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Original Investigation
May 30, 2019

Association of Perceived Discrimination With Emotional Well-being in Older Adults With Visual Impairment

Author Affiliations
  • 1Department of Behavioural Science and Health, University College London, London, United Kingdom
  • 2Vision and Eye Research Unit, School of Medicine, Anglia Ruskin University, Cambridge, United Kingdom
  • 3Cambridge Centre for Sport and Exercise Sciences, Anglia Ruskin University, Cambridge, United Kingdom
JAMA Ophthalmol. 2019;137(7):825-832. doi:10.1001/jamaophthalmol.2019.1230
Key Points

Questions  How prevalent is perceived discrimination among older people with visual impairment and to what extent is it associated with emotional well-being?

Findings  In this study of 7677 older adults (≥50 years of age), 476 (52.1%) of those with poor eyesight reported discrimination vs 2963 (43.8%) of those with good eyesight, a significant difference. People with poor eyesight who reported discrimination were more likely to be depressed, lonely, and dissatisfied with life, and their quality of life was lower than those who did not report discrimination.

Meaning  The findings suggest that older adults with impaired vision are at increased risk of discrimination, which, if experienced, may be associated with poor well-being.


Importance  A significant proportion of individuals with visual impairment report experiences of discrimination. However, evidence comparing perceived discrimination among people with visual impairment with the general population is lacking. In addition, poorer mental health and well-being have been detected in this population, but the association between discrimination and well-being in those with visual impairment is unknown.

Objective  To investigate perceived discrimination among people with visual impairment and its association with well-being in a population-based sample of older adults.

Design, Setting, and Participants  This study collected data from 7677 participants 50 years or older from the English Longitudinal Study of Ageing, a representative sample of older men and women in England. Experiences of perceived discrimination were reported from July 2010 to June 2011. Depressive symptoms, life satisfaction, quality of life, and loneliness were assessed from July 2010 to June 2011 and May 2016 to June 2017. Data analysis was performed from September 27, 2018, to October 10, 2018.

Exposures  Self-rated eyesight, categorized as poor (ratings of fair, poor, or blind) or good (good, very good, or excellent), which was not previously validated for this population.

Main Outcomes and Measures  We used logistic regression to analyze differences in perceived discrimination between participants reporting poor vs good eyesight and cross-sectional and prospective associations between perceived discrimination and well-being in those with poor eyesight.

Results  A total of 7677 participants (mean [SD] age, 66.71 [9.17] years; 4023 [52.4%] female) were included in the study. Participants with poor eyesight had increased odds of reporting perceived discrimination compared with those with good eyesight (odds ratio [OR], 1.41; 95% CI, 1.23-1.63; P < .001). Cross-sectionally, participants who reported poor eyesight and discrimination had increased odds of depressive symptoms (OR, 2.14; 95% CI, 1.57-2.92; P < .001) and loneliness (OR, 2.17; 95% CI, 1.61-2.92; P < .001) and lower quality of life (B = −4.06; 95% CI, −5.29 to −2.84; P < .001) and life satisfaction (B = −2.37; 95% CI, −3.28 to −1.46; P < .001) compared with poor eyesight and no reported discrimination. Prospectively, perceived discrimination was associated with increased risk of depressive symptoms among participants reporting poor eyesight at 6-year follow-up (OR, 1.72; 95% CI, 1.08-2.76; P = .02).

Conclusions and Relevance  These findings suggest that older adults with impaired vision are at increased risk of perceived discrimination. Those who reported experiencing discrimination had higher levels of depressive symptoms and loneliness and lower quality of life and life satisfaction. Action to address discrimination may help mitigate the increased risk of poor well-being in this population.