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Helping Seniors Cope With Macular Degeneration

Posted on: Monday, 24 May 2004, 06:00 CDT

Age-related macular degeneration is a serious form of visual impairment. It consists of the degeneration of receptor cells (cones) in the retina's macular section. At the center of the macula is the fovea, the area most densely packed with cones and the most sensitive part of the retina.

The macula is where most of our perception of visual details originates. The loss of receptors results in the inability to resolve finer visual details. Consequently, reading and driving become virtually impossible. But receptors in the periphery of the retina are rarely affected. Thus, affected individuals are usually able to see sufficiently well to move about and perform some of the simpler activities of daily living.

Severe visual impairment of all kinds is associated with three major negative outcomes for many:

_ Declining functional ability, that is, the ability to perform various activities of daily living _ for example, preparing meals or using public transportation;

_ Poor adaptation to visual impairment (for example, failure to accept impairment realistically);

_ Frequent bouts of anger and/or depression and a lack of joy and happiness.

Such situations are especially likely for elders with macular degeneration. Other visual disorders are often treatable by either medication (for example, glaucoma) or laser surgery (for example, cataracts). Such treatments are less likely with macular degeneration.

Of course, there are individual differences among elders in how they cope. What's important is discovering the attributes that make some elders better able to deal with such impairment than others. Many elderly people could possibly be trained to apply such attributes to improve the quality of their lives.

Dr. Hans-Werner Wahl and his associates of the University of Heidelberg in Germany hypothesized that a critical attribute is the degree of control elders with the disorder believe they have over events in their lives. Those with greater control beliefs are expected to have lower levels of negative outcomes than those with lesser control beliefs.

The researchers tested their hypothesis with 90 elders (26 men, 64 women) with age-related macular degeneration. They ranged in age from 61 to 93 years (average age of 79.5 years).

Several forms of control beliefs were included. The degree of each was assessed by responses that ranged from "never true" to "almost always true" to such statements as "Once I decide on a goal, I do whatever I can to achieve it" and "When I have decided on a goal, I always keep in mind its benefits."

Functional ability was assessed by rating 18 activities of daily living on a scale from 1 ("performs task with no difficulty") to 4 ("can perform task only with help"). Adaptation to visual loss was assessed by rating, on a scale from 0 ("strongly agree") to 3 ("strongly disagree"), 14 statements relevant to adaptation _ for example, "I feel I can never really do things for myself." The frequency of positive emotions over the previous week was assessed by rating 10 adjectives indicating positive emotions, ranging from 1 ("not at all') to 5 ("very often").

In general, the results supported the researchers' hypothesis. Stronger control beliefs were associated with greater functional ability, more favorable adaptation to vision loss and more frequent feelings of positive emotions. Elders suffering from age-related macular degeneration should be offered help in strengthening their belief in their ability to control everyday events.

(Dr. Donald H. Kausler, emeritus professor of psychology at the University of Missouri-Columbia, is author of "The Graying of America: An Encyclopedia of Aging, Health, Mind, and Behavior." E-mail him at dkausler2(at)aol.com.)

(Distributed by Scripps Howard News Service, http://www.shns.com)

© 2004 Scripps Howard News Service.

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