Stereotyping as a barrier to the social participation of older adults with low vision: a qualitative focus group study

First-in-Human Whole-Eye Transplantation: Ensuring an Ethical Approach to Surgical Innovation

As innovations in the field of vascular composite allotransplantation (VCA) progress, whole-eye transplantation (WET) is poised to transition from non-human mammalian models to living human recipients. Present treatment options for vision loss are generally considered suboptimal, and attendant concerns ranging from aesthetics and prosthesis maintenance to social stigma may be mitigated by WET. Potential benefits to WET recipients may also include partial vision restoration, psychosocial benefits related to identity and social integration, improvements in physical comfort and function, and reduced surgical risk associated with a biologic eye compared to a prosthesis. Perioperative and postoperative risks of WET are expected to be comparable to those of facial transplantation (FT), and may be similarly mitigated by immunosuppressive protocols, adequate psychosocial support, and a thorough selection process for both the recipient and donor. To minimize the risks associated with immunosuppressive medications, the first attempts in human recipients will likely be performed in conjunction with a FT. If first-in-human attempts at combined FT-WET prove successful and the biologic eye survives, this opens the door for further advancement in the field of vision restoration by means of a viable surgical option. This analysis integrates recent innovations in WET research with the existing discourse on the ethics of surgical innovation and offers preliminary guidance to VCA programs considering undertaking WET in human recipients.

Using co-creation focus groups to customise a remote multidomain programme designed to increase dementia literacy

OBJECTIVES

To adapt the content and functionalities of Brain Health PRO, a web-based multidomain program designed to increase dementia literacy, to the context and needs of users, providers and community organisations across Québec, Canada.

DESIGN

Five consecutive qualitative co-creation focus group sessions 30-90 min in duration each, exploring potential barriers and facilitators to usability, accessibility, comprehensibility, participant recruitment and retention.

SETTING

Virtual meetings.

PARTICIPANTS

A 15-member team based in Québec and Ontario, Canada, consisting of 9 researchers (including a graduate student and the project coordinator), representing occupational therapy, sensory rehabilitation, neuropsychology, psychology, health science and research methods, 3 informal caregivers of older adults living with cognitive decline and 3 members of the Federation of Quebec Alzheimer Societies.

DATA ANALYSIS

Session recordings were summarised through both qualitative description and thematic analysis.

RESULTS

The synthesised recommendations included adjustments around diversity, the complexity and presentation styles of the materials, suggestions on refining the web interface and the measurement approaches; it influenced aspects of participant recruitment, retention efforts and engagement with the content of Brain Health PRO.

CONCLUSIONS

Co-creation in dementia prevention research is important because it involves collaboration between researchers, community support and service providers, and persons with lived experience as care providers, in the design and implementation of clinical studies. This approach helps to ensure that the content and presentation of educational material is relevant and meaningful to the target population and those involved in its delivery, and it leads to a greater understanding of their needs and perspectives.

[Touch, a crucial sense in social interactions to improve homeostasis in aging and promote healthy longevity]

Aging is associated with the generalized deterioration of the organism, being of great relevance experienced by homeostatic systems such as the nervous, immune, and endocrine systems, which increases the risk of morbidity and mortality. Among the lifestyle strategies that have been researched to improve these systems and achieve greater healthy longevity, this review will focus on the social environment. In order to verify the effectiveness of these both in the improvement of homeostasis and in life expectancy, the research carried out with experimental animals that have allowed this to be done will be discussed. In addition, as it has been observed that physical contact is crucial for the positive outcomes of social interaction on homeostatic systems and longevity to occur, we will focus on that mechanism, as well as some of the possible molecular pathways underlying the effects found.

Perceptions on Their Own Social Participation: A Qualitative Exploration of Ethiopian Secondary Students with Visual Impairments

Social participation is a vital part of life and has multifaceted positive outcomes on personal health and wellbeing. Social participation or the lack thereof might have more profound psychological impacts on individuals in a collectivist culture than its counterpart. The current study explored personal and environmental barriers that have hindered the effective social participation of secondary students with visual impairments. Exploration addressed various activities in and outside school settings in Ethiopia and discussed findings in relation to the prevailing cultural orientation. In-depth semi-structured interviews were conducted to gather qualitative data on barriers to social participation of 17 secondary students with visual impairments in Addis Ababa, Ethiopia. The qualitative data were analysed thematically, yielding four major themes and identifying twenty sub-themes that limited the social participation of students with visual impairments, such as personal, attitudinal, sociocultural, and practical barriers. The study showed a range of barriers that participants experienced related to social participation, the criticality of cultural orientation in providing context to understand the impacts of social participation, and the need for future research in the area.

Stigma Among Older Adults with Age-Related Vision Impairments

Introduction: Limited research has examined the experience and psychosocial effect of vision impairment in older adults. We examine the relationship between vision impairment and stigma using guided interviews among older adults with age-related eye disease. Methods: Thirty-six participants with vision impairment were recruited from glaucoma ( n = 18) (better eye visual fields mean deviations: >5 and <15 decibels) or retina ( n = 18) (better eye visual acuity: <20/40 and >20/400) clinics of the Johns Hopkins Wilmer Eye Institute between 2015 and 2020. Participants completed interviews to examine stigma surrounding age-related vision impairment. Interviews were transcribed and analyzed using directed content analysis. Results: Content analyses of interview transcripts revealed underlying stigma within our cohort. Starting with categories of (1) interpersonal relationships and (2) evolving self-perception, specific domains of stigma were realized in this study. Although both enacted (external) stigma and perceived stigma were acknowledged by a subset of participants, few endorsed internalized stigma. In the face of stigma, participants demonstrated notable resiliency in adapting to and living with age-related vision impairment, captured in an additional category of (3) behavioral adaptations. Discussion: In-depth interviews revealed that older adults with vision impairment confront specific domains of stigma, including enacted and perceived stigma. Features protective against internalized stigma included older age, community support, and assistive technologies. Implications for Practitioners: A recognition of the subtypes of stigma that older adults with age-related vision impairment face is necessary to tailor support and target interventions.

Is social participation associated with good self-rated health among visually impaired older adults?: the JAGES cross-sectional study

Background

While it has been recognized that visual impairment is associated with poor self-rated health (SRH), in addition to various negative health outcomes of visual impairment, the number of older adults with visual impairment is increasing due to population aging. As increasing evidence has been found for the effectiveness of social participation on good SRH, we examined whether there was an association between social participation and SRH and investigated whether the effect differed by visual status.

Methods

Questionnaire data on self-reported visual status, social participation, socioeconomic status, and SRH were obtained in 2016. A total of 24,313 community-dwelling individuals aged 65 and over participated. We examined the association of social participation and SRH status among older adults with visual impairment. Stratified analysis and analysis with an interaction term between social participation and visual status were also conducted. Social participation was assessed by the number of participating groups (no participation, one, two, and three or more).

Results

Overall visual impairment prevalence was 9.3% (95% CI: 8.9–9.7). Among those with and without visual impairment, prevalence of poor SRH was 38.4 and 13.1%, respectively. However, the association between social participation with SRH was similar, especially for those who participated in one or two groups. For people with (PR = 0.54) and without visual impairment (PR = 0.50), those who participated in two groups showed lower prevalence ratios for poor SRH compared to people without social participation.

Conclusion

Social participation showed a beneficial association with SRH among older adults with visual impairment. Future interventions could focus on the potentially positive role of social participation on SRH among older adults with visual impairment.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12877-021-02554-7.

Evaluating Well-being of Individuals With Chronic Visual Conditions Requiring Regular Eyecare During COVID-19 Lockdown: A Cross-Sectional Study

OBJECTIVES

To assess health-related quality of life (HRQoL) and its predictors among individuals with chronic vision conditions during COVID-19 lockdown.

METHODS

A cross-sectional, survey-based study targeted Jordanian adults with a variety of chronic vision conditions requiring regular ophthalmic follow-up. Outcome measures included HRQoL measured by the 12-item Short-Form Health Survey (SF-12), mental health symptoms measured by the Depression Anxiety Stress Scale, and vision ability measured by the National Eye Institute Visual Functioning Questionnaire (VFQ-25) General Vision and Role Limitation subscales. Data were analyzed descriptively and using a multiple variable linear regression model to identify HRQoL predictors.

RESULTS

A total of 203 participants with a mean age of 52.09 (±15.41) years participated, and SF-12 mean scores were 58.15 for the physical component and 57.48 for the mental component. The level of HRQoL was significantly associated with VFQ-25 Role Limitation subscale, diabetes, the need of ophthalmic follow-up, and stress. The regression model explained 47.1% of the variance in HRQoL (r2=0.471, F=35.57, P<0.001).

CONCLUSIONS

Jordanian individuals with chronic vision conditions demonstrated low levels of HRQoL during COVID-19 lockdown. Participants also showed high levels of mental health symptoms and reported low accessibility to ophthalmic care. Access to nonurgent ophthalmic care in individuals with chronic vision diseases should be carefully planned in future pandemics.

Device abandonment in deafblindness: a scoping review of the intersection of functionality and usability through the International Classification of Functioning, Disability and Health lens

OBJECTIVES

Abandonment of vision, hearing or mobility aids suggests common barriers and facilitators to ongoing device use. However, the possible interactive effects of combined hearing and vision disabilities on device use by those living with deafblindness are unclear. Here we summarise existing knowledge on variables influencing assistive technology use from the perspective of persons living with deafblindness. We used the WHO's International Classification of Functioning, Disability and Health (ICF) framework to contextualise the findings, asking 'What is currently known about variables influencing the (non-)use of assistive devices recommended for persons with deafblindness?'

DESIGN

A scoping review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews Checklist.

DATA SOURCES

PubMed; ProQuest: ERIC; ProQuest Dissertation; ProQuest: Sociological Thesaurus; Web of Science; Scientific Electronic Library Online; Bielefeld Academic Search Engine; Pascal & Francis; APA PsycINFO and Ebsco for CINAHL were searched through 9 November 2020.

ELIGIBILITY CRITERIA

We included peer-reviewed studies that reported on assistive technology, device abandonment/utilisation and provided data from persons living with deafblindness.

DATA EXTRACTION AND SYNTHESIS

Four team members independently scored 83 studies for eligibility.

RESULTS

Ten articles were chosen for data extraction. The emerging variables replicated established categories of barriers and facilitators: personal, device-related, environmental and intervention variables. The use of the ICF highlighted how an intermediate variable (eg, device acceptability) was necessary in order for a variable to become a barrier or a facilitator to device use.

CONCLUSIONS

The variables influencing device use by persons with deafblindness followed the same categories described for single impairments. Usability was challenged in devices that rely on the 'other' sense. Haptic and tactile aids are rarely studied. The limited available information and the dire need for assistive technologies for people with deafblindness emphasises the urgency of research and technology development for this marginalised population.

Vision impairment and depression among older adults in low- and middle-income countries

OBJECTIVES

To investigate the association between visual impairment (VI) and depression in low- and middle-income countries (LMICs) and the mediating role of disability and social participation.

METHODS/DESIGN

The World Health Organization Study on global AGEing and adult health (SAGE) provided data on objective and subjective visual function, depression, disability (WHODAS-12), and social participation for nationally representative samples of adults 50 years and older in China, India, Ghana, Mexico, Russia, and South Africa. Multivariable logistic and linear models were used to test the association between VI and depression and the indirect pathways through disability and social participation. Analyses were adjusted for sociodemographics, medical comorbidities, and complex survey design features.

RESULTS

Visual acuity was worse in respondents with depression compared to those without depression in China (0.32 vs 0.23 logMAR; P < .001), Ghana (0.26 vs 0.18 logMAR; P < .001), and India (0.36 vs 0.30 logMAR; P < .001); self-reported vision was also significantly worse in these three countries, but not in Mexico, Russia, or South Africa. Greater disability significantly mediated the association of both objective and self-reported VI with depression in China and India. Social participation significantly mediated the association between subjective vision and depression in Ghana.

CONCLUSIONS

There is variability in the association between VI and depression across LMICs and in the mediating role of disability and social participation. Culture-specific instruments may be needed to better characterize the association between VI and depression and further research is needed to assess causality.

What couples say about living and coping with sensory loss: a qualitative analysis of open-ended survey responses

The current study reports the results of open-ended questions from a follow-up survey of adults with sensory loss and their spouses who had previously taken part in an online study. In total, 111 participants completed the survey (72 adults with a sensory loss and 39 spouses). Open-ended questions asked about the overall experience of living with sensory loss, sensory loss-related challenges, and support and coping mechanisms. Thematic analysis was used to identify dominant themes in participants' responses. Three core themes capturing their overall experience emerged: (1) sensory loss-related challenges, (2) support and coping, and (3) adjustment and readjustment. Sensory loss was characterized as a challenging experience, causing communication and emotional disturbances. Coping strategies reported by both partners included the use of assistive technology, positive re-appraisal, acceptance and/or denial of the loss, while support strategies were mostly derived from the comments of spouses (for AWSLs), family members and peer networks (for both partners). Finally, respondents described sensory loss as an adventurous learning experience. Our findings underscore the significance of considering sensory loss from a social relational/family perspective and highlight the importance of addressing the needs of both adults with sensory loss and their partners in treatment and rehabilitation.Implications for rehabilitationStudy highlights the need to consider sensory loss from a relational/family perspective.Healthcare professionals should try to increase the involvement of significant others and close family members (e.g., spouses, parents, children) into the rehabilitation process.Greater emphasis should be placed on exploring and reinforcing positive experiences and attitudes associated with sensory loss during counselling/rehabilitation sessions.Improved education about sensory loss for both the general public and health care professionals could minimize the adverse outcomes associated with sensory loss.

Enablers and barriers encountered by working-age and older adults with vision impairment who pursue braille training

PURPOSE

We explored the experiences of working-age and older adults with acquired vision impairment who pursued braille rehabilitation training, and the facilitators and barriers they encountered throughout this process.

METHODS

Semi-structured interviews of up to 90 min in length were conducted with 14 participants from across Canada who learned braille between the ages of 33 and 67 (Mdn = 46). Transcripts were analyzed by two researchers using interpretive phenomenological analysis.

RESULTS

A variety of personal, social and institutional factors characterize the adult braille learning experience. Among these, participants highlight the role of prior identity and experience, the impact of access to resources and the cost of materials and devices needed to maintain braille skills. Findings also emphasize invisible barriers, including the role of societal perceptions towards braille, the level of support provided by family and friends, and the influence of unconscious biases towards braille and aging held by both adult learners and those around them.

CONCLUSIONS

These findings provide important context to improve policies and practice in adult braille rehabilitation. As the prevalence of age-related vision impairment continues to increase, it will become imperative to understand the unique needs of working-age and older adults with acquired vision impairment who pursue braille.Implications for REHABILITATIONThis study is one of the first to explore the experiences of working-age and older adults with acquired visual impairment who pursue braille rehabilitation training.Rehabilitation professionals must take into account prior learning and reading experiences which may shape the braille learning process.Family members require greater access to resources and support during the training process.There is a significant need for public education to address societal misconceptions about braille and blindness that can lead to a reluctance to use braille.Interactions with other braille users foster more empowering definitions of braille that align with the social model understanding of disability.