Coping With Depression
By LaDonna S. Ringering, PhD
Although older adults experiencing a loss of vision report significant emotional distress, the risk of a major depressive disorder or suicide is low. However, moderate and even mild levels of depression can seriously compromise the rehabilitation process and increase the risk of physical health problems. Often a vision loss comes at a time when older adults are facing additional physical decline and financial and social losses. The combined challenges can overwhelm the individual's previously effective coping resources.
The first few months are particularly difficult. They are often filled with grieving over the loss of function and physical integrity, discontinuation of enjoyable activities, and disrupted retirement plans. Older adults with recent vision loss fear dependency, changes in their social roles, and loss of control over their privacy and personal freedom. Many of these reactions are unavoidable. However, professionals can ease the adaptation process, both shortening and alleviating this painful transition period. Efforts can be made to intervene on the individual, social and community levels.
Individual: Education, Rehabilitation and Activity
Feelings
of hopelessness are a large part of depression, and education about
rehabilitation possibilities and the nature of the vision loss can
restore hope about the future. The majority of older adults have
attitudes about vision loss based on inaccurate stereotypes of
helplessness and dependency. Although most people who lose sight later
in life will never become functionally blind, they fear the prospect of
total blindness.
Another goal of education is to enlist the older adult in the rehabilitation regimen. Sometimes this process involves coaching people to be more active in their approach to rehabilitation. For rehabilitation to be successful, people must remain motivated and understand that it is an incremental and interactive process.
For many older adults, the loss of vision is the first sign aging
process. As a result, adaptation is colored by attitudes about aging,
decline, and mortality. The loss of vision compounds fears of becoming
useless. Finding activities that can combat these feelings is very
effective in reducing depression.
Studies have shown that
activities that decrease depression are different for the young and the
old. Younger people tend to find reinforcement in successfully meeting
challenges, while older adults find rewards in feeling useful or being
involved in meaningful activities. Encouragement to participate in
volunteer activities or to pursue second career opportunities can
overcome fears of becoming a burden on others.
Professional treatment of depression is sometimes necessary.
Cognitive therapy, which requires only a brief period of treatment and
teaches skills that can inoculate against the development of future
depressive episodes, is being used very effectively in the treatment of
depression in older adults. Sometimes when depression is very severe,
accompanied by suicidal thoughts, extreme lethargy, and sleep
disturbances, medication may be needed. This treatment is best when
combined with other interventions, like cognitive therapy and peer support groups.
Social: Family and Peer Support
Stress
research has shown that social support acts as a buffer against some of
the more disturbing reactions to a variety of losses. Adaptation to
recent vision loss can be assisted by reassuring people that
depression, anxiety, and frustration are normal and healthy responses.
Even denial is adaptive initially, when it can give the individual time
to gradually absorb the loss without overwhelming internal and external
coping resources.
Isolation often results from the lack of mobility and discomfort in
social situations that can accompany vision loss. Prolonged isolation
exacerbates feelings of depression. Connections with community
resources can address many barriers to independent functioning and can
lead to increased social interactions. Unfortunately, those most in
need of these resources are least likely to locate them. Information
about community services should be routinely provided as part of the
rehabilitation program.
Successful peers, consumer
organizations, and support groups can all provide living evidence of
the potential for positive adaptation. Interactions with peers also
provides the empathy and problem-solving opportunities that are so
effective when coming from a positive role model.
Too often rehabilitation programs focus entirely on the person with the disability and fail to recognize that the entire family system is affected by vision loss. Education of family members is crucial. Without this participation, role changes are made based on inaccurate perceptions about the capabilities of the person with impaired vision. Family members also need information about community services that can complement the care they provide.
Involvement in the rehabilitation process allows family members to reinforce new techniques. Interactions with family members serve as either positive reinforces or as inhibitors of independence. Depression can become more severe or chronic when the individual is put in a position of unnecessary dependence.
Community: Information and Early Intervention
Public
education efforts to address negative beliefs and attitudes about
vision loss can work as preventive measures against depression.
Information about effective vision rehabilitation services can increase
the likelihood of early intervention, when it is most effective. When
intervention is delayed, older adults make restricting and isolating
behavioral adaptations that interfere with subsequent rehabilitation
efforts.
Public education should also target community accessibility for vision impaired older adults. High contrast, large print, and improved lighting are simple and inexpensive modifications that can be made by restaurants, agencies serving older people, volunteer programs, banks, and markets. These modifications result in fewer disruptions in daily routines, thus making the loss of vision less devastating and the adaptation needs less extreme.
References:
Beck, A. T (1987). Cognitive models of depression. Journal of Cognitive Psychotherapy, 1, 5-37.
Burns, D.D. (1980). Feeling Good New York: Signet Press.
Herson, M. & Bellack, A.S. (Eds.). (1985) Handbook of Clinical Behavior Therapy with Adults. New York: Plenum Press.
Rolland, J.S. (1994). Families, Illness, and Disability. New York: Basic Books.
Thompson,
P, Goldhaber, J., Amaral, P, et al (1992). Psychological strategies for
assisting older adults who are partially sighted. Journal of Vision
Impairment and Blindness, 86, 78.
LaDonna S. Ringering, PhD is the Executive Director of The Center for the Partially Sighted, Los Angeles, CA.
Source: The Lighthouse Inc.'s Aging & Vision News newsletter (Spring 1995)
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