Protective and risk factors of mental health of working age adults with adventitious total bilateral blindness and low vision: A scoping review protocol

Vision loss has been associated with mental health problems such as depression, anxiety, and post-traumatic stress disorder, which significantly impact lives of working age adults with adventitious total bilateral blindness and low vision. It is imperative, therefore, to prioritize the mental health in this population by exploring and understanding the factors that impact on their mental health. Hence, the objective of this scoping review is to identify and chart existing literature on the protective and risk factors of mental health of working age adults with adventitious total bilateral blindness and low vision. We developed this scoping review protocol in line with the Joanna Briggs Institute guidance. This scoping review will include publications in English language with no date restrictions exploring the protective and risk factors of mental health of our study population. A three-step search strategy will be employed. Searches will be carried out in the following databases: Medline, Embase, PsycInfo, PsycArticles, CINAHL and Web of Science. Search for grey literature will be conducted in Google, Google Scholar and Websites dedicated to information on visual impairment. Collated results will be imported into Endnote Basic (Clarivate) for deduplication. Two reviewers will independently conduct double screening of all the titles and abstracts in Rayyan- a web application, and full texts in Endnote while three other reviewers will conduct screening of a subset of for example 10% of titles and abstracts and full texts. Furthermore, two reviewers will independently conduct double data extraction while three other reviewers will revise, cross check, and correct any extraction errors. Extracted data will be presented in tabular formats and summarized descriptively in line with the research objectives. This scoping review will generate evidence on factors impacting the mental health of the working age adults with adventitious total bilateral blindness and low vision as well as critically highlight gaps in the literature. The findings will inform and critically underpin future empirical research which will explore the lived experiences of working age people with adventitious total bilateral blindness. Additionally, evidence from this review will inform the development of interventions in the promotion of mental health as well as assisting rehabilitation specialists and workers, public health practitioners and other relevant stakeholders in addressing the mental health needs of working age adults with adventitious total bilateral blindness and low vision.

Chronic disease interventions for people with visual impairment: A systematic review

AIM

To identify the characteristics of chronic disease interventions for people with visual impairment (PVI) and provide suggestions for future interventions.

BACKGROUND

Chronic diseases are more common in PVI than people without visual impairment, and PVI have difficulty managing chronic diseases due to physical, social, and psychological problems associated with visual impairment. However, evidence regarding chronic disease intervention for PVI is limited.

METHODS

This review was guided by the PRISMA methodology. Data were extracted and checked, and each study was evaluated to ensure their methodological quality using appropriate tools based on the study design. Findings were described through a qualitative synthesis, and the above process was carried out by all four researchers.

RESULTS

28 studies were selected. The intervention for mental disorders was the most common with about 39.3%, followed by stroke (25.0%), diabetes (17.8%), various chronic diseases (10.7%), chronic pain (3.6%), and scoliosis (3.6%). Most of the intervention was delivered individually, and the place of intervention often depends on the preference or convenience of PVI. A wide range of intervention materials was used, from large print, audio, or braille version reading materials to technology products. Based on the results, the main areas of the outcomes were daily living function, psychological conditions, and quality of life.

CONCLUSIONS

This review identified the components of interventions for PVI and provided intervention strategies. In particular, chronic disease interventions for PVI should be planned by considering how and where appropriate interventions are provided, various available materials, and the problems to be addressed.

Occupational Therapy Practice Guidelines for Older Adults With Low Vision

Importance: The aging of the population is generating increased demand for occupational therapy practitioners to address the occupational performance of those experiencing low vision.

Objective: This Practice Guideline, which is informed by systematic reviews on interventions for older adults with low vision, is meant to serve as a reference for occupational therapy practitioners to guide best practice in service delivery, improve quality of care, enhance consumer satisfaction, and justify occupational therapy services to external stakeholders. Interventions included in this guideline address performance of activities of daily living (ADLs) and instrumental activities of daily living (IADLs), reading, and leisure and social participation.

Method: We examined, synthesized, and integrated the results of three systematic reviews into recommendations for practice, education, and research.

Results: Thirty-eight articles were included in the systematic reviews, which served as the basis for clinical recommendations. A case study describes translation and application of the recommendations to clinical practice.

Conclusions and Recommendations: Strong evidence supports the role of occupational therapy for older adults with low vision. On the basis of the evidence, we recommend routine use of low vision rehabilitation for ADL and IADL impairments, multicomponent interventions to improve ADL and IADL performance and leisure and social participation, stand-based electronic magnification to enhance reading, and visual skills training to enhance reading for clients with a central field impairment. We recommend using client-centered problem-solving training to enhance ADL and IADL performance, reading, and leisure and social participation. Mainstream technology may be considered for use on a case-by-case basis to enhance reading performance. Finally, adapted tango may be considered for use on a case-by-case basis to enhance ADL and IADL performance and leisure and social participation.

What This Article Adds: This Practice Guideline provides a summary of the current evidence supporting occupational therapy intervention for older adults with low vision. It summarizes the emerging literature supporting the use of mainstream technology and provides additional support for the use of multicomponent intervention strategies.

Knowledge, skills, and attitudes of psychologists working with persons with vision impairment

PURPOSE

Psychologists working with persons with vision impairment face unique challenges in providing psychological services, including mental health care and cognitive assessments. While existing competency guidelines for general disability and rehabilitation psychology are relevant to working with persons with vision impairment in many ways, specific competencies are needed. Previous psychological research into the provision of therapy for persons with vision impairment has focused mainly on communication and intervention strategies and lacks input from the vision-impaired community.

MATERIALS AND METHODS

This qualitative study, grounded in disability, rehabilitation psychology, and competency frameworks aimed to identify the knowledge, skills, and attitudes necessary for psychologists working with persons with vision impairment.

RESULTS

Through triangulating responses from both registered psychologists (N = 10) and persons with vision impairment (N = 5), a thematic analysis identified 29 competencies under six major themes, including: Expertise, Impact, Approach, Collaboration, Assessment, and Flexibility. Competencies were discretely categorized as knowledge, skills, or attitudes.

CONCLUSIONS

This study provides data that may be used as the basis for more rigorous research into identifying areas for vision impaired-specific competency-based training in undergraduate, postgraduate, and professional psychology curricula.Implications for rehabilitationWhilst competencies for disability and rehabilitation psychology already exist, the competencies for psychologists working with persons with vision impairment require updating, informed by both practitioners and clients with vision impairment.These competencies include: knowledge of eye conditions and pathologies; knowledge of the variation in impact of vision loss; general knowledge about vision loss and normal lifespan development; and, the ability to assess the specific impact of vision loss on the individual.Other skills and attitudes, such as oral communication skills and relaying hope and optimism, whilst necessary for all therapeutic encounters, may require particular modification when working with vision-impaired persons.Educators responsible for professional postgraduate courses in psychology should ensure that training incorporates an understanding of the need to modify approaches for particular groups of clients, such as those with vision impairment.

Insight into falls prevention programmes for people with visual impairments and intellectual disabilities: A scoping review

The aim of this study was to review the current literature on falls prevention in people with visual impairment and to estimate the applicability of methods of fall prevention for people with visual impairment and intellectual disability. A scoping review was performed according to the Arksey and O’Malley framework. Relevant studies were collected from PubMed, Web of Science, and the Cochrane Register of Controlled Trials (CENTRAL). All records covering the time span from January 1980 until November 2017 were collected. Studies were included if the participants had a visual impairment according to objective ophthalmic assessments, the article described interventions to reduce falls or risk factors for falls, and the study was written in English and published in a peer-reviewed journal. The methodological quality of the studies were determined by consensus of the authors on the PEDro scale. Fifteen articles were included in this scoping review. Three articles focused on screening and intervention programmes, five articles addressed the effectiveness of environmental adjustments, and seven articles involved training programmes for physical improvement. Environmental adjustments emerged as having the best evidence for falls prevention for people with a visual impairment. Physical training programmes improved balance in those with a visual impairment but could not reduce the number of falls. Environmental adjustments also may be effective for persons with a visual impairment and intellectual disability. In addition, multifactorial screening and intervention programmes are recommended as an important new research direction with important clinical implications.

Health for Older Adults: The Role of Social Capital and Leisure-Time Physical Activity by Living Arrangements

BACKGROUND

The purposes of this study were to (1) explore the influence of social capital and leisure-time physical activity on older adults' physical and mental health and (2) test whether these relationships varied by living arrangement.

METHODS

This cross-sectional study used national data from the 2013 National Health Interview Study. The subjects included 7714 adults aged 65 years or older. Logistic regressions were used to predict the probability of subjects being overweight or obese. Ordinary linear regressions were performed to predict mental health outcomes.

RESULTS

Older adults living alone were more likely to report feeling sad (alone: 1.5; with others: 1.36), hopeless (alone: 1.25; with others: 1.18), and worthless (alone: 1.22; with others: 1.15). They were also more likely to experience lower levels of social support (alone: 3.24; with others: 3.30), trust (alone: 3.34; with others: 3.44), cohesion (alone: 2.95; with others: 2.98), and enjoy less leisure-time physical activity (alone: 49.85 min; with others: 64.64 min) than those living with others. Hispanic and divorced/separated older adults who lived alone were prioritized for health intervention.

CONCLUSIONS

Older adults living alone had poorer mental health, less social capital, and engaged in less frequent leisure-time physical activity. Promoting social capital could improve mental health in older adults living alone.

Psychosocial interventions to improve mental health in adults with vision impairment: systematic review and meta-analysis

PURPOSE

To systematically assess the literature on psychosocial interventions to improve mental health (i.e. depression, anxiety, mental fatigue, loneliness, psychological stress and psychological well-being) in visually impaired adults (≥18 years).

METHODS

The databases Medline, Embase and Psychinfo were searched for relevant studies, which were categorised into randomised controlled trials (RCTs), non-RCTs and before and after comparisons (BA). The Cochrane Collaboration Risk of Bias Tool was used to assess study quality. Standardised mean differences (SMD) were calculated to quantitatively summarise the outcomes of the RCTs and non-RCTs in a meta-analysis. Meta-regression was used to explore sources of heterogeneity in the data.

RESULTS

The search identified 27 papers (published between 1981 and 2015), describing the outcomes of 22 different studies (14 RCTs, four non-RCTs, and four BAs). Pooled analyses showed that interventions significantly reduced depressive symptoms (SMD -0.30, 95% confidence interval (CI) -0.60 to -0.01), while effects on anxiety symptoms, mental fatigue, psychological stress and psychological well-being were non-significant. Meta-regression analyses showed homogeneity in effect sizes across a range of intervention, population, and study characteristics. Only a higher age of participants was associated with less effective results on depressive symptoms (b = 0.03, 95% CI 0.01 to 0.05), psychological stress (b = 0.07, 95% CI 0.01 to 0.13) and psychological well-being (b = -0.03, 95% CI -0.05 to 0.01). However, after removing a clear outlier the overall effect on depressive symptoms and the influence of age on depressive symptoms and psychological stress were no longer significant, while the influence of age on psychological well-being remained.

CONCLUSIONS

There is currently only limited evidence for the effectiveness of psychosocial interventions in the field of low vision. More well-designed trials are needed with specific attention for interventions tailored to the needs of elderly patients.

Changing what it Means to be “Normal”: A Grounded Theory Study of the Mobility Choices of People who are Blind or Have Low Vision

Introduction

The ability to travel to destinations outside of the home is important to social inclusion and quality of life, and it is one of the most significant challenges for people who are visually impaired (that is, those who are blind or have low vision). There has been little research into the underlying concerns of people who are visually impaired when making decisions about mobility.

Methods

This grounded theory study explored the main mobility-related concerns of people who are visually impaired. It uses qualitative data drawn from a combination of online discussions; face-to-face, telephone, and e-mail interviews; and focus groups with people who are visually impaired and rehabilitation practitioners.

Results

The primary concern of people who are visually impaired when making choices about where to go, and when and how to do so, was a desire to see oneself and to be seen by others as “normal.” Self-identity and perceived “normality” are subjective and changeable and are continually internally coreconstructed (that is, simultaneously and interdependently reinterpreted and reconceptualised) to achieve congruence between them. The mobility strategies used are those that are perceived as most “normal.”.

Discussion

Perceived “normality” has a powerful influence on behavior. By acknowledging this influence, rehabilitation services may be better able to promote autonomy and self-reliance.

Implications for practitioners

To promote independence, rehabilitation services must change people's perception of what is “normal.” People must be supported to come to perceive fulfillment of valued social roles, autonomy, and self-reliance as “normal.”

Personality and Functional Vision in Older Adults with Age-Related Macular Degeneration

Introduction

The purpose of the study was to determine whether personality traits influence self-reported functional vision in patients with age-related macular degeneration (AMD).

Methods

This is a prospective cross-sectional analysis of baseline data from the Low Vision Depression Prevention Trial. Participants ( N = 182) over age 65 with bilateral AMD, visual acuity worse than 20/70 in the better-seeing eye, and subthreshold depression were recruited from the Wills Eye Hospital retina practice. Assessments included visual acuity, contrast sensitivity, National Eye Institute Visual Function Questionnaire–25 plus Supplement (NEI VFQ–25) near and distance subscales, depression, and personality testing. Structural equation models were used to investigate the relationship of the NEI VFQ near activities and distance activities with the various demographic, clinical, and psychological predictors.

Results

In the single-predictor model for near functional vision, visual acuity at logMAR ≤ 1 (estimate = −0.33 [95% confidence interval {CI} −0.46, −0.20]; p ≤ 0.001), neuroticism (estimate = −0.05 [95% CI −0.08, −0.01]; p = 0.01), and education (estimate = −0.08 [95% CI 0.01, 0.15]; p = 0.03) were statistically significant predictors. In the single-predictor model for distance functional vision, only visual acuity at logMAR ≤ 1 (estimate = −0.49 [95% CI −0.69, −0.29]; p ≤ 0.001) and neuroticism (estimate = −0.09 [95% CI −0.15, 0.02]; p = 0.008) were statistically significant predictors. Discussion: Self-reported functional vision depends on the severity of vision loss as well as the personality trait of neuroticism.

Implications for practitioners

Assessment of personality traits, particularly neuroticism, may increase the precision of rating scales of functional vision and suggest new rehabilitative interventions to improve the functional vision and quality of life of patients with AMD.