[Deteriorating vision in the elderly: double stress?].
BACKGROUND
Epidemiologic studies have provided clear evidence that the majority of people affected by severe visual impairment are adults above the age of 60 years. The goal of this psychological research was to analyze the emotional and behavioral consequences of age-related visual impairment in three steps: descriptive data concerned with subjective well-being, depression, everyday competence, and leisure as well as explanations of interindividual variability based on individual and environmental variables are presented (study I). Also, the impact of the time of onset (early versus late in life) is addressed (study II). Finally, the role of the living accomodation (institutional versus private household) was the main target of another study (study III).


METHODS
Study I was based on 84 elderly adults who experienced an irreversible visual loss after age 55 years; a control group of unimpaired elderly adults is also included (mean age 75.8, range 59 to 92). In study II, 18 elderly adults who had been blind since their early childhood were compared to nine matched elderly adults who experienced blindness in their later life as well as nine matched unimpaired elderly adults (mean age 71.7, range 63 to 83). The data for study III came from 15 visually impaired institutional residents who were compared to 15 matched unimpaired residents and 15 matched visually impaired and 15 unimpaired older adults living in private households (mean age 87.0, range 78 to 93). All subjects underwent an intensive psychological measurement program.


RESULTS
The findings of study I emphasize that age-related visual impairment is associated with lower subjective well-being, greater depression, reduced everyday competence, and lowered leisure activity level. A significant portion of interindividual variability in these outcomes can be explained by addressing individual variables (e.g., comorbidity) as well as environmental variables (e.g., quality of the dwelling unit). Study II data offer evidence that older adults suffering from blindness since their early childhood are better adapted than older adults who experienced blindness only in their later years. Study III shows that visually impaired institutional residents reveal deficits in everyday competence and social contacts as contrasted with their unimpaired counterparts, whereas no difference is observed in the domain of subjective well-being.


CONCLUSIONS
All three studies point to the negative impact of age-related visual impairment on emotional and behavioral adaptation in later life. This highlights the need for a whole range of rehabilitative efforts, including psychosocial elements, which are described in the final part of this article.
Wahl
H W
HW
Deutsches Zentrum für Alternsforschung an der Universität Heidelberg.
Heyl
V
V
Oswald
F
F
Winkler
U
U
D000203:Activities of Daily Living / Q000523:psychology; D000223:Adaptation, Psychological; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001766:Blindness / Q000523:psychology* / Q000534:rehabilitation; D002648:Child; D003863:Depression / Q000523:psychology* / Q000534:rehabilitation; D005260:Female; D006801:Humans; D007899:Leisure Activities; D008297:Male; D008875:Middle Aged; D010348:Patient Care Team; D011305:Presbyopia / Q000523:psychology* / Q000534:rehabilitation; D011788:Quality of Life; D012803:Sick Role; D012919:Social Behavior; D012931:Social Environment