The ways in which individuals cope with difficult life challenges has captivated interest among social workers and health care providers. Several studies have provided empirical support for applying the stress and coping model to various chronic health conditions (Benn, 1997; Carver & Scheier, 1994; Folkman, Chesney, Pollack, & Coates, 1993; Lazarus & Folkman, 1984). Yet, existing literature on stress and coping has fallen short of confirming the underlying constructs of coping domains, requiring further research on domain-specific coping based on the nature of particular stressors (Brennan et al., 2001).
The onset of chronic disability in later life involves a disruption in the equilibrium between person and environment, and it spurs a role transformation. Particularly, age-related vision loss has been identified as one of the most disabling conditions of later life, reducing an older person's ability to function independently at home and in the community (Branch, Horowitz, & Carr, 1989; Horowitz & Reinhardt, 2000; Morse & Rosenthal, 1996). Reduced vision can disrupt lifestyles in a broad range of behavioral, psychological, and social domains in terms of mobility, self-concept, and communication skills (Brennan & Silverstone, 2000). Hence, how one copes with vision impairment is an important factor in adaptation to this potentially disabling condition. A better understanding of patterns of stressors and coping styles would allow social work practitioners and researchers to better address the complex nature of and processes involved in this adjustment to visual impairment in late adulthood.
STRESS AND FUNCTIONAL CHALLENGES ASSOCIATED WITH VISUAL IMPAIRMENT
In 2002 among people age 40 and older in the United States, nearly one million were blind, and 2.4 million people had low vision, defined as best corrected acuity of 20/70 or poorer (Congdon, Friedman, & Lietman, 2003). In their recent examination of the prevalence of self-reported visual impairment among a nationally representative adult sample age 45 and older (N = 1,219), Horowitz and colleagues (2005) found that 16.6 percent of respondents self-reported visual impairments even when wearing glasses. This figure increased to 26.5 percent of those ages 75 and older. Risk factors of self-reported visual impairment were advanced age, poverty, poor self-rated health, and unavailability of informal social support.
Numerous empirical and clinical studies have illustrated the functional challenges confronted by those who lived as sighted individuals and experienced visual impairment in later life. Reading is one of the most frequently cited challenges. Ryan and colleagues (2003) conducted in-depth semistructured interviews with 26 visually impaired seniors and illustrated the importance of reading for learning and life enjoyment both before and after vision loss. These respondents identified difficulty with such daily reading demands as small print, telephone dials, and medicine bottles--all of which have a negative effect on performance of instrumental activities of daily living (IADLs). Other large-scale nationally representative studies of older adults have found that visual impairment was strongly associated with difficulties in performing these and other IADL tasks (Brennan, Horowitz, & Su, 2005; Campbell, Crews, Moriarty, Zack, & Blackman, 1999).
Mobility is also usually affected by visual impairment in late adulthood. There is a strong relationship between impaired vision and increased risk of accidents, particularly falls (Evans & Rowlands, 2004; Horowitz & Reinhardt, 2000). In a study of the community-travel habits and perceptions of a sample of 32 visually impaired elderly people and their sighted peers, Long and colleagues (1996) reported infrequent independent travel in the community among those with vision loss. In addition, the vast majority of these respondents with visual impairment (75 percent) were relatively dissatisfied with their ability to travel independently and with the number of opportunities they had to leave their homes in comparison with their sighted peers.
The prevalence of vision problems among adults suggests unmet needs for both basic eye care and vision rehabilitation interventions to reduce functional limitations. Visual impairment has also been found to be associated with poor psychosocial well-being, increased depressive symptomatology, decreased life satisfaction, and poorer adaptation to vision loss (Brennan & Cardinali, 2000; Horowitz & Reinhardt, 1998; Horowitz, Reinhardt, McInerney, & Balistreri, 1994).
COPING WITH VISUAL IMPAIRMENT
The most widely used standardized measures of coping, such as the Ways of Coping Questionnaire (WOCQ) (Folkman & Lazarus, 1988), are intended to measure the thoughts and actions that people use to address stressful situations in general. However, such generality in terms of specific chronic conditions produces results that are difficult to interpret. Benn (1997), for example, examined the interrelationships of personality (that is, neuroticism and optimism), coping (that is, distancing, accepting responsibility, escape-avoidance, problem solving, and positive reappraisal), and adaptation among 150 older adults experiencing late-life visual impairment. The study failed to confirm the factor structure of the WOCQ. In addition, path analyses in this study indicated that personality and coping--primarily distancing and escape-avoidance--appeared to exert direct effects on adaptation. Drawing on the model of assimilative and accommodative coping (Brandtstaedter & Renner, 1990), Boerner (2004) investigated the relations among coping, disability, and mental health of 55 middle-aged (ages 45-64) and 52 older adults (age 65 and older). The study found a beneficial effect of accommodative coping (that is, flexible goal adaptation) as opposed to assimilative coping (that is, tenacious goal pursuit) in the process of adaptation.
Brennan and colleagues (2001) argued that earlier quantitative studies of coping strategies and adaptation to chronic visual impairment and their relationship to various physical and mental health outcomes were limited in their ability to identify underlying factors that explain a complex adaptation process and psychosocial well-being. Thus, more recent studies have attempted to use alternative conceptual frameworks to investigate coping strategies that may be specific to age-related vision loss using qualitative methods to study this topic. To illustrate, in a study of 12 older adults' successful adjustment to vision loss, Kleinschmidt (1999) identified major coping and adaptation themes. These included use of prior life experiences, use of external resources, use of internal resources (such as a positive attitude, a sense of humor, and a problem-solving perspective), and religious beliefs.
Applying Glaser and Strauss's (1967) grounded theory approach in an examination of self-reported coping strategies among older visually impaired respondents, Brennan and colleagues (2001) developed a typology of coping strategies reported by older adults in adapting to the emotional and functional consequences of vision impairment. These data identified numerous domain-specific coping strategies for vision loss that had not been captured with pre-existing quantitative measures (see Brennan & Cardinali, 2000; Brennan et al., 2001; Lee & Brennan, 2002, 2003). Among the most important coping strategies identified were tapping into personal resources (for example, independence, self-reliance, or humor) and activation of instrumental and emotional social support from family, friends, and neighbors. The present study builds on these earlier works and further examines these data for patterns involving self-reported stress constellations and coping styles using a cluster analysis of quantitative data extracted from the earlier study.
STUDY PURPOSE AND RATIONALE
Although much research has been conducted applying the stress and coping model to examine adaptational outcomes, less attention has been paid to understanding the nature of the stressors germane to age-related visual impairment. This study was undertaken to further identify the different patterns of stress constellations and coping styles in response to vision loss in a later life to better understand the constituents of vision loss adaptation. In the present study, a stress constellation refers to significant functional, psychological, and social experiences and reactions resulting from age-related visual impairment that are a major focus of coping efforts. Involving available personal, social, and environmental resources, coping styles are defined as patterns of processes initiated by an individual that are perceived as furthering adaptation through a rebalancing of the life-space and activation of pre-existing or novel strategies (Brennan et al., 2001).
In the present study, we used quantitative classification techniques, namely cluster analyses, to identify groups of similar individuals based on self-reported stressors and coping strategies. Quantitative data for the present study were extracted from narrative qualitative data that were initially coded for self-reported stressors and coping strategies. We chose cluster analysis for this study to determine whether individuals were similar enough to fall into groups emblematic of stress constellations and coping styles among older adults with visual impairment (see Aldenderfer & Blashfield, 1984).
Information from older adults (age 65 and older) experiencing age-related visual impairment in two earlier studies (Horowitz & Reinhardt, 1992: Reinhardt, 1996) provided data for the present analyses. The first sample consisted of 155 new applicants for vision rehabilitation services who were interviewed before receipt of services at Lighthouse International, a nonprofit organization in New York City (Horowitz & Reinhardt, 1992). The second sample consisted of 352 new applicants for vision rehabilitation services (Reinhardt, 1996). Characteristics of both samples in terms of formal service use were similar, and this resulted in a total sample of 507 visually impaired older adults for the present analysis.
The mean age of the participants was 78.8 years. One-fourth (25 percent) were age 85 or older. In both studies there were more women (n = 280, 55.2 percent) than men (n = 227, 44.8 percent), and the vast majority of participants were white. The proportions of ethnic minority older adults in the two samples, consisting primarily of black and Hispanic older adults, ranged from 14 percent in the first study to 20 percent in the second (study 2), which was representative of the racial and ethnic diversity of older New Yorkers during the study period (Cantor & Brennan, 1993). Nearly one-half (47 percent) of older adults in the first study did not complete high school. The second study had a slightly more educated sample, with about two-thirds (65 percent) having a high school diploma and some college education.
Structured interviews were conducted in respondents' homes. Research participants reported their sociodemographic information, physical health status, vision status, subjective experience of age-related vision loss, functional ability, social support from family and friends, activity participation, rehabilitation service use, and coping strategies. Detailed descriptions of the standardized interview processes that elicited these data have been reported elsewhere (Brennan et al., 2001; Horowitz et al., 1994; Reinhardt, 1996).
Coding and Research Procedures
As noted earlier, self-reported stressors and coping strategies were identified in our earlier studies using the grounded theory approach. Coding of stressors reflected functional, psychological, and social problems experienced as a result of vision impairment (for example, reading small print, depression, and not having family available, respectively). Coping style codes were organized according to life-space domains of behavioral, psychological, and social strategies (Brennan et al., 2001). Behavioral coping was defined as overt, observable actions (that is, using optical or adaptive devices), and psychological coping was defined as involving emotions or cognitions (that is, acceptance of visual impairment). Social coping was conceptualized as involving members of the informal social network or formal service providers (that is, activating emotional and instrumental support). Previous work has described coding procedures in detail (see Brennan & Cardinali, 2000; Brennan et al.; Lee & Brennan, 2002, 2003).
Additional data reduction techniques organized the coded narratives, linking concepts embedded in coping styles and stressor codes (Miles & Huberman, 1994). To this end, individual codes were organized into "families" as a way of aggregating the results of qualitative data and to establish connections between main categories and their subcategories. From 98 individual codes based on the stressors, 17 family codes were derived in three domains of functional, psychological, and social coping (Table 1). Several functional difficulties (for example, trouble with reading and small print, trouble writing, problems with finances and paperwork) were classified into a family of "reading and paperwork" codes. The seven functional code families included (1) reading and paperwork, (2) health problems other than vision impairment, (3) housework and personal care, (4) problems with vision, (5) driving and mobility, (6) leisure and work, and (7) environmental issues. Self-report of different types of rehabilitation services was distinguished from medical treatment. Both dissatisfaction with rehabilitation services and dissatisfaction with medical treatment were grouped together.
Correspondingly, 85 individual codes of self-reported coping strategies were categorized into 21 family codes in three domains of behavioral, psychological, and social coping (see Table 2). To illustrate, several psychological coping strategies (for example, believes in independence or self-reliance; believes in perseverance; keeps problem to self/doesn't bother others; relies on humor, patience, positive attitude or personality) were classified into a family of "relies on personal attributes" codes. The eight coping style families in psychological domains were (1) relies on personal attributes, (2) accepts vision impairment, (3) uses cognitive refocusing, (4) avoids negative thoughts and feelings, (5) expresses negative thoughts and feelings, (6) makes attribution of causes, (7) expresses hope, and (8) engages situations.
Frequency and percentage of self-report were counted and constructed to note the emerging patterns, across and within the stress constellations and coping styles (see Tables 1 and 2). As mentioned earlier, to make sense of a large amount of qualitative data, this study used the quantitative classification technique of cluster analysis. The quantified data on frequency of self-reported coping by each case were computed and entered into SPSS. Self-report of each individual coping and stress constellation code for each case was dichotomized as 1 if an individual mentioned a certain type of stressors and coping styles and 0 if there was no reported use of such coping. Such self-reported accounts were summed within the various families in preparation for the cluster analysis.
Design and Analysis
The present study used a single-group correlation design to examine the interrelationships of stressors and coping strategies. For examination of the quantified data, K-mean cluster analysis was used to identify groups of similar individuals with regard to how individuals exhibited similar or different profiles in their report of stress constellation and coping styles (Everitt, Landau, & Leese, 2001; Kaufman & Rousseeuw, 1990).
Initially, we attempted to analyze both stress constellations and coping styles together; however, this did not yield meaningful cluster groups. Subsequently, we resorted to separating stressors from the coping styles. We examined various numbers of cluster groups, between three and seven. Examining the output carefully, we decided that the five-cluster solution provided the most meaningful groupings for both stressors and coping styles. Our final step was to compare differences and similarities in stressors and coping strategies among the five groups to describe the stress constellations and coping strategies in this population.
Cluster Analysis of Stress Constellations
The cluster analysis of stress constellation yielded five groups, including stoics (n = 83), complainers (n = 42), taciturns (n = 304), sentimentalists (n = 67), and articulates (n = 11; see Table 1). The stoics identified more problems with their deteriorating vision as well as particular challenges of dealing with daily demands. The stoics placed greater emphasis on reporting these daily fife challenges than on reporting psychosocial issues. Reading was mentioned most often as the hardest problem, followed by housework and personal care. These informants were moderately outspoken about expressing their negative thoughts and feelings (that is, depression, fear of blindness, loneliness, and loss of independence). However, they were sensitive about preserving social desirability and reluctant to verbalize their issues about vision rehabilitation services. Across the five cluster groups, these help-rejecting, "stoic" individuals were the least likely to receive either instrumental or emotional support from informal helpers.
Group 2 (n = 42) members, the "complainers," often experienced negative social interaction as a result of their challenges of recognizing people, unavailability of informal support, and prejudices of others regarding vision impairment. The complainers expressed their anger and depression associated with age-related vision impairment, along with functional challenges, such as reading, driving, and leisure activities. Unlike the stoics, these individuals reported receipt of both instrumental and emotional informal support. Both complainers and stoics were similar, however, in terms of their skepticism that vision rehabilitation and other formal services would improve their quality of life.
Group 3 (n = 304), the taciturns, were the largest group of older adults and reported receiving emotional and instrumental support more frequently than other groups. The taciturn group members kept their negative emotions and information on social interactions to themselves. They were least likely to report troubles with vision or functional challenges with reading, housework, and mobility. This was the only group of individuals who did not describe issues with medical and surgical treatment. They neither discussed the use of formal rehabilitation services nor spoke about issues regarding environmental barriers.
Group 4 (n = 67), the sentimentalists, were fairly expressive about their adverse reactions to both intra- and interpersonal issues. Although verbalizing negative emotions and negative social support most frequently, they also recounted receiving more emotional than instrumental support. This group reported functional challenges with driving, reading, housework, and other health problems. The sentimentalists also mentioned types of rehabilitation services they received and the inefficacy of optical devices. Instead of accepting vision impairment, they presented denial (that is, nonacceptance) more frequently than members of the other cluster groups.
The most frequent accounts of negative introspection and affect in the psychological domain were reported by group 5 (n = 11), the articulates. These older adults with visual impairment reported their troubles with reading small print, personal finances, housekeeping, driving, leisure activities, and environmental factors (for example, inadequate lighting and neighborhood safety). Unlike their counterparts in the other four groups who failed to show any distinctive effort to strengthen their coping efforts, articulate members acknowledged the importance of their psychological acceptance of vision loss and made an effort to boost their self-esteem. In the social domain, the articulate group also demonstrated the most frequent receipt of both instrumental and emotional support across the five groups. At the same time, they reported numerous incidents of perceiving negative social support and were vocal about their expectation that rehabilitation services should improve their vision. By expressing their negative thoughts and feelings, these group members seemed to be able to activate their social support system, whereas complainers did not obtain help in a more constructive manner.
Cluster Analysis of Self-Reported Coping Styles
Table 2 presents cluster analysis related to coping code families, which resulted in five cluster solutions. These included mavericks (n = 12), autonomous (n = 76), pragmatists (n = 44), hermits (n = 41), and nonchalants (n = 334).
Compared with their counterparts in the other four groups, the mavericks in group 1 (n = 12) demonstrated a heavy reliance on self-perceived attributes as resources in coping with vision loss. These respondents presented a strong belief in independence, self-reliance, perseverance, patience, and positive attitude or personality. They were most active in using a variety of psychological coping styles, characterized by their manifestation of negative emotions, maintenance of positive expectations toward the future, and active psychological engagement concerning visual impairment and functional losses. The mavericks tried to find an explanation for their visual impairment as being a normative part of aging instead of blaming themselves or others. In addition, they tried to confront their negative emotions when they were preoccupied with anger, depression, and fear of blindness.
Mavericks coped with their difficulties with driving and mobility issues by optimizing behavioral aspects of coping styles (that is, acting more cautiously and restricting their range of geographical activities). They were the most likely to report learning new skills to compensate for their vision loss (for example, using systems for identifying money, finding things, and crossing the street). It was very important for the mavericks to maintain behavioral continuity by acting as though things were normal. Across the five clusters, the mavericks were most proactive in initiating support from informal helpers and other people with vision impairment, but they were very reluctant to seek information and advice on vision rehabilitation services and to activate formal, instrumental support from service providers.
The autonomous respondents in group 2 (n = 76) presented similar coping behaviors as the mavericks in terms of their belief in independence and active engagement to focus on their abilities in the psychological domains. However, the autonomous reported accepting vision loss more frequently than mavericks. In the behavioral coping domains, the most frequent reports of seeking and using rehabilitation services were found among the autonomous. These older adults used not only their residual vision but also their other senses to compensate for their vision problems. The social domain showed more frequent activation of informal help, both instrumental and emotional, than the use of social avoidance.
Older adults in group 3 (n = 44), the pragmatists, reported their effort to use residual vision by using various optical devices and lighting systems. They used this coping method the most frequently across the five groups. Pragmatists were active seekers and recipients of vision rehabilitation services, including adaptive devices, low vision exams, counseling, and other services to learn new skills. These individuals preferred to seek out advice, emotional support, and companionship rather than instrumental help with low vision aids and sighted guides. The psychological coping reported by the pragmatists included reliance on personal attributes, cognitive refocusing, and acceptance of vision impairment.
Group 4 (n = 41), the hermits, were the most socially isolated among the five coping groups. This tendency was characterized by their frequent report of using social avoidance as a means to cope with their visual impairment. Hermits failed to initiate social interaction or modify their social environments, partly because of their feelings of embarrassment and perceived stigma attached to visual impairment. Other than reliance on personal attributes, they were passive in revealing psychological coping strategies such as positive avoidance, hope for cures, planning for the future, and expression of negative thoughts and feelings. They were less likely than others to seek instrumental and emotional support. They neither depended on informal helpers within their social support network nor identified their needs for services from the formal social service providers.
Group 5 (n = 334), the nonchalants, were the largest number of informants. They failed to report any distinctive coping strategies other than relying on their own internal resources (that is, belief in self-reliance) or help from significant others. Nonetheless, self-report of such strategies was infrequent compared with the other four groups. Such infrequencies make it difficult to interpret specific styles of coping used by this group.
This study sought to enhance our understanding of domain-specific stress constellations and coping styles reported by older adults with vision loss in the process of adaptation. The cluster analyses were an attempt to classify the patterns of stress constellations and coping styles concerning age-related vision loss among the informants. The analyses of self-reported stress constellations across the five clusters demonstrated a high frequency of expression of negative thoughts and feelings, occurrence of negative social interactions, and loss of functional ability to perform everyday tasks such as reading and housework. The present findings also revealed limited efforts on the part of older adults with visual impairment to secure formal instrumental services from social workers and rehabilitation professionals.
The majority of older adults with visual impairment mainly tried to cope with their difficulties by using personal resources, particularly their beliefs in independence and self-reliance. Respondents rarely identified successful adaptation by accepting vision loss and strengthening self-confidence. This reliance on personal resources, as opposed to activation of social support systems, appears to play an important role in influencing the help-seeking behaviors of these older adults. Thus, although individuals with age-related vision impairment endorsed strong values of independence and self-reliance as important factors that enhanced the quality of their lives, the majority were reluctant both to ask for help and to actively use rehabilitation services.
In terms of stress constellations, the vast majority of informants were classified as taciturns. Regarding coping style, the majority belonged to the nonchalant group, who infrequently reported proactive coping strategies. Due to the self-report nature of these data and the lack of systematic probing for narrative responses, it is difficult to discern the accuracy of these strategies in terms of actual behaviors. It is also possible that much of what occurs as coping behavior probably goes unrecognized by respondents because of familiarity with their coping behaviors. As a result, the taciturn and nonchalant groups may not have mentioned certain coping strategies, even though they may in fact have used them in dealing with the effect of vision loss on their daily activities. Such underreporting makes it challenging to obtain accurate clinical assessment and research information.
Findings from this study underscore the importance of social support as well as the impact of negative social support among older adults with visual impairment. The activation of emotional support and instrumental aid are critical for many older adults during adjustment to chronic visual impairment. In the present study, many informants reported that they withdrew socially because of their inability to cope with the stresses involved in active community participation. Numerous incidents of negative social interaction and negative support from significant others may have interfered with other kinds of help-seeking behaviors, such as engagement in vision rehabilitation services.
The findings of our present quantitative and earlier qualitative analyses with this sample suggest that adaptation to visual impairment is facilitated by the person's ability to integrate vision loss into his or her life-space (Brennan et al., 2001; Lee & Brennan, 2002, 2003). This integration occurs in the context of the various coping resources (that is, personal, social, and behavioral) that are available. These results support the need for enhancing the convergent validity of qualitative measures of coping strategies that have not been identified in conventional measurements of coping such as the WOCQ.
Strengths and Limitations
The narrative data that formed the basis for the present study captured the voices of older adults with vision loss and demonstrated the potential for exploring new insights into the processes of coping and adaptation that may provide unexpected perspectives for researchers. In addition, multidimensional self-reports of feelings, recollections, and behaviors were translated into quantifiable variables amenable to statistical analysis. Such quantitative techniques worked well in identifying the clusters of stress constellations and coping styles in this study.
The earlier works based on this data discussed the study limitations in terms of self-selection bias in the sample and unsystematic data collection methods (Brennan & Cardinali, 2000; Brennan et al., 2001; Lee & Brennan, 2002, 2003). Furthermore, future research should use findings regarding self-reported stress constellations and coping styles to develop a more comprehensive measure of the adjustment process appropriate for the growing population of visually impaired older adults. There can be some potential overlap between stress constellation and coping styles. This should be further clarified in the future studies. Also, future research should use a longitudinal design to compare coping styles of the new applicants of the services and experienced users of the services.
Implications for Practice and Research
Findings imply that many older adults with vision loss present relatively stronger reliance on personal resources than on social and environmental resources and need both formal and informal social support to cope effectively. Unanticipated realization of the functional limitations resulting from vision loss in later life imposes a tremendous burden on the part of older Americans who take pride in their independent lifestyles. The greatest shame for these individuals was not being self-sufficient enough, and hence they stoically preferred to keep their feelings to themselves and not bother others (Lee & Brennan, 2002). As the population ages and the prevalence of visual impairment increases, training for independent living and the design of supportive social environments will become even more important. Appropriate social work intervention, in the form of individual counseling, support groups, and rehabilitation education, should be developed to help older adults to accept their vulnerability and to ask for help when needed without feeling ashamed.
Across stress and coping clusters, there was a pattern of limited efforts to obtain vision rehabilitation services to address instrumental needs among these older adults. The majority of respondents indicated that they did not know what to expect or that they came with unrealistic expectations about having their vision "cured" when they first applied for rehabilitation services. Few referring physicians and ophthalmologists adequately inform their older patients or explain the possibility, process, and efficacy of vision rehabilitation services (Brennan et al., 2001; Brennan & Silverstone, 2000). Hence, early intervention and education to prevent psychosocial harm to the older adults who experience severe vision loss after a lifetime of seeing is a critical area for social work intervention. Such early intervention and education can help older individuals and their family caregivers be knowledgeable about vision rehabilitation services (Heyl & Wahl, 2001).
A type of support for the visually impaired is most likely to come from socially similar individuals who are facing the same stressors and who are coping more effectively than the distressed individuals (Thoits, 1986). Both sociocultural and situational similarities enhance the likelihood of the perception of empathic understanding, the condition under which coping assistance is most effective. Orr (1994) demonstrated the efficacy of a mutual-aid group, originally formed to provide older adults with a forum in which to address the problems imposed by their recent vision loss. Such a support group can allow members to share their concerns, encompassing a broader range of losses.
Families and other caregivers can encourage and support older adults with vision impairment to participate in rehabilitation programs. Mobility and driving become an extremely important issue in family caregiving of elderly people who are visually impaired. Rosenblum and Corn (2002) reported that some families do not want their older adults to stop driving because of increasing caregiving responsibilities. Therefore, it is necessary to establish strong public education, outreach, and action regarding the increasing numbers of older drivers who may develop a visual impairment. An assessment of alternative transportation approaches and support for older adults in the transition to reduction and cessation of driving is an important area for social work intervention.
Finally, an appropriate intervention should include modifying the physical and social environment to make a better fit with the older person. Increasing public awareness and acceptance of age-related disabilities, such as visual impairment, may help us to construct a more caring and accommodating society that is sensitive to the growing number of aging individuals who may develop some type of disability at some point in later life. Although the focus of the present study was on vision impairment, the association and interaction between coping styles and stress constellation will be applicable to other populations who are living with other chronic disabling conditions. Such complex relations should be further examined in future research.
Original manuscript received December 1, 2005
Accepted July 26, 2006
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Eun-Kyoung Othelia Lee, PhD, MSW, is assistant professor, Graduate School of Social Work, Boston College, 140 Commonwealth Avenue, McGuinn Hall No. 206, Chestnut Hill, MA 02135; e-mail: email@example.com. Mark Brennan, PhD, is senior research associate, Lighthouse International, New York, NY. Please address all correspondence to Dr. Lee. The authors thank Dr. Amy Horowitz and Dr. Joanne P. Reinhardt of Lighthouse International for the use of the qualitative and quantitative data presented here. This study was partially funded by the Macular Degeneration Foundation, Virginia Beach, VA. An earlier version of this article was presented at the 58th Annual Scientific Meeting of the Gerontological Society of America, Orlando, FL.
Table 1: Mean of Cluster Analysis of Stress Constellations Code Families among Visually Impaired Older Adults (n = 507) Stoics Complainers Taciturns Stress Factor (n = 83) (n = 42) (n = 304) Functional * Rehabilitation services .13 .17 .12 * Problems with vision 1.94 .38 .24 * Medical treatment .58 .12 .00 * Health problems .35 .45 .20 * Housework and personal care 1.01 .43 .24 * Reading and paperwork 2.53 .79 .26 * Driving and mobility .77 .74 .33 * Leisure and work .48 .55 .22 * Environmental factors .22 0 0 Psychological * Nonacceptance of vision loss 0 .12 .11 * Expression of negative thoughts and feelings 1.0 1.17 .32 * Strengthening personal resources 0 0 0 Social * Receives formal support 0 0 0 * Receives instrumental support .67 .74 .72 * Negative social support .98 5.45 .71 * Received emotional support .28 .74 .87 * Dissatisfaction with services 0 0 0 Sentimentalists Articulates Stress Factor (n = 67) (n = 11) Functional * Rehabilitation services .30 0 * Problems with vision .51 2.18 * Medical treatment .12 .18 * Health problems .48 .45 * Housework and personal care .58 3.55 * Reading and paperwork .55 4.36 * Driving and mobility .78 2.36 * Leisure and work .36 2.18 * Environmental factors 0 .69 Psychological * Nonacceptance of vision loss .27 0 * Expression of negative thoughts and feelings 3.07 6.64 * Strengthening personal resources 0 .27 Social * Receives formal support 0 0 * Receives instrumental support 1.09 1.91 * Negative social support 2.09 3.36 * Received emotional support 1.63 1.10 * Dissatisfaction with services .30 .45 Note: Because of the low mean scores, some values were actually rounded to zero. Table 2: Mean of Cluster Analysis of Coping Code Families among Visually Impaired Older Adults (N = 507) Mavericks Autonomous Pragmatists Coping Mean (n = 12) (n = 76) (n = 44) Behavioral * Uses other senses or memory .25 .39 .30 * Seeks information or advice 0 0 0 * Systematically modifies tasks .33 .14 .20 * Seeks/uses rehabilitation .16 .51 1.23 services * Uses residual vision .07 .29 1.84 * Restricts activities .75 .17 .18 * Maintains continuity .50 .16 .23 Psychological * Accepts vision impairment .58 .72 .36 * Relies on personal attributes 6.67 2.55 .48 * Uses cognitive refocusing .33 .21 .43 * Avoids negative thoughts or 0 .13 .16 feelings * Expresses negative thoughts or .25 .22 .14 feelings * Makes attributions of cause .42 0 0 * Expresses hope .77 .14 .25 * Engages situation .50 .50 .18 Social * Activates formal instrumental 0 0 0 support * Activates informal support- .42 .39 .39 instrumental * Activates informal support- .42 .51 .59 emotional * Seeks peer support .33 0 .14 * Relies on specific informal .83 .28 .14 helpers * Uses social avoidance .33 .16 .14 Hermits Nonchalants Coping Mean (n = 41) (n = 334) Behavioral * Uses other senses or memory .27 0 * Seeks information or advice 0 0 * Systematically modifies tasks .12 0 * Seeks/uses rehabilitation .17 .17 services * Uses residual vision 0 .11 * Restricts activities .12 0 * Maintains continuity .15 0 Psychological * Accepts vision impairment .29 .16 * Relies on personal attributes .85 .25 * Uses cognitive refocusing .17 0 * Avoids negative thoughts or 0 0 feelings * Expresses negative thoughts or 0 0 feelings * Makes attributions of cause 0 0 * Expresses hope 0 0 * Engages situation .15 .14 Social * Activates formal instrumental 0 0 support * Activates informal support- .22 0 instrumental * Activates informal support- .27 0 emotional * Seeks peer support 0 0 * Relies on specific informal 0 .24 helpers * Uses social avoidance 2.46 .11 Note: Because of the low mean scores, some values were actually rounded to zero.…