As the leading cause of irreversible blindness and severe vision loss among older adults, Age-related Macular Degeneration (AMD) affects more than 10 million people in the US. The aging of the population has led some to forecast an epidemic of AMD. Loss of independence and valued activities places AMD patients at increased risk for depression, anxiety, and disability. Many are pessimistic and reluctant to plan for future housing and mobility problems associated with vision loss. Patients'emotional and behavioral responses to AMD can exacerbate the long-term health threat of the disease and contribute to preventable health care costs, loss of productivity, and burden to family members. We propose a randomized controlled trial of a psycho-social intervention that addresses three mental health promotion goals: (1) increase emotional well-being, (2) improve future outlook, and (3) protect or enhance current and future-oriented functioning. Our Preventive Problem Solving Intervention (PREPSI) is a short, standardized modification of problem- solving therapy that trains participants to identify and clearly define current and future problems, and then generate, evaluate, choose, and implement solutions. In addition, we provide group-based education on disease-management.
We aim to improve risk perception, awareness of options, preference formation, and active decision-making for future concerns, e.g., care settings, social needs, and residential adjustments. The long-term goal of our research program is to improve quality of life in late adulthood by conducting basic and translational research on preventive future planning. The proposed study examines the effects of the PREPSI on 400 AMD patients 60 and older, who have best corrected vision acuity of 20:60 in their better eye. They will be randomized to 8 PREPSI sessions with master's level trainers or to an enhanced attention control arm in which medical students conduct "Life and Health Review." All study participants will receive 4 vision education classes and resource information. Assessors blind to treatment condition will measure Psychological Well-being (primary outcome), Future Outlook, Everyday Functioning, and Preparation for Future Care (secondary outcomes) at 4 time points throughout the intervention and every 6 months in a 24 month follow-up. Our intervention will improve AMD patients'quality of life and could inform programs for other chronic diseases. PREPSI is designed to be transportable and could be implemented in low vision clinics by staff with minimal training. Next steps could include multi-site trials or dissemination into eye clinic networks. This proposal builds on a NIA K01 to the PI that focused on observational studies of the effect of PFC on subjective well-being and everyday functioning for older adults. This is the applicant's first R01 submission.

Public Health Relevance

Age-related Macular Degeneration (AMD) is the leading cause of irreversible blindness and severe vision loss among older adults;its down-hill course is well-described, and many patients suffer from subsequent emotional distress, negative future outlook and functional impairments. Effective problem-solving, planning for future care and residential needs, and disease management education could address the emotional and behavioral effects of AMD and prevent the consequent adverse health outcomes, such as falls, emergency room visits and increased Medicare costs. Because most AMD patients do not plan proactively for long-term care or future residential needs, this application proposes a randomized controlled trial of a psycho-educational health- promotion intervention, Preventive Problem Solving Training to determine whether problem-solving and future planning interventions can enhance emotional well-being, functioning, and planning in patients with this and other chronic progressive illnesses.

National Institute of Health (NIH)
National Institute on Aging (NIA)
Research Project (R01)
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Behavioral Medicine, Interventions and Outcomes Study Section (BMIO)
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Nielsen, Lisbeth
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University of Rochester
Schools of Dentistry
United States
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