The Impact of Assistive Device Use on Disability and Depression Among Older Adults With Age-Related Vision Impairments

Abstract

We propose that these differential effects result from the fact that optical devices optimize residual vision and thus allow for greater continuity in the way tasks are accomplished (i.e., reading still performed visually), whereas use of adaptive aids (e.g., talking books) involves learning new methods in order to compensate for lost functions and thus is not as desirable either functionally or psychologically.

How Effective is Low Vision Service Provision? A Systematic Review

“…69,93,100,107 Although clinical outcomes are important, they do not necessarily reflect the abilities that the patients will show in their home environment; for example, a large discrepancy has been demonstrated between individuals with a good near VA in the clinic (75%), and those able to resolve small print at home (39%). 93 From this review, it was apparent that in the past decade there has been a drive towards assessing outcomes based on measures of ability and/or independence in performing daily tasks, 48,65,110 on measures of psychological status, 52,72,75 or on patient-reported quality-of-life. 43,70,91,115 Instruments assessing functional status may be scored entirely based on a patient's judgment of their own ability (self-report/patient-rated assessment), e.g.…”

“…33,69,70,115,121,122,124 Validity of low vision aid usage as a surrogate for service effectiveness is supported by the findings of Horowitz et al, who reported that the use of LVAs is associated with a reduction in disability and depression at 6 months. 72 The Manchester Low Vision Questionnaire (MLVQ) has been used as a standardised tool to assess aspects of LVA usage and satisfaction. 70,115,122,124 For example, Reeves et al used the MLVQ as an outcome measure in following up 226 patients for up to 1 year after provision of 3 different service models, and showed that patients valued their LVAs highly, and showed a high use of LVAs throughout the trial, despite apparently negative outcomes in vision-related QoL and QoL domains.…”

“…Outcomes have included participation levels in ADLs, 60 confidence in performance of ADLs, 116 dependence or independence in performing ADLs, 48 activity levels, 102 and perceived security/insecurity in performing ADLs, 41,49 as well as assessing basic ability in performance. 55,66,68,72,75,104,110,118,129,137,138,143,144 Despite the disparity in evaluation tools used, there is very good evidence that low vision service provision improves functional ability.…”

“…5,41,44,45,48,49,60,72,73,75,76,105,109,110,116,139 There is very good evidence that the Veterans Affairs outpatient program does not reduce the symptoms of depression. Stelmack et al found no improvement in self-reported symptoms of depression using the Centre for Epidemiological Studies Depression Scale (CES-D) at the 4 month follow up, even after a high dose intervention (Veterans' Affairs outpatient service) which showed large improvements in visual function.…”

“…In another trial, with a shorter follow-up period of 6 months, Horowitz et al found a larger, although still small, improvement in depressive symptoms (effect size -0.11) using the CES-D, even though there was an overall increase in functional disability (effect size 0.05). 72 Robbins and McMurry evaluated depression outcomes of 57 individuals at the Kooyong Low Vision Clinic (a multidisciplinary service, without any specified counselling or psychological service), using the Geriatric Depression Scale (GDS-30). 116 There was a small to moderate reduction in depression, but this change was not statistically significant.…”