression Scale (CES-D) and the Revised Eysenck Personality Questionnaire-Short Scale for Chinese (EPQ-RSC) by trained interviewers.

Results

The adjusted prevalence of mild, moderate and severe depressive symptoms among the 1003 individuals who successfully completed the survey were 8.8% (95% confidence interval [CI]=5.7-11.8%), 15.6% (CI=12.8-18.5%) and 16.0% (CI=13.7-18.3%), respectively. Factors significantly associated with more severe depressive symptoms in the multivariate logistic regression analysis (in order of importance) were emotional instability (OR=5.84, CI=4.19-8.14), introverted personality (OR=2.94, CI=2.10-4.12), having religious beliefs (OR=2.03, CI=1.06-3.90), being blind (versus those who were only visually impaired) (OR=1.52, CI=1.09-1.95), being unmarried (OR=1.51, CI=1.06-2.15), and having limited education (OR=1.49, CI=1.06-2.10).

Conclusions

Over one-third of all individuals with visual disabilities registered with the Disabled Persons' Federation in in Wuhan have clinically significant depressive symptoms. Almost none of these individuals receive treatment. Services for persons with serious visual disabilities – and for individuals with other types of serious physical or sensory disabilities – should include activities aimed at improving psychological wellbeing, periodic screening for psychological problems and, when needed, professional treatment for mental disorders.

Social support and depression of adults with visual impairments

Relatively little research exists with regard to the relationship between social support and depression among adults with visual impairments. Such a gap is noteworthy when one considers that individuals become more dependent on others as they enter middle and late adulthood. The present research will examine the association between social networks, social support and depression among adults with visual impairments. Seventy-seven adults with visual impairments participated in the study. Depression, social network and emotional/practical social support were measured with self-report measures. Additionally, the degree to which emotional/practical social support received were positive or negative and the ability of respondents to self-manage their daily living were assessed. Less than a third of respondents scored above the threshold for depressive symptoms. Depressive symptoms were not related to gender or vision status. Depression was correlated with age, educational level, less positive practical support, more negative practical support and more negative emotional support, with lower perceptions of self-management representing the most robust predictor of depression. Age moderated the relationship between depression and self-management, and between depression and negative emotional support. Lower perceptions of self-management and negative emotional support were significantly associated with depressive symptoms.

Depression screening among older adults attending low-vision rehabilitation and eye-care services: Characteristics of those who screen positive and client acceptability of screening

AIM

To investigate characteristics associated with screening positive for depressive symptoms among older adults accessing low-vision rehabilitation and eye-care services and to determine client acceptability of depression screening using the Patient Health Questionnaire-2 (PHQ-2) in these settings.

METHODS

One-hundred and twenty-four older adults (mean = 77.02 years, SD = 9.12) attending low-vision rehabilitation and eye-care services across Australia were screened for depression and invited to complete a telephone-administered questionnaire to determine characteristics associated with depressive symptoms and client acceptability of screening in these settings.

RESULTS

Thirty-seven per cent (n = 46/124) of participants screened positive for depressive symptoms, and the majority considered the new depression screening method to be a 'good idea' in vision services (85%). Severe vision loss (<6/60 in the better eye) was associated with an increased odds of screening positive for depressive symptoms (odds ratio 2.37; 95% confidence interval 1.08-6.70) even after adjusting for potential confounders. Participants who screened positive had a preference for 'talking' therapy or a combination of medication and 'talking therapy' delivered within their own home (73%) or via telephone (67%).

CONCLUSION

The PHQ-2 appears to be an acceptable method for depression screening in eye-care settings among older adults. Targeted interventions that incorporate home-based or telephone delivered therapy sessions may improve outcomes for depression in this group.

Change-readiness of the blind: a hospital based study in a coastal town of South India

Purpose:

Blindness is a devastating condition with psychosocial and economic effects. The shortcomings result in a burden to the blind person, the family and society. Rehabilitation of the blind can transform their lives. The aim of this study was to assess the “change-readiness” of the blind to undergo a “change-management”.

Materials and Methods:

The study was a semi-structured pre-tested questionnaire-based study of 50 blind subjects in a medical college hospital. The blind participants were assessed for depression using the Beck Depression Inventory II, for the perceived effect of blindness on family, social life and occupation. The participants were counseled to undergo psychiatric management, vocational training, use blind aids and learn Braille. The willingness of the participants with reasons was assessed using a verbal analogue scale. Pearson Chi-square test, ANOVA and the t-test were used for statistical analysis.

Results:

Over two-thirds of the subjects were depressed. Family life, social life and occupation were perceived to be affected by 44%, 66% and 74%, respectively. Change-readiness scores were low for low vision and blind aids, vocational training, psychiatric management, change of job and learning Braille. The low score was due to the associated taboo, dependence, lack of skills, embarrassment, etc., The most valuable feature was the family cohesiveness.

Conclusion:

The results suggest that there is a need to modify health policy to include blind rehabilitation, to improve visibility of blind rehabilitation centers, to include family members and co-professionals while managing the blind so that we treat the “blind person” and not a “pair of blind eyes”.

The impact of individual characteristics in self-esteem and locus of control of young adults with visual impairments

In this study the impact of personal/individual characteristics (gender, vision status, age, age at loss of sight, recency of vision loss, education level, employment status, and ability of independent movement) in locus of control (LOC) and self-esteem were examined. Eighty-four young adults with visual impairments (42 with blindness and 42 with low vision) took part in this study. The significant predictors of self-esteem were vision status, age at loss of sight, recency of vision loss and educational level. Moreover, significant predictors of LOC were vision status and independent movement.

Clinically relevant symptoms of anxiety and depression in low-vision community-living older adults

OBJECTIVE

The objective of this study was to examine the association of low vision with clinically relevant symptoms of anxiety and depression among community-living older adults seeking vision rehabilitation services.

METHODS

Differences in the prevalence of clinically relevant symptoms of anxiety and depression (assessed with the Hospital Anxiety and Depression Scale) between 148 persons with low vision and a reference sample (n = 5,279), all ≥ 57 years, were compared.

RESULTS

A total of 14.9% of the older persons with vision loss had clinically relevant symptoms of anxiety and 14.2% had clinically relevant symptoms of depression. These percentages were at least as twice as high as in the reference sample.

CONCLUSION

Vision loss is substantially associated with both symptoms of anxiety and depression. Healthcare professionals may improve their quality of care and the quality of life of their clients as they take such information into account in their intervention work.

Prevalence and impact of depressive symptoms in patients with age-related macular degeneration

OBJECTIVE

This study sought to identify the point prevalence of depressive symptoms, quality-of-life (QOL) impairment, and demographic parameters associated with depression in patients with age-related macular degeneration (AMD) attending a retina clinic in Edmonton, Alberta.

DESIGN

A cross-sectional design was used.

METHODS

Consecutive patients with AMD were invited to participate in the study. Demographic data, as well as ophthalmic, medical, and psychiatric histories, were collected. Participants completed the Center for Epidemiological Studies Depression Scale (CES-D) and the Visual Function Questionnaire (VFQ-25) scales to quantify the burden of depressive symptoms and vision-related QOL impairment.

RESULTS

The study enrolled 101 patients, of whom 7 (6.9%) had a previous history of depression. Twenty (21.3%) of the remaining patients endorsed severe symptoms of depression that had not yet been diagnosed. Significant differences in vision-related QOL between depressed and not depressed patients were identified. Depressed patients were also found to have worse visual acuity (p = 0.047) and were less likely to live with others (p = 0.020) than those who were not depressed.

CONCLUSIONS

After excluding patients with a history of diagnosed depression, 20 (21.3%) patients demonstrated severe symptoms of depression. Development of depression screening protocols for patients with AMD would improve identification and referral of patients at risk. The finding that patients who lived with others had a lower prevalence of depressive symptoms suggests that further research into the relationship between mood symptoms and environmental supports is merited.

Co-morbidity of depression and anxiety in common age-related eye diseases: a population-based study of 662 adults

This study examined the prevalence of co-morbid age-related eye disease and symptoms of depression and anxiety in late life, and the relative roles of visual function and disease in explaining symptoms of depression and anxiety. A community-based sample of 662 individuals aged over 70 years was recruited through the electoral roll. Vision was measured using a battery of tests including high and low contrast visual acuity, contrast sensitivity, motion sensitivity, stereoacuity, Useful Field of View, and visual fields. Depression and anxiety symptoms were measured using the Goldberg scales. The prevalence of self-reported eye disease [cataract, glaucoma, or age-related macular degeneration (AMD)] in the sample was 43.4%, with 7.7% reporting more than one form of ocular pathology. Of those with no eye disease, 3.7% had clinically significant depressive symptoms. This rate was 6.7% among cataract patients, 4.3% among those with glaucoma, and 10.5% for AMD. Generalized linear models adjusting for demographics, general health, treatment, and disability examined self-reported eye disease and visual function as correlates of depression and anxiety. Depressive symptoms were associated with cataract only, AMD, comorbid eye diseases and reduced low contrast visual acuity. Anxiety was significantly associated with self-reported cataract, and reduced low contrast visual acuity, motion sensitivity and contrast sensitivity. We found no evidence for elevated rates of depressive or anxiety symptoms associated with self-reported glaucoma. The results support previous findings of high rates of depression and anxiety in cataract and AMD, and in addition show that mood and anxiety are associated with objective measures of visual function independently of self-reported eye disease. The findings have implications for the assessment and treatment of mental health in the context of late-life visual impairment.

The impact of first eye cataract surgery on mental health contacts for depression and/or anxiety: a population-based study using linked data

PURPOSE

Cataract is the leading cause of reversible blindness worldwide, and the incidence of cataract surgery is projected to increase as the population ages. Gaining an understanding of the effects of cataract surgery on a range of health outcomes is important for maintaining the health and safety of older adults.

METHODS

A before and after cohort study was conducted using the Western Australian Hospital Morbidity Data System, Mental Health Information System and the Western Australian Death Registry.

RESULTS

Of the 21 110 patients who underwent cataract surgery in one eye only, 295 had mental health contacts for depression and/or anxiety 1 year before (n = 158) or 1 year after (n = 137) surgery. Results from Poisson generalized estimating equations showed a significant decrease of 18.80% (p ≤ 0.001) in the number of mental health contacts for depression and/or anxiety the year after cataract surgery after accounting for potential confounding factors. A 27.46% increase in mental health contacts the year after cataract surgery was reported by women compared with men (95% CI: 1.08-1.50). Those living in remote areas had less contact with mental health services compared with those living in metropolitan areas (adjusted risk ratio 0.62, 95% CI: 0.46-0.84). The corresponding reduction in health care costs for treatment of depression and/or anxiety was 28%.

CONCLUSION

Further research should be conducted to collect information on the utilization of health care resources not captured in this study, namely community-based services, visits to general practitioners and/or emergency departments as well as medication usage such as antidepressants.

Depression in the elderly with visual impairment and its association with quality of life

Background

Visual impairment is more prevalent in the elderly and depression is common in this population. Although many studies have investigated depression or quality of life (QOL) in older adults with visual impairment, few have looked at the association between these two concepts for this population. The aim of this systematized review was to describe the association between depression and QOL in older adults with visual impairment.

Methods

A search was done using multiple electronic databases for studies addressing the relationship between QOL and depression in elders with visual impairment. The concept of QOL was divided into two different approaches, ie, QOL as achievement and QOL as subjective well-being. Comparison of QOL scores between participants with and without depression (Cohen’s d) and correlations between depression and QOL (Pearson’s r) were examined.

Results

Thirteen studies reported in 18 articles were included in the review. Nearly all of the studies revealed that better QOL was moderately to strongly correlated with less severe depressive symptoms (r = 0.22–0.68 for QOL as achievement; r = 0.68 and 0.72 for QOL as subjective well-being). Effect sizes for the QOL differences between the groups with and without depression ranged from small to large (d = 0.17 to 0.95 for QOL as achievement; no data for QOL as subjective well-being).

Conclusion

Additional studies are necessary to pinpoint further the determinants and mediators of this relationship. Considering the high prevalence rate of depression in this community and its disabling effects on QOL, interventions to prevent and treat depression are essential. More efforts are needed in clinical settings to train health care practitioners to identify depressed elders with visual impairment and provide appropriate treatment.

Analysis of Excess Direct Medical Costs of Vision Impairment in Taiwan

OBJECTIVES

To quantify the annual excess direct medical costs of vision impairment from the perspective of the Bureau of National Health Insurance in Taiwan and to examine whether the costs vary by severity and duration of vision impairment.

METHODS

A retrospective matched cohort analysis was conducted by using data from the Longitudinal Health Insurance Databases between January 1, 2000, and December 31, 2008. All patients newly diagnosed with vision impairment were categorized as having moderate vision loss, severe vision loss, or blindness. Each patient with vision impairment was matched to one randomly selected patient with normal vision by age (±1 year) and sex. At each level of vision impairment, generalized linear models were used to quantify the total annual excess costs and component costs incurred in the first and second years.

RESULTS

Vision impairment was associated with significantly higher crude excess medical costs. At each level of vision impairment, the total crude medical costs were attributable to different resource utilization and dominated by non-eye-related medical care. After adjusting for covariates, the first-year annual excess costs increased with escalating severity of vision impairment: New Taiwan (NT) $9894 for moderate vision loss, NT $22,760 for severe vision loss, and NT $52,687 for blindness. Similarly, the second-year adjusted costs were estimated as NT $3477, NT $19,532, and NT $28,272 for moderate vision loss, severe vision loss, and blindness, respectively.

CONCLUSIONS

Consistent with Western countries, vision impairment is associated with significantly increased health care costs in Taiwan. The excess costs seem to increase with severity of vision impairment and decrease in the second year.

The decline in attentional visual fields over time among older participants in the Salisbury Eye Evaluation Driving Study

PURPOSE

The loss of attentional visual field (AVF) has been linked to poor mobility and car crashes. We investigated the risk factors associated with a decrease in AVF over time among participants in the Salisbury Eye Evaluation Driving Study (SEEDS).

METHODS

In a longitudinal cohort of 968 individuals ages 67 to 87, demographic, medical, visual, and cognitive factors were obtained at baseline (2005-2006) and follow-up (2007-2008) using structured medical questionnaires and onsite examinations. Using the standard deviation for the difference in AVF over 2 years of 4.3°, two subgroups were created: Those who lost 5° or more in two years and those who had no loss (i.e., loss of 5° or less, or no loss). Age-adjusted and multivariate odds ratios (OR) with 95% confidence intervals (95% CI) for each explanatory factor were determined using logistic regression.

RESULTS

The overall change in AVF was -0.34° (SD = 4.32), which was a significant decline from baseline. of the population, 14% lost 5° or more of AVF. The following determinants were associated with a minimum loss of 5° over 2 years: female sex (OR = 1.59, P = 0.03), history of stroke (OR = 1.90, P = 0.03), depression (OR = 1.07, P = 0.02), a lower baseline Trails A and B scores (OR = 1.09, P = 0.003 and OR = 1.02, P = 0.02, respectively), and lower baseline visual acuity (OR = 1.21, P = 0.03). In addition, decline was related to a lower baseline measure of auditory attention (OR = 1.14, P = 0.007) and lower baseline visual fields in the central 20° (OR = 1.24, P = 0.01).

CONCLUSIONS

Loss in AVF over time is related independently to decrements in cognition and vision. The higher odds of loss in female subjects, independent of these factors, deserves further research.

Improving balance and mobility in people over 50 years of age with vision impairments: can the Alexander Technique help? A study protocol for the VISIBILITY randomised controlled trial

BACKGROUND

Falls are an increasingly important and costly public health problem. Vision is key to postural stability as we age and this puts adults with visual impairments at greater risk of falls. Physical interventions improve balance in the general population and in older adults with visual impairments in residential care. They also prevent falls in the general community but to date have not been shown effective in community-dwelling adults with visual impairments.

OBJECTIVE

To investigate, with a randomised controlled trial, whether the Alexander Technique (AT) can improve balance and mobility in the community-dwelling population with visual impairments and thus reduce the risk of falls. The AT is a form of physical re-education that has recently received attention for its possible value in rehabilitation.

METHOD AND DESIGN

One hundred and twenty people with visual impairments over 50 years of age will be recruited from Guide Dogs New South Wales/Australian Capital Territory (NSW/ACT). Participants will be independently mobile and cognitively able to take part in the programme. After baseline assessment participants will be randomly assigned to two groups. The control group will receive usual care from Guide Dogs NSW/ACT, and the intervention group will receive 12 weekly home-based lessons in the AT in addition to usual care. The primary outcome measures will be physical measures from the short physical performance battery at 3 months. Secondary outcome measures will be balance, mobility, social participation and emotional well-being at 3 and 12 months.

TRIAL REGISTRATION NUMBER

The protocol is registered with the Australian New Zealand Clinical Trials Registry (ACTRN12610000634077).

Depression of Late Age-Related Macular Degeneration Patients in Korea

PURPOSE

The aim of study was to investigate the relationship between depression and age-related macular degeneration (AMD) in Korea treated with intravitreal ranibizumab.

METHODS

This was a cross-sectional study. This study included 107 patients diagnosed with AMD treated with intravitreal ranibizumab. All patients answered the Korean version of the Geriatric Depression Scale (GDS-K), and the prevalence of depression was evaluated. The patients from 1 center were classified into groups with and without depression according to GDS-K. Visual acuity (VA), duration, bilaterality, history of previous treatment for AMD, and comorbidities were assessed and compared between groups. The correlations between GDS-K and other variables were investigated.

RESULTS

The prevalence of depression was 26.2% with AMD treated with intravitreal ranibizumab in this study. In subanalysis, the 23 depressed patients (33.3%) were older (P = 0.022) than the nondepressed. Positive correlations were observed between GDS-K and age, VA of injected eye, VA of better eye, duration of AMD, and the number of previous treatments for AMD.

CONCLUSIONS

This is the first study evaluating the relationship between depression and AMD in Koreans treated with intravitreal ranibizumab. The prevalence of depression in AMD is substantial and similar to those in previous reports. Interventions to diagnose and treat depression in AMD patients are necessary.

Baseline traits of low vision patients served by private outpatient clinical centers in the United States

OBJECTIVE

To characterize the traits of low vision patients who seek outpatient low vision rehabilitation (LVR) services in the United States.

METHODS

In a prospective observational study, we enrolled 764 new low vision patients seeking outpatient LVR services from 28 clinical centers in the United States. Before their initial appointment, multiple questionnaires assessing daily living and vision, physical, psychological, and cognitive health states were administered by telephone. Baseline clinical visual impairment measures and disorder diagnoses were recorded.

RESULTS

Patients had a median age of 77 years, were primarily female (66%), and had macular disease (55%), most of which was nonneovascular age-related macular degeneration. More than one-third of the patients (37%) had mild vision impairment with habitual visual acuity (VA) of 20/60 or greater. The VA correlated well with contrast sensitivity (r = -0.52) but poorly with self-reported vision quality. The intake survey revealed self-reported physical health limitations, including decreased endurance (68%) and mobility problems (52%). Many patients reported increased levels of frustration (42%) and depressed mood (22%); memory and cognitive impairment (11%) were less frequently endorsed. Patients relied on others for daily living support (87%), but many (31%) still drove.

CONCLUSIONS

Most patients seeking LVR are geriatric and have macular disease with relatively preserved VA. The disparity between VA and subjective quality of vision suggests that LVR referrals are based on symptoms rather than on VA alone. Patients seen for LVR services have significant physical, psychological, and cognitive disorders that can amplify vision disabilities and decrease rehabilitation potential.

The impact of low vision on activities of daily living, symptoms of depression, feelings of anxiety and social support in community-living older adults seeking vision rehabilitation services

PURPOSE

Previous studies showed that older persons with vision loss generally reported low levels of health-related quality of life, although study outcomes with respect to feelings of anxiety and social support were inconsistent. The objective of this study was to examine the impact of low vision on health-related quality of life, including feelings of anxiety and social support, among community-living older adults seeking vision rehabilitation services.

METHODS

Differences of activities of daily living (Groningen Activity Restriction Scale-GARS), symptoms of depression and feelings of anxiety (Hospital Anxiety and Depression Scales-HADS) and social support (Social Support Scale Interactions-SSL12-I) between 148 older persons ≥57 years with low vision and a reference population (N = 4,792) including eight patient groups with different chronic conditions were tested with Student's t tests.

RESULTS

Older persons with vision loss reported poorer levels of functioning with respect to activities of daily living, symptoms of depression and feelings of anxiety as compared to the general older population as well as compared to older patients with different chronic conditions. In contrast, older persons with vision loss reported higher levels of social support.

CONCLUSIONS

Vision loss has a substantial impact on activities of daily living, symptoms of depression and feelings of anxiety. Professionals working at vision rehabilitation services may improve their quality of care as they take such information into account in their intervention work.

Loneliness and self-management abilities in the visually impaired elderly

OBJECTIVE

To describe the degree of loneliness among the visually impaired elderly and to make a comparison with a matched reference group of the normally sighted elderly. In addition, we examined self-management abilities (SMAs) as determinants of loneliness among the visually impaired elderly.

METHOD

In a cross-sectional study, 173 visually impaired elderly persons completed telephone interviews. Loneliness and SMAs were assessed with the Loneliness Scale of De Jong Gierveld and the SMAS-30, respectively.

RESULTS

The prevalence of loneliness among the visually impaired elderly was higher compared with the reference group (50% vs. 29%; p < .001). Multivariate hierarchical regression analysis showed that the SMA self-efficacy, partner status, and self-esteem were determinants of loneliness. Severity and duration of visual impairment had no effect on loneliness.

DISCUSSION

The relationship between SMAs (i.e., self-efficacy) and loneliness is promising, as SMAs can be learned through training. Consequently, self-management training may reduce feelings of loneliness.

The impact of eyeglasses on vision-related quality of life in American Indian/Alaska Natives

PURPOSE

To determine the change in vision-related quality-of-life scores after providing eyeglasses to American Indian/Alaska Natives with undercorrected refractive error.

STUDY DESIGN

Prospective, comparative (nonrandomized) interventional study.

METHODS

We compared a group with undercorrected refractive error to a control group who did not need a change in eyeglasses. Undercorrected refractive error was defined as distance visual acuity 20/40 or worse in the better-seeing eye that could be improved by at least 2 lines in Snellen visual acuity. Intervention was the provision of new glasses to the undercorrected refractive error group members, based on results of manifest refraction. The main outcome measures were the differences in the 25-Item National Eye Institute Visual Functioning Questionnaire (NEI VFQ-25) scores from baseline (Time 1) to the time after providing eyeglasses (Time 2).

RESULTS

The NEI VFQ-25 median Composite score at Time 1 was significantly lower in those with undercorrected refractive error when compared to the control group (75 vs 92, P = .001). The median Composite score for the undercorrected refractive error group improved to 96 (P < .001) at Time 2 when compared to Time 1, while the control group remained stable at 93 (P = .417). The undercorrected refractive error group showed significantly greater improvement than the control group in 8 of 12 subscale scores and in the overall Composite score (all P values ≤ .05). A multivariate linear regression analysis, which controlled for differences in age, percent self-identified American Indian/Alaskan Native, and best-corrected visual acuity between the undercorrected refractive error and control group, showed eyeglasses to be significantly associated with improvement in NEI VFQ-25 composite score.

CONCLUSION

Visual impairment from undercorrected refractive error is common in American Indian/Alaskan Natives. Providing eyeglasses results in a large, significant increase in vision-related quality of life.

Effectiveness of home treatment for elderly people with depression: randomised controlled trial

BACKGROUND

There is little evidence available about what service models are effective in the treatment of elderly people with depression.

AIMS

To test the effectiveness of home treatment for elderly people with depression living independently.

METHOD

In a randomised controlled trial, 60 out-patients aged over 64 years with major depression were allocated to a home treatment model over a 1-year period or to conventional psychiatric out-patient care. The primary outcome was the level of depressive symptoms after 3 and 12 months. The secondary outcomes were global functioning, subjective quality of life (SQOL), admissions to nursing homes, duration of psychiatric hospital treatments and the cost of care.

RESULTS

Individuals receiving home treatment had significantly fewer symptoms of depression, better global functioning and a higher SQOL at 3 months and at 12 months. Over 1 year they had fewer admissions to nursing homes, spent less time in psychiatric in-patient care and the cost of care was lower.

CONCLUSIONS

Home treatment appears an effective and cost-effective service model for elderly people with depression.

Participation of the elderly after vision loss

PURPOSE

To assess the degree of participation of the visually impaired elderly and to make a comparison with population-based reference data.

METHOD

This cross-sectional study included visually impaired elderly persons (≥55 years; n = 173) who were referred to a low-vision rehabilitation centre. Based on the International Classification of Functioning, Disability and Health (ICF) participation in: (1) domestic life, (2) interpersonal interactions and relationships, (3) major life areas, and (4) community, social and civic life was assessed by means of telephone interviews. In addition, we assessed perceived participation restrictions.

RESULTS

Comparison with reference data of the elderly showed that visually impaired elderly persons participated less in heavy household activities, recreational activities and sports activities. No differences were found for the interpersonal interactions and relationships domain. Participants experienced restrictions in household activities (84%), socializing (53%), paid or voluntary work (92%), and leisure activities (88%).

CONCLUSIONS

Visually impaired elderly persons participate in society, but they participate less than their peers. They experience restrictions as a result of vision loss. These findings are relevant, since participation is an indicator for successful aging and has a positive influence on health and subjective well-being.

Home-based activity program for older people with depressive symptoms: DeLLITE--a randomized controlled trial

PURPOSE

We wanted to assess the effectiveness of a home-based physical activity program, the Depression in Late Life Intervention Trial of Exercise (DeLLITE), in improving function, quality of life, and mood in older people with depressive symptoms.

METHODS

We undertook a randomized controlled trial involving 193 people aged 75 years and older with depressive symptoms at enrollment who were recruited from primary health care practices in Auckland, New Zealand. Participants received either an individualized physical activity program or social visits to control for the contact time of the activity intervention delivered over 6 months. Primary outcome measures were function, a short physical performance battery comprising balance and mobility, and the Nottingham Extended Activities of Daily Living scale. Secondary outcome measures were quality of life, the Medical Outcomes Study 36-item short form, mood, Geriatric Depression Scale (GDS-15), physical activity, Auckland Heart Study Physical Activity Questionnaire, and self-report of falls. Repeated measures analyses tested the differential impact on outcomes over 12 months' follow-up.

RESULTS

The mean age of the participants was 81 years, and 59% were women. All participants scored in the at-risk category on the depression screen, 53% had a Diagnostic and Statistical Manual of Mental Disorders or International Classification of Diseases, Tenth Revision diagnosis of major depression or scored more than 4 on the GDS-15 at baseline, indicating moderate or severe depression. Almost all participants, 187 (97%), completed the trial. Overall there were no differences in the impact of the 2 interventions on outcomes. Mood and mental health related quality of life improved for both groups.

CONCLUSION

The DeLLITE activity program improved mood and quality of life for older people with depressive symptoms as much as the effect of social visits. Future social and activity interventions should be tested against a true usual care control.