Patients with macular degeneration -- the leading cause of incurable vision loss in older adults -- experienced better moods, made greater use of visual aids, and had greater confidence in their ability to function after completing a six-week program specially designed to help them cope with the physical and emotional demands of the disease.
"The progressive deterioration of vision caused by macular degeneration causes great distress, and medical treatments to slow this disease are limited," said Stuart I. Brown, MD, one of the authors of the study. "Our findings demonstrate the utility of a brief, behavioral self-management group in reducing distress, enhancing self-efficacy, and improving adaptation among a population with few other options for treatment."
Macular degeneration does not result in total blindness. Atrophy or hemorrhage of a structure on the retina called the macula destroys a person's central field of vision -- preventing them from reading, driving, or performing other detail-oriented tasks -- but leaves their peripheral vision intact.
Brown and colleagues at the University of California, San Diego designed a six-week self-management program to help patients cope with the disease. They compared the functioning of 44 elderly patients who completed the program with 48 other patients waiting to participate. During the program, participants heard talks on the cause and treatments for the disease and were introduced to visual aids to help maintain their independence. They also learned cognitive behavioral techniques designed to help them maintain a positive attitude, identify and use positive coping techniques, and set realistic goals. The researchers reported their findings in the current issue of Annals of Behavioral Medicine.
About one month after completing the program, patients reported significant improvements in mood compared with those on the program waiting list. For example, participation in the program increased patients' ability to concentrate and think clearly and reduced symptoms of anxiety, depression, and loneliness.
Those who completed the program also showed greater confidence in their ability to manage on a daily basis with the disorder. Previous research suggests that higher levels of this trait -- called "self-efficacy" -- can lead to better outcomes for patients with chronic illnesses, the investigators note.
That increase in self-confidence appeared to translate into action. Program participants not only reported greater use of vision aids, they also were more likely to participate in new activities, such as gardening and landscaping, and were more likely to continue other activities, such as walking, attending sporting events, and sewing or other crafts. Attendance at movies and religious observances declined, however.
"This intervention has the potential to benefit many with age-related macular degeneration who currently have no other options for treatment," said Brown. "Although it is a disease that cannot be cured or prevented, the consequences of the ensuing deterioration of vision have the potential to be modified by behavioral intervention."
Annals of Behavioral Medicine is the official peer-reviewed publication of The Society of Behavioral Medicine. For information about the journal, contact Arthur Stone, PhD, 516-632-8833.
Posted by the Center for the Advancement of Health www.cfah.org. For information about the Center, call Petrina Chong, pchong@cfah.org (202) 387-2829.
Journal
Annals of Behavioral Medicine