Academic journal article Journal of Visual Impairment & Blindness

The Effectiveness of a Multidisciplinary Group Rehabilitation Program on the Psychosocial Functioning of Elderly People Who Are Visually Impaired

Academic journal article Journal of Visual Impairment & Blindness

The Effectiveness of a Multidisciplinary Group Rehabilitation Program on the Psychosocial Functioning of Elderly People Who Are Visually Impaired

Article excerpt

A decline in visual function is a common problem among the elderly population. Along with the general consequences of aging, elderly persons who are visually impaired experience restrictions in daily life because of vision loss that may lead to dependence (Alma et al., 2011a; Crews & Campbell, 2001; West et al., 2002). The impact of vision loss is profound, evidenced by deleterious effects on emotional adaptation (Horowitz, 2004; Wahl, Schilling, Oswald, & Heyl, 1999), an elevated risk for depression (Burmedi, Becker, Heyl, Wahl, & Himmelsbach, 2002; Casten, Rovner, & Tasman, 2004), a high level of emotional distress (Williams, Brody, Thomas, Kaplan, & Brown, 1998), reduced mental health (Lee, Cunningham, Nakazono, & Hays, 2009), and a decline in life satisfaction (Heyl & Wahl, 2001; Wahl et al., 1999), and general well-being (Burmedi et al., 2002). Furthermore, social functioning may be impaired, which may lead to social isolation and loneliness (Alma et al., 2011b). Therefore, the psychosocial needs of those who are visually impaired should not be neglected and should be part of their rehabilitation (Agency for Healthcare Research and Quality, 2002).

In the Netherlands, the majority of low-vision rehabilitation services are provided on an individualized basis. Group-based programs, however, offer the opportunity for social interaction and allow the participants to share a range of experiences and coping strategies for both functional and emotional issues (Rees, Saw, Lamoureux, & Keeffe, 2007). Contact with peers is highly valued by persons who are visually impaired (Rees et al., 2007) and allows for social support, which seems to be an effective buffer against the negative effects of vision loss (Burmedi et al., 2002).

Therefore, we developed a multidisciplinary group rehabilitation program, Visually Impaired Elderly Persons Participating (VIPP), according to the principles of intervention mapping (Bartholomew, Parcel, & Kok, 1998). For this purpose, we reviewed the literature; performed focus group interviews with elderly persons with visual impairments; organized a meeting with rehabilitation health professionals, researchers, and elderly persons with visual impairments; and examined the determinants of participation (Alma, Van der Mei, Groothoff, & Suurmeijer, 2012). The results guided the development and design of the VIPP program.

The program aims to promote adaptation to vision loss and to improve psychosocial functioning. It consists of 20 structured weekly group sessions (duration 2 hours) and a booster session at 12 weeks. There are four components: (1) training of practical skills; (2) education, social interaction, counseling, and training in problem-solving skills; (3) individual and group goal setting; and (4) a home-based exercise program. The structured sessions start with 60 minutes of practical training by two occupational therapists. After a 15-minute break, a social worker continues with a 45-minute education and counseling session. In addition, an exercise coach introduces simple physical exercises and a graded walking program and delivers telephone counseling throughout the program according to the principles of motivational interviewing (Miller & Rollnick, 2002). The perceived progress, benefits, and difficulties of physical activity are discussed. Sessions are conducted in small groups that contain sufficient participants to enable social interaction, but have a maximum of nine participants to ensure safety within the practical training component. The program's supervisors were trained before the start of the intervention. Detailed information and the program manual (in Dutch) can be obtained from the first author. The pilot study was a preliminary investigation of the impact of VIPP on psychosocial functioning, that is, adaptation to vision loss, helplessness, self-efficacy, mental health, and fear of falling.

Methods

PARTICIPANTS

The participants originated in a previous cross-sectional study (Alma et al. …

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