Chronic Disability in Old Age

Chronic impairments such as arthritis and vision or hearing loss become more normative with age and often involve major limitations in functional ability that can threaten a person's mental health and quality of life. Performing daily life tasks can become [Page 253]increasingly difficult due to an impairment, and new ways of coping are needed that allow a person to maintain his or her quality of life despite limitations.

Addressing this issue, recent research has shown that older adults who deal with any sort of major loss or decline tend to use and benefit from ways of coping that are compensatory in nature (Brandtstädter & Rothermund, 2002; Heckhausen & Schulz, 1995). Two main groups of compensatory strategies have been defined in this literature.

The first group of strategies may be characterized as a “maintenance approach,” because it aims at maintaining functional independence in one's daily life routines. This includes seeking out help from others or using technical aids or devices. For example, to compensate for a difficulty in reading, a person with visual impairment may ask others to read something to him or her or decide to use devices such a magnifier or special lighting. Similarly, a person with a hearing impairment may ask others to speak louder and more slowly, and use hearing aids or a selective amplification device to facilitate social interactions. An older person with arthritis may ask others to lift things, or use elevated beds and chairs that are easier to get in and out of.

Another strategy in this category could be to develop a system that allows getting a task done. For example, one might deal with mobility problems due to vision impairment by meticulously planning out one's route beforehand in order to be prepared, or manage the task of organizing one's home by creating contrast to counteract the problem of poor contrast sensitivity (e.g., using a white coffee cup to drink black coffee). A person with a hearing impairment may seek out or set up social interaction settings that minimize interfering background noise (e.g., having people over for dinner at home instead of meeting at a restaurant).

These kinds of strategies can help a person maintain prior levels of functioning and quality of life in many regards. However, when a chronic impairment worsens over time, there may be a point at which accomplishing certain tasks with the compensatory means described above becomes too difficult or even impossible. For example, if a person's vision gets much worse, reading with the help of a magnifier may become harder to do and help from others may not always be available as often as needed. In such a case, maintaining one's quality of life requires compensatory strategies of a different nature that are used either in addition to or instead of those described above.

Research has demonstrated that when efforts to reach an important goal repeatedly fail or become too costly, coping activity that allows for an internal adjustment becomes increasingly important (Brandtstädter & Renner, 1990). This kind of strategy may be referred to as a “reorientation approach,” because it includes adopting a mind frame of acceptance as well as focusing on other equally important activities. A person may think that while it is hard to no longer be able to read, there are other activities that are also very satisfying (e.g., listening to music). Alternately, the person with a hearing impairment may be increasingly bothered by listening to music with a hearing aid because of the distorting effects of the aid's amplification and may respond by thinking that listening to the music in one's own mind is still an option. Other possible strategies in this group could be to comfort oneself by locating the source of the problem externally (e.g., this is God's will), by thinking of others who may be worse off, or by reminding oneself that there have been worse times in one's own life. Overall, these types of strategies involve an inner adjustment of values, standards, and priorities that becomes adaptive when change in some daily activities become necessary.

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