Amy Horowitz

Positive aspects of caregiving and adaptation to bereavement.

This study examined how positive aspects of caregiving affect adaptation to bereavement among older adults who cared for a family member with dementia. The sample consisted of 217 caregivers who were part of the Resources for Enhancing Alzheimers Caregiver Health Study. Using pre- and postloss data, hierarchical regressions were carried out to examine the effects of positive aspects of caregiving (caregiving benefit) on postloss depression and grief. Findings show that preloss caregiving benefit was associated with higher levels of postloss depression and grief, even after controlling for caregiver demographic characteristics, contextual factors, and caregiving burden. This effect was particularly strong for the relation between benefit and grief. Results demonstrate the importance of studying both positive and negative aspects of caregiving and their relation to bereavement outcomes.

Good to have but not to use: Differential impact of perceived and received support on well-being

Research documents a positive association between perceived support availability and well-being in later life. Other work shows that actually receiving support can have negative effects. Instrumental support receipt may be negative for persons with chronic impairment as it may emphasize their inability to accomplish daily tasks. This study contrasted the impact of perceived and received affective and instrumental support on adaptation to chronic vision impairment in 570 elders. After accounting for the significant, positive impact of perceived support, receiving instrumental support had a negative effect, while receiving affective support had a positive effect on well-being. Findings underscore the importance of distinguishing the association of multiple support components and outcomes to increase understanding of how support affects adaptation in later life.

Major and Subthreshold Depression Among Older Adults Seeking Vision Rehabilitation Services

OBJECTIVE Authors examined the potential risk factors of major and subthreshold depression among elderly persons seeking rehabilitation for age-related vision impairment. METHODS Participants (N=584), age 65 and older, with a recent vision loss, were new applicants for rehabilitation services. Subthreshold depression was defined as a depressive syndrome not meeting criteria for a current major depression (i.e., minor depression, major depression in partial remission, dysthymia) or significant depressive symptomatology. RESULTS Seven percent of respondents had a current major depression, and 26.9% met the criteria for a subthreshold depression. Poorer self-rated health, lower perceived adequacy of social support, decreased feelings of self-efficacy, and a past history of depression increased the odds of both a subthreshold and major depression, versus no depression, but greater functional disability and experiencing a negative life event were significant only for a subthreshold depression. Only a history of past depression was significant in increasing the odds of having a major versus a subthreshold depression. CONCLUSION Results highlight similarities in characteristics of, and risk factors for, subthreshold and major depression. Future research is needed to better understand both the trajectory and treatment of subthreshold depression, relative to major depressive disorders.

The influence of health, social support quality and rehabilitation on depression among disabled elders

This study examined the influence of health, social support, disability, and vision rehabilitation services on depression among visually impaired older adults seeking vision rehabilitation services. Participants (n = 95) were interviewed at application and approximately two years later. The first hierarchical regression model focused on concurrent relationships at baseline. The second model used baseline health and social support variables, along with indicators of change in vision and use of rehabilitation services, in order to predict change in depression over time. Findings indicate that being unmarried, in poorer health, having lower quality of relationships with family, and lower stability in friendships were significant independent risk factors for initial depression, explaining 50% of the variance. Decline in depression over time was predicted by younger age, better self-rated health, stability of friendships, and use of rehabilitation services that, along with baseline depression, explained 61% of the variance in depressive symptomatology at the two-year follow-up. Findings highlight the importance of qualitative aspects of social support for older disabled adults, as well as the distinction that needs to be made between factors that predict concurrent mental health status and those predicting change in status over time.

The effect of rehabilitation on depression among visually disabled older adults

There has been a great deal of interest in identifying the impact of rehabilitation on psychological well-being, as well as functional ability, among elders with disabilities, but empirical data remain limited. This descriptive study of participants in vision rehabilitation service examines the effect of specific vision rehabilitation services (low vision clinical services, skills training, counseling, optical device use, and adaptive device use) on change in depression among a sample of older adults with age-related vision impairments. Participants (N = 95) were interviewed at application for services and then approximately two years later. Findings from hierarchical regression analyses indicated that low vision clinical services, counseling, and use of optical devices, in separate models, each significantly contributed to a decline in depression, after controlling for age, health status, vision status, functional disability, as well as baseline depression. When all service variables were entered into the same equation, they explained an additional 10% of the variance in change in depression. Given the well documented robust relationship between disability and depression, findings point to the influence of vision rehabilitation interventions on both physical and psychological functioning, and underscore the need for future, controlled research on rehabilitation service models that address mental health issues.

Prevalence and Risk Factors for Self-Reported Visual Impairment Among Middle-Aged and Older Adults:

This study examined the prevalence of and risk factors for self-reported visual impairment among American adults. Data were collected via telephone interviews with a nationally representative sample (n= 1,219) aged 45 and older and were weighted for population parameter estimates. Hierarchical logistic regression examined independent risk factors of self-reported visual impairment. Seventeen percent of adults aged 45 and older self-reported visual impairments, increasing to 26.5% of those aged 75 and older. Greater age, not being Hispanic, in poor or fair self-rated health, and low availability of informal social support were significant risk factors associated with visual impairment. The prevalence of vision problems among adults suggests unmet needs for both basic eye care and vision rehabilitation interventions to reduce functional limitations that can result from visual impairment. Longitudinal research is needed to examine prevalence and incidence of vision loss as a function of population aging and changing health behaviors.

Longitudinal associations between dual sensory impairment and everyday competence among older adults.

Given the prevalence of sensory impairment in older adults, the relationship of sensory impairment to everyday competence among older adults is gaining attention. Dual impairment, or concurrent impairments of vision and hearing, affects anywhere from 5% to 21% of older adults. Using Longitudinal Study on Aging data, we examined the longitudinal associations of self-reported dual sensory impairment with everyday competence in self-reported activities of daily living among adults aged 70 and older (N = 5,151). Self-reported dual sensory impairment was associated with higher levels of self-reported functional disability at baseline and at the 2-year follow-up interview, but the effect gradually diminished over time. However, self-reported dual sensory impairment was not associated with greater levels of self-reported disability as compared with self-reported visual impairment alone. Findings highlight the importance of vision and aural rehabilitation programs for older adults to mitigate the loss of competence in later life due to sensory impairment.

In their own words: Strategies developed by visually impaired elders to cope with vision loss.

Abstract The present study developed a typology of self-reported coping strategies used by older adults in adapting to vision impairment using qualitative analyses. Narrative data were examined from three previous quantitative studies of adaptation to vision loss. Major themes in coping with vision loss included difficulty in balancing norms of independence with the functional losses resulting from eye disease, and the importance of the informal social network. Importantly, a number of coping mechanisms that have not been examined in prior quantitative work were identified through the present qualitative analyses. Implications of this typology of self-reported coping with age-related vision loss for research and practice are discussed.

Challenges faced by older adults with vision loss: a qualitative study with implications for rehabilitation

Objective: To provide an in-depth assessment of challenges faced by older adults with recent vision loss and to determine changes in the nature of these challenges over time for the purpose of informing the design of vision rehabilitation services. Design: Longitudinal, qualitative study with three time points. Setting: Vision rehabilitation agency. Subjects: Three hundred and sixty-four older adults aged 65 with significant vision impairment due to age-related macular degeneration. Interventions: In-person interviews conducted at baseline, one year and two years and coded using a qualitative analytical approach. Main measures: Open-ended questions assessing challenges faced due to vision loss in functional, social and psychological life domains. Results: Almost all participants reported a wide variety of challenges across all three domains with the most variety in the functional domain. Over a two-year period, functional challenges (e.g. using transportation) increased, social challenges (e.g. recognizing people) remained stable, and psychological challenges (e.g. negative affect) decreased overall. Conclusions: Although functional challenges are predominant, social and psychological challenges are quite common and need to be addressed in vision rehabilitation. Rehabilitation planning should also consider that vision-related challenges can change over time.

The effect of rehabilitation service use on coping patterns over time among older adults with age-related vision loss

Objective: To enhance our understanding of coping and rehabilitation in the context of adaptation to disability by examining how coping may change over a two-year time period, and how different vision rehabilitation services may affect coping over time. Design: Longitudinal two-wave study (baseline and two-year follow-up). Setting: Vision rehabilitation agency. Subjects: Older adults with visual impairment. Method: In-person interviews using structured assessments of functional vision loss and functional disability, rehabilitation service use and coping strategies. Results: Ninety-five people participated in both study waves. Findings showed change in patterns of coping over the two-year period of the study, as participants adjusted to living with age-related vision loss. Although instrumental coping was the only coping mode with evidence for average change (a decrease), affective and escape/distraction strategies showed individual variation in change over time. Rehabilitation use explained variance in coping at time 2 over and above impairment status and coping at time 1. Those who used a greater number of assistive aids between time points were likely to report more instrumental coping at time 2, and those who used counselling between time points were likely to report more affective coping at the two-year follow-up. Finally, those who used more optical aids were likely to report more escape/distraction coping at time 2, whereas those who saw a low vision specialist tended to report less of this type of coping over time. Conclusions: Findings suggest that rehabilitation interventions can affect coping patterns over time, and that direction and magnitude of such an effect may depend on the type of rehabilitation received.