Participation of the elderly after vision loss

Employment and retirement among workers who develop vision loss in midlife

BACKGROUND

Vision loss increases with age and is thus more likely to happen later in one's career. With more individuals working beyond typical retirement age, the possibility of experiencing vision loss while working has increased.

OBJECTIVE

The purpose of this study was to investigate how developing vision loss during midlife affects employment and retirement.

METHOD

Using longitudinal Health and Retirement Study data, we identified a sample of 167 workers, 44 to 64 years old, who developed vision loss and a matched comparison sample of 800 workers who did not. We explored job retention and retirement differences between the groups and differences between people with vision loss who retained jobs versus those who did not.

RESULTS

Vision loss was associated with leaving the labor force, although there was a clear trend over time of increasing likelihood of job retention. Occupational category was associated with job retention and people who continued working had more favorable financial situations. Retirees with vision loss were more likely to report involuntary retirement and dissatisfaction with retirement.

CONCLUSIONS

The decreasing likelihood of leaving the labor market after vision loss is an encouraging finding of this study. Workers who left the labor force after vision loss were more likely to be in precarious financial positions, and retirees did not have positive experiences with retirement. Assisting workers with vision loss to remain in the labor force is of vital importance, and increasing awareness and usage of free services for this population may reduce involuntary retirement and its negative consequences.

The use of tele-audiology in ototoxicity monitoring: A scoping review

INTRODUCTION

Due to the growing burden of disease in South Africa, encompassing conditions such as tuberculosis, human immunodeficiency virus, and cancer, the holistic management of affected patients incorporating ototoxicity monitoring is a necessity. However, ototoxicity monitoring in developing countries may be limited due to a lack of resources and inadequate healthcare facilities. Subsequently, the use of tele-audiology may be a revolutionary technique with the potential to provide audiology services to under-served populations with limited access.

METHODS

The study aimed to describe the use of tele-audiology services in ototoxicity monitoring through a scoping review of English peer-reviewed articles from June 2009 to June 2020. Seventeen articles were purposively selected from the following databases: PubMed, Science Direct, Taylor and Francis Online, WorldCat, and Google Scholar. Data was extracted as per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses diagram and results were analyzed using deductive thematic analysis.

RESULTS AND DISCUSSION

While a minority of the studies indicated that the cost of implementation and network connectivity within a South African context pose as barriers, most researchers reported that tele-audiology provides a reliable, time-efficient, cost-effective, and easily accessible alternative for ototoxicity monitoring. Hardware including the WAHTS, KUDUwave, and OtoID, along with software such as the TabSINT, Otocalc, uHear, and the hearTest, have proven to be useful for ototoxicity monitoring. A need for further investigations regarding the feasibility of tele-audiology implementation in South Africa is evident. Despite this, it provides audiologists with an opportunity to offer contact-less services during COVID-19, thus, confirming its versatility as an augmentative method for ototoxicity monitoring.

How does the UK public think and feel about people with visual impairment: a review of existing evidence

Despite legislation to protect people with visual impairment (V.I.) from discrimination in the United Kingdom (UK), the latter continue to experience overt and covert negative behaviours. Perceived discrimination has been associated with an adverse impact on identity, health and well-being, while negative attitudes have been identified as the biggest barrier to participation in everyday life. This article provides a narrative review of existing evidence of how the UK public treats (behaviours), thinks (perceptions) and feels (attitudes) about people with V.I. Despite limitations, the findings suggest that there is a gap between the behaviours reported by people with V.I. and the attitudes expressed by members of the UK public. Social psychological theories are used to explore possible reasons for this gap, and ways in which it may be addressed. As such, the article provides an example of how social psychological theories can be used to address problems in an applied context.

Health economic evaluation of a nurse-assisted online eye screening in home healthcare to reduce avoidable vision impairment (iScreen): study protocol for a cluster randomized controlled trial

BACKGROUND

Among older people undiagnosed and untreated vision impairment and blindness are common. The leading causes are uncorrected refractive errors and cataracts. Vision problems are associated with a lower quality of life, several health problems, and a higher chance of falling accidents and fractures. To eliminate avoidable vision impairment and blindness, targeted eye screening programs are recommended. Older patients, receiving home healthcare, have not yet been considered as a population at risk who could benefit from eye screening.

METHODS

A cluster-randomized controlled trial will be conducted to investigate the cost-effectiveness and cost-utility of online nurse-assisted eye screening in home healthcare, compared to care as usual, in reducing avoidable vision impairment. A healthcare and societal perspective will be used. The study will be performed in collaboration with several home healthcare organizations in the Netherlands. The online eye screening consists of near and distance visual acuity, followed by an Amsler grading test. Measurements in both groups will take place at baseline and after 6 and 12 months of follow-up. A total of 240 participants will be recruited. Older men and women (65 +), who receive home-based nursing and are cognitively able to participate, will be included. The primary outcome will be the change of two lines or more on the Colenbrander-1 M visual acuity chart between baseline and 12-month follow-up.

DISCUSSION

An eye screening for populations at risk contributes to the detection of undiagnosed and untreated vision impairment. This may reduce the health-related consequences of vision loss and the high economic burden associated with vision impairment.

TRIAL REGISTRATION

ClinicalTrials.gov NCT06058637. Registered on 27 September 2023.

Social functioning in adults with visual impairment from minority ethnic communities in the United Kingdom

Background

Visual impairment (V.I.) has been associated with a negative impact on social functioning, while social support can impact on well-being in those with V.I. Adults from minority ethnic communities (MEC) are projected to make up an increasing proportion of adults living with V.I. in the UK, but limited research has explored their social functioning. This article provides a preliminary insight into social functioning among MEC adults living with V.I. in the UK.

Methods

The article reports findings from a secondary analysis of V.I. Lives survey data. V.I. Lives was a UK telephone survey, which explored the life experiences of people with V.I. across a wide range of topics including social functioning. This secondary analysis explored social participation, support, isolation, and relationships among a matched control sample of 77 MEC and 77 adults aged 18 and over from White communities (WC). Participants were matched on age, gender, UK region and urban/rural setting. Subgroup analyses were also conducted for the two largest subgroups within the MEC group, Asian (n = 46) and Black participants (n = 22).

Results

Contact with like-minded people (U = 2174.50, p = 0.003, r = -0.24) and opportunities to take part in more social activities (U = 2253.50, p = 0.007, r = -0.22) was significantly more important to MEC than WC participants. Moreover, MEC participants were significantly less likely to feel supported by friends/family (U = 3522.50, p = 0.017, r = 0.19) and had fewer people they could ask for help (U = 3775.50, p = 0.001, r = 0.26), but there were no significant differences in the perceived impact of V.I. on their friendships/social life and marriage/relationship, their ability to take part in a range of activities, nor their marital status. Asian participants were significantly more likely than Black participants to feel cut off from the people and places around them (U = 655.50, p = 0.042, r = 0.25). Effect sizes were overall small. Although there were no further statistically significant differences between the two groups, Asian participants were also less likely to be able to take part in activities, and more likely to report a negative impact on their social life/friendships and on their marriage/relationship, as well as a smaller social network.

Conclusion

The findings suggest that V.I. may have had a greater impact on social functioning among Asian participants in this sample, including on experiences of social isolation and participation in social activities. Future research will need to confirm these findings and explore the possible reasons.

Access to eye care and support services among adults from minority ethnic communities living with visual impairment in the United Kingdom

Background

Despite an increased risk of certain eye conditions which can lead to visual impairment (V.I.), there is evidence of a greater delay to treatment-seeking among adults from minority ethnic communities (MEC). MEC adults may also be underrepresented on V.I. registers, within early intervention services, and among the beneficiaries of national V.I. charities. However, much of this evidence is outdated or anecdotal.

Methods

This secondary analysis of V.I. Lives survey data explored use of eye health and support services and mobility aids among a matched control sample of 77 MEC and 77 adults aged 18 and over from white communities (WC). Participants were matched on age, gender, UK region and urban/rural setting. Additional subgroup analysis was conducted for Asian (n = 46) and black participants (n = 22).

Results

There were no significant group differences in areas such as eye health service use, registration status, contact with charities, and level of practical support received. But MEC participants were significantly more likely than WC participants to have received direct payments from social services to cover their care needs, Χ2 (1, 154) = 8.27, p = 0.004, and to use apps on their mobile for mobility, Χ2 (1, 154) = 5.75, p = 0.017. In contrast, WC participants were significantly more likely to agree that they were getting the level of emotional support to get on with their life, U = 3,638, p = 0.010, to feel confident to ask their friends for support, U = 2,416, p = 0.040, and to have a guide dog for mobility, Χ2 (1, 154) = 3.62, p = 0.057, although the latter did not reach statistical significance. Within the MEC group, Asian participants were significantly more likely than black participants to use a long cane, Χ2 (1, 68) = 7.24, p = 0.007, but they were significantly less likely to agree that they had received the right level of support when they started to experience V.I., U = 236.5, p = 0.040.

Conclusion

The preliminary findings suggests that there is scope to increase support provided by V.I. charities and the V.I. register, although, contrary to existing evidence, there were no statistically significant differences in eye health service use, registration status and use of wider support services. Further research is required to confirm these findings and explore reasons for differences.

Price tag of glaucoma care is minor compared with the total direct and indirect costs of glaucoma: Results from nationwide survey and register data

BACKGROUND

The estimations of the economic burden of glaucoma have focused on comparing different treatment modalities; hence, the total direct and indirect costs of glaucoma at population level are not well known.

OBJECTIVE

To estimate the direct and indirect costs of glaucoma and its treatment in Finland.

METHODS

Economic and glaucoma data were collected from the cross-sectional nationwide Health 2000 health examination survey linked to multiple national registers, which allowed a 13-year follow-up between 1999-2011 among survey participants. Direct costs covered eye- and non-eye-related hospitalizations and outpatient visits, outpatient health care services, and travel costs among participants aged 30 years or older, adjusted for age and sex. Indirect costs covered premature retirement and productivity losses among participants aged 30-64 years. Glaucoma patients (n = 192) were compared with non-glaucomatous population (n = 6,952).

RESULTS

The annual additional total direct costs were EUR 2,660/glaucoma patient, EUR 1,769/glaucoma patient with medication, and EUR 3,979/operated glaucoma patient compared with persons without glaucoma. The respective additional total indirect costs were EUR 4,288, EUR 3,246, and EUR 12,902 per year. In total, the additional annual direct and indirect expenditures associated with glaucoma in Finland were EUR 202 million (0.86% of total expenditures of health care) and EUR 71 million (0.03% of the Finnish gross domestic product) arising mainly from non-eye-related hospitalizations and productivity losses, respectively.

CONCLUSION

Glaucoma is associated with an increased health care consumption mainly due to non-eye-related health care, which can be explained by the vision loss as well as increased number of co-morbidities among glaucoma patients. Therefore, glaucoma constitutes a major economic burden for the health care system and society, highlighting the importance of early glaucoma interventions. The difference in direct and indirect costs between glaucoma treatment groups is explained by the uneven distribution of co-morbidities.

Impact of vision on generic health-related quality of life - A systematic review

The aim of the study was to provide an overview on the relation between vision and generic health-related quality of life (HRQoL) in general populations worldwide. We conducted a systematic review to identify articles that have evaluated the relation of binocularly measured distance visual acuity (VA) and HRQoL in adults at population level around the world. Used search terms were related to visual acuity, vision loss, visual impairment and HRQoL. We identified 780 articles, of which 12 satisfied the eligibility criteria. The studies were conducted in the USA, Europe, Asia and Australia. Generic HRQoL was measured using EQ-5D, 15D, SF-36, SF-12 and/or WHOQoL. Nine studies reported a trend between decreasing VA and deteriorating HRQoL of at least some degree. Vision loss was mostly associated with dimensions related to physical health and capability, including self-care, mobility and usual activities. Mental dimensions - vitality and social functioning in particular - were also affected, although the results were inconsistent. Six studies compared the impact of different medical conditions on HRQoL, all of which reported that the impact of visual impairment was equal or stronger compared with other major medical conditions. In conclusion, generic HRQoL instruments are sensitive to detect the relation between vision and HRQoL, as they cover dimensions influenced by vision. Declining vision is associated with reduced functioning, which leads to dependence and isolation - both major factors in an individual's well-being. This phenomenon showed surprising similarity around the world and therefore emphasises the global burden of vision loss at both individual and societal level and encourages its prevention and treatment.

Examining the impact of a Volunteer-Delivered counselling service for people experiencing sight loss: a mixed methods evaluation

PURPOSE

This article describes a mixed methods evaluation of a volunteer-delivered counselling service for people experiencing sight loss, to identify the outcomes, benefits, and challenges of this model of service provision within rehabilitation services.

MATERIALS AND METHOD

A mixed methods approach was used, with both outcome and process evaluation components. Outcomes for 817 service users were assessed pre-and-post service use, using standardised (CORE10) measures. Semi-structured interviews and surveys with 22 volunteer counsellors and 4 senior counsellors were conducted, to understand their experiences of the format, content, and delivery of the service.

RESULTS

Clients presenting for counselling experienced significant levels of self-reported depression, anxiety, and feelings of bereavement. Analysis showed a significant positive change in clinical outcomes for service users who received volunteer-delivered counselling services. Volunteer counsellors saw the unique and specialist nature of the service as critical for its impact on clients, and reported benefits of volunteering for this service, including developing their skills with this client group.

CONCLUSIONS

Volunteer-delivered counselling can be effective for people affected by sight loss, providing accessible and much-needed psychological support, which is relevant given current pressures on health and social care services. There are key lessons for future models of this type.Implications for RehabilitationVision loss can have a profound negative impact on people's emotional and mental well-being, with many advocating for counselling and emotional support (CESS) to be included in low vision rehabilitative services.Despite this, access to psychological support is often overlooked in low vision rehabilitation, and access to CESS services is often poor.This study evaluated a volunteer-delivered CESS service, demonstrating that this model of service delivery is effective for this group.There are clear advantages to a volunteer-delivered model for those with sight loss, in terms of widening access, supporting integrated rehabilitative care, and reducing health inequalities.

Exploring mental well-being, the emotional impact of visual impairment and experiences of prejudice and discrimination among adults from minority ethnic communities in the UK

Background

Visual impairment (V.I.) has been associated with a negative impact on mental health outcomes, including a process of grief among those who lose their sight. Older adults with V.I. who had experienced discrimination have been found to be at increased risk of depression, loneliness, poorer life satisfaction and poorer quality of life. Adults from minority ethnic communities (MEC) may be at increased risk of V.I. and yet, research on the experiences of MEC adults with V.I. remains limited. This article forms part of a series which explores issues and status among MEC adults living with V.I. in the UK.

Methods

A secondary analysis of V.I. Lives survey data was performed to explore mental well-being assessed by the short Warwick-Edinburgh Mental Well-being scale (SWEMWBS), the emotional impact of V.I., and prejudice and discrimination among a matched control sample of 77 MEC and 77 adults from white communities (WC). Participants were matched by age, gender, UK region and urban/rural setting. Subgroup analyses were also conducted for the two largest MEC subgroups, Asian (n = 46) and black participants (n = 22).

Results

There were few statistically significant differences between the groups. MEC participants were significantly more likely than WC participants to rate emotional support to come to terms with their V.I. as important and to feel optimistic about their V.I. but they were significantly less likely to agree that they were receiving the level of emotional support they needed to get on with their life. Within the MEC group, participants from Asian communities had significantly poorer mental well-being, and they were also significantly more likely to agree that the general public were often prejudiced against people with V.I. and less likely to feel optimistic about their V.I. than black participants.

Conclusion

Although there were few statistically significant differences, participants from Asian communities were more likely to report poor mental and emotional well-being, and experiences of discrimination, than black and white participants. In contrast, participants from black communities fared the same as, or in some cases better than, white participants. Future research will need to confirm these findings and explore reasons for these.

The evaluation of an online nurse-assisted eye-screening tool in older adults receiving home healthcare

PURPOSE

To investigate the agreement between an online nurse-assisted eye-screening tool and reference tests in older adults receiving home healthcare and to collect user experiences.

METHODS

Older adults (65+) receiving home healthcare were included. Home healthcare nurses assisted in administering the eye-screening tool at participants' homes. Approximately 2 weeks later, a researcher administered reference tests at participants' homes. Experiences from participants and home healthcare nurses were collected. Agreement in outcomes (distance and near visual acuity, with the latter being measured using two different optotypes, and macular problems) between the eye-screening tool and reference clinical testing was compared. A difference of less than ±0.15 logMAR was considered acceptable.

RESULTS

A total of 40 participants were included. Here, we describe the results for the right eye; results for the left eye were similar. The mean difference between the eye-screening tool and reference tests for distance visual acuity was 0.02 logMAR. The mean difference between the eye-screening tool and reference tests using two different optotypes for near visual acuity was 0.06 and 0.03 logMAR, respectively. The majority of the individual data points were within the ±0.15 logMAR threshold (75%, 51% and 58%, respectively). The agreement between tests for macular problems was 75%. Participants and home healthcare nurses were generally satisfied with the eye-screening tool, although remarks for further improvements were made.

CONCLUSIONS

The eye-screening tool is promising for nurse-assisted eye screening in older adults receiving home healthcare, with the mostly satisfactory agreement. After implementing the eye-screening tool in practice, cost-effectiveness needs to be investigated.

A rapid review of evidence relating to service use, experiences, and support needs of adults from minority ethnic communities along the eyecare pathway in the United Kingdom

Background

There is growing awareness of the health inequalities experienced by minority ethnic communities, who make up an increasing proportion of the United Kingdom (UK) population and have been found to be at increased risk of visual impairment (V.I.). V.I. impacts on a wide range of life domains including employment, social functioning and activities of daily living. Considering existing health inequalities, the increased risk of V.I. and its wide-ranging impact, it is important to understand the experiences of adults from minority ethnic communities living with V.I. in the UK.

Methods

A rapid evidence review of academic and gray literature published since 2005 and in English was performed. A search of AMED, CINAHL Plus and MEDLINE via EBSCOhost identified 969 articles. Articles were included in the review if they reported findings relating to the UK-context, to adults from minority ethnic communities living with V.I., and to experiences of V.I. and the eyecare pathway.

Results

A total of 11 academic articles and 4 charity reports presented findings relating to perceptions of V.I. and eye disease (n = 3), access to services and service use (n = 5), impact of interventions (n = 7), the wider impact of V.I. (n = 2), and registration status (n = 1). Much of the literature focused on primary eyecare resulting in a comprehensive list of barriers and recommendations to increase eye tests. Less research addressed experiences and use of services further along the eyecare pathway although use of services may be low. Overall, the research on the experiences of adults with V.I. from minority ethnic communities in the UK remains anecdotal, outdated or unavailable. There are substantial gaps in the evidence relating to the wider impact of V.I., the impact of perceptions of V.I., and the use of services beyond primary eyecare.

Conclusions

This review summarizes our current knowledge of the experiences of adults from minority ethnic communities living with V.I. in the UK and highlights substantial gaps in the evidence. The findings provide practical implications for practitioners and researchers committed to addressing health inequalities in the field of eyecare in the UK.

The impact of low vision on social function: The potential importance of lost visual social cues

Visual cues usually play a vital role in social interaction. As well as being the primary cue for identifying other people, visual cues also provide crucial non-verbal social information via both facial expressions and body language. One consequence of vision loss is the need to rely on non-visual cues during social interaction. Although verbal cues can carry a significant amount of information, this information is often not available to an untrained listener. Here, we review the current literature examining potential ways that the loss of social information due to vision loss might impact social functioning. A large number of studies suggest that low vision and blindness is a risk factor for anxiety and depression. This relationship has been attributed to multiple factors, including anxiety about disease progression, and impairments to quality of life that include difficulties reading, and a lack of access to work and social activities. However, our review suggests a potential additional contributing factor to reduced quality of life that has been hitherto overlooked: blindness may make it more difficult to effectively engage in social interactions, due to a loss of visual information. The current literature suggests it might be worth considering training in voice discrimination and/or recognition when carrying out rehabilitative training in late blind individuals.

Visual impairment and depression in China: a 7-year follow-up study from national longitudinal surveys

OBJECTIVES

To explore the longitudinal association between visual impairment (VI) and depression among adults 45 years and older in China based on a nationally representative follow-up dataset.

SETTING

Participants in China from the China Health and Retirement Longitudinal Study were included.

PARTICIPANTS

A total of 6748 participants from two waves of the China Health and Retirement Longitudinal Study 2011-2018 were included for analysis by age group.

PRIMARY AND SECONDARY OUTCOME MEASURES

VI and depression were defined by self-diagnosis and the Center for Epidemiological Studies Depression Scale-10, respectively. Lagged dependent variable regression models with ordinary least squares estimation were used to evaluate the association between VI and depression. Age was divided into three groups, that is, 45-54, 55-64, and 65 years and older, to explore the relationship between VI and depression in different age groups.

RESULTS

In our study sample, VI remarkably predicted an increase in depressive scores. The magnitude of depressive scores increased among those with VI points greater than 3.517 (β=3.517; 95% CI=2.697 to 4.331) points than those without VI in the 7-year follow-up. Significant relationships were also found between VI and depression in the three age groups in the sensitivity analysis.

CONCLUSION

VI was associated with an increase in depression scores over a 7-year period. Female respondents, low educational attainment and high alcohol intake significantly predicted an increase in depressive status.

Barriers to Low Vision Services Among Optometrists in Saudi Arabia

Introduction:

This study identifies the barriers and challenges to the provision of low vision services among practicing optometrists in Saudi Arabia.

Methods:

In this study, a self-administered online structured survey for practicing optometrists was used. Responses were collected to understand the number and percentage of low vision service providers, level of awareness, and barriers to the provision of low vision services.

Results:

This study included 154 (79 females and 75 males) practicing optometrists. They were from the five regions of Saudi Arabia (23 cities). The age of the practitioners ranged from 22 to 54 years. They had Bachelor’s, Master’s, and Doctor of Philosophy degrees. Forty-four participants (30%) provided low vision services. The major barriers reported were lack of training (87%), lack of awareness about low vision services (76%), lack of availability of low vision devices (70%), lack of motivation (65%), low vision services being time-consuming (55%), being busy in providing general optometry (65%), and lack of financial sources (31%).

Conclusion:

Building an efficient model for low vision rehabilitation in Saudi Arabia is needed. Moreover, encouraging more optometrists to be involved in low vision rehabilitation is necessary. There is also a need for more low vision education, national health coverage of patients with low vision, and better collaboration between low vision service providers.

Self-determination and Physical Functioning as Mediators of the Association between Self-reported Sensory Impairments and Happiness among Older Adults

Introduction: The prevalence of vision and hearing impairments increases through age. This development is individually associated with physical functioning difficulties, self-determination issues, and lower levels of happiness. Method: This study examined how self-reported sensory impairments relate to happiness with physical autonomy and social engagement as mediators using structural equation modelling. Using the nationally representative 2017 Survey of Older Persons in Thailand, the analytic sample size was 34,195 with an age range of 60-103 years and a mean age of 69.6 years. Results: A negative association between subjective vision impairment and happiness was observed through the mediation of limitations in physical functioning and community activity. Subjective hearing impairment was observed to lack association with happiness taking into account all the mediating factors. Conclusion: The care needs of older adults in Thailand where the ageing of the population progresses could then differ depending on their health and well-being status.

Assistive Technology Use among Older Adults with Vision Loss: A Critical Discourse Analysis of Canadian Newspapers

Low vision assistive devices are often positioned as enabling continued social participation and engagement by older adults in everyday activities; however, previous research suggests that the use of such technologies is restricted by various environmental factors. With little attention previously paid to the discursive environment, this critical discourse analysis critically examined how aging persons with vision loss and assistive technology (AT) were constructed and the occupational possibilities promoted and marginalized through technology use in six Canadian newspapers. In total, 7,289 articles were screened, 1,867 articles underwent a full-text review, and 51 articles were selected for data analysis. Results highlight four key discursive threads related to the framing of disability and AT, positioning of seniors with vision loss, and the ideals and occupations to be attained through AT, and point to the importance of re-configuring discourses addressing AT for seniors with vision loss to expand occupational possibilities and embrace collaborative design approaches.

The Long-Term Impact of the COVID-19 Pandemic on Loneliness in People Living With Disability and Visual Impairment

Background: There has been growing concern about the impact of restrictions put in place to contain the coronavirus pandemic on loneliness, particularly in individuals with disabilities. This study explored the longitudinal impact of the pandemic on loneliness in these individuals, with a focus on those living with visual impairment (VI). Methods: An online survey was conducted in April-2020 and repeated in March 2021 to explore current life circumstances, health-related behaviours, sleep (Pittsburgh Sleep Quality Index) and social well-being, including state anxiety (State-Trait Anxiety Index) and loneliness (UCLA Loneliness scale). A convenience sample of 602 participants completed the first survey. Participants who agreed to be re-contacted were invited to take part in the follow-up survey. Results: Data is presented for the 160 participants who completed both timepoints. At both timepoints, median loneliness was significantly higher in participants with disabilities and those with VI than in participants with no disabilities. While there was no significant change in loneliness in any of the three subgroups, participants with VI experienced the largest increase in median loneliness. Loneliness was associated with having a mental health condition and higher levels of state anxiety at both timepoints. Conclusions: Individuals with disabilities such as VI experienced consistently higher levels of loneliness than those with no disabilities throughout the pandemic. While loneliness remained relatively stable in individuals with no disabilities, it increased, albeit to a non-significant level, in those with disabilities and particularly those with VI. Interventions designed to alleviate loneliness may benefit from addressing state anxiety.

Do You See What Eye See? Measurement, Correlates, and Functional Associations of Objective and Self-Reported Vision Impairment in Aging South Africans

Objectives: Our study investigates measurement, correlates, and functional associations of vision impairment (VI) in an aging population in rural South Africa. Methods: 1582 participants aged 40-69 reported on near (NVI) and distance vision impairment (DVI) and completed objective vision tests. Logistic and linear regression were used to evaluate sociodemographic, health, and psychosocial correlates of VI and assess relationships between VI and cognitive and physical function. Results: VI prevalence was considerably higher according to objective testing (56%) versus self-reports (18%). Older adults were especially likely to underreport impairment. Objective VI was associated with age, education, cardiometabolic disease, and female sex. Conversely, self-reported VI was associated with psychosocial factors. Objective NVI and both types of DVI were associated with worse visual cognition and slower gait speed, respectively. Discussion: Self-reported and objective VI measures should not be used interchangeably in this context. Our findings highlight extensive burden of untreated VI in this region.

Global economic productivity losses from vision impairment and blindness

BACKGROUND

In the absence of accessible, good quality eye health services and inclusive environments, vision loss can impact individuals, households and communities in many ways, including through increased poverty, reduced quality of life and reduced employment. We aimed to estimate the annual potential productivity losses associated with reduced employment due to blindness and moderate and severe vision impairment (MSVI) at a regional and global level.

METHODS

We constructed a model using the most recent economic, demographic (2018) and prevalence (2020) data. Calculations were limited to the working age population (15-64 years) and presented in 2018 US Dollars purchasing power parity (ppp). Two separate models, using Gross Domestic Product (GDP) and Gross National Income (GNI), were calculated to maximise comparability with previous estimates.

FINDINGS

We found that 160.7 million people with MSVI or blindness were within the working age and estimated that the overall relative reduction in employment by people with vision loss was 30.2%. Globally, using GDP we estimated that the annual cost of potential productivity losses of MSVI and blindness was $410.7 billion ppp (range $322.1 - $518.7 billion), or 0.3% of GDP. Using GNI, overall productivity losses were estimated at $408.5 billion ppp (range $320.4 - $515.9 billion), 0.5% lower than estimates using GDP.

INTERPRETATION

These findings support the view that blindness and MSVI are associated with a large economic impact worldwide. Reducing and preventing vision loss and developing and implementing strategies to help visually impaired people to find and keep employment may result in significant productivity gains.

FUNDING

MJB is supported by the Wellcome Trust (207472/Z/17/Z). JR's appointment at the University of Auckland is funded by the Buchanan Charitable Foundation, New Zealand. The Lancet Global Health Commission on Global Eye Health was supported by grants from The Queen Elizabeth Diamond Jubilee Trust, Moorfields Eye Charity (GR001061), NIHR Moorfields Biomedical Research Centre, The Wellcome Trust, Sightsavers, The Fred Hollows Foundation, The SEVA Foundation, The British Council for the Prevention of Blindness and Christian Blind Mission. The funders had no role in the design, conduct, data analysis of the study, or writing of the manuscript.

[Diabetes Self-Management Experience of Patients with Diabetes: Focused on the Visually Impaired]

PURPOSE

This study aimed to understand and describe the diabetes self-management experience of visually impaired people with diabetes.

METHODS

Ten participants were recruited through a website used by the visually impaired from February to March 2020. Data were collected through two focus group interviews conducted in June 2020; each group consisted of five participants. All interviews were recorded with the consent of the participants and transcribed verbatim. The transcribed data were analyzed using qualitative content analysis.

RESULTS

Seven categories were as follows; a two-faced, lifelong companion, an unprepared encounter, struggle to live, love-hate relationship with family, strategies to adapt, lessening attention to self-management, the desire to learn properly.

CONCLUSION

It can be concluded that the visually impaired have fewer opportunities for receiving diabetes self-management education than general diabetic patients. Consequently, plans to improve the education available to such patients are required. Additionally, psychological counseling and diabetes education for patients' families are necessary, and improving the perception of medical workers regarding the visually impaired will be prove useful.

Setting research priorities in age-related vision loss: The first step in a critical participatory action research approach

There are no known examples of studies utilizing a critical participatory action research (CPAR) approach with older adults aging with vision loss, to better understand how environmental factors impact activity engagement. As such, the aim of this article was to share the process of initiating a CPAR approach with older adults with age-related vision loss to identify a set of research and/or rehabilitation priorities related to the influence of physical, social, cultural, political, and institutional environmental factors on activity engagement. This study utilized a CPAR approach. Eight older adults (aged 65 years of age and older) with a diagnosis of age-related vision loss (including macular degeneration, glaucoma, and/or diabetic retinopathy) took part in three half-day meetings as well as a one-on-one interview over a period of 2 months. Through a series of facilitated group discussions, the older adults identified research and/or rehabilitation priorities related to how environmental influences support or limit the participation of older adults with age-related vision loss (ARVL) in everyday activities. Three research and/or rehabilitation priorities were identified including (1) community mobility; (2) assistive technology; and (3) community support and services. For each priority, the older adults, along with the researchers, answered four key questions including (1) What do we need to know more about? (i.e., research question); (2) How could we learn more about this? (i.e., proposed methods of data collection); (3) Who would we need to involve as key stakeholders? (i.e., participants); and (4) What would change look like? (i.e., action potential). This study shared the process of initiating a CPAR process with eight older adults with ARVL to identify research and/or rehabilitation priorities. By doing so, this study will help to provide direction for future ARVL research and rehabilitation that is grounded, methodologically, in a CPAR approach.

Sociodemographic, behavioral, and clinical factors associated with low atrial fibrillation knowledge among older adults with atrial fibrillation: The SAGE-AF study

BACKGROUND

Management of AF requires patient engagement in disease management which requires adequate knowledge about AF.

OBJECTIVE

To identify the patient characteristics associated with low AF knowledge among older adults with AF.

METHODS

The SAGE-AF cohort enrolled adults aged ≥65 diagnosed with AF in 2016-2018. Patient characteristics associated with low AF knowledge (<6/8 JAKQ items correct) were examined using multivariable adjusted logistic regression models.

RESULTS

Participants (N = 950) were on average 74 years old (SD: 6.7), 50 % female, and 87 % non-Hispanic white. The average JAKQ score was 68.7 (SD: 17.1), and 78 % had low AF knowledge. Participants aged ≥ 75 (OR: 1.55, 95 % CI: 1.03, 2.33), without a college degree (OR: 0.46, 95 % CI: 0.32, 0.65), cognitively impaired (OR: 1.72, 95 % CI: 1.15, 2.58), with a history of anxiety (OR: 1.76, 95 % CI: 1.09, 2.83), myocardial infarction (OR: 1.82, 95 % CI: 1.08, 3.07), and heart failure (OR: 1.84, 95 % CI: 1.16, 2.91) were more likely to have low AF knowledge.

PRACTICE IMPLICATIONS

Characteristics available in the electronic medical record may identify patients at risk for low AF knowledge. Formal assessment of AF knowledge may identify areas of weakness and allow for targeted education.

Visual Impairment and Mental Health: Unmet Needs and Treatment Options

Purpose

An estimated 2.2 billion people are visually impaired worldwide. Given that age-related vision loss is a primary cause of vision impairment, this number is projected to rise with increases in average lifespan. Vision loss often results in significant disability and is associated with a substantial economic burden, reduced quality-of-life, concurrent medical issues, and mental health problems. In this review, the mental health needs of people with vision impairment are examined.

Patients and methods

A review of recent literature on mental health outcomes and current treatments in people with visual impairment was conducted.

Results

Considerable data indicate that rates of depression and anxiety are elevated among people with visual impairments. Moreover, individuals of lower socioeconomic status may be at increased risk for vision impairment and subsequent mental health problems. Existing psychosocial interventions for improving mental health in people with visual impairment show some promise, but are limited by low adherence and lack generalizability.

Conclusion

In order to improve outcomes, a better understanding of the mechanisms linking visual impairment and poor mental health is needed. It will also be essential to develop more effective interventions and expand access to services to improve the detection and treatment of mental health problems in this population.

The extent to which mobile applications support independence among the visually impaired - a pilot study

Background and aim: Visual impairment (VI) problems are increasing as the global aging population grows. Mobile devices have become essential to interacting with friends and society. Because the visually impaired are no exception, it would be useful to determine the functionalities that best support the independence of people with VI. The currently available functionalities and applications were analysed to provide insight about which features the visually impaired value most.Materials and methods: A Webropol survey with structured and open-ended questions was carried out. The participants (n = 26) were asked about their use of mobile applications and opinions regarding the usefulness of certain applications in promoting independent functioning. An instrument was developed for this study based on previous literature, and its quality was assured through an expert panel evaluation and pre-testing. The collected data were analysed statistically and by inductive content analysis.Results: A majority of the participants were active users of mobile devices. Substantial variation was observed in the evaluations of how useful various applications are to different everyday tasks. The participants suggested numerous improvements, such as additional customization, to the current mobile devices and applications.Implications for RehabilitationPeople with VI benefit from the use of mobile devices in the same way that the population with normal vision does, and mobile devices and applications can be pivotal to supporting their independence.The participants offered innovative ideas and suggestions for how mobile devices and applications could be designed to better meet the needs of the visually impaired.

Nutrition and the aging retina: A comprehensive review of the relationship between nutrients and their role in age-related macular degeneration and retina disease prevention

Age-related macular degeneration (AMD) is the leading cause of severe vision loss in developed countries and is highly common among aging individuals. Considering the rate at which the global population is aging, the increasing prevalence of AMD and age-related eye disease is cause for concern. AMD is associated with the degeneration of the macula, the most central region of the retina, leading to a loss of central vision. A wide array of research has focused on the ability of lipid soluble nutrients to prevent and mitigate the harmful effects of AMD. These nutrients in question tend to be highly saturated within retinal tissues including the carotenoids lutein and zeaxanthin and the polyunsaturated fatty acid docosahexaenoic acid (DHA). Additionally, the unique presence of very long chain polyunsaturated fatty acids (VLCPUFAs, C24-C36) in the retina may be essential to prevent retinal degeneration as demonstrated by abnormal retinal functioning in the absence of these novel fatty acids. Existing literature has suggested that lutein, zeaxanthin and DHA consumption tend to enhance the health of the retina, protecting against the development of AMD. However, little improvement to the previously deteriorated retina is demonstrated and more research is required to understand the role of these nutrients in the retina and for the prevention of AMD. Considering the global impact of AMD and age-related eye disease, utilizing nutrients to prevent the formation of these debilitating diseases is a highly affordable and promising strategy.

The association between vision impairment and social participation in community-dwelling adults: a systematic review

Vision impairment (VI) is an important contributor to the global burden of disability and is associated with decreased well-being. Recent research has attempted to devise a conceptual framework to explain the health consequences of VI. One proposed mechanism by which VI leads to declines in well-being and other adverse health and disability outcomes is through limitations in social participation (SP). SP is an integral component of overall functioning, optimal aging, and well-being, and reductions in SP are associated with lower health-related quality of life. The purpose of this systematic review was to appraise the existing literature on the relationship between VI and SP. The protocol for this review was registered on PROSPERO (CRD42018102767) and adhered to PRISMA guidelines. A comprehensive search of five databases (MEDLINE, EMBASE, PsycINFO, Scopus, Sociology Database) yielded 881 unique studies, of which 19 met inclusion criteria. Among the 19 included studies, 18 concluded that VI was associated with reduced SP and one reported mixed results. Bias was assessed using the Effective Public Health Practice Project Quality Assessment. In the quality assessment, four studies were rated "moderate" and fifteen were rated "weak." There was wide variation in study populations and measurement of VI and SP. In conclusion, there is consensus that VI is associated with reduced SP. However, more rigorous study design and better standardization in the assessment of VI and SP could facilitate valid comparisons across populations, diseases, and levels of VI. Attempts to provide vision rehabilitation and mitigate the effects of VI on overall health and well-being might consider strategies to improve SP.

Geriatric Conditions and Prescription of Vitamin K Antagonists vs. Direct Oral Anticoagulants Among Older Patients With Atrial Fibrillation: SAGE-AF

Background: Geriatric conditions are common among patients with atrial fibrillation (AF) and relate to complications of oral anticoagulation (OAC).

Objective: To examine the prevalence of geriatric conditions among older patients with AF on OAC and relate type of OAC to geriatric conditions.

Methods: Participants had a diagnosis of AF, were aged ≥65 years, CHA₂DS₂VASC ≥ 2, and had no OAC contraindications. Participants completed a 6-component geriatric assessment that included validated measures of frailty (CHS Frailty Scale), cognitive function (MoCA), social support (MOS), depressive symptoms (PHQ9), vision, and hearing. Type of OAC prescribed was documented in medical records.

Results: 86% of participants were prescribed an OAC. These participants were on average aged 75.7 (SD: 7.1) years, 49% were women, two thirds were frail or pre-frail, and 44% received a DOAC. DOAC users were younger, had lower CHA₂DS₂VASC and HAS-BLED scores, and were less likely to be frail. In Massachusetts, pre-frailty was associated with a significantly lower odds of DOAC vs. VKA use (OR = 0.64, 95%CI 0.45, 0.91). Pre-frailty (OR = 0.33, 95%CI 0.18–0.59) and social isolation (OR = 0.38, 95%CI 0.14–0.99) were associated with lower odds of DOAC receipt in patients aged 75 years or older. Social isolation was associated with higher odds of DOAC use (OR = 2.13, 95%CI 1.05–4.29) in patients aged 65–74 years.

Conclusions: Geriatric conditions were common and related to type of OAC prescribed, differentially by age group. Research is needed to evaluate whether a geriatric examination can be used clinically to better inform OAC decision-making in older patients with AF.

Understanding fatigue in adults with visual impairment: A path analysis study of sociodemographic, psychological and health-related factors

Background

Fatigue is a disabling problem in patients with visual impairment, but its etiology is still poorly understood. Our objective was to identify the determinants of fatigue in adults with visual impairment compared to adults with normal sight.

Methods

Cross-sectional data on fatigue and sociodemographic, psychological and health-related factors was obtained with validated questionnaires. Structural equational modeling using hypothesized relationships and explorative analyses were used to identify (in)direct pathways contributing to fatigue in 247 adults with visual impairment. The model was then tested in a reference group of 151 adults with normal sight.

Results

The final model explained 64% of fatigue variance in participants with visual impairment and revealed the following factors to be directly associated with fatigue: depressive symptoms (β = 0.723, p<0.001), perceived health (β = -0.158, p = 0.004), accommodative coping (β = 0.116, p = 0.030) and somatic comorbidity (β = 0.311, p = 0.001). Self-efficacy demonstrated a beneficial indirect effect on fatigue (β = -0.228, p<0.001) mediated by depression, accommodative coping and perceived health. Sleep disorder had an indirect effect on fatigue (β = 0.656, p<0.001) mediated by depression and perceived health. After removal of sleep disorder, the model explained 58% of the fatigue variance in normally sighted adults but pathways involving accommodative coping and somatic comorbidity were not confirmed.

Conclusions

These findings suggest that depression and perceived health are important mediating factors that contribute to fatigue in persons with visual impairment and normal sight. In contrast, somatic comorbidity, sleep disorders and accommodative coping seem to have a specific contribution to vision-related fatigue. These factors should be addressed in interventions to assist individuals with visual impairment in dealing with fatigue.

Before Hospice: Symptom Burden, Dementia, and Social Participation in the Last Year of Life

Background: Little is known about clinical symptom burden, dementia, and social isolation in the last year of life among older adults. Objective: To describe and contrast the type and severity of symptom burden for older decedents with and without dementia, and whether specific symptoms and presence of dementia are associated with limitations in social participation in the last year of life. Design: Cross-sectional logistic regression analysis of a population-based study. Setting/Subjects: A total of 1270 community-dwelling adults of age ≥65 years in the United States participated in the 2011 National Health and Aging Trends Study and died by 2015. Measurements: Dementia status, 13 clinical symptoms, and limitations in 6 social activities were drawn from the interview preceding death. Severity of sensory, physical, and psychiatric symptom burden was examined in tertiles. Results: Decedents with dementia (37.3%) had higher prevalence of all symptoms (p's < 0.05), except insomnia and breathing problems. Dementia was associated with greater likelihood of high versus low burden of sensory (odds ratio [OR] 4.52 [95% confidence interval {CI} 3.08-6.63]), physical (OR 3.49 [95% CI 2.48-4.91]), and psychiatric (OR 2.80 [95% CI 1.98-3.95]) symptoms. Dementia and physical symptoms (problems with speaking, leg strength/movement, and balance) were independently associated with limitations in at least three social activities (p's < 0.05 for adjusted ORs). Conclusion: Symptom burden is higher in patients with dementia. Dementia and physical symptoms are associated with social activity limitations. Older patients with dementia or physical symptoms may benefit from earlier emphasis on palliative care and quality of life.

Reduced social participation among seniors with self-reported visual impairment and glaucoma

Objective

Social participation benefits health. We assessed the relationship between self-reported visual impairment (VI) and glaucoma versus seniors’ social participation.

Methods

Data from individuals aged ≥65 years responding to the Canadian Community Health Survey Healthy Aging 2008/2009 (n = 16,369) was analyzed. Participation in eight social activities by seniors with and without self-reported VI or glaucoma was compared.

Results

Seniors with VI had significantly reduced participation (p<0.05) in sports/physical activities (18.0% vs. 33.6%), family/friendship activities outside the household (39.7% vs. 53.0%), service club/fraternal organization activities (11.4% vs. 18.4%), volunteer/charity work (13.4% vs. 24.9%), educational/cultural activities (16.2% vs. 24.5%), and other social recreational activities (21.6% vs. 31.0%) compared to those without VI. Differences in participation in church/religious activities (40.6% vs. 44.5%) and community/professional association activities (15.3% vs. 18.0%) were non-significant between seniors with and without VI. Seniors with glaucoma versus those without had significantly reduced participation (p<0.05) in family/friendship activities (46.6% vs. 52.9%), sports/physical activities (26.0% vs. 33.6%) and volunteer/charity work (20.4% vs. 24.9%). No participation in any social activity was significantly higher among seniors with VI versus those without (10.1% vs. 2.9%, p<0.05), but was similar among seniors with and without glaucoma (3.9% vs. 3.1%, p>0.05). After adjusting for the effects of age, sex, education, household income, ethnicity, job status and chronic diseases (adjusted odds ratio, aOR = 3.4 (95% confidence interval (CI) 2.0–5.8), seniors with VI but no glaucoma were more likely not to engage in any social activities compared to seniors without VI and no glaucoma. Seniors with glaucoma but without VI had a similar level of non-participation (aOR = 0.9, 95%% CI 0.5–1.7).

Conclusions

Significantly reduced social participation was found across six community activities among seniors with self-reported VI and in three activities among those with self-reported glaucoma. Policies and programs that help seniors with VI or glaucoma engage in social activities are needed.

Productivity Losses and Their Explanatory Factors Amongst People with Impaired Vision

Purpose: To estimate productivity losses amongst people with impaired vision in Portugal and to investigate explanatory factors associated with non-participation in the labour market.Methods: A total of 546 visually impaired individuals participated in face-to-face interviews. Participants were asked about their workforce participation to determine productivity (employment status questionnaire), their health-related quality of life - HRQoL (EQ-5D) and their visual acuity and visual ability (Activity Inventory). Productivity losses included absenteeism and reduction in workforce participation. Logistic regression was used to determine independent factors associated with participation in the labour market.Results: From the 546 participants, 50% were retired, 47% were of working age and 3% were students. The employment rate was 28%, and the unemployment rate was 21% for the working age sample. For those of working age, productivity losses were estimated at €1.51 million per year, mean of €5496 per participant. The largest contributor to productivity losses was reduced workforce participation, estimated from 159 early retired or unemployed participants. After controlling for visual acuity and ability, younger individuals, with more years of education, without comorbidities and high HRQoL had a higher probability of being employed.Conclusions: Our findings show a high unemployment rate and high productivity losses amongst people with impaired vision. The probability of being employed was associated with education, HRQoL and comorbidities. We speculate that promoting education and health through effective visual rehabilitation programs may help to increase participation in the labour market. These findings can inform decisions to intervene to reduce the burden of vision loss.

Reducing avoidable visual impairment in elderly home healthcare patients by basic ophthalmologic screening

PURPOSE

To investigate the prevalence of potential age-related eye conditions in elderly who are assisted by home healthcare nurses. The number of referrals to the general practitioner (GP), feasibility of screening and associations between vision loss and health outcomes were also studied.

METHODS

Cross-sectional study in which trained home healthcare nurses screened the eyes of 151 patients [mean age 80 (50-96 years)] using their available correction, with VISION 2020 Netherlands screeners (e.g. acuity/field loss). Health outcomes were assessed with questionnaires.

RESULTS

Distance decimal visual acuity was ≤0.3 in 20.5% (unilateral) and 19.9% (bilateral) of patients, and near visual acuity was ≤0.4 in 17.7% (unilateral) and 33.3% (bilateral). Macular dysfunction was present in 21.5% (unilateral) and 8.3% (bilateral) and peripheral field problems in 11.4% (unilateral) and 7.9% (bilateral). GP referrals were proposed in 21.5%; in 40%, the GP or ophthalmologist was already aware of eye problems. Although health problems were prominent in participants (8.6% fractures, 22% depression and 18% anxiety), no significant associations were found between vision loss and self-reported outcomes.

CONCLUSION

Sixty per cent of frail elderly home healthcare patients had an ophthalmologic condition. Although a large number was already known in eye health care, >20% was referred with an unrecognized ophthalmologic problem. Basic ophthalmologic screening by home healthcare nurses might be a potentially relevant tool to reduce the burden of age-related vision loss, contributing to the joint World Health Organization - VISION 2020 initiative to eliminate avoidable blindness. Relevant health outcomes do not seem to be clearly related to having visual impairment, but rather to having general health problems.

Adaptations to support occupational engagement with age-related vision loss: A metasynthesis study

BACKGROUND.

Age-related vision loss (ARVL) is a progressive process that adversely affects older adults' occupational engagement. As such, older adults often employ a variety of psychological adaptation strategies.

PURPOSE.

The purpose of this study was to identify those psychological adaptation strategies employed by older adults aging with ARVL.

METHOD.

This metasynthesis searched and identified 21 qualitative articles that described a link between psychological adaptation strategies and occupational engagement.

FINDINGS.

The psychological strategies identified were categorized into five themes. The strategies of persisting with hope, positivity, and acceptance and portraying a self-image consistent with independence, competence, and self-reliance were well established in the literature, while other themes were more emerging, such as using humour, relying on religious/spiritual beliefs, and comparing the self to others.

IMPLICATIONS.

By understanding the psychological adaptation strategies employed by older adults with ARVL, occupational therapists will be better positioned to guide their clients toward positive adaptive patterns.

The Effectiveness of a Multi-Disciplinary Group Rehabilitation Program on the Psychosocial Functioning of Elderly People who are Visually Impaired

Introduction

The pilot study reported here determined the effectiveness of a multidisciplinary group rehabilitation program, Visually Impaired Elderly Persons Participating (VIPP), on psychosocial functioning.

Methods

The single-group pretest–posttest pilot study included 29 persons with visual impairments (aged 55 and older) who were referred to a low-vision rehabilitation center. The VIPP intervention (20 weekly meetings) consisted of four components (practical training; education, social interaction, counseling, and training in problem-solving skills; individual and group goal setting; and a home-based exercise program). Psychosocial adaptation to vision loss, helplessness, self-efficacy, mental health, and fear of falling were used as indicators of psychosocial functioning and were assessed at the baseline, halfway, immediately after completion of the intervention, and at the six-month follow-up.

Results

Directly after the intervention, the participants’ adaptation to vision loss (ES = 0.57), self-efficacy (ES = 0.50), and mental health (ES = 0.39) improved compared to the baseline. Moreover, helplessness and a generic and vision-specific fear of falling decreased (ES = 0.26, ES = 0.20, and ES = 0.24, respectively). The six-month follow-up measure indicated improved adaptation to vision loss (ES = 0.54), a lesser feeling of helplessness (ES = 0.53), better mental health (ES = 0.22), and a lesser vision-specific fear of falling (ES = 0.27). In contrast, a decrease in self-efficacy (ES = 0.14) and an increase in the generic fear of falling (ES = 0.18) were found.

Discussion

The tentative conclusion of this small-scale pilot study is that the VIPP program benefits psychosocial functioning in both the short and long term.

Implications for practitioners

The study showed that low-vision rehabilitation centers could implement multidisciplinary group rehabilitation programs, such as VIPP, to improve the psychosocial functioning of elderly people who are visually impaired.

Participation of adults with visual and severe or profound intellectual disabilities: Analysis of individual support plans

BACKGROUND

The extent of participation of adults with visual and severe or profound intellectual disabilities (VSPID) is unclear.

AIMS

To explore participation of adults with VSPID and the association between occurrence and importance of aspects of participation.

METHODS

Individual support plans (ISPs) of 40 adults with VSPID were analyzed: selected text fragments were categorized according to 125 previously operationalized statements that had different levels of importance and were divided into seven participation clusters.

RESULTS

The ISPs contained 2791 text fragments that related to a statement. All clusters were covered: the clusters 'Experience and discover' (91.7%), 'Involvement' (90%), and 'Social relations' (87.5%) were well covered. 'Inclusion' (53.6%) and 'Leisure and recreation' (57.1%) were mentioned less often. Among the 36 high-importance statements, two related to 'Inclusion', 'Involvement' and 'Social Relations' each, three to 'Communication and being understood', and five to 'Self-management and autonomy' had at least 30 text fragments.

CONCLUSIONS

The participation domains 'Experience and discover', 'Involvement', and 'Social relations' are well-documented, suggesting that adults with VSPID participate in those areas. However, domains such as 'inclusion in society' and 'leisure in society' were not documented. This overview of participation offers residential facilities the opportunity to determine in which areas participation can be improved.

WRINKLED VASCULARIZED RETINAL PIGMENT EPITHELIUM DETACHMENT PROGNOSIS AFTER INTRAVITREAL ANTI-VASCULAR ENDOTHELIAL GROWTH FACTOR THERAPY

BACKGROUND/PURPOSE

Neovascular age-related macular degeneration (nAMD) is frequently associated with vascularized pigment epithelial detachment (v-PED). We observed a peculiar characteristic of v-PED characterized by small lacy folds of the retinal pigment epithelium, appearing as a wrinkled PED (w-PED) on spectral domain optical coherence tomography (SD-OCT). Our purpose was to describe the visual prognosis and number of intravitreal injections in w-PED compared with non-w-PED.

METHODS

In this retrospective, case-control series, we reviewed retrospectively medical records of 52 eyes of 51 patients who were consecutively included between November 1 and 30, 2015 with a previous minimum 3-year follow-up. Inclusion criteria were: neovascular age-related macular degeneration, affected with w-PED. Baseline characteristics, best-corrected visual acuity (BVCA), number of intravitreal anti-vascular endothelial growth factor injections (anti-VEGF IVT) and maximal recurrence-free interval, that is, without intravitreal anti-vascular endothelial growth factor injection, were analyzed. A w-PED was defined as a v-PED ≥200 μm in height on SD-OCT imaging, presenting with at least 4 small lacy folds on the surface of the retinal pigment epithelium. Patients were compared with a control group, that is, patients harboring PED without wrinkle shape (non-w-PED). All patients had been treated by intravitreal anti-vascular endothelial growth factor injection of either ranibizumab (IVR) or aflibercept (IVA) using a pro re nata (PRN) protocol after three initial monthly treatments, with a minimum of follow-up of 3 years.

RESULTS

Two groups of patients were compared, w-PED (29 eyes, from 29 patients), and non-w-PED (23 eyes from 22 patients). In the w-PED group, mean BCVA evolved from 0.28 (±0.18) log MAR (20/40, range 20/25-20/63) at baseline, to 0.29 (±0.21) log MAR (20/40, range 20/25-20/63) at 1 year (P = 0.41), 0.34 (±0.26) log MAR (20/40, range 20/25-20/80) at 2 years (P = 0.49), 0.35 (±0.28) log MAR (20/40, range 20/25-20/80) at 3 years (P = 0.54). In the non-w-PED group, mean BCVA was 0.40 (±0.28) log MAR (20/50, range 20/25-20/100) at baseline and decreased to 0.48 (±0.46) log MAR (20/63, range 20/20-20/160) at 1 year (P = 0.19), 0.48 (±0.35) log MAR (20/63, range 20/25-20/125) at 2 years (P = 0.02), 0.60 (±0.38) log MAR (20/80, range 20/32-20/200) at 3 years (P = 0.002). In the w-PED group, the mean maximal documented recurrence-free interval was 7.87 (±2.94) months at Year 1, 13.5 (±7.52) at Year 2 and 14.78 (±10.70) at Year 3, versus 4.59 (±2.95) months at Year 1, 7.83 (±6.62) at Year 2, 8.57 (±11.18) at Year 3 in the non-w-PED group (P = 0.0004; 0.0101; 0.0168 respectively at Years 1, 2 and 3).

DISCUSSION

The evolution of v-PED after intravitreal anti-vascular endothelial growth factor injection is still difficult to predict despite intense clinical research in this topic. In our study, we noticed that w-PED might be a phenotypic prognosis factor for better visual acuity and longer maximal recurrence-free interval.

Low vision and mobility scooters: the experiences of individuals with low vision who use mobility scooters

Purpose: Older adults with low vision are a growing population with rehabilitation needs including support with community mobility to enable community participation. Some older adults with low vision choose to use mobility scooters to mobilize within their community, but there is limited research about the use by people with low vision. This paper describes a pilot study and asks the question: what are the experiences of persons with low vision who use mobility scooters? Methods: This study gathered the experiences of four participants with low vision, aged 51 and over, who regularly use mobility scooters. Diverse methods were used including a go-along, a semi-structured interview and a new measure of functional vision for mobility called the vision-related outcomes in orientation and mobility (VROOM). Findings: Four themes were found to describe experiences: autonomy and well-being, accessibility, community interactions and self-regulation. Discussion and implications: This study was a pilot for a larger study examining self-regulation in scooter users. However, as roles emerge for health professionals and scooters, the findings also provide evidence to inform practice, because it demonstrates the complex meaning and influences on performance involved in low vision mobility scooter use. Implications for rehabilitation Scooter use supports autonomy and well-being and community connections for individuals with both mobility and visual impairments. Low vision scooter users demonstrate self-regulation of their scooter use to manage both their visual and environmental limitations. Issues of accessibility experienced by this sample affect a wider community of footpath users, emphasizing the need for councils to address inadequate infrastructure. Rehabilitators can support their low vision clients' scooter use by acknowledging issues of accessibility and promoting self-regulation strategies to manage risks and barriers.

The everyday lives of older adults with visual impairment: An occupational perspective

Introduction

In order to live in a world created for the sighted, older adults with visual impairment must adapt to complete vision-dependent activities that require reading, writing, and object identification. The objective of this study was to explore the occupational lives of three older adults with visual impairment.

Method

A qualitative study with four interviews each and two observation sessions each was conducted with older adults with visual impairment. Data were analyzed by participant and across participants using open, axial, and selective coding. Codes were refined throughout the process yielding the themes of the study.

Results

Three themes emerged from the analysis: an occupational life of doing, an occupational life rich with well-being, and an occupational life filled with motivation for independence. Participants were highly motivated to complete their occupations and activities independently. Participation in activities in the home and community environments provided participants with life satisfaction and happiness. Through problem-solving skills, adaptations, and support of family and friends, participants successfully completed their desired occupations.

Conclusion

This study highlights the importance of motivation and support to facilitate participation in occupations in the home and community environments.

Exploring the Facilitators and Barriers to Physical Activity in Older People With Sight Loss

This study aimed to explore facilitators and barriers to physical activity in older people with sight loss. Focus groups were conducted with 13 community-dwelling older adults with sight loss ranging from poor to completely blind. Transcripts were analyzed using an inductive thematic analysis. Facilitators and barriers are experienced in three ways: psychologically; through opportunity and access; and at a societal and policy level. Campaigns are needed to challenge unhelpful age-related stereotypes at both psychological and societal levels. Additionally, interventions grounded in evidence and theory should be trialled and evaluated for increasing physical activity in this population.

Visual Impairment Is Associated With Depressive Symptoms-Results From the Nationwide German DEGS1 Study

INTRODUCTION

Visual impairment (VI) is associated with a variety of comorbidities including physical and mental health in industrial countries. Our aim is to examine associations between self-reported impairment and depressive symptoms in the German population.

METHODS

The point prevalence of self-reported VI in Germany was computed using data from the German Health Interview and Examination Survey for adults from 2008 to 2011 (N = 7.783, 50.5% female, age range 18-79 years). VI was surveyed by two questions, one for seeing faces at a distance of 4 m and one for reading newspapers. Depressive symptoms were evaluated with the Patient Health Questionnaire-9 questionnaire and 2-week prevalence was computed with weighted data. Depressive symptoms were defined by a value of ≥10. Logistic regression analysis was performed to analyze an association between self-reported VI and depressive symptoms. Multivariable analysis including adjustment for age, gender, socioeconomic status, and chronic diseases were carried out with weighted data.

RESULTS

The 2-week prevalence of depressive symptoms was 20.8% (95% CI: 16.6-25.7%) for some difficulties in distance vision and 14.4% (95% CI: 7.5-25.9%) for severe difficulties in distance vision, while 17.0% (95% CI: 13.3-21.4%), respectively, 16.7% (95% CI: 10.7-25.1%) for near vision. Analysis revealed that depressive symptoms were associated with self-reported VI for reading, respectively, with low VI for distance vision. Multivariable regression analysis including potential confounders confirmed these findings.

CONCLUSION

Depressive symptoms are a frequent finding in subjects with difficulties in distance and near vision with a prevalence of up to 24%. Depressive comorbidity should therefore be evaluated in subjects reporting VI.

Does Visual Impairment Affect Social Ties in Late Life? Findings of a Multicenter Prospective Cohort Study in Germany

OBJECTIVE

To investigate how visual impairment affects social ties in late life longitudinally.

DESIGN

Population-based prospective cohort study.

SETTING

Individuals in old age were recruited via general practitioners' offices (at six study centers) in Germany. They were interviewed every 18 months.

PARTICIPANTS

Individuals aged 75 years and above at baseline. Follow-up wave 2 (36 months after baseline, n=2,443) and wave 4 (72 months after baseline, n=1,618) were used for the analyses presented here.

MEASUREMENTS

Social ties were assessed using the 14-item form of the questionnaire for social support (F-SozU K-14). Visual impairment was self-rated on a three level Likert scale (no impairment, mild visual impairment, or severe/profound visual impairment).

RESULTS

Adjusting for sociodemographic factors, hearing impairment and comorbidity, fixed effects regressions revealed that the onset of mild visual impairment decreased the social support score, in particular the emotional support score. Additionally, the onset of mild hearing impairment decreased the social support score in men. Moreover, increasing age decreased the social support score in the total sample and in both sexes. Loss of spouse and increasing comorbidity did not affect the social support score.

CONCLUSION

Our results highlight the importance of visual impairment for social ties in late life. Consequently, appropriate strategies in order to delay visual impairment might help to maintain social ties in old age.