Verena R. Cimarolli

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.

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

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

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

Objective: To examine personal characteristics, disease-related impairment variables, activity limitations, and environmental factors as correlates of social participation in older adults with vision loss guided by the World Health Organization’s International Classification of Functioning, Disability and Health Model. Design: Baseline data of a larger longitudinal study. Setting: Community-based vision rehabilitation agency. Subjects: A total of 364 older adults with significant vision impairment due to age-related macular degeneration. Main Measures: In-person interviews assessing social participation (i.e. frequency of social support contacts, social/leisure challenges faced due to vision loss, and of social support provided to others) and hypothesized correlates (e.g. visual acuity test, Functional Vision Screening Questionnaire, ratings of attachment to house and neighborhood, environmental modifications in home). Results: Regression analyses showed that indicators of physical, social, and mental functioning (e.g. better visual function, fewer difficulties with instrumental activities of daily living, fewer depressive symptoms) were positively related to social participation indicators (greater social contacts, less challenges in social/leisure domains, and providing more support to others). Environmental factors also emerged as independent correlates of social participation indicators when functional variables were controlled. That is, participants reporting higher attachment to their neighborhood and better income adequacy reported having more social contacts; and those implementing more environmental strategies were more likely to report greater challenges in social and leisure domains. Better income adequacy and living with more people were related to providing more social support to others. Conclusion: Environmental variables may play a role in the social participation of older adults with age-related macular degeneration.

Challenges Experienced at Age 100: Findings From the Fordham Centenarian Study

ABSTRACT This article examines the challenges experienced by very old individuals and their consequences for well-being and mental health. In order to capture unique issues experienced in very old age, 75 participants of the population-based Fordham Centenarian Study answered open-ended questions on everyday challenges. Theme-based coding was then used to categorize and quantify responses. The challenges mentioned most often were challenges faced in the functional (e.g., physical health/activities of daily living restrictions, mobility, sensory impairment), psychological (e.g., loss of well-liked activity, dependency, negative emotions, death), and social (e.g., family loss) life domains. Functional challenges were negatively associated with aging satisfaction and positively associated with loneliness. Psychological challenges were positively linked to aging satisfaction. Social challenges were marginally related to loneliness. Notably, challenges were not related to depression. In conclusion, the challenges experienced in very old age are multidimensional and multifaceted, unique in nature, and have differential relations to mental health. Functional, psychological, and social challenges affect very old individuals’ lives and therefore need to be better understood and addressed. Given their consequences, it is imperative for policy makers to develop an awareness for the different types of challenges faced by centenarians, as there may be unique policy implications related to each.

Impact of Vision Impairment on Intensity of Occupational Therapy Utilization and Outcomes in Subacute Rehabilitation

OBJECTIVE To examine whether vision impairment is a predictor of intensity of occupational therapy utilization and outcomes in a sample of older adults ages ≥55 receiving subacute rehabilitation in a long-term care setting. METHOD Data for this cohort study were collected by means of structured, in-person interviews with 100 older adult rehabilitation patients at admission to a subacute unit in a long-term care facility and by medical chart review after discharge. RESULTS Regression analyses indicated that after controlling for sociodemographic, health, and social support variables, worse contrast sensitivity was a significant predictor of decreased time in occupational therapy, and worse visual acuity was a significant predictor of higher functional dependency at discharge. CONCLUSION Vision impairment may prevent full use of occupational therapy and hinder occupational therapy efficacy in subacute care settings. Study findings underscore the importance of developing low vision rehabilitation interventions that can be delivered in conjunction with more traditional subacute rehabilitation.

Perceived overprotection, instrumental support and rehabilitation use in elders with vision loss: A longitudinal perspective

Objectives. This studys purpose was to investigate changes in perceived overprotection – a problematic aspect of close relationships – over time in relationship to instrumental support receipt and vision rehabilitation service use in a sample of older adults with vision impairment. Methods. Participants were 584 older adults with chronic vision impairment who were interviewed three times over a 12-month period. Longitudinal data were analysed using a latent growth curve methodology to examine change over time in perceived overprotection and instrumental support in relation to vision rehabilitation service use. Main outcome measures. Self-reported levels of overprotection and receipt of instrumental support. Results. Over time perceived overprotection increased but not instrumental support. While perceived overprotection was positively associated with instrumental support initially, over time this relationship did not emerge. Perceived overprotection and instrumental support functioned as predictors of vision rehabilitation hours. However, over time vision rehabilitation service use did not influence these social supports. Conclusions. Perceived overprotection increases over time, yet this change is unaffected by rehabilitation service use and instrumental support. Both family members and elders need to be involved in the vision rehabilitation process and educated about how some level of independence can be regained.

The effects of telehealth use for post-acute rehabilitation patient outcomes

Introduction Previous research has shown that home telehealth services can reduce hospitalisations and emergency department visits and improve clinical outcomes among older adults with chronic conditions. However, there is a lack of research on the impact of telehealth (TH) use on patient outcomes in post-acute rehabilitation settings. The current study examined the effects of TH for post-acute rehabilitation patient outcomes (i.e. discharge setting and change in functional independence) when controlling for other factors (e.g. cognitive functioning). Methods For this retrospective study, electronic medical records (EMRs) of 294 patients who were discharged from a post-acute rehabilitation unit at a skilled nursing facility were reviewed. Only patients with an admitting condition of a circulatory disease based on ICD-9 classification were included. Main EMR data extracted included use of TH, cognitive functioning, admission and discharge functional independence, and discharge setting (returning home vs. returning to acute care/re-hospitalisation). Results Results from a regression analysis showed that although TH use was unrelated to post-acute rehabilitation care transition, it was significantly related to change in functional independence. Patients who used TH during their stay had significantly more improvement in functional independence from admission to discharge when compared to those who did not use TH. Discussion Findings indicate that TH use during post-acute rehabilitation has the potential to improve patient physical functioning.

Awareness, Knowledge, and Concern about Age-Related Macular Degeneration.

Age-related macular degeneration (AMD)—a common eye disease causing vision loss—can be detected early through regular eye-health examinations, and measures can be taken to prevent visual decline. Getting eye examinations requires certain levels of awareness, knowledge, and concern related to AMD. However, little is known about AMD-related awareness, knowledge, and concern levels of population groups who may be affected by or at risk for AMD. The purpose of this descriptive study was to assess these factors among—and health information seeking patterns of—four groups of individuals: [a] the general population, [b] a group at-risk for AMD due to race and advanced age, [c] a group at high-risk for AMD due to race, advanced age, and smoking behavior, and [d] a group diagnosed with AMD. Data were collected through telephone interviews with 894 adults using a computer assisted telephone interview method. Results demonstrate that while AMD awareness is high, knowledge about AMD risk factors and concern about the disease is lacking. The most prominent source of AMD awareness was knowing someone who had been diagnosed, and physicians were the main source for health-related information. AMD-related awareness campaigns should focus on educating older adults about AMD risk factors and involving healthcare professionals and older adults with AMD as peer educators.

End-of-Life Conversations and Hospice Placement: Association with Less Aggressive Care Desired in the Nursing Home

ABSTRACT Education about end-of-life care and treatment options, communication between family and health care providers, and having advance directives and medical orders in place are important for older adults with chronic, progressive decline and end-stage disease who spend their last days in the nursing home. This study used retrospective data (6 months before death) of long-stay nursing home decedents (N = 300) taken from electronic health records to capture the end-of-life experience. Findings showed for almost all decedents, Do Not Resuscitate and Do Not Intubate orders were in place, and just over one-half had Do Not Hospitalize and No Artificial Feeding orders in place. A small proportion had No Artificial Hydration or No Antibiotic orders in place. Overall, there was congruence between documented medical orders and treatment received. Findings showed that use of hospice and discussions about particular life-sustaining treatments each had significant associations with having less aggressive medical orders in place. These results can inform best practice development to promote high quality, person-directed, end-of-life care for nursing home residents.

An evaluation of a Geriatric Substance Abuse Recovery Program in post-acute care of a skilled nursing facility

ABSTRACT Alcohol and substance misuse is an overlooked and under-acknowledged problem among older adults. Hence, a substantial number of older adults go without needed recovery treatment. To meet the need of identifying and addressing alcohol and substance misuse issues in older adults, we created a Geriatric Substance Abuse Recovery Program (GSARP) for post-acute care patients within a skilled nursing facility (SNF). The GSARP integrates medical rehabilitation and substance abuse recovery services. This paper provides a description of the GSARP and reports on the results of the evaluation. Findings showed high program acceptability as demonstrated by an 80% program participation rate of patients who based on screenings for alcohol and substance misuse issues were found eligible to receive recovery services. Minority older adults were significantly less likely to participate when compared to Caucasians. GSARP participants were significantly more likely to return home when compared to those who did not participate and they had lower 30-day-rehospitalization rates. At two follow-up points, at least 60% of program participants reported that they had not relapsed. This pilot demonstrated feasibility of implementing a recovery program within an SNF and produced preliminary evidence for the effectiveness of the program in improving patient outcomes.