The primary aim of this longitudinal study is to examine the strategies used by older persons with visual impairment to balance and rebalance control in daily life, and to understand the course and consequences of such strategies over time. Because late-life vision loss constitutes a major threat to one's sense of competence and control, the proposed study provides a unique opportunity to apply the life-span theory of control (Heckhausen & Schulz, 1995) to a prototypical age-related loss characterized by gradual onset and progressive deterioration. In addition, differences in assimilative and accommodative coping dispositions (Brandtstädter & Renner, 1990) that may underlie patterns of control-related coping behavior will be examined.
The study sample consists of 364 older persons with a recent onset of age-related vision loss due to macular degeneration, a common cause of vision loss in late life. Data are being collected through inperson interviews at baseline, 1- and 2 year follow ups, with one interim telephone interviews each year at 6 and 18 months to capture both short and long-term stability and change in the use of control strategies over time, and the latter's relationship to functional and psychological well-being. Analyses will address concurrent associations (cross-sectional) and prospective relationships (longitudinal) using regression, individual growth modeling, and structural equation modeling (SEM) techniques.
Sample recruitment as well as data collection of baseline, 6-months and 1-year follow-up interviews is completed. Data collection of 18-months and 2-year follow-up interviews is still in progress but is anticipated to be completed in the beginning of 2008. Preliminary results based on baseline data have been presented at conferences on multiple occasions (see below), and a series of manuscripts reporting on baseline data are being prepared for submission to peer-reviewed journals.
Results (baseline data, N=364)
Control Scale Development
A critical component of this project is the development of the Vision-Specific Optimization in Primary and Secondary Control Scale (VIS-OPS), a domain-specific version of the general Optimization in Primary and Secondary Control scale (OPS; Heckhausen, Schulz, & Wrosch, 1998). The VIS-OPS contains 31 items and is comprised of four subscales representative of the four lifespan control domains; selective primary control (SPC; 6 items), compensatory primary control (CPC; 9 items), selective secondary control (SSC; 9 items), and compensatory secondary control (CSC; 7 items). Confirmatory factor analysis (CFA) was conducted on the four VIS-OPS subscales using structural equation modeling conducted with M-plus version 4.0 (Müthen & Müthen, 1998-2007). Goodness of fit was evaluated with the Root Mean Square Error of Approximation (RMSEA), with values of less than .08 considered acceptable fit. The SPC subscale fit the data well as a unidimensional measure (RMSEA = .024). The SSC scale fit the data well after the deletion of one item with weak factor loadings (RMSEA = .047). For the CSC subscale, the sequential elimination of two weakly loading items resulted in excellent model fit (RMSEA = .00). The CPC subscale was a more complicated issue. Initial CFA of the CPC subscale indicated poor model fit. We then conducted an exploratory factor analysis that indicated the presence of three factors for CPC items; CPC Informal Help, CPC Technical Aids, and CPC Unusual Means. The three-factor solution for the CPC items fit the data well (RMSEA = .037). Further work revealed that the three CPC subscales are explained by a second-order factor of general CPC. Chronbach's alphas for the revised version of the OPS show acceptable inter-item reliability; SPC = .61, CPC = .71, SSC = .73; CSC = .64.
Compensatory Strategies and Well-Being
We examined the role of different types of compensatory strategies in mediating the effect of functional disability on well-being based on the full baseline sample of n=364, using structural equation modeling. Three types of compensatory strategies were measured: use of technical aids (e.g., magnifiers, or special lighting), other people's help (e.g., help from family or friends), and new/unusual means (e.g., relying on other senses or memory to compensate for the vision loss). As expected, functional disability had indirect effects on well-being outcomes, as mediated by compensatory strategies. The model fit the data well (RMSEA = .058; 90% CI = .044-.073). Participants with greater disability reported more use of help from others and of unusual means, but they reported less use of technical aids. Technical aids use was related to better well-being, while use of unusual means and other's help indicated poorer wellbeing. Findings demonstrated the importance of compensatory strategies for adaptation to late life disability, and revealed differential effects for specific strategy types.
Vision-Specific Control Strategies and Well-Being
To address the cross-sectional aspects with regard to the role of control strategies, we finalized our analyses of the use of vision-specific control strategies and their relationship with psychological wellbeing (i.e., self acceptance, personal growth, and positive affect), utilizing the complete baseline data (n=364). Hierarchical regression analyses revealed that control strategies explained a significant proportion of the variance in the outcomes (between 4% and 9%) over and above demographics, disability, and social support. The direction of the effects was that more strategy use was related to better well-being. In terms of individual effects, one of the subcategories of compensatory primary control, the use of adaptive aids, was particularly important in the prediction of personal growth, and selective and compensatory secondary control emerged as important predictors of self acceptance and positive affect.
Boerner, K., Horowitz, A., Reinhardt, J. P., & Brennan, M. (2004). Coping behavior and mental health in elders with vision loss: Preliminary findings from a longitudinal study. Maximizing Human Potential, 12(2), pp. 3, 7.
Boerner, K., Brennan, M., Horowitz, A., & Reinhardt, J. P. (November, 2006). Coping with functional loss in later life: Compensatory strategy use and well-being. In H. W. Wahl & K. Boerner (Chairs), Adaptation under constraints: Chronic conditions and very old age. Symposium presented at the annual scientific meeting of The Gerontological Society of America, Dallas TX.
Brennan, M., & Boerner, K. (November, 2005) Psychometric Analysis of the TEN-FLEX Coping Scales: Evidence for 2nd-order Factors and Further Psychometric Development. Poster to be presented at the annual scientific meeting of The Gerontological Society of America, New Orleans, LA.
Brennan, M., Boerner, K., Horowitz, A., & Reinhardt, J. P. (August, 2005). Problem solving and adaptation to age-related vision loss. Poster presented at the annual convention of The American Psychological Association. Washington, DC.
Brennan, M., Boerner, K., Horowitz, A, & Reinhardt, J. P. (November 2007). Further development of the vision-specific OPS scale: Differentiating three dimensions of compensatory primary control. Poster submitted to the annual scientific meeting of The Gerontological Society of America, San Francisco, CA.
Brennan, M., Boerner, K., Reinhardt, J. P., & Horowitz, A. (November, 2004). Applying the Life-span Theory of Control in Adjustment to Chronic Illness: The Development of the Vision-Specific OPS Scale. Poster presented at the annual meeting of The Gerontological Society of America, Washington, DC.
Horowitz, A., Boerner, K., Brennan, M., & Reinhardt, J. P. (November, 2004). Successful aging within the context of disability: Use of control strategies by visually impaired elders. In D. Jopp (Chair). Successful development and aging: On the impact of resources, strategies, and beliefs. Paper presented at the annual meeting of The Gerontological Society of America, Washington, DC.
Horowitz, A., Boerner, K., Brennan, M., & Reinhardt, J. P. (November 2007). Tackling late life challenges: Control strategy use as a function of disability. In H. W. Wahl (Chair), Crossroads of psychological, social and physical function: Implications for disability research. Symposium submitted to the annual scientific meeting of The Gerontological Society of America, San Francisco, CA.
Horowitz, A., Boerner, K., Brennan, M., & Reinhardt, J. P. (November, 2005). Coping with Age-Related Vision Loss: The Role of Domain-Specific Control Strategies as well as Assimilative and Accommodative Coping for Well-Being. In K. Boerner (Chair), Coping with disability in later adulthood. Symposium to be presented at the annual scientific meeting of The Gerontological Society of America, New Orleans, LA.
Horowitz, A., Boerner, K., Reinhardt, J. P., & Brennan, M. (November, 2002). Applying the Life-Span Theory of Control to research on adaptation to age-related vision loss. Paper presented at the annual meeting of The Gerontological Society of America, Boston, MA.
Investigators: Amy Horowitz, DSW, Principal Investigator
Joann P. Reinhardt, PhD, Co-Investigator
Mark Brennan, PhD, Co-Investigator
Kathrin Boerner, PhD, Co-Investigator/Project Director
Luba Popivker, BA, Admin/Research Assistant
Meghan Marty, MA, EdM, Research Assistant
Funded by: National Institute of Mental Health (NIMH)
Project Period: 5/15/02 - 4/30/07