Depressive Disorders

Mood Disturbances in Older Adults with Impaired Vision

Avatar photoBatya Swift Yasgur, MA, LSW
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Tactile Identification of Medications 

Because many visually impaired individuals use touch to identify their pills, it is extremely important to alert the pharmacy so the patient has been forewarned in the event of a medication substitution; for example, the use of a generic pill of 1 shape in place of a generic pill of the same dosage but a different shape, Dr Packer emphasized.

She recounted the story of a blind patient whose pharmacy switched to the generic formulation of a medication without alerting the patient. “The patient’s new pills were shaped like his cholesterol pills, and he was confusing each for the other,” she reported. “I found out because he was someone who had never called for an early refill, but he called, saying that he ran out of his medication in the middle of the month.” 

“This was a dangerous situation and a near miss,” she added.

Tips for Psychiatrists Treating Visually Impaired Patients 

  • Refer all patients with permanent vision loss to low vision rehabilitation. A vision rehabilitation team might include an ophthalmologist, low-vision specialist, occupational therapist, rehabilitation teacher, orientation and mobility specialist, and possibly a social worker or counselor.8 Government and private programs offer educational and vocational counseling, occupational therapy, and rehabilitation training. Many Medicare carriers now have policies that cover some vision rehabilitation services.9
  • Consider referring patients for psychotherapy. For example, stepped care, which consists of watchful waiting, guided self-help based on cognitive behavioral therapy, problem-solving treatment, and referral to a general practitioner, has been shown to be effective in improving depression and anxiety in visually impaired older adults.10 Cognitive behavioral therapy may be a helpful intervention for depression in visually impaired older adults.11 Problem solving therapy has likewise shown promise.12 It also may be helpful for patients to see a psychotherapist to talk about issues that are arising for them, Dr Rovner said. 

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Conclusion 

With the rising number of older adults experiencing comorbid visual impairment and mood disorders, it is essential to develop effective interventions. “Integrated care, a model that combines psychiatry and medicine is just around the corner and shows promise when looking at psychiatric treatments for people with low vision,” Dr Packer said. 

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Dr Rovner added, “”Do not give up or fall into therapeutic nihilism, thinking that blindness necessarily leads to depression.” There are many helpful interventions, and once the visual impairments are addressed, the depression will most likely improve as well. 

References 

  1. American Foundation for the Blind. Key definitions of statistical terms. http://www.afb.org/info/blindness-statistics/key-definitions-of-statistical-terms/25. Accessed August 17, 2017.
  2. American Foundation for the Blind. Aging and vision loss fact sheet. http://www.afb.org/section.aspx?SectionID=68&TopicID=320&DocumentID=3374&rewrite=0. Accessed August 17, 2017.
  3. Wahl HW. The psychological challenge of late-life vision impairment: concepts, findings, and practical implications. J Ophthalmol. 2013;2013:278135.
  4. Casten R, Rovner B. Depression in age-related macular degeneration. J Vis Impair Blind. 2008;102(10):591-599.
  5. Casten R, Rovner BW, Leiby BE, et al. Depression despite anti–vascular endothelial growth factor treatment of age-related macular degeneration. Arch Ophthalmol. 2010;128(4):506-508.
  6. Rovner BW, Casten RJ, Hegel MT, et al. Low vision depression prevention trial in age-related macular degeneration: a randomized clinical trial. Ophthalmology. 2014;121(11):2204-2211.
  7. Richa S, Yazbek JC. Ocular adverse effects of common psychotropic agents: a review. CNS Drugs. 2010;24(6):501-526.
  8. American Optometric Association. Low vision rehabilitation. https://www.aoa.org/patients-and-public/caring-for-your-vision/low-vision/low-vision-rehabilitation?sso=y. Accessed: August 17, 2017.
  9. Turbert D. Low vision rehabilitation and low vision aids. https://www.aao.org/eye-health/diseases/low-vision-aids-rehabilitation. Accessed August 17, 2017.
  10. Van der Aa HP, van Rens GH, Comijs HC, et al. Stepped care for depression and anxiety in visually impaired older adults: multicentre randomised controlled trial. BMJ. 2015;351:h6127.
  11. Utoyo DB. Modifying cognitive-behavioral therapy for a depressed older adult with partial sight: a case report. Gerontol Geriatr Med. 2015;1:2333721415585432.