The Positive Effects of In-Home Occupational Therapy
by Lynn Hetzler
When people lose their vision as they grow older, they also lose the ability to socialize, engage in hobbies, and participate in activities of daily living. A person may not be able to read, cook, or socialize with friends and family, and this can cause the older adult to feel embarrassed, demoralized, and withdrawn.
In-home occupational therapy can reduce the rate and severity of depression in patients who are at a high risk for disorder due to serious visual impairment, according to a new study by researchers from Johns Hopkins, while it helps improve visual function.
Depression is not a normal part of aging, according to the Centers for Disease Control and Prevention. Fortunately, the majority of older adults do not experience chronic depression. While it is not an inevitable part of aging, depression affects an estimated 1 to 5 percent of older adults living in the community, 11.5 percent of older hospital patients, and 13.5 percent of those requiring home health care. Depression is more common in those with chronic, debilitating conditions, such as visual impairment.
About 6.7 percent of people who are 65 and older in the United States have a visual disability, according to 2014 statistics presented by the National Federation for the Blind. Vision loss often causes a short bout of depression, particularly in cases of age-related macular degeneration. People with this condition are at particular risk for depression because of the way AMD affects vision – by robbing them of the ability to see fine details. Those with AMD lose the ability to read, watch TV, recognize faces, and read facial expressions.
Deep feelings of grief, frustration, and anger resulting from the isolation and loneliness can lead to depression, as can the prolonged inactivity and boredom associated with vision loss. Depression can also develop out of fear for the future or feeling out of control or out of options. Some individuals with vision impairment may think there is nothing they can do about their loss.
Previous research shows that multidisciplinary treatment can help depression from age-related vision loss.
The goal of the study was to find out if occupational therapy was a better investment than supportive therapy for preventing depression in patients with low vision.
Scientists evaluated information gathered from previous research, the Low Vision Depression Prevention Trial in Age-Related Macular Degeneration (VITAL) study at Thomas Jefferson University in Philadelphia. The researchers included data on 188 patients with age-related macular degeneration. The average age of participants was 84, and 70.2 percent of participants were female. Average visual acuity was 20/96, meaning the average participant could see an object 20 feet away as someone with good vision could see at 96 feet.
All participating patients reported borderline depressive symptoms and scored higher on a clinical survey used to estimate depression risk, known as the Patient Health Questionnaire-9. A score of 0 on this survey indicates no depression or a low risk of depression, while a score of 20 or higher indicates a risk for severe depression. All participants included in the recent study scored greater than 5 on the Patient Health Questionnaire-9.
The patients participating in the study visited a low-vision rehabilitation optometrist after enrollment in the study. There, they completed the activity inventory questionnaire to rate the difficulty of everyday tasks. The adaptive visual function AI questionnaire assesses the difficulty and importance of daily activities, such as driving, using a computer, reading for pleasure, and cooking. The scientists performed this assessment at the beginning of the study and again at 4 months.
The researchers then divided the participants into two groups. An occupational therapy group served as the test group, and a supportive therapy group served as the control. Members of the test group met underwent six one-hour occupational therapy sessions in their homes. There, occupational therapists offered behavioral activation. Behavioral activation is a structured behavioral treatment that increases adaptive behaviors in ways to help patients achieve goals they deem important. In addition to behavioral activation, the therapists offered low vision rehabilitation, in which they trained participants to use magnifying glasses, computers and electronic devices to help them perform tasks the patients deemed important and difficult. If an individual had difficulty reading mail, for example, the occupational therapist would train the patient to use a magnification device and practice with the patient until the participant could successfully read the mail.
Acting as the control group for comparison, the supportive therapy group met with a social worker for six one-hour talk therapy sessions, which focused on supporting personal expression about disability and loss. These sessions provided attention and empathetic support but did not offer any specific occupational therapy that would improve function.
The participants took the PHQ-9 test and the activity inventory again after 4 months of treatment.
At the start of the study, the average PHQ-9 score for the occupational therapy group was 5.5. For the supportive therapy group, it was 5.6. This means participants in both groups were at the borderline for having a depressive disorder.
The participants completed the PHQ-9 depression questionnaire again after 4 months of treatment. After treatment, depression scores for those in the occupational therapy patient group dropped to 4.62 while the average score for those receiving supportive therapy dipped to 4.54, which shows that both occupational and supportive therapy can have protective effects against depression.
At the follow-up, the researchers found that depression symptoms worsened for 26 percent of those receiving supportive therapy while depression symptoms worsened for only 12 percent of those receiving occupational therapy.
Improvements in functional vision too
Participants in both the occupational therapy group and the supportive therapy group enjoyed improvements in functional vision. Specifically, those receiving occupational therapy demonstrated greater improvements in reading, inside-the-home tasks, and outside-the-home tasks as compared with those receiving only supportive therapy. The greatest effects were noted in the occupational therapy group, with a visual acuity greater than 20/70.
In the results of the study, published in Investigative Ophthalmology & Visual Science, the researchers concluded that patients with low vision who engage in in-home training with an occupational therapist to improve their activities of daily living improve visual function and have less severe depression symptoms than do similar patients who do not train with an occupational therapist.