The Difference That Age Makes: Cultural Factors That Shape Older Adults' Responses to Age-Related Macular Degeneration

Abstract: This article suggests that approaching vision loss from age-related macular degeneration from a sociocultural perspective, specifically considering perceptions of aging, blindness, disability, and generational viewpoints and norms, may be critical to understanding older adults' responses to vision loss and visual rehabilitation. ********** Older adults in rehabilitation practice are not only a growing population, but a unique one. The physiological differences between older adults with age-related macular degeneration (AMD) and young or middle-aged adults play a role in their overall function (for example, common age-related changes in learning patterns, balance, flexibility, muscle strength, hearing acuity, and tactile sensitivity). In addition, clients' medical conditions may contribute to functional deficits (such as the possibility of a minor stroke having caused idiosyncratic vision loss, the challenges of arthritis in handling adaptive devices, and the need to use a support cane to maintain balance). Furthermore, older adults with AMD present with a variety of patterns of vision loss that may appear unusual (like the combination of high acuity and low function caused by the loss of contrast sensitivity or ring scotomas). This article makes a corollary point with regard to culture: Just as the physical body--including the eyes affected by AMD--is unique in later life, so, too, may be the sociocultural perspectives of clients in later life. This uniqueness may matter in visual rehabilitation practice because it may contribute to the experiences of and responses to vision loss by older adults. A sociocultural perspective may include the social, psychological, and cultural aspects of vision loss (Milian & Erin, 2001). It focuses on the factors that shape an individual's experiences and perspectives and that are collectively shared by the community, such as language and social practices, service structures, and cultural viewpoints. This approach is rooted in social constructivism (Goffman, 1963). Sociocultural inquiry is rare in the context of studies on adults with AMD, who are most often culturally dominant Caucasians and for whom AMD represents the onset of a disease process, not the onset of a change in cultural identity or even a cultural experience. Rather, psychosocial is the more prominent term in the literature on adults with AMD. This literature suggests that a complex range of psychological factors are influential in determining older adults' responses to the loss of central vision. Negative responses to adapting to impairments may be caused or exacerbated by clinical depression (Tolman, Hill, Kleinschmidt, & Gregg, 2005). The belief that one's own actions determine outcomes, or one's internal locus of control, may substantially explain interindividual differences in affect, adaptation to vision loss, and functional ability, and beliefs about control are predictive of the use of assistive devices (Wahl, Becker, Burmedi, & Schilling, 2004). Spirituality, as opposed to religiosity, also predicts better adaptation to vision loss later in life (Brennan, 2004). This article suggests that along with psychosocial factors, sociocultural factors, including the intersections of AMD, aging, vision loss, blindness, disability, and generational norms, are more complex than they appear. These factors may have a significant impact on patients' or clients' self-reports, behaviors, and responses to vision loss. Exploratory interviews This article draws from semistructured, discussion-format interviews with 12 adults aged 78-92 with vision loss from AMD. These interviews were not designed to be representative, but, rather, exploratory and illustrative. The aim was to suggest areas for future qualitative research that move beyond psychosocial studies of older adults with AMD that focus on discrete answers to directed questions about individual coping strategies and elicit frameworks that may not account for the range of sociocultural dynamics at play in the complexity of older adults' responses to vision loss in later life. …