The goals of this qualitative study were: (1) To document and develop a typology of the coping strategies that older adults self-report in adapting to the emotional and functional consequences of vision impairment; (2) To identify emerging patterns and themes in the coping strategies reported by elders with vision impairment; and (3) To disseminate this information to both professionals and persons experiencing vision impairment. Additional analyses have examined the utilization of novel self-reported coping strategies in the process of adaptation to a chronic impairment among older adults.
Three previous studies (n = 155, 95, and 343, respectively) were primarily designed as quantitative explorations of factors predicting more successful adaptation to vision impairment among older applicants for Lighthouse services. However, all three studies also included the collection of extensive qualitative data in the form of verbatim recordings of spontaneous comments or responses to open-ended questions concerning factors that may have helped or hindered adaptation to visual impairment. Using the "Grounded Theory" approach, self-reported coping strategies were organized into three major areas; behavioral (overt, observable actions), psychological (cognitions or emotions), and social (involving other individuals) means of coping (Glaser & Strauss, 1967). Because the grounded theory approach was employed, codes were not developed a priori, but instead were based on actual responses. In developing coping codes, the focus was on the function of a particular way of coping rather than its outcomes. A codebook was constructed for reference that provided definitions and examples for each code.
Older respondents reported a vast array of different coping strategies in behavioral, psychological and social domains in adapting to vision impairment; most individuals reported using multiple coping strategies. A major theme in the coping strategies reported by older people in the psychological domain is the difficulty in balancing cultural and personal norms of independence with the functional losses resulting from vision impairment. Many older adults with vision impairment, most of whom have struggled to be independent adults and have taken pride in their self-reliance, grapple with the realization that in some cases they may need to be dependent on others. Another theme was the importance of members of the informal social support network in helping the older person with vision loss to adapt. Many elderly reported they relied on specific persons, such as a spouse or a child, to provide them with needed assistance. Additional analyses have supported the hypothesis that older adults utilize novel coping strategies in the process of adaptation to chronic vision impairment. Overall, the use of novel coping strategies was found to be associated with better adaptational outcomes, emphasizing the importance of novel coping in response to stressful life circumstances. Findings from the present qualitative study, along with inconsistency in prior quantitative work in coping with chronic health conditions, would suggest the need for future research on the underlying factors involved in coping with stressful life events, such as late-life vision loss, in order to better facilitate adaptation to vision impairment in later life as well as clarify our understanding of this important topic.
Demographic factors have been found to be related to the self-reported coping strategies of older adults with vision loss. For example, the old-old were less motivated to use rehabilitation training and withdrew socially. Women were more likely to utilize non-family social supports, while men relied on immediate family. Compared to other groups, White respondents in the study seem to have better personal, social, and environmental resources, indicated by their self-report of having greater availability of their spouse and friends, greater access to optical as well as adaptive devices, and greater motivation to learn from others with vision loss. Latinos presented coping strategies of activating emotional support from informal sources. Elderly with African and Hispanic heritage appeared to be more flexible with the notion of interdependency, expressing their needs for support from family and sometimes close friends, which is a positive predictor of better adaptation. The high-level education group showed more frequent self-reports of seeking certain resources and services (e.g., low vision exam, information on eye condition, advice from doctors, and counseling), whereas they reported the least frequent use of rehabilitation services overall. These findings underscore the complexity of needs in the older visually impaired population.
Finally, we have used a mixed-methods approach to better understand the constellations of functional stressors and coping strategies used by older adults in adaptation to visual impairment. The analysis yielded five stress constellation groups: Stoic (n=83), Complainers (n=42), Taciturn (n=295), Sentimentalists (n=67), and Articulate (n=11). The analyses of self-reported stress constellations across the five clusters demonstrated a high frequency of expression of negative thoughts and feelings, occurrence of negative social interactions, and loss of functional ability to perform everyday tasks such as reading and housework. Clusters based on self-reported coping that emerged included Mavericks (n=12), Autonomous (n =76), Pragmatists (n= 44), Hermits (n=41), and Nonchalant (n=325). The Hermits and Nonchalant placed the greatest reliance on personal resources, sometimes at the expense of social ties, with little use of either formal or informal social supports. Across groups, there was a pattern of limited efforts to obtain vision rehabilitation services for instrumental needs, along with low acceptance of vision loss or desire to strengthen personal resources.
Further qualitative analyses are examining the relation of coping strategies to (1) adaptational outcomes, and (2) change in self-reported coping strategies over time. Findings from this study are also being used in the ongoing development of valid and reliable measures of coping and psychosocial outcomes to chart the course of adaptation to age-related vision loss.
Project Period: February 1997 - January 1998. Further qualitative analyses are ongoing.
Lee, O., & Brennan, M. (2006). Stress constellations and coping styles of older adults with age-related visual impairment. Health and Social Work, 31 (4), 289-298.