Association between visual impairment and depression in the elderly

Background and Purpose: Visual disturbances greatly influence daily activities and social activities of the elderly. The purpose of this study was to investigate the association between impaired vision and depression among the elderly in a metropolitan community. Methods. A population-based survey of eye diseases among subjects 65 years of age and older was conducted in Taipei between July 1, 1999, and December 31, 2000. A total of 2045 subjects were invited to participate, and 1361 (66.6%) participated in the survey. A structured questionnaire was used for door-to-door data collection. Interviewers also collected information on subjects' demographic characteristics, medical history, and from the Geriatric Depression Scale-Short Form (GDS-S). Those subjects who had been interviewed were invited to the hospital for detailed eye examinations, including best-corrected visual acuity measurement. Results. Among the participants, the prevalence of impaired vision (visual acuity less than 6/12 in the better eye) was 7.2% and the percentage with depression (GDS-S scores of greater than or equal to 5) was 8.8%. Impaired vision [p < 0.05, odds ratio (OR) = 2.11], female gender (p < 0.05, OR = 2.03), cardiovascular disease (p < 0.05, OR = 1.72), and stroke (p < 0.05, OR = 2.85) were significantly associated with depression in multivariate analyses. Multiple logistic regression models were used to evaluate the impact of impaired vision on each depressive item of the GDS-S. After controlling for all other covariates, impaired vision was a positive predictor for the following 4 items of the GDS-S: elderly with impaired vision feel unhappy most of the time [OR = 1.73; 95% confidence interval (0) = 1.01 to 2.88]; they do not think it is wonderful to be alive now (OR = 2.13; 95% CI = 1.21 to 3.64); they feel worthless the way they are now (OR = 2.23; 95% CI = 1.24 to 3.90); and they feel that their situation is hopeless (OR = 1.95; 95% CI = 1.03 to 3.52). Conclusions: Visual impairment was associated with feelings of worthlessness and hopelessness in this community population of older adults. However, elderly people often ignore disturbances or impact associated with worsening vision. There is an ongoing need for public education regarding the need for elderly people to pay active attention to visual care in their later life.