Poor vision, functioning, and depressive symptoms: a test of the activity restriction model

Abstract

Purpose: This study tested the applicability of the activity restriction model of depressed affect to the context of poor vision in late life. This model hypothesizes that late-life stressors contribute to poorer mental health not only directly but also indirectly by restricting routine everyday functioning.

Method: We used data from a national probability-based sample of older adults (N = 1,178; M = 69.2 years, approximately 50% female). Vision was assessed both subjectively (via self-report) and objectively (via a visual acuity test). Respondents also reported on their levels of physical and driving limitations, feelings of social isolation, and symptoms of depression.

Results: Path analyses indicated a strong fit of the data to the activity restriction model for subjective vision. In addition to directly contributing to higher depressive symptomatology, subjective vision contributed to depressive symptoms indirectly by predicting more physical limitations and feelings of social isolation that, in turn, contributed to more symptoms of depression; driving limitations did not mediate the relationship between subjective vision and depressive symptomatology. Objective vision contributed significantly to physical and driving limitations but was unrelated to feelings of social isolation and depressive symptomatology.

Implications: Supporting the activity restriction model, poorer self-rated vision in late life contributes to lower mental health directly and also indirectly by restricting individuals' ability to carry out routine day-to-day physical activities and increasing their feelings of social isolation. Interventions for older adults with vision-related problems could focus on maintaining or enhancing their physical and social functioning in order to promote their adaptation to poor vision.

Figure 1.

Final path model testing physical limitations, driving limitations, and social isolation as mediators of the vision-depressive symptomatology link. Notes: **Standardized path coefficients significant at p < .01 or better. Significant paths from the control variables to the endogenous variables (not shown in Figure 1) were as follows: Being female (β = .09, z = 2.99, p < .001) and less educated (β = −.13, z = −4.34, p < .001) were associated with more physical limitations, and being older (β = .12, z = 4.36, p < .001), female (β = .16, z = 6.05, p < .001), less educated (β = −.09, z = −2.98, p < .001), and non-White (β = .06, z = 2.18, p < .05) were associated with more driving limitations. Being younger (β = −.12, z = −3.83, p < .001), female (β = .08, z = 2.61, p < .05), and not married (β = .17, z = 5.71, p < .001) were significantly associated with more feelings of social isolation. Being less educated (β = −.07, z = −2.93, p < .01) and being White (β = −.05, z = −2.00, p < .05) were linked to more depressive symptoms.