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Adjustment to Aging and Low Vision

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Describes interaction between vision loss and issues related to aging ... Impact of these limitations is compounded by other losses that accompany aging ... – PowerPoint PPT presentation

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Title: Adjustment to Aging and Low Vision


1
Adjustment to Aging and Low Vision
2
Lecture Objectives
  • Understands factors affecting adjustment
    physical, emotional, social, cognitive
  • Describes interaction between vision loss and
    issues related to aging
  • Identifies appropriate intervention strategies

3
Stalemate When I was young and in my prime Bill
paying took such little time. One little sheet
with message clear, Pay this amount was written
here. Now Im older, visions poor Hands are
shaky, and whats more, Bills now come
computerized, Page 1 of 4, page 3 of 5. With
digitals that look the same. 5,3, or 8, a
guessing game. When I was young and in my
prime Twas hard to pay my bills on time. Now
Ive got dough but theyre apt to sue Cause I
cant find the balance due Leta Harvey,
Writer and Poet, age 82
4
Small Group Activity
  • List typical losses associated with aging
  • List losses specifically related to vision loss

5
Low Vision and Aging Facts
  • Older adults make up 2/3rds of low vision
    population
  • Age is the single best predictor of vision loss
  • Person makes 2 simultaneous adjustments
  • To the chronic progressive nature of vision loss
  • To the chronic progressive nature of aging

6
Low Vision Aging cont
  • No two people age the same way
  • There is infinite variety among individual
    older persons, whether visually impaired or
    sighted. Neither chronological age nor functional
    disability determines behavior
  • Hendricks (1992)
  • Persons become more heterogeneous as they age

7
Adjustment to aging and vision loss is a product
to many factors
8
Adjustment to aging and vision loss is a product
to many factors
  • Physical ability
  • Cognitive ability
  • Sensory abilities
  • Psychological make up
  • Emotional fortitude
  • Family and community support
  • Financial resources

9
Vision loss does not automatically result in
increased dependency and disability
  • Successful adjustment to vision loss depends in
    part on success in handling life crisis in the
    past
  • Older adult who has coped with challenges in life
    and arrives in old age with a strong ego and self
    concept likely will accept challenges of vision
    loss and remain independent
  • Kleinschmidt 1999

10
Vision loss presents a formidable obstacle to
maintaining independence
  • Especially when accompanied by other impairments
  • Impact of these limitations is compounded by
    other losses that accompany aging

11
Vision loss presents a formidable obstacle to
maintaining independence
  • Especially when accompanied by other impairments
  • Impact of these limitations is compounded by
    other losses that accompany aging
  • Death of spouse/diminished family life
  • Diminished financial resources
  • Reduce social outlets

12
Combination of these factors can cause increasing
isolation and inactivity
  • Isolation and inactivity are two of the most
    challenging problems facing older adults with
    visual impairment
  • Both have been shown to have a negative impact on
    adjustment

13
Challenges for Family and Friends
  • Persons with low vision present an ambiguous
    social situation for others
  • Fletcher et al 1991
  • They do not carry outwards signs of disability
  • White cane, dark sunglasses, dog guide
  • They look no different than when they were fully
    sighted

14
  • Persons disability is often inconsistent
  • Person with AMD may be able to navigate a maze
    of obstacles in a grocery store but be unable to
    identity a can of soup
  • Because of ambiguities and contradictions,
    family/friends often dont know how to react to
    the person
  • May expect too little or too much
  • May attribute limitations to dementia,
    depression, or just not trying

15
  • Family members may experience fear regarding
    persons safety
  • Children may experience desire to reverse roles
    and do everything for parent
  • Family members may feel burdened with
    responsibilities and worries
  • Family /friends may be uncertain whether to talk
    about the loss with the person
  • Becomes the elephant in the room that nobody
    talks about

16
Person is also confused by nature of visual
condition
  • Often told that they are legally blind but
    realize that they can see
  • Often take 2 opposite approaches
  • May try to pass as having normal vision to
    avoid social awkwardness
  • May stop using vision altogether to prepare for
    further loss of sight in the future
  • Conrod and Overbury 1998
  • Either approach may result in reluctance to seek
    help from a low vision rehab program

17
Emotional Support is an Important Factor in
Adjustment
  • Person faces a set of three stressors
  • The vision loss is progressive
  • Vision loss is irreversible-there is no cure
  • Possibility of significant decline in functional
    capacity
  • Ability to adjust to these stressors depends in
    part availability of emotional support

18
Emotional Support cont.
  • Quantity of support is not as important as
    quality
  • Do not need a large network
  • A single source of emotional support is
    sufficient if support reflects acceptance and
    caring
  • Children provide best source of support
  • Peer and support groups and telephone contacts
    can be effective (Kleinschmidt 1999)

19
Remaining Engaged is also a Key Factor in
Adjustment
  • 3 top sources of high morale for adults
  • Entertainments and diversions
  • Socializing
  • Productive activity
  • Primary sources of low morale
  • Dependency (financial or physical)
  • Physical discomfort or sensory loss
  • Loneliness
  • Bereavement
  • Loss of nuturing
  • Boredom, inactivity
  • Immobility and confinement

20
Engagement continued
  • Vision loss can limit participation in the
    sources of high morale and exacerbate sources
    that contribute to low morale
  • Majority of older adults fill days not with work
    but with leisure
  • TV viewing, visiting and reading account for
    greatest share of leisure time
  • Consume approximately 6 hrs per day

21
Engagement continued
  • Older adults are the largest subscribers to daily
    newspapers and use the newspaper to stay informed
    and connect with daily events
  • Vision loss can interfere with performance of
    these activities
  • Unable to read print, clearly see TV or dial a
    telephone
  • Difficulty recognizing faces
  • Limited transportation options

22
Engagement continued.
  • As a result, older adults often have to give up
    activities that were not only a source of
    satisfaction but also a means of staying engaged
    and active in world
  • Assisting the person to overcome limitations and
    increase activity level is one of the primary
    issues of low vision rehabilitation

23
Dealing with Loss is Another Factor in Adjustment
  • Face loss of family and friends with greater
    frequency than younger adults
  • Spousal loss can be especially devastating
  • Lose companionship and independence if spouse
    performed activities person can no longer do
  • Can also lose access to social outlets

24
Dealing with Loss cont
  • Other losses faced by older adults
  • Loss of income and prestige following retirement
  • experience identity crisis
  • Loss of home when decision is made to move into
    assisted living
  • Loss of driving privileges
  • Loss of control over personal finances

25
Successful Coping
  • Each person with vision loss is unique
  • Adjustment to any change, even a positive change
    is a process
  • Occurs in incremental steps and stages that build
    on one another to restore psychological well being

26
Many variables enter into successful adjustment
  • Motivation to remain independent
  • Cognitive ability
  • Personality
  • Attitude
  • Self concept
  • Nature of the visual impairment
  • Presence of other disabilities

27
Variables continued
  • Past experiences
  • Vocational and avocational involvement
  • Family support
  • Financial resources
  • Physical environment and resources

28
Initial Reaction to Diagnosis
  • Shock or denial of the vision loss
  • Can take several forms
  • Continuing to complete activities despite serious
    difficulty and safety risks
  • Doctor and program shopping
  • Anger at living longer but not necessarily better
  • May direct anger to a situation
  • Or to a family member

29
Initial Reaction continued
  • Feelings of deterioration and vulnerability
  • Sense that they are falling apart
  • One loss will lead to another in a downward
    spiral
  • Despair and hopelessness
  • Social isolation/psychological withdrawal
  • Fear
  • Grief and mourning
  • Although painful, a positive sign that person is
    moving through the adjustment process

30
Coping
  • the process through which people adjust to the
    stressful demands of their daily environments
  • Christiansen 1991

31
Coping Requirements
  • Person engages in specific problem solving
    efforts
  • Uses personal resources and competencies to
    create new ways of dealing with problem
    situations and reducing stress

32
Three Components of Coping
  • Must be able to acquire/process new information
    needed to understand the situation
  • Must be able maintain control over emotional
    state
  • Identify emotions being experienced
  • Express them appropriately
  • Control their expression
  • Must have freedom of response or realistic
    alternatives for dealing with the situation

33
Successful Coping Leads to Adaptation
  • Adaptation is the satisfactoriness of fit between
    an individual and the environment
  • Equates with quality of life

34
Two Classifications of Coping Responses
  • Problem focused
  • Person makes effort to manage the nature of the
    problem
  • Change the circumstances of the situation
  • Emotion focused
  • Person attempts to regulate the emotions or
    distress accompanying the situation

35
Q Which of the two responses is predominantly
used to deal with chronic conditions?
36
Q Which of the two responses is predominantly
used to deal with chronic conditions?Emotion
focused because person cant make the problem go
away
37
Coping process begins with cognitive appraisal
  • Person sizes up a situation and decides how to
    respond
  • Very complex process with many factors
  • Environmental factors
  • Personal characteristics

38
Environmental Factors in Coping Process
  • Type and nature of stressors
  • Long term vs. short term
  • Negative vs. positive
  • Social network
  • Number and quality of supports
  • Generally, social support is positive
  • Depends on the type of support offered
  • Positive material assist, emotional comfort,
    inclusion, encouragement
  • Negative irritation, resentment, judging,
    unwilling to hear emotions expressed, pessimism,
    supplying misinformation

39
  • Availability of social supports does not equate
    with use
  • Some persons view support has an indication that
    they are unable to cope without assistance
  • Offer of support would threaten self esteem

40
Environmental Factors cont
  • Economic and educational resources
  • Provides more options and choice
  • Increases locus of control
  • But can also increase frustration when money
    cant solve problems
  • Situational ambiguity
  • Presence greatly magnifies stress and taxes
    coping ability
  • Cant formulate a plan for coping

41
Personal Characteristics
  • Commitments
  • A persons values, motives, goals, the things
    that give meaning to their life
  • Point of view
  • Powerful influence-can direct a person towards or
    away from certain activities, situations
  • Determines perception, appraisal of a situation
  • Therapy can be a godsend or a supreme waste of
    time
  • Strong commitments can create psychological
    vulnerability
  • Create desire for secondary gain

42
Personal Characteristics
  • Beliefs
  • Serve as perceptual lens through which person
    views the environment
  • Shapes cognitive appraisal
  • Two major categories
  • Belief that person has some control over events
  • Belief that person is vulnerable and at the mercy
    of fate
  • Beliefs play a greater role when the situation is
    ambiguous and are less influential when a
    situation is clear cut

43
Personal Characteristics
  • Personality disposition
  • Optimist vs. pessimist
  • Influences the strategy the person chooses to
    cope
  • Optimists tend to do better
  • Engage in problem focused coping
  • Seek social support
  • Avoid denial and disengagement
  • The most successful personality
  • Self confident and easy going

44
Personal Characteristics
  • Personal history
  • If person has faced hard times and survived,
    h/she can often draw on that strength to cope
    with vision loss
  • Cultural influences
  • Example Midwesterners have a very stoic
    personality
  • Less likely to actively solicit help from any
    source

45
  • Environmental factors and personal
    characteristics affect the way in which a person
    perceives and appraises a stressful situation and
    formulates a response

46
Coping Strategies
  • Cognitive
  • Behavioral
  • Avoidant

47
Cognitive Coping Strategies
  • Attempt to manage appraisal of the situation
  • Frame the situation to see it in a certain light
  • Example drawing on past experiences to see the
    positive side
  • Employ information gathering

48
Behavioral Coping Strategies
  • Apply information gathering and problem related
    actions aimed directly at the source of stress
  • Why am I feeling this way, how can I change my
    emotional response
  • Rehearse alternative outcomes
  • Request reassurance and emotional support

49
Avoidant Coping Strategies
  • Reduce emotional attention through diversion or
    conscious efforts to circumvent or sidestep the
    source of stress
  • If I cant read, Ill watch TV instead
  • Two forms of denial are used
  • Denial of fact
  • My vision is perfect
  • Denial of implication
  • My vision is poor but I can continue to live in
    my own home and drive

50
  • Because western cultures place great value on
    mastery, tend to equate successful coping with
    problem solving and gaining mastery over a
    situation
  • Cognitive or behavioral strategies take
    preference over avoidance strategies
  • However research suggests avoidance strategies
    may be more useful in the early stages to help
    person avoid being overwhelmed by the situation
  • As long as the person also employs active coping
    strategies

51
  • Avoidance strategies are also most successful for
    dealing with long term disability
  • I am a person with a visual impairment
  • I am a visually impaired person

52
OT Intervention
  • Realize there are many coping styles
  • Acknowledge the style and work with it unless it
    is maladaptive
  • Important to identify the clients style as early
    as possible
  • Shapes the plan of care
  • Helps you set realistic goals

53
  • Person will not necessarily experience all of
    these feelings or experience them in any kind of
    order
  • See a lot of shifting back and forth

54
Improving Coping Strategies
  • Use strategies designed to strengthen problem
    solving skills and provide accurate appraisal of
    the situation facing the person
  • Provide factual information about the persons
    visual condition
  • Assist the person to view the situation
    realistically
  • Assist the person to draw on past experiences to
    draw strength

55
Facilitate Problem Solving
  • Effective problem solving should increase the
    likelihood that the person will select the most
    effective solution
  • 5 steps in problem solving
  • Problem orientation person develops attitude
    that an effective solution can be found
  • Problem definition and formulation person is
    taught to define problem situations in detail

56
Facilitate Problem Solving cont
  • Generation of solutions various solutions are
    tried out and assessed for success
  • Determination of course of action examination of
    the expected consequences of the action
  • Verification of the effectiveness of the
    solution person reflects on performance and
    seeks and receives feedback

57
  • Problem orientation

58
  • Problem orientation
  • Assist person to frame the problem so that h/she
    can see h/she has control over certain
    circumstances
  • Show person they have options in completing a
    task

59
  • Problem definition and formulation

60
  • Problem definition and formulation
  • Assist person to analyze tasks
  • Break them down into components
  • Address each component
  • Can be very successful at dispelling the sense
    that the task is overwhelming and cant be solved
  • How do you eat an elephant?

61
  • Generate solutions

62
  • Generate solutions
  • Direct person towards achievable, feasible
    solutions
  • Be creative and flexible
  • More than one way to skin a cat
  • Have another suggestion ready if one solution
    fails
  • Encourage persistence

63
  • Determine a course of action
  • Completed through establishment of the plan of
    care
  • Set clear, realistic, achievable goals
  • define the patients limitations in a way that
    the patient is able to appraise them properly and
    respond to them as challenges rather than threats
  • Solicit the persons commitment by requiring that
    they sign the plan
  • If person commits to a goal, motivation will
    increase
  • But so will psychological vulnerability
  • Person is putting themselves out there
  • Critical that the treatment approach is
    structured so that the person experiences early
    success

64
  • Verify effectiveness of the solution

65
  • Verify effectiveness of the solution
  • Provide objective but compassionate feedback

66
Key to Success
  • Enlist the person as a partner
  • Client centered approach
  • Gives person control and increases their
    commitment
  • Successful therapy approach as long as there is
    sufficient time to employ it
  • Takes multiple treatment sessions

67
Utilize Environmental Resources
  • Most important resource is social support
  • Involve family members in treatment if their
    support is constructive
  • Refer to support groups
  • Share common experiences
  • Gain information
  • Provide mutual help and support

68
Dealing with Depression
  • Many adjustment problems can be addressed with
    a well designed intervention designed to increase
    occupational performance
  • Person is not so much depressed as frustrated
  • Clinical depression is another matter
  • Shown to lead to greater disability
  • Can lead to suicide

69
Increased Disability
  • Rovner et al (Wills Eye Hospital Philadelphia)
  • Visual function and self care independence
    declines in persons whose depressive symptoms
    increase
  • Discouragement and helplessness drain inner
    resolve and resiliency and anergia, poor appetite
    and sleep impair effortful behaviors
  • Archives of Ophthalmology August 2002
  • Depression must be recognized as a distinct
    treatable disorder

70
Suicide
  • Suicide rates are increasing among older adults
  • Represent 13 of population but commit 19 of
    suicides
  • More likely to be successful if suicide is
    attempted
  • Not a plea for help but a way out
  • Any mention of suicide should be taken as a
    serious threat
  • Contributors to suicide
  • Depression, poor sleep quality, limited social
    supports

71
Symptoms of Depression
  • Persistent, pervasive depressed mood
  • Loss of interest or pleasure in usual activities
  • Increase or decrease in appetite or weight
  • Insomnia or hypersomnia
  • Psychomotor agitation or retardation
  • Fatigue or loss of energy
  • Feelings of worthlessness or excessive,
    inappropriate guilt
  • Impaired thinking or concentration

72
  • Seek professional help for any signs of depression
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