Research documents a positive association between perceived support availability and well-being in later life.

Family members of persons with advanced dementia may be asked to make complex treatment decisions without having adequate knowledge regarding the risks and benefits. This 6-month, prospective, randomized trial tested the effect of an intervention consisting of a face-to-face, structured conversation about end-of-life care options with family members of nursing home residents with advanced dementia. A comparison group received only social contact via telephone. Structured conversations between a palliative care team and intervention group family members included goals of care and how best to achieve those goals, and provision of psychosocial support. Psychosocial support was also provided via telephone at three 2-month intervals. Family members participated in three telephone interviews: baseline, 3, and 6 months. Specific advance directives for persons with dementia were extracted from medical records. Results showed that intervention families had higher satisfaction with care than comparison families at the 6-month time point, and they were more likely to have decided on medical options listed in residents' advance directives (Do Not Resuscitate, Intubate, Hospitalize) over time. Study findings reinforce the need for increased education and support for families around issues of end-of-life care decisions for advanced dementia.

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The importance of friendship and family support in adaptation for 241 elders experiencing age-related vision loss was examined. Adaptation was operationalized with two global measures of psychological well-being (life satisfaction, depressive symptoms) and a domain-specific measure, adaptation to vision loss. Hierarchical regression analyses tested the effects of sociodemographic, vision, health, and functional disability variables in the first step, family support quality in the second step, and friendship support quality in the third step. Variables entered at each step contributed significant portions of explained variance in outcome variables. Thus, the importance of friendship support, independent of family support, in adaptation to chronic impairment was demonstrated. The effect of relationship type and gender on multiple support components was also assessed. Scores for family support were higher than those for friend support on almost all components. Close relationships were perceived as providing greater attachment in females and greater instrumental assistance and social integration in males.

There has been a great deal of interest in identifying the impact of rehabilitation on psychological well-being, as well as functional ability, among elders with disabilities, but empirical data remain limited. This descriptive study of participants in vision rehabilitation service examines the effect of specific vision rehabilitation services (low vision clinical services, skills training, counseling, optical device use, and adaptive device use) on change in depression among a sample of older adults with age-related vision impairments. Participants (N = 95) were interviewed at application for services and then approximately two years later. Findings from hierarchical regression analyses indicated that low vision clinical services, counseling, and use of optical devices, in separate models, each significantly contributed to a decline in depression, after controlling for age, health status, vision status, functional disability, as well as baseline depression. When all service variables were entered into the same equation, they explained an additional 10% of the variance in change in depression. Given the well documented robust relationship between disability and depression, findings point to the influence of vision rehabilitation interventions on both physical and psychological functioning, and underscore the need for future, controlled research on rehabilitation service models that address mental health issues.

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We propose that these differential effects result from the fact that optical devices optimize residual vision and thus allow for greater continuity in the way tasks are accomplished (i.e., reading still performed visually), whereas use of adaptive aids (e.g., talking books) involves learning new methods in order to compensate for lost functions and thus is not as desirable either functionally or psychologically.