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The relationship between loneliness and perceived quality of life among older persons with visual impairments.

Older persons with visual impairments are consistently found to score lower on measures of qualify of life (QOL) than their sighted peers regardless of the type of measure used (such as measures of PQOL, health-related QOL or vision-related QOL; Bekibele & Gureje, 2008; Chia et al., 2004; Frost et al., 2001; La Grow, Alpass, Stephens, & Towers, 2011; La Grow, Sudnongbua, & Boddy, 2011). These lower scores are generally attributed to a number of factors associated with late-onset visual impairment, including increasing age, decreased physical and mental health, the onset of functional limitations including a reduction in independent mobility, reduced economic status, higher rates of social isolation, and lowered levels of satisfaction with life (Frost et al., 2001; La Grow, Alpass et al., 2011).

Interestingly, all of these factors, as well as the onset of visual impairment, are also associated with increased rates of loneliness in the older population in general (Heylen, 2010; Luanaigh & Lawlor, 2008; Prieto-Flores, Forjaz, Fernandez-Mayoralas, Rojo-Perez, & MartinezMartin, 2011; Routasalo & Pitkala, 2003). As such, it is logical to assume that rates of loneliness would be higher among older persons who are visually impaired than among those who are not. Also, since loneliness has been identified as a fundamental contributor to decreased QOL in older adults in general (Hawton et al., 2011), it is logical to assume that this relationship exists for the subpopulation of older visually impaired people as well.

There is some evidence to suggest that the rates of loneliness are higher in people with visual impairments (Alma et al., 2011; Verstraten, Brinkmann, Stevens, & Schouten, 2005). However, there is little to no evidence regarding an association between loneliness and PQOL in this population, nor is there any evidence that loneliness differentially impacts on the PQOL of visually impaired and sighted older adults. There appear to be two primary reasons that informative research in these areas has been stifled. First, research with older adults has often conceptualized loneliness in objective terms (that is, quantity of social contacts, or levels of social isolation; La Grow, Alpass et al., 2011). However, this research differs from the subjective experience of loneliness (that is, the quality of social relationships regardless of their frequency or volume), since it is commonly defined in the literature (de Jong Gierveld, 1998; Peplau & Perlman, 1982) and is known to affect perceived well-being in older adulthood (Golden et al., 2009). Second, while some previous research has explored QOL in older visually impaired people, the QOL measures utilized were predominantly either vision-related (Hernandez, Trillo, & Dickinson, 2012), health-related (Crews, Chou, Zhang, Zack, & Saadine, 2014), or proxy indicators (Lewis, Brown, & Barrett, 2011), rather than being measures of PQOL. Such measures simply define QOL as the impact of disease, while measures of PQOL provide a much broader assessment of general well-being and social satisfaction that is foundational for understanding successful aging in visually impaired and sighted older adults (Gabriel & Bowling, 2004; Renaud et al., 2010). The consistent use of condition-specific or proxy QOL indicators in research on visually impaired populations means that there is little understanding of the level of PQOL in older visually impaired people living in the community; that levels of PQOL and loneliness in visually impaired and sighted populations cannot be compared; and that it is not possible, therefore, to identify whether perceived loneliness differentially predicts PQOL for visually impaired or sighted people.

With older adults (those aged 65 and older) constituting the majority of the visually impaired population globally (WHO, 2012), there is growing need for robust, high-quality studies to explore the role loneliness plays in the PQOL of those who are visually impaired (Nyman, Gosney, & Victor, 2010). This study seeks to use a subjective measure of loneliness (the de Jong Gierveld Loneliness Scale; see de Jong Gierveld, van Groenou, Hoogendoorn, & Smit, 2009) to determine: (a) the rate and degree of loneliness in a group of older visually impaired persons, (b) the association between degree of loneliness and variables thought to impact PQOL in this population, and (c) the contribution social and emotional loneliness make to the prediction of variance in PQOL.

Methods

SAMPLE

The sample for this study constituted all participants in the second wave (2012) of the New Zealand Longitudinal Study of Ageing (NZLSA) who had responded to the single item that served as the visual status screen, and to all 11 items in the de Jong Gierveld Loneliness Scale (N = 2,683). The NZLSA selection methods and procedures have been described in detail elsewhere (Towers & Stevenson, 2014) but, in brief, all participants in NZLSA were randomly selected from the New Zealand electoral roll and asked to complete a paper-based postal questionnaire that included a broad range of measurement domains. Study procedures were approved by the Massey University Human Ethics Committee (MUHEC Southern B 09/70) and were carried out in accordance with the tenets of the Declaration of Helsinki. Demographic characteristics of this sample are provided in Table 1.

MEASURES

Demographic variables and visual status

Participants were asked to report their date of birth, gender, marital status, and living arrangement, and were screened for visual impairment using the single-item measure sourced from the New Zealand Disability Survey (Statistics New Zealand, 2014a), which reads "Can you see ordinary newsprint with glasses or contacts if you usually wear them?" Participants could respond with (1) "easily," (2) "with difficulty," or (3) "not at all." Those who responded "with difficulty" or "not at all" were designated as being visually impaired.

Loneliness

The degree (continuous variable) and level (categorical variable) of loneliness were determined using the de Jong Gierveld Loneliness Scale (de Jong Gierveld et al., 2009). The scale requires participants to read 11 statements and rate whether each item applies to their current feelings by responding "Yes," "More or less," or "No." Six items measure emotional loneliness and five measure social loneliness. Levels of loneliness were determined based on the number of items to which the participant responded as being lonely (with a "Yes" or "No," depending on the direction of the question); cut-off points proposed by the authors of the scale were used. Participants were categorized as being not lonely (scores of 0 to 3), moderately lonely (scores of 4 to 8), and severely lonely (scores of 9 to 11). Total emotional and social loneliness scores were also determined by summing the scores obtained on each of these subscales in accordance with the scale authors' instructions. Scores were transformed as required to ensure that higher scores indicated a greater degree of loneliness; scores ranged from 6 to 18 on the emotional loneliness scale and 5 to 15 on the social loneliness subscale.

PQOL, ability to get around, satisfaction with activities of daily living, and satisfaction with life

PQOL, ability to get around, satisfaction with activities of daily living, and satisfaction with life were assessed using single items which read: (a) "How would you rate your quality of life?" (b) "How well are you able to get around?" (c) "How satisfied are you with your ability to perform your daily living activities?" and (d) "All things considered, how satisfied are you with your life as a whole these days?" Responses were made on a 5-point scale, with 1 being very negative and 5 very positive.

Economic well-being

Participants completed the Economic Living Standard Index-Short Form (ELSISF; Jensen, Spittal, Crichton, Sathiyandra, & Krishnan, 2002), which was developed by the New Zealand government as an indicator of well-being related to capacity for economic consumption, economic-related social activity, and asset ownership, rather than providing a simple assessment of the economic resources that enable them (income). The 25-item scale assesses restrictions in ownership of assets (eight items), restrictions due to cost in social participation (six items), the extent to which respondents economize (eight items), and a self-rated indicator of standard of living (three items). The individual subscales are recoded (as per scale authors' instructions), and overall items are summed to form a continuous variable ranging from 0 to 31 such that higher scores reflect higher economic living standards.

Physical and mental health

Physical and mental health was assessed using the 12-item Health Survey-Short Form, Volume 2 (SF-12v2; Ware, Kosinski, & Dewey, 2000). The SF12v2 produces separate summary indicators of physical and mental health. Scores on each summary indicator are normalized to a mean of 50 for the general population. Participants were also asked to indicate if they had been diagnosed by a health professional with any of 12 specified and one unspecified ("other") chronic health conditions commonly associated with aging (for example, arthritis, heart trouble, and high blood pressure). Responses were summed to indicate the total number of diagnosed health conditions identified.

PROCEDURES AND ANALYSIS

This study constituted a secondary analysis of data from the second wave (2012) of NZLSA (Towers & Stevenson, 2014). Analyses for this study were conducted in three stages. In stage one, participants were assigned to two visual status groups (visually impaired and sighted) based on their visual status screening response. These groups were compared on all variables assessed except for visual status. Stages two and three were conducted with those from the visually impaired group only. In stage two, participants were assigned to three groups based on degree of loneliness (not lonely, moderately lonely, or severely lonely) and compared on all variables assessed except for visual status and degree of loneliness. In stage three, all variables, except for visual status and PQOL, were considered for inclusion as independent variables in the equation used to conduct a standard multiple regression analysis that was run to determine the contribution they made both singly and collectively to the prediction of variance in PQOL.

Preliminary assumption testing was carried out before any analyses were conducted. No violations of assumptions were found for any of the cross-group analyses planned for stages one and two. Thus, no adjustments were required for analyses conducted in these stages. However, as recommended by Pallant (2011), a Bonferroni adjustment was made to all alpha levels in the comparisons of scaled factors (such as age, physical and mental health, or PQOL) across groups in order to reduce the possibility of an increased chance of making a Type I error resulting from the high number of repeated measures. As a result, alpha was set at p = 0.01(0.05/9 = 0.006) for these comparisons. Violations of multicolinearity and singularity were found for the multiple regression planned for stage three. Required adjustments were made for this analysis and are reported in the Results section. Indicators of effect size for all statistical analyses were reported, as per best practice for statistical communication, in order to provide greater clarity of the impact that any independent variable might have on a dependent variable. All analyses in this study were conducted using IBM SPSS 22 and AMOS 22.

Results

STAGE 1: A COMPARISON OF VISUALLY IMPAIRED AND SIGHTED OLDER ADULTS

Of the 2,683 participants in this study, 315 (11.7%) indicated that they could read newsprint with difficulty or not at all. These participants were designated as being visually impaired. The remaining 2,368 (88.3%) who stated that they could read ordinary newsprint easily were designated as "sighted." Crosstabs with chi-square ([chi square]) were employed to compare visually impaired and sighted groups on all categorical factors (for instance, gender) and independent-samples t tests were used to assess differences between the groups on scaled factors. The results in Table 1 indicate that no statistically significant differences exist between groups on age, gender or living arrangement. Significant differences found on the remaining variables suggest that the visually impaired group is more likely to be single, in poorer health, less economically well off, less satisfied with their ability to perform activities of daily living, less mobile, less satisfied with their lives, and experiencing worse PQOL than the sighted group. The visually impaired group was also found to be significantly lonelier (particularly severely lonely) than the comparison group. Although the effect size for the differences found between the groups was small for loneliness, the effect size for all other significant differences found met or exceeded the "medium" threshold, indicating that visual impairment is significantly and detrimentally associated with older adults' general well-being.

STAGE 2: ASSESSING OLDER VISUALLY IMPAIRED adults' WELL-BEING BY LEVELS OF LONELINESS

In order to assess the relationship between loneliness and well-being in older visually impaired adults, those in this group (n = 315) were divided into three subgroups according to reported loneliness level: not lonely = 147, moderately lonely = 122, and severely lonely = 46. Crosstabs with chi-square ([chi square]) were employed to compare the groups on all categorical factors. Analyses of variance (ANOVA) were used to assess differences on the scaled factors across the three subgroups with Tukey's Honestly Significant Difference test utilized to determine specific group differences. The results in Table 2 indicate that significant differences were found across the groups on all variables except for age, gender, marital status, and living arrangement. Follow-up analysis indicates that ordinal increases in loneliness were directly associated with significant decreases in economic well-being, mental health, satisfaction with activities of daily living, satisfaction with life, and PQOL. Furthermore, these differences were found to have very large effect sizes, suggesting that broad increases in loneliness impact substantially on these factors. Significant differences in the number of diagnosed health conditions reported and physical health were only found between the not lonely and severely lonely groups, indicating that the former were healthier than the latter. Lastly, while the not lonely group had significantly better ability to get around than either the moderately or severely lonely groups, the differences were small.

STAGE 3: ASSESSING THE OVERALL IMPACT OF SOCIAL AND EMOTIONAL loneliness ON THE PQOL OF OLDER VISUALLY IMPAIRED adults

In stage three, a regression analysis was conducted to determine the extent to which the variables under consideration, including the separate indicators of social and emotional loneliness, collectively and uniquely predict variance in PQOL. Prior to this analysis a bivariate correlation (see Table 3) was run to check that all independent variables were at least minimally ([greater than or equal to] 0.3) correlated with PQOL and that no independent variables were too highly correlated ([greater than or equal to] 0.7) with one another. Age, gender, marital status, living arrangements, and total number of diagnosed health conditions were not found to meet the standard set for being considered at least minimally correlated with PQOL, and were therefore excluded from further analysis. Ability to get around was found to be too highly correlated with both physical health and satisfaction with activities of daily living, and was also excluded. The resulting regression model, therefore, included the following independent variables: economic well-being, physical health, mental health, satisfaction with activities of daily living, satisfaction with life, social loneliness, emotional loneliness, and the dependent variable PQOL. The results of the regression analysis (see Table 4) indicate that this seven-predictor model accounts for 66% ([R.sup.2] = .66) of observed variance in PQOL among this group of older visually impaired people. Physical health, mental health, satisfaction with activities of daily living, satisfaction with life, and social loneliness all made unique and significant contributions to PQOL, while economic well-being and emotional loneliness did not.

Discussion

Just over 11.5% of this sample met the criteria to be designated as being visually impaired; similar to the 11% estimated for persons 65 years and older living in New Zealand (Statistics New Zealand, 2014b). This group of participants was found to have more diagnosed health conditions and poorer physical and mental health, economic well-being, mobility, satisfaction with activities of daily living, satisfaction with life, and PQOL, and reported significantly higher rates of moderate and severe loneliness than their sighted counterparts. The key distinctions in the profiles of older visually impaired and sighted adults found in this study are consistent with previous findings (Bekibele & Gureje, 2008; Chia et al., 2004; Frost et al., 2001; La Grow, Alpass et al., 2011: La Grow, Sudnongbua et al., 2011). However, this study adds to the sparse evidence available on the comparative rates of loneliness among older visually impaired adults. Specifically, we found that 53.3% of those who were designated as having a visual impairment felt lonely compared to 35.5% of those who were sighted. Furthermore, the rate of severe loneliness among the visually impaired group (14.6%) was almost double that of the sighted group (8.4%).

Increasing levels of loneliness were found to be associated with large decreases in economic well-being, mental health, satisfaction with activities of daily living, satisfaction with life, and PQOL among those who were visually impaired. Smaller decreases in physical health and the number of chronic health conditions were also apparent, but only between those at the extreme ends of the loneliness scale (not lonely vs. severely lonely). Those who were not lonely reported a greater ability to get around than those who were lonely, although this difference was relatively small. To the best of our knowledge, this is the first study to provide such detailed analysis of the factors associated with increased loneliness in an older visually impaired sample.

Our findings that physical health, mental health, satisfaction with activities of daily living, and satisfaction with life made a unique and significant contribution to the PQOL of older visually impaired people confirms our earlier findings (La Grow, Alpass et al., 2011; Yeung, La Grow, Towers, Alpass, & Stephens, 2011). However, the inclusion of social and emotional loneliness in the current model was novel, as was the finding that social loneliness made a unique and significant contribution to the prediction of variance in PQOL above and beyond that of other predictors in this sample, while emotional loneliness did not. Social loneliness reflects a perceived deficiency in the size and extent of one's social circle (de Jong Gierveld et al., 2009). This relationship may be attributed to the fact that the onset of visual impairment is often associated with a reduction in the ability to complete a number of common activities of daily living, including those related to mobility, and a concurrent reduction in the socioeconomic, social, and psychological resources that facilitate social interaction. Although the effects of such reductions could simply diminish with time, it appears likely that a targeted intervention, especially as an outcome of other interventions (for instance, activities of daily living or mobility instruction) may be of value in rehabilitation programs designed to enhance the PQOL of older visually impaired adults.

It was heartening to see that satisfaction with activities of daily living and mental health were important predictors of PQOL in this population, since activities of daily living and mental health currently reflect the primary focus of rehabilitation programs for older visually impaired persons (physical adaptation and psychological adjustment to functional limitations or loss), along with orientation and mobility instruction which addresses one's ability to get around in one's home and community. Although previous research has found one's ability to get around was a primary predictor of PQOL in this population (La Grow, Alpass et al., 2011; Yeung et al., 2011), it was excluded from the final model in this study due to the degree to which it was correlated with both physical health and satisfaction with activities of daily living, the effects of both factors thus subsuming any impact of ability to get around on PQOL. Since physical health and satisfaction with life do not appear to be in the purview of a rehabilitation program, social loneliness appears to be the only remaining predictor of PQOL in our final model that is open to direct intervention in such a program.

There are a number of limitations in this study that should be considered. First, the analyses conducted here were simple cross-sectional analysis from a single wave of a larger longitudinal study and are therefore not indicative of causation. As such, it is not clear if physical or mental health predicts subsequent loneliness levels or if loneliness predicts latter patterns of physical or mental health. Further analysis with multiple longitudinal data waves will be required to make this determination. Second, this study lacked any information on the degree, type, or cause of visual impairment and the time since onset, all of which would be helpful in better understanding the relationship between loneliness and PQOL in this population. Thus, further study is required to more clearly identify the rela tionship between loneliness and visual impairment, as would be controlled studies to test the assumption that social loneliness may be responsive to intervention.

References

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Towers, A., & Stevenson, B. (2014). NZLSA cohort profile: Technical report for the New Zealand Longitudinal Study of Ageing. Palmerston North: Massey University. Retrieved from http://www.massey.ac.nz/massey/learning/departments/school-ofpsychology/research/hart/publications/project-reports_nzlsa.cfm

Verstraten, P. F. J., Brinkmann, W. L. J. H., Stevens, N. L., & Schouten, J. S. A. G. (2005). Loneliness, adaptation to vision impairment, social support and depression among visually impaired elderly. International Congress Series, 1282, 317-321.

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Yeung, P., La Grow, S., Towers, A., Alpass, F., & Stephens, C. (2011). The centrality of O&M in rehabilitation programs designed to enhance quality of life: A structural equation modelling analysis. International Journal of Orientation, & Mobility, 4, 10-20.

Steven J. La Grow, Ph.D., professor emeritus, College of Health, Massey University, Private bag 11222, Palmerston North, New Zealand 4442; e-mail: <s.j.lagrow@massey.ac.nz>. Andy Towers, Ph.D., senior lecturer, School of Public Health, Massey University, Palmerston North, New Zealand; e-mail: <a.j.towers@massey.ac.nz>. Polly Yeung, Ph.D., senior lecturer, School of Social Work, Massey University, Palmerston North, New Zealand; e-mail: <p.yeung@massey.ac.nz>. Fiona Alpass, Ph.D., professor, School of Psychology, Massey University, Palmerston North, New Zealand; e-mail: <f.m.alpass@massey.ac.nz>. Christine Stephens, Ph.D., professor, School of Psychology, Massey University, Palmerston North, New Zealand; e-mail: <c.v.stephens@massey.ac.nz>.
Table 1

Comparison of well-being predictor variables between older
visually impaired and sighted adults.

Variables                     Visually impaired     Sighted No
                                Yes (n = 315)       (n = 2368)

Age                            66.87 (7.69)         65.91 (7.71)
Gender
  Male                        138 (44.1)          1068 (45.2)
  Female                      175 (55.9)          1297 (54.8)
Marital status
  Married or partnered        216 (68.6)          1765 (74.5)
  Other                        99 (31.4)           603 (25.5)
Living arrangement
  Alone                        70 (22.2)           437 (18.5)
  With others                 245 (77.8)          1931 (81.5)
Economic well-being            21.09 (7.81)         24.48 (5.86)
Number of health conditions     3.38 (2.54)          2.51 (1.93)
Physical health                43.48 (12.91)        50.29 (10.25)
Mental health                  46.26 (9.68)         49.74 (7.61)
Satisfaction with ADL           3.66 (1.10)          4.19 (0.84)
Ability to get around           3.95 (1.11)          4.52 (0.79)
Satisfaction with life          3.82 (0.93)          4.10 (0.79)
Perceived quality of life       4.03 (0.90)          4.45 (0.68)
Loneliness
  Not lonely                  147 (46.7)          1528 (64.5)
  Moderately lonely           122 (38.7)           641 (27.1)
  Severely lonely              46 (14.6)           199 (8.4)

Variables                         Statistics        p-value

Age                                t = -2.07          0.04
Gender
  Male                        [chi square] = 0.72     0.38
  Female
Marital status
  Married or partnered        [chi square] = 5.12    0.02 *
  Other
Living arrangement
  Alone                       [chi square] = 2.58     0.11
  With others
Economic well-being                t = 6.99         0.000 **
Number of health conditions        t = -5.60        0.000 **
Physical health                    t = 8.31         0.000 **
Mental health                      t = 5.65         0.000 **
Satisfaction with ADL              t = 8.14         0.000 **
Ability to get around              t = 8.65         0.000 **
Satisfaction with life             t = 5.11         0.000 **
Perceived quality of life          t = 7.95         0.000 **
Loneliness
  Not lonely                  [chi square] = 39.2   0.000 **
  Moderately lonely
  Severely lonely

Variables                       Effect size

                               d     [PHI]

Age                           0.12    --
Gender                         --    0.00
  Male
  Female
Marital status                 --    0.00
  Married or partnered
  Other
Living arrangement             --    0.00
  Alone
  With others
Economic well-being           0.50    --
Number of health conditions   0.40    --
Physical health               0.59    --
Mental health                 0.40    --
Satisfaction with ADL         0.55    --
Ability to get around         0.58    --
Satisfaction with life        0.33    --
Perceived quality of life     0.53    --
Loneliness                     --     --
  Not lonely
  Moderately lonely
  Severely lonely

Variables                      Effect size

                              [[phi].sub.c]

Age                                --
Gender                             --
  Male
  Female
Marital status                     --
  Married or partnered
  Other
Living arrangement                 --
  Alone
  With others
Economic well-being                --
Number of health conditions        --
Physical health                    --
Mental health                      --
Satisfaction with ADL              --
Ability to get around              --
Satisfaction with life             --
Perceived quality of life          --
Loneliness                        0.09
  Not lonely
  Moderately lonely
  Severely lonely

ADL = activities of daily living; * p < 0.05, ** p < 0.006;
Cohen's d: small = 0.2, medium = 0.5, large = 0.8; Phi '[PHI]':
small = 0.1, medium = 0.3, large = 0.5; Cramer's
V '[[phi].sub.c]': small = 0.07, medium = 0.21, large = 0.35.

Table 2
Comparison of well-being predictor variables among older
visually impaired adults stratified by level of loneliness.

Variables          Not lonely      Moderately       Severely
                    (n = 147,      lonely (n =     lonely (n =
                     46.7%)        122, 38.7%)     46, 14.6%)

Age               67.00 (7.41)    67.13 (8.02)    65.76 (8.16)

Gender

  Male              59 (40.4)       63 (51.6)       16 (35.6)

  Female            87 (59.6)       59 (48.4)       29 (64.4)

Marital status

  Married or       100 (68.0)      103 (64.4)       23 (50.0)
    partnered
  Other             47 (32.0)       57 (35.6)       23 (50.0)

Living
  arrangement

  Alone             27 (18.4)       28 (23.0)       15 (32.6)

  With others      120 (81.6)       94 (77.0)       31 (67.4)

Economic          23.96 (5.91)    21.17 (7.61)    13.46 (8.94)
  well-being
Number of          2.92 (2.60)     3.53 (2.25)     4.54 (2.76)
  health
  conditions
Physical health   46.29 (11.78)   41.91 (12.51)   38.15 (15.41)

Mental health     49.58 (8.29)    45.19 (9.38)    37.86 (9.39)

Satisfaction       4.03 (0.95)     3.50 (1.03)     2.93 (1.23)
  with ADL
Ability to         4.28 (0.97)     3.82 (1.09)     3.27 (1.20)
  get around
Satisfaction       4.15 (0.73)     3.78 (0.85)     2.84 (0.99)
  with life
Perceived          4.38 (0.75)     3.93 (0.78)     3.20 (1.06)
  quality
  of life

Variables          Statistics    p-value   Group differences
                                           1 and 2; 1 and 3;
                                                2 and 3

Age                 F = 0.57      0.57       p = 0.99; p =
                                            0.61; p = 0.56

Gender

  Male            [chi square]    0.08            --
                     = 4.95
  Female

Marital status

  Married or      [chi square]    0.08            --
    partnered        = 4.96
  Other

Living
  arrangement

  Alone           [chi square]    0.12            --
                     = 4.17
  With others

Economic           F = 32.12     0.000**    p = 0.000; p =
  well-being                               0.000; p = 0.000
Number of           F = 6.70     0.001**    p = 0.138; p =
  health                                   0.001; p = 0.075
  conditions
Physical health     F = 7.27     0.001**    p = 0.025; p =
                                           0.002; p = 0.266
Mental health      F = 26.18     0.000**    p = 0.001; p =
                                           0.000; p = 0.000
Satisfaction       F = 21.98     0.000**    p = 0.000; p =
  with ADL                                 0.000; p = 0.005
Ability to         F = 17.81     0.000**    p = 0.001; p =
  get around                               0.000; p = 0.008
Satisfaction       F = 43.71     0.000**    p = 0.001; p =
  with life                                0.000; p = 0.000
Perceived          F = 37.72     0.000**    p = 0.000; p =
  quality                                  0.000; p = 0.000
  of life

Variables         Effect size

                  [PHI]   [n.sup.2]

Age                --       0.00

Gender            0.02       --

  Male

  Female

Marital status    0.02       --

  Married or
    partnered
  Other

Living            0.01       --
  arrangement

  Alone

  With others

Economic           --       0.19
  well-being
Number of          --       0.05
  health
  conditions
Physical health    --       0.05

Mental health      --       0.17

Satisfaction       --       0.13
  with ADL
Ability to         --       0.10
  get around
Satisfaction       --       0.23
  with life
Perceived          --       0.20
  quality
  of life

ADL = activities of daily living; * p < 0.05, ** p < 0.006;
Phi "[PHI]": small = 0.1, medium = 0.3, large = 0.5; Eta
squared "[n.sup.2]": small = 0.01, medium = 0.06, large =
0.14.

Table 3

Correlation matrix of perceived quality of life and independent
predictors under study.

Variable                                 1       2       3       4

1. Perceived QOL
2. Age                                 -0.02
3. Gender                              -0.05   -0.05
4. Marital status                      -0.18    0.05    0.26
5. Living arrangement                   0.10   -0.12   -0.17   -0.76
6. Economic well-being                  0.50    0.18   -0.07   -0.24
7. Total number of health conditions   -0.25    0.14    0.01    0.24
8. Physical health                      0.51   -0.22   -0.08   -0.18
9. Mental health                        0.49    0.14    0.04   -0.07
10. Satisfaction with ADL               0.67   -0.10   -0.02   -0.11
11. Ability to get around               0.58   -0.19   -0.03   -0.21
12. Satisfaction with life              0.68    0.05   -0.04   -0.14
13. Social loneliness                  -0.47   -0.13    0.02    0.11
14. Emotional loneliness               -0.45   -0.01    0.01    0.18

Variable                                 5       6       7

1. Perceived QOL
2. Age
3. Gender
4. Marital status
5. Living arrangement
6. Economic well-being                  0.20
7. Total number of health conditions   -0.29   -0.36
8. Physical health                      0.11    0.37   -0.39
9. Mental health                       -0.01    0.32   -0.22
10. Satisfaction with ADL               0.05    0.41   -0.28
11. Ability to get around               0.15    0.32   -0.33
12. Satisfaction with life              0.09    0.52   -0.26
13. Social loneliness                  -0.12   -0.42    0.21
14. Emotional loneliness               -0.18   -0.46    0.24

Variable                                 8       9      10

1. Perceived QOL
2. Age
3. Gender
4. Marital status
5. Living arrangement
6. Economic well-being
7. Total number of health conditions
8. Physical health
9. Mental health                        0.05
10. Satisfaction with ADL               0.68    0.31
11. Ability to get around               0.75    0.23    0.70
12. Satisfaction with life              0.33    0.55    0.55
13. Social loneliness                  -0.21   -0.36   -0.38
14. Emotional loneliness               -0.29   -0.46   -0.37

Variable                                11      12      13

1. Perceived QOL
2. Age
3. Gender
4. Marital status
5. Living arrangement
6. Economic well-being
7. Total number of health conditions
8. Physical health
9. Mental health
10. Satisfaction with ADL
11. Ability to get around
12. Satisfaction with life              0.42
13. Social loneliness                  -0.25   -0.47
14. Emotional loneliness               -0.39   -0.44   0.55

ADL = activities of daily living; QOL = quality of life.

Table 4

Standard multiple regression of seven core predictors of
perceived quality of life among older visually impaired
adults (N = 315).

Variables entered        [beta]    P      R     [R.sup.2]     Adj.
                                                            [R.sup.2]

Model                            0.000   0.81     0.66        0.65
Economic well-being      0.06    0.23
Physical health          0.22    0.000
Mental health            0.19    0.000
Satisfaction with ADL    0.19    0.003
Satisfaction with life   0.36    0.000
Social loneliness        -0.11   0.03
Emotional loneliness     -0.06   0.27

ADL = activities of daily living.
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Article Details
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Author:La Grow, Steven J.; Towers, Andy; Yeung, Polly; Alpass, Fiona; Stephens, Christine
Publication:Journal of Visual Impairment & Blindness
Article Type:Clinical report
Geographic Code:8NEWZ
Date:Nov 1, 2015
Words:5941
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