Stress Constellations and Coping Styles of Older Adults with Age-Related Visual Impairment
Lee, Eun-Kyoung Othelia, Brennan, Mark, Health and Social Work
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. …