Visual Loss and Depression

Abstract

Depression in the elderly is an often under-recognized and undertreated medical condition. Three factors—vision loss, loss of function, and depression—can create a cycle of disability in the visually impaired elderly. An elderly patient who is clinically depressed may not ask for help with depression explicitly. They may present with visual loss as their chief complaint and may manifest symptoms that may be mistaken for “old age” or “dementia.” Older patients with both hearing and visual impairments, known as dual sensory impairment, face even more unique communication difficulties and social isolation. Sensitivity to the older patient’s specific needs and desires during evaluation and management is integral to maintaining the patient’s dignity, respecting their autonomy, and allowing them to participate in their own care and decision-making. Simple screening by an ophthalmologist can be an effective diagnostic tool and is the first step in ensuring patients gain access to treatment through appropriate channels. Screening alone is insufficient to improve outcomes for older visually impaired adults; an ophthalmologist’s referrals and facilitation of treatments for depression and low-vision rehabilitation can significantly reduce elderly patients’ morbidity and mortality.