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European Journal of Ageing logoLink to European Journal of Ageing
. 2008 Aug 21;5(3):223–231. doi: 10.1007/s10433-008-0087-3

Life satisfaction and quality of life of older New Zealanders with and without impaired vision: a descriptive, comparative study

Gretchen Ann Good 1,✉
PMCID: PMC5546331  PMID: 28798574

Abstract

A study involving older New Zealanders (aged 65+) explored levels of life satisfaction reported by groups with and without impaired vision as well as factors contributing to and detracting from quality of life (QOL). Those with impaired vision (n = 135) had a visual acuity of 6/24 (i.e., 20/80) or worse in the better eye with corrective lenses, or a field of vision not greater than 20° at its widest diameter and had a mean age of 82.3 (SD = 6.76). Those with no significant impairment of vision (n = 425) were able read newsprint and legally drive and had a mean age of 74 (SD = 6.49). Overall, those with impaired vision reported a significantly lower level of life satisfaction in comparison to their sighted peers. There was a significant interaction effect of vision status and age, such that those with impaired vision aged 85+ reported life satisfaction scores higher than those reported by their sighted peers. Family and friends emerged as most important contributors to QOL for the vision-impaired group, where good health was the primary contributor to those with sight. Detractors to QOL reported by those with impaired vision included poor vision, inability to drive and poor health. Those with no significant impairment of vision reported poor health, physical impairment and poor finances detracted from QOL. Results could enable ageing and rehabilitation service providers to design rehabilitation programmes addressing areas reported to be most important to older adults with and without impaired vision.

Keywords: Ageing, Activities of daily living, Vision impairment

Introduction

Quality of life (QOL) is emerging as a central construct within many disciplines. QOL measures are particularly difficult to utilise in quantitative studies due to the contention and debate about defining QOL. More recently, QOL research has extended the traditional objective measures of health, wealth and social functioning to include subjective perceptions of well-being (Aberg et al. 2005; Good 2001). Because subjective dimensions of life are more commonly being recognised as important in the field of rehabilitation (Scherer and Cushman 2001) this paper focuses on subjective aspects of QOL so that assumptions are not made about the impact of impairment upon one’s life: as Horowitz (2004) noted, for older people with impaired vision, reduced QOL is not inevitable. Life satisfaction (LS) is initially examined in this study, as it has been identified as a measurable, subjective dimension of QOL for older people (Chachamovich et al. 2006). Because the ideal multi-dimensional instrument for measuring QOL in older people has not yet been developed (Aberg et al. 2005; Chachamovich et al. 2006; Gough 1994), this paper further explores potential components for future development of QOL scales for older people with and without impaired vision. The use of open-ended questions provides a unique, cultural and disability subgroup perspective on relevant components of QOL.

Research has demonstrated clear links between impaired vision and depression, communication breakdown, psychological dysfunction, decreased well-being and QOL, mood and social relationships in those aged 65+ (Carabellese et al. 1993; Crews and Campbell 2001; D’Argent-Molina et al. 1996; Heine and Browning 2002; Horowitz 2003; Horowitz et al. 2000; Stuen 1990; Williams et al. 1998). Links have also been drawn between vision impairment and lower levels of LS (Burmedi et al. 2002a, b).

Research linking impaired vision, age and LS include a study by Heyl and Wahl (2001) that found older people with impaired vision reported a lower score on overall LS in a study comparing them to their sighted peers. Davis et al. (1995) also found evidence of this and attributed this to lack of social support. Reinhardt (1996) used regression analysis to predict LS in older people with impaired vision. After controlling for social support, socio-economic status and physical functioning levels, significant vision impairment was found to be a predictor of low LS, as measured by the Life Satisfaction Index-A (Adams 1969).

Literature on ageing suggests that the majority of older people age with some diminished functioning, but little loss of satisfaction, happiness, independence and meaningful activity. This perspective is evident in the “successful ageing” literature where research has shown that older adults adapt to new situations and expectations of success (Freund and Baltes 1998). Heyl and Wahl (2001) found that both the vision impaired and sighted groups reported a decline in overall LS, however, several studies have found that LS actually improved with age in those aged 65+ (Hamarat et al. 2002; Hileras et al. 2001). Moreover, Diener (1984) found LS generally improves after about age 40. These researchers hypothesised that this apparent improvement is likely related to personality, resilience and improved coping mechanisms that come along with accumulated life experience.

There is compelling evidence that QOL and LS are negatively affected by living with impaired vision. There is also evidence that QOL and LS may improve with age, and that age can buffer the negative impact of a serious health-event, such as acquiring a severe vision-impairment (Wurm et al. 2008). However, what is not known is specifically, why impaired vision detracts from QOL, how increasing age, in combination with impaired vision, may affect QOL and LS and what specific factors will be identified by those with and without impaired vision that have positive and negative impacts on QOL.

Previous research on QOL for older people has often involved statistical correlations between variables and measures of well-being and multiple regressions. This has created only an incomplete picture and does not explain the variance in LS or the more personal and culture-specific responses to QOL. No identified previous research has explored the question about what contributes to and detracts from QOL for older-age groups using open-ended questions and comparing responses of vision impaired to sighted older respondents. QOL has recently been summarised by Bowling and Gabriel (2004) as being comprised of psychological characteristics and outlook, health and functional status, personal and neighbourhood social capital, financial situation and independence. It is not known if these components are valued in similar ways by the age groups often used in research with older people (65–74; 75–84 and 85+), in a New Zealand context, or with those living with significant vision-impairment.

Rehabilitation is often targeted to improve activity and independence levels of blind and vision-impaired adults. In light of the growing evidence that aspects other than activity and independence are more closely related to QOL and LS (Good 2005b; Kim 1997), further research is needed so that rehabilitation goals can be reassessed carefully to ensure optimal outcomes.

The present study is designed to further research in this context by examining two ideas. Do older adults with impaired vision report a different level of LS compared to their sighted peers across three age groups? And further, this study used descriptive findings to identify factors affecting QOL for an older population, with and without impaired vision.

Methods

The study involved a questionnaire distributed to all those registered with the sole provider of vision rehabilitation services in New Zealand (NZ), the Royal New Zealand Foundation of the Blind (RNZFB) aged 65+ living in the community (non institutional homes) in the Manawatu region of the North Island of NZ (N = 312). Participants classified as having impaired vision had a visual acuity of 6/24 (i.e. 20/80) or worse in the better eye with corrective lenses, or a field of vision not greater than 20° at its widest diameter (RNZFB 2004). Participants with no significant impairment of vision were recruited through the voter registration roll. A total of 800 questionnaires were sent to randomly-selected registered voters, aged 65+ who lived in the community. Voter registration is mandatory in NZ and so this results in a representative sample. A total of 560 surveys were completed (50% response rate); 135 respondents had impaired vision (43% response) and 425 had no significant impairment of vision (not eligible for RNZFB registration and able to read newsprint and to legally drive) (53% response). This study received approval from the Massey University Human Ethics Committee.

Materials were made available in the format preferred by each individual (Braille, large print, cassette recording, electronic disc), and telephone and face-to-face assistance was offered to all participants. Demographic details of participants are provided in Table 1.

Table 1.

Demographic details

Vision impaired N = 135 Sighted N = 425
n % n %
Age (years)
 65–74 16 12 242 57
 75–84 68 50 150 35
 85+ 51 38 33 8
Gender
 Male 46 34 194 46
 Female 89 66 231 54
Ethnicity
 New Zealander of European descent 121 90 383 91
 New Zealander of Maori descent 5 4 15 4
 New Zealander of Pacific Island descent 1 1 0 0
 Other (includes European, Asian, Indian, Pacific Islander, Australian and North American) 8 6 23 5
 Missing data 0 0 4 1
Size of community
 Urban area 125 93 347 82
 Rural area 10 7 78 18
Current living situation
 Alone 68 50 139 33
 With others 67 50 286 67
Marital status
 Married 56 41 274 65
 Not-married 9 7 35 8
 Widowed 70 52 115 27
 Missing data 0 0 1 0.2
Occupation/former occupation
 Homemakers 44 34 100 24
 Legislators, administrators, managers 4 3 14 3
 Professionals 11 8 72 18
 Associate professionals, technicians 9 7 16 4
 Clerks 11 8 49 12
 Service and sales workers 11 8 28 7
 Agriculture and fishery workers 14 11 38 9
 Trades workers 12 9 54 13
 Plant and machine operators, assemblers 10 8 20 5
 Elementary occupations 4 3 17 4
 Missing data 5 4 17 4
Educational qualification
 No school qualification 59 45 155 37
 School certificate passes 24 18 83 20
 Matriculation/University entrance+ 13 10 26 6
 Trade apprenticeship, professional certificate or diploma 23 18 86 21
 Government exams for public service 7 5 17 4
 University qualification 5 4 47 11
 Missing data 4 3 11 3
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(Good 2005a, b)

Instruments used in the study

Demographics

The brief demographic questionnaire asked for details regarding date of birth, gender, ethnic identity, size of community, living situation, marital status, former occupation, income, education and impairment/health status. Questions were adapted from the New Zealand Census of Populations and Dwellings (Statistics New Zealand 2001). Coding was categorical.

The satisfaction with life scale

The Satisfaction With Life Scale (SWLS) (Diener et al. 1985) is a five-item scale of subjective well-being. The items require a response on a 7-point scale from strongly disagree to strongly agree. The questions are:

  • In most ways my life is close to the ideal.

  • The conditions of my life are excellent.

  • I am satisfied with my life.

  • So far I have achieved the important things I want in my life.

  • If I could live my life over again I would change nothing.

The scale has reported internal consistencies of 0.85 and test–retest coefficients of 0.84, and has been validated using other independent LS measures including the Philadelphia Geriatric Morale Scale (Headey et al. 1993; Pavot and Diener 1993). Diener et al. (1985) obtained a Cronbach’s alpha score of 0.87 for the SWLS. In the present study, an alpha of 0.84 was obtained. Scores can range from 5 to 35 with higher scores indicating a higher level of LS. This measure was found to be highly correlated with both the Life 3 (Andrews and Withey 1976) and the World Health Organization’s WHOQOL-BREF one-item global scale (WHO 1993) (r > 0.525) with this population (Good 2005a). This measure has been successfully used in NZ with older, vision-impaired populations in NZ (Good et al. 2003). Other measure of well-being were less-suited to this analysis as the five-item SWLS is considered to be more robust than the one-item measures, and participants were reluctant to respond to the Positive and Negative Affect Scale, also used at the time of data collection.

Open-ended questions

Participants were asked to list three things that contributed to their QOL and three things that detracted from their QOL. Responses were coded into unique, mutually-exclusive categories after data had been collected and reviewed. Data was coded inductively and based on specific observations rather than based on theory or general observations. Two research assistants worked simultaneously with the author in creation of the code book and in coding the data from the first 50 questionnaires, as a reliability measure. The author then completed the coding of all open-ended questions, eliminating concerns about intercoder reliability.

Social support questionnaire (SSQ)

The Social Support Questionnaire (SSQ) (Sarason et al. 1987) assesses network size and perceived social support. The measure comprises six items. In part A, respondents list people upon whom they rely for support in a particular circumstance and in part B they rate their satisfaction with the support they currently receive from those listed in part A. Scores for part A were summed and divided by six for an overall score of size of social support networks. For part B, scores for satisfaction, measured by a six item Likert scale, are added and divided by six for a total score of satisfaction with support. This measure has previously reported validity and reliability coefficient alphas for parts one and two ranging from 0.90 to 0.93 (Siegert et al. 1987). In this study, alphas of 0.95 (part A) and 0.97 (part B) were obtained.

Results

Demographics

Demographic factors were examined and comparisons made between those with impaired vision and those with sight. There was no significant difference between the vision-status groups in terms of level of education: χ2(5, n = 545) = 10.24, p = 0.069, previous occupation χ2(9, N = 538) = 15.19, p = 0.086, or median income (Mann-Whitney U = 15,776.5, p = 0.636). The majority in both vision-status groups was of European background with a representation of Maori participants at 3.6%. There was no significant difference in the proportion of those who identified as NZ European between the group with impaired vision and the sighted group χ2(1, n = 504) = 0.018, p = 0.767. There were no significant differences between the two groups in social support network size or social support satisfaction using two-way between-groups ANOVA [F(1, 430) = 0.204, p = 0.652] [F(1, 363) = 3.82, p = 0.052].

There were differences found between the vision-status groups on several demographic measures. Age was then used as a control. There were no significant differences between the vision status groups in proportions of males to females found in any of the three age groups [age group 1: χ2(1, N = 258) = 0.208, p = 0.649; age group 2: χ2(1, N = 218) = 3.58, p = 0.058; age group 3: χ2(1, N = 84) = 0.116, p = 0.734]. Nor were significant differences found between the vision-status groups in numbers of impairments or health conditions (other than vision) [age group 1: t (14.82) = 1.21, p = 0.246; age group 2: t (206) = 0.147, p = 0.883; age group 3: t (79) = −0.310, p = 0.757; in the proportion of those who lived in main urban areas: [age group 1: χ2(1, N = 258) = 0.000, p = 1; age group 2: χ2(1, N = 218) = 1.97, p = 0.159; age group 3: χ2(1, N = 84) = 0.084, p = 0.772]; marital status (married or unmarried/widowed) [age group 1: χ2(2, N = 258) = 1.36, p = 0.564; age group 2: χ2(2, n = 217) = 2.08, p = 0.370; age group 3: χ2(2, N = 84) = 1.41, p = 0.683]; nor in the proportion of those who lived alone or with others [age group 1: χ2(1, N = 258) = 0.029, p = 0.769; age group 2: χ2(1, N = 218) = 458, p = 0.498; age group 3: χ2(1, N = 84) = 0.188, p = 0.664].

The group with impaired vision (M = 82.3, SD = 6.76) was significantly older than the sighted group (M = 74, SD = 6.49; t (558) = 12.86, p = 0.000). The effect size was large (η2 = 0.228).

In summary, there were no statistically significant demographic, impairment or social-support differences between the group with impaired vision and the group with no significant impairment of vision, except for age. Therefore, for the analyses of variance (ANOVA) the sample was divided into three age-groups as a measure of control. Age group 1 included those aged 65–74; age group 2, 75–84; age group 3, age 85+.

Of those with impaired vision, 84% (n = 108) had lost vision after age 65, and 81% had lost vision within the past 10 years, meaning late-life onset of vision impairment is primarily what is being investigated in this study.

A two-way between-groups ANOVA was conducted to explore the relationship between vision status, age and satisfaction with life as measured by the Satisfaction With Life Scale (SWLS).

Participants were divided into the three age-groups. The main effect of age on satisfaction with life was not statistically significant [F(2, 471) = 2.31, p = 0.100]. There was a highly significant main effect for vision status on LS [F(1, 471) = 13.57, p = 0.000]. The effect size was small (partial η2 = 0.028). The mean satisfaction with life score for the group with impaired vision (M = 21.26, SD = 7.03) was significantly lower than that of the sighted group (M = 24.50, SD = 6.30). The interaction effect of age and vision did reach statistical significance [F(2, 471) = 5.40, p = 0.005]. The effect size was small (partial η2 = 0.022). A follow-up analysis of simple effects was conducted with a one-way ANOVA which explored the effects of age on satisfaction with life separately for those with impaired vision and the sighted group. Significant differences across the three age-groups were found within the group with impaired vision, but not within the sighted group. Post-hoc comparisons using Tamhane’s T2 test found a significant difference within the group with impaired vision between age groups 2 and 3 (M = 19.58, SD = 6.96; M = 24.49, SD = 5.76), respectively, where those in age group 3 had a higher level of LS. Age group 1 of those with impaired vision (M = 18.73, SD = 9.16) did not differ significantly from age group 2, nor did it differ significantly from age group 3. This is likely explained by the higher standard-deviation in the younger age group. Details of the ANOVA are shown in Table 2.

Table 2.

Main and interaction effects of age and vision status on satisfaction with life

Satisfaction with life*
Age group 65–74 75–84 85–100
n M SD n M SD n M SD
Vision impaired 15 18.73 9.16 53 19.58 6.95 42 24.28 5.75
Sighted 222 24.94 5.93 120 23.93 6.82 25 23.28 6.93
Main effects
df M 2 F p Eta 2
Age 2 96.09 2.31 0.100 0.010
VI/sighted 1 562.97 13.57 0.000* 0.028
Interaction effect age by vision status 2 223.99 5.40 0.005* 0.022
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(Good 2005a)

* p ≤ 0.05

In summary, the group with impaired vision did report a lower score in LS. Upon further analysis, however, there was an interaction effect of age and vision status on LS such that group with impaired vision in the oldest age group demonstrated no significant difference in LS in comparison to their sighted peers, as had been observed at the younger age groups.

Vision impairment clearly has a negative relationship with well-being. What is still unknown is just which aspects of living with a vision impairment is related to lower LS or QOL. Within this study 500 participants provided 1,412 responses to the question “What contributes to your quality of life?”. There were 39 coded-response categories with three or more responses. There were 119 vision-impaired respondents and 381 sighted respondents. In general, the sighted group reported that good health (40% of respondents), family (excluding spouse) (39%), spouse (23%), friends (21%), attitude (17%), and independence (17%) contributed to QOL. The vision-impaired group reported that family (excluding spouse) (43%), friends (30%), good health (19%), independence (18%), attitude (17%) and spouse (13%) contributed to QOL. The group of participants with sight reported that their health and spouse contributed to their QOL in significantly greater proportions than their vision-impaired peers mentioned these factors, although a similar proportion of those with impaired vision who had a spouse also reported them to be important contributors to their QOL, and when the three age groups were examined, the youngest of those with impaired vision also mentioned their spouse/partner as an important contributor to QOL.

Unique responses about what contributes to QOL for this NZ population, not found in previous QOL studies, included fitness and exercise, rural living, food, gardening, television, radio, talking books and telephones, animals, ability to get around, music, social clubs, sleep, kindness from others and clean living.

Respondents (N = 409) provided 966 responses to the question “What detracts from your QOL?”. Respondents included 115 with impaired vision and 294 without impaired vision. Unique-coded response categories were established (N = 27). Those with no impairment of vision provided 677 responses including, poor health (35%), physical impairment (19%), poor finances (17%), family difficulties (15%), and age (13%) were primary detractors from QOL. Those with impaired vision provided 289 responses. Poor vision (81% of respondents), inability to drive (24%), poor health (21%), hearing loss (20%), mobility problems (16%) and physical impairment (13%) were the primary detractors for the vision-impaired group.

Those with impaired vision reported in significantly greater proportions that poor vision, inability to drive and hearing loss detracted from their QOL. Those with sight reported in significantly greater proportions that poor health and finances detracted from QOL.

Other factors mentioned by both groups included lack of confidence, lack of energy, miserable people, weather and inability to garden. Unique detractors to QOL mentioned by those with sight included finances, family worries, ageing, disappointment in others and the current state of the world.

Within each age group, the factors mentioned most often, which contribute to and detract from QOL are listed in Tables 3 and 4. Emerging patterns show health is valued in greater proportions by those with no significant impairment of vision in the older age groups and poor health is disproportionally viewed as a detractor from QOL. Those with impaired vision clearly identified relationships as important to QOL and identified their impairment, as a detractor from QOL, although it is still not clear what aspect of life with impaired vision is perceived as negative.

Table 3.

Factors contributing to QOL by age group (identified by >20% respondents)

Age Vision impaired
n = 14		 n % Sighted
n = 218		 n %
65–74 Family 4 29 Family 88 40
Friends 4 29 Good health 92 42
Partner/spouse 4 29 Spouse 61 28
Good health 4 29 Friends 43 20
n = 61 n = 136
75–84 Family 31 51 Good health* 52 38
Friends* 21 34 Family 45 33
Friends 33 24
n = 44 n = 27
85+ Family 16 36 Family 13 48
Good health 9 20 Good health 11 41
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* Proportionally greater than reported by other impairment-group using Standard Error of Proportions (SEP) significant at 0.05

Table 4.

Factors detracting from QOL by age-group (identified by >20% respondents)

Age Vision impaired
n = 13		 n % Sighted
n = 155		 n %
65–74 Impaired vision* 10 77 Poor health 53 34
Independence* 4 31 Finances 41 26
Mobility 4 31
n = 59 n = 113
75–84 Impaired vision* 47 80 Poor health 40 35
Inability to drive* 18 30
Poor health 15 25
n = 43 n = 26
85+ Impaired vision* 36 84 Poor health* 11 42
Impaired hearing* 13 30 Mobility 6 23
Poor vision 6 23
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* Proportionally greater than reported by other impairment group using Standard Error of Proportions (SEP) significant at 0.05

Discussion

Life satisfaction is a “conscious cognitive judgment of one’s life in which the criteria for judgment are up to the person” (Pavot and Diener 1993, p. 164). LS is a subjective dimension of QOL that is known to be reliably measurable and is more commonly being recognised as important in the field of rehabilitation.

The overall mean SWLS score obtained in the present study was 23.75 on this scale which has a range of 5–35. Previous studies, related to LS in general, have produced scores for older adults that were about 24 on the SWLS (Pavot et al. 1991). The sighted group’s mean score was 24.50, similar to what has been found in other studies. In the present study those with impaired vision had a mean score (21) just about at the neutral point on the scale (20). This was comparable to scores obtained from disabled students in a study by Chwalisz et al. (1988) who found a mean score of 20 in their sample.

Thus, overall, the findings related to LS are supportive of earlier studies that link vision impairment with lower reported levels of LS and similar measures of well being (Bazargan et al. 2001; Branch et al. 1989; Carabellese et al. 1993; Gillman et al. 1986; Heine and Browning 2002; Reinhardt 1996; Upton et al. 1998; Williams et al. 1998).

However, it was unexpected to find that those with sight reported similar levels of LS in all three age-groups and that a higher level of LS was found in the oldest group with impaired vision. No similar findings have been found in other studies. Previous studies tell us that LS has been found to increase with age, but no study has previously investigated older age groups, and the difference that impaired vision can make in LS. Others have also found that older age groups have higher levels of LS (Hamarat et al. 2002; Hileras et al. 2001). Hamarat et al. found that among healthy, active adults, aged 45+, the oldest old reported LS at least as good as, and better than the younger age groups. These authors attributed this result to resilience of those who have coping resources, which are adequate throughout life, and remain so after age 75. They also surmised that LS, like the use of coping resources and personality traits, remains stable over our adult lives. Logical as these arguments are, they offer no clear explanation for why significant differences across age groups were found within the group with impaired vision, or while no such differences were found within the sighted group. It is possible that the explanation lays in another hypothesis of Hamarat et al. that is, that flexibility and cognitive adjustments in coping increase LS and further, that older people, who have already experienced a great loss such as loss of vision, may have enhanced coping-skills and flexibility, in comparison to their sighted peers. Perhaps we should not expect to find pronounced differences in LS between those with and without impaired vision in the oldest of older adults.

In a study that examined the links between physical health, social comparisons and LS, Frieswijk et al. (2004) found that social comparisons had a greater and independent association with LS than frailty did in older people. This finding is similar to what was found by Good (2005a), in that subjective components of functioning (i.e. social comparisons) were more closely associated with LS than more objective measures (i.e. health or functioning).

As with the current study, Ringering and Amaral (1990) and Leinhass and Hedstrom (1994) found no difference in social supports between older people with impaired vision and with sight, although Davis et al. (1995) did find that those with vision impairments experienced lower levels of social support. Hersen et al. (1995) speculated that a reduction in social support for older people with impaired vision was due to lack of skills for reciprocation in social situations.

Components of QOL identified by those with and without impaired vision and by the three age-groups often identified in gerontological research, did not reflect what has been found in European countries. Functional status and finances were not identified the current study as they have been consistently in other research (Walker 2005). The subgroup with impaired vision identified relationships with great frequency, while their sighted peers identified health more consistently as a component of QOL. The finding of independence as important to this population is relatively unique in QOL studies. Other studies have found religion/spirituality and financial security themes emerging from data, but these themes did not emerge from this population to any great degree. Components of QOL may need to be broadened to include some identified in this study, such as transport and hearing concerns.

In summary, satisfaction with life was found to be lower overall for those who had impaired-vision in this study, as has been found in most previous research, with a few exceptions. The finding that the oldest age group with impaired vision reported a relatively high LS score perhaps is as a result of resiliency and accumulated flexibility and skills for coping. This result could also be explained by social comparison theories developed by Festinger (1954) and recently applied in studies relating to older people (Frieswijk et al. 2004). At this age (85+) the group with impaired vision functioned more similarly to their sighted peers, and reported that they perceived this to be true. It may be this that explains a higher level of LS. At age 85+, for the first time, as older people, the group with impaired vision may realistically compare themselves favourably to their peers, in terms of daily functioning, and it may be this which explains their higher levels of LS. People with impaired vision, especially at the oldest age groups, may be more flexible, adapted to dependence, have been compelled by need to build up social and practical supports, and may be especially resilient to the losses of health that may only be beginning to affect their sighted peers. Time since onset of impairment of vision would seem a logical explanation for the relatively high level of LS at the oldest age, however, even among those age 85+, the average time since onset was 5 years.

There was not a significant main effect for age on LS, but there was an interaction effect of age and vision status on LS, such that at the older age groups there was a lower LS score for the sighted group, but for the group with impaired vision, there were higher LS scores at the older age groups. Although the practical effects found were relatively small, and possibly explained by the relatively large variance, the effect of vision and the interaction effect of age and vision on LS is an important finding. This could be explained by the evidence that those with sight experience a steady increase, with age, of impairments. Those with impaired vision do not demonstrate this pattern.

Limitations to this study include the use of cross-sectional, rather than longitudinal data, which limits inferences that can be made regarding causality. Generalisability of the findings may be limited, especially as criteria for vision rehabilitation services are less restrictive in NZ than in other parts of the world. Not all people eligible for RNZFB services do register, however this is the only avenue for vision rehabilitation services in the country, and so the vision-impaired sample may represent RNZFB clients, but not necessarily all of those who are older and living with impaired vision. Sample sizes of groups varied significantly, and there was a particularly low number of sighted participants in the youngest age cohort, however, sample sizes represented the general age structure of age groups in NZ and in RNZFB registration statistics. Few participants were able to report their visual acuity and therefore, analysis of the influence of degree of vision loss on QOL was limited. Alternative explanations of these results could be related to skewed scales, unequal group sizes, or missing data, although participant numbers were high enough to accommodate these differences and multivariate statistical assumptions were met on multivariate tests with the untransformed data.

Vision impairment clearly has a negative impact on QOL and LS. Ageing does not seem to have such an obvious impact on QOL and LS, and the effects of ageing upon well-being appear to differ for those with impaired vision in comparison to those with sight. Varied aspects of daily living have positive and negative impacts on older people, and those with impaired vision reported that different aspects of life impact QOL, in comparison to their sighted peers. Inability to drive, hear and see is what those with impaired vision reported frequently detract from QOL, and good relationships, good health, independence and a positive attitude contribute most to life. Older people with no significant impairment of vision emphasised finances, ageing and the current state of the world as detractors from QOL. These identified factors could be further utilised in the development of QOL measures for older people, and for those who have impaired vision. Services to older people could be informed by this study. Alternative modes of transport, assistance for hearing loss and methods for cultivating, maintaining and appreciating relationships could be prioritised, as they are the factors that are viewed as important to QOL for this population.

Acknowledgments

This paper is based primarily on doctoral research, conducted under the supervision of Professor Steven J. La Grow and Dr. Fiona M. Alpass, of Massey University, Palmerston North, New Zealand. Thanks to Wayne State University’s Institute of Gerontology in Detroit, Michigan, USA and to Drs. Peter Lichtenberg, Catherine Lysack and Tom Jankowski who provided supervision and support to the author, who was a 2006 post-doctoral fellow at the IOG.

References

  1. Aberg AC, Sidenvall B, Hepworth M, O’reilly K, Lithell H. On loss of activity and independence, adaptation improves life satisfaction in old age: a qualitative study of patients’ perceptions. Qual Life Res. 2005;14:1111–1125. doi: 10.1007/s11136-004-2579-8. [DOI] [PubMed] [Google Scholar]
  2. Adams DL. Analysis of a life satisfaction index. J Gerontol. 1969;24:470–474. doi: 10.1093/geronj/24.4.470. [DOI] [PubMed] [Google Scholar]
  3. Andrews FM, Withey SB. Social indicators of well-being. New York: Plenum Press; 1976. [Google Scholar]
  4. Bazargan M, Baker RS, Bazargan SH. Sensory impairments and subjective well-being among aged African American persons. J Gerontol B Psychol Sci Soc Sci. 2001;56B:268–278. doi: 10.1093/geronb/56.5.p268. [DOI] [PubMed] [Google Scholar]
  5. Bowling A, Gabriel Z. An intergenerational model of quality of life in older age. A comparison of analytic and lay models of quality of life. Soc Indic Res. 2004;69:1–36. doi: 10.1023/B:SOCI.0000032656.01524.07. [DOI] [Google Scholar]
  6. Branch LG, Horowitz A, Carr C. The implications for everyday life of incident self-reported visual decline among people over age 65 living in the community. Gerontologist. 1989;29:359–365. doi: 10.1093/geront/29.3.359. [DOI] [PubMed] [Google Scholar]
  7. Burmedi D, Becker S, Heyl V, Wahl HW, Himmelsbach (2002a) Behavioral consequences of age-related low vision. Vis Impair Res 4:15–45
  8. Burmedi D, Becker S, Heyl V, Wahl HW, Himmelsbach I. Emotional and social consequences of age-related low vision: a narrative review. Vis Impair Res. 2002;4:47–71. doi: 10.1076/vimr.4.1.47.15634. [DOI] [Google Scholar]
  9. Carabellese C, Appollonio I, Rozzini R, Bianchetti A, Frisoni GB, Frattola L, et al. Sensory impairments and quality of life in a community elderly population. J Am Geriatr Soc. 1993;41:401–407. doi: 10.1111/j.1532-5415.1993.tb06948.x. [DOI] [PubMed] [Google Scholar]
  10. Chachamovich E, Trentini C, Fleck MP. Assessment of the psychometric performance of the QHOQOL-BREF instrument in a sample of Brazillian older adults. Int Psychogeriatr. 2006;40(5):1–12. doi: 10.1017/S1041610206003619. [DOI] [PubMed] [Google Scholar]
  11. Chwalisz K, Diener E, Gallagher D. Autonomic arousal feedback and emotional experience: evidence from the spinal cord injured. J Pers Soc Psychol. 1988;54:820–828. doi: 10.1037/0022-3514.54.5.820. [DOI] [PubMed] [Google Scholar]
  12. Crews JE, Campbell VA. Health conditions, activity limitations, and participation restrictions among older people with visual impairments. J Vis Impair Blind. 2001;95:453–467. [Google Scholar]
  13. D’Argent-Molina P, Hays M, Breart G. Sensory impairments and physical disability in aged women living at home. Int J Epidemiol Aging Hum Dev. 1996;25:621–629. doi: 10.1093/ije/25.3.621. [DOI] [PubMed] [Google Scholar]
  14. Davis C, Lovie-Kitchin J, Thompson B. Psychosocial adjustment to age-related macular degeneration. J Vis Impair Blind. 1995;89:16–27. [Google Scholar]
  15. Diener E. Subjective well-being. Psychol Bul. 1984;45:542–575. doi: 10.1037/0033-2909.95.3.542. [DOI] [PubMed] [Google Scholar]
  16. Diener E, Emmons RA, Larsen RJ, Griffin S. The satisfaction with life scale. J Pers Asses. 1985;49:71–75. doi: 10.1207/s15327752jpa4901_13. [DOI] [PubMed] [Google Scholar]
  17. Festinger L. A theory of social comparison processes. Hum Relat. 1954;7:117–140. doi: 10.1177/001872675400700202. [DOI] [Google Scholar]
  18. Freund AM, Baltes PB. Selection, optimization, and compensation as strategies of life-management: correlations with subjective indicators of successful aging. Psychol Aging. 1998;13:531–543. doi: 10.1037/0882-7974.13.4.531. [DOI] [PubMed] [Google Scholar]
  19. Frieswijk N, Buunk BP, Steverink N, Slaets JPJ. The effect of social comparison information on the life satisfaction of frail older persons. Psychol Aging. 2004;19:183–190. doi: 10.1037/0882-7974.19.1.183. [DOI] [PubMed] [Google Scholar]
  20. Gillman AE, Simmel A, Simon EP. Visual handicap in the aged: self-reported visual disability and the quality of life of residents of public housing for the elderly. J Vis Impair Blind. 1986;80:588–590. [Google Scholar]
  21. Good GA (2001) Ageing, vision loss and quality of life: Are we asking the right questions? In: La Grow SJ (ed) New Zealand rehabilitation association 2001 conference. NZRA, Wellington, pp 21–26
  22. Good GA (2005a) Ageing and vision impairment: activity, independence and life satisfaction. Unpublished doctoral dissertation, Massey University, Palmerston North
  23. Good GA. Testing an adapted ICF model: aging, vision impairment, activity, participation and subjective dimensions of functioning. Aust J Rehabil Couns. 2005;11(2):115–135. [Google Scholar]
  24. Good G, La Grow S, Alpass F (2003) Activity, independence, and life satisfaction of older, vision impaired New Zealanders. In: Proceedings for the 11th international mobility conference (IMC-11), Stellenbosch, March–April, 2003
  25. Gough IR. Quality of life as an outcome variable in oncology and surgery. Aust N Z J Surg. 1994;64:227–235. doi: 10.1111/j.1445-2197.1994.tb02190.x. [DOI] [PubMed] [Google Scholar]
  26. Hamarat E, Thompson D, Steele D, Matheny K, Simons C. Age differences in coping resources and satisfaction with life among middle-aged, young-old, and oldest-old adults. J Genet Psychol. 2002;163:360–367. doi: 10.1080/00221320209598689. [DOI] [PubMed] [Google Scholar]
  27. Headey BW, Kelley J, Wearing AJ. Dimensions of mental health: life satisfaction, positive affect, anxiety and depression. Soc Indic Res. 1993;29(1):63–82. doi: 10.1007/BF01136197. [DOI] [Google Scholar]
  28. Heine C, Browning CJ. Communication and psychosocial consequences of sensory loss in older adults: overview and rehabilitation directions. Disabil Rehabil. 2002;24:763–773. doi: 10.1080/09638280210129162. [DOI] [PubMed] [Google Scholar]
  29. Hersen M, Kabacoff RI, Van Hasselt VB, Null JA, Ryan CF, Melton MA, et al. Assertiveness, depression and social support in older visually impaired adults. J Vis Impair Blind. 1995;89:524–530. [Google Scholar]
  30. Heyl V, Wahl H. Psychosocial adaptation to age-related vision loss: a six-year perspective. J Vis Impair Blind. 2001;95:739–748. [Google Scholar]
  31. Hileras PK, Jorm AF, Herlitz A, Winblad B. Life satisfaction among the very old: a survey on a cognitively intact sample aged 90 years or above. Int J Aging Hum Dev. 2001;52:71–90. doi: 10.2190/B8NC-D9MQ-KJE8-UUG9. [DOI] [PubMed] [Google Scholar]
  32. Horowitz A. Depression and vision and hearing impairments in later life. Generations. 2003;27(1):32. [Google Scholar]
  33. Horowitz A. The prevalence and consequences of vision impairment in later life. Top Geriatr Rehabil. 2004;20(3):185–195. [Google Scholar]
  34. Horowitz A, Leonard R, Reinhardt JP. Measuring psychosocial and functional outcomes of a group model of vision rehabilitation services for older adults. J Vis Impair Blind. 2000;94:328–337. [Google Scholar]
  35. Kim JK. Determinants of life satisfaction among the high-functioning elderly: implications of effects of psychological factors and activity participation. Diss Abstr Int MAI. 1997;36(03):706. [Google Scholar]
  36. Leinhass MM, Hedstrom NJ. Low vision: how to assess and treat its emotional impact. Geriatrics. 1994;49(5):53–55. [PubMed] [Google Scholar]
  37. Pavot W, Diener E. Review of the satisfaction with life scale. Psychol Asses. 1993;5:164–172. doi: 10.1037/1040-3590.5.2.164. [DOI] [Google Scholar]
  38. Pavot WG, Diener E, Colvin CR, Sandvik E. Further validation of the satisfaction with life scale: evidence for the cross-method convergence of well-being measures. J Pers Assess. 1991;57:149–161. doi: 10.1207/s15327752jpa5701_17. [DOI] [PubMed] [Google Scholar]
  39. Reinhardt JP. The importance of friendship and family support in adaptation to chronic vision impairment. J Gerontol B Psychol Sci Soc Sc. 1996;51B:268–278. doi: 10.1093/geronb/51b.5.p268. [DOI] [PubMed] [Google Scholar]
  40. Ringering L, Amaral P (1990) Vision loss in the elderly: psychosocial repercussions and interventions. In: Johnson A, Lawrence M (eds) Low vision ahead: proceedings of the international conference on low vision 1990. Association for the Blind, Melbourne, pp 193–198
  41. Royal New Zealand Foundation of the Blind (RNZFB) (2004) Member services. http://www.rnzfb.org.nz(Accessed 11 November 2004)
  42. Sarason IG, Sarason BR, Shearin EN, Pierce GR. A brief measure of social support: practical and theoretical implications. J Soc Pers Relat. 1987;4:497–510. doi: 10.1177/0265407587044007. [DOI] [Google Scholar]
  43. Scherer MJ, Cushman LA. Measuring subjective quality of life following spinal cord injury: a validation study of the assistive technology device predisposition assessment. Disabil Rehabli. 2001;23:387–393. doi: 10.1080/09638280010006665. [DOI] [PubMed] [Google Scholar]
  44. Siegert RJ, Patten DM, Walkey FH. Development of a brief social support questionnaire. NZ J Psychol. 1987;16:79–83. [Google Scholar]
  45. Statistics New Zealand . New Zealand census of population and dwellings. Wellington: Statistics New Zealand; 2001. [PubMed] [Google Scholar]
  46. Stuen C (1990) Psychosocial consequences of vision loss among the elderly. In: Johnson A, Lawrence M (eds) Low vision ahead: proceedings of the international conference on low vision. Association for the Blind, Melbourne, pp 149–153
  47. Upton LR, Bush BA, Taylor RE. Stress, coping, and adjustment of adventitiously blind male veterans with and without diabetes mellitus. J Vis Impair Blind. 1998;92:656–665. [Google Scholar]
  48. Walker A. A European perspective on quality of life in old age. Eur J Ageing. 2005;2:2–12. doi: 10.1007/s10433-005-0500-0. [DOI] [PMC free article] [PubMed] [Google Scholar]
  49. Williams RA, Brody BL, Thomas RG, Kaplan RM, Brown SI. The psychosocial impact of macular degeneration. Arch Ophthalmol. 1998;116:514–520. doi: 10.1001/archopht.116.4.514. [DOI] [PubMed] [Google Scholar]
  50. World Health Organization (WHO) (1993) The World Health Organization Quality of Life (WHOQOL)-BREF. http://www.who.int (Accessed 18 January 2001)
  51. Wurm S, Tomasik MJ, Tesch-Romerc (2008) Serious health events and their impact on changes in subjective health and life satisfaction: the role of age and a positive view of ageing. Eur J Ageing 5:117–127 [DOI] [PMC free article] [PubMed]

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