Horowitz, Ann, Leanard, Robin and Reinhardt, Joann P.,

2000,

Reviewed by Sally French, King Alfreds College of Higher Education, Winchester
& John Swain, University of Northumbria

Methodology

395 visually impaired older people (aged 55 to 99 years) took part in the Adaptive Skills Training Programme. This programme, which trains people in groups, was developed by the New York State Commission for the Blind and Visually Handicapped in conjunction with private agencies.

The research participants were obtained by contacting five rehabilitation centres in rural areas of the USA. The data was collected from 1995 to 1998 and was designed to evaluate the psychosocial and functional outcomes of group rehabilitation for visually impaired older people.

79% of the research participants were women with a mean age of 77 years. 95% had low vision and 5% were blind. The programme consisted of 12 sessions of three to four hours each. On average the research participants attended eight sessions. The goals of the rehabilitation were to encourage as much independence as possible and to help people to decide how and when to request assistance ‘appropriately’. The training covered areas concerned with: personal care, clothing, meals, household tasks, orientation and mobility, communication skills and adaptive equipment. Counsellor facilitated discussion was also provided. It was hypothesised that functional ability and psychosocial well-being would improve following the training.

The research participants completed a questionnaire before and after the training. Staff involved in the rehabilitation programme were trained to assist the research participants to complete the questionnaires which contained questions relating to demographic information, functional ability and psychosocial well-being. The analysis was conducted to compare pre and post-training indicators of psychosocial status and functional ability. In addition the interaction of each outcome variable with age and living arrangements was examined. The tentative hypothesis was that the younger people would respond more positively to the training. Age was categorised as ‘young old’ (55-79) and ‘old old’ (80 and over). Analysis of variance was used to analyse the data. The three psychosocial variables were: Adaptation to visual loss, life satisfaction, and feelings of sadness or depression. The three functional variables were: Managing daily household tasks, getting to places outside the home, and caring for personal needs.

Most research concerning the rehabilitation of visually impaired people relates to young people and focuses on individual rehabilitation or residential services. There had been no evaluation of the outcome of group rehabilitation prior to this study even though the importance of peer support is well known.

Critical appraisal

Because of financial constraints, the interviews were completed with the help of staff working in the service rather than a neutral person. This may have inhibited the research participants in saying what they really felt with a possible distortion of the data.

Changes were measured over a relatively short period of time. It would be interesting to see whether the changes were still present a year or two later.

There was no control group of visually impaired people who had received one-to-one rehabilitation.

The data was quantitative and structured giving little opportunity for the research participants to expand their views in the complex areas of functional ability and psychosocial well-being.

There was no evidence that the research participants had been consulted or were in any way involved in the research other than as research participants.

There was no indication of the factors which had helped the research participants to improve their psychosocial well-being. Was it, for example, contact with their peers who were going through the same experience, the counselling, their greater competence with functional tasks or a combination of these factors?

Key findings

Statistically significant differences were found on all three psychosocial variables (p<.001) with substantial improvement following the rehabilitation programme. Those who lived with others were better adapted to their vision loss (p<.04) and were more satisfied with life overall (p<.009). Age was not a significant factor on any of the variables.

Statistically significant differences were found on all three areas of functional status with substantial improvement following the rehabilitation programme: managing daily household tasks (p<.01), getting to places outside the home (p<.001) and caring for personal needs (p<.01). 75% of the research participants planned to continue rehabilitation services after the programme which indicates their positive feelings about it.

Social work practice/ policy implications

• This research indicates that visually impaired people, despite their age, are capable of improving on both functional and psychosocial dimensions following group rehabilitation. Such rehabilitation should be increased and made available to visually impaired people regardless of their age.
• There needs to be greater involvement of visually impaired older people in the planning of rehabilitation services where their views can be gathered on what they want and what they feel is likely to be most useful to them.
• More resources and planning need to be devoted to the growing number of older visually impaired people.