Online MINGLE Program Improves the Health of Older Adults with AMD

Age-related macular degeneration (AMD), a blinding condition associated with depression and loneliness, is the leading cause of permanent blindness among adults—but healthy habits can halt the progression of AMD, as well as reduce depression and loneliness.¹

Approximately 200 million people live with AMD, and because of the increase in life expectancy, the number is estimated to increase to nearly 300 million by 2040. People can either be diagnosed with early AMD, described as “drusen deposits, pigment changes and minimal vision loss,” or late-stage AMD, “associated with moderate to severe vision loss.” With all these people living with AMD, creating an effective program to promote healthy lifestyles can prevent further vision problems.

The team of a qualitative study, led by Richard Kha of the University of Sydney in Australia, created a remote 10-week lifestyle intervention called MINGLE. The program serves as a platform to improve the health of older adults with AMD—physically and socially. MINGLE promotes social-building and group exercises.

According to previous studies, treatments such as self-management programs, group problem-solving sessions, and mindfulness activities can reduce depression and loneliness. Also, quitting smoking, eating a Mediterranean diet, and increasing physical activity can reduce onset and progression of AMD.

Before MINGLE, there were no lifestyle intervention programs targeted for patients with AMD. Programs like Walk N’Talk for your Life (WTL) targeted social isolation and loneliness in older adults. WTL was conducted in person and over Zoom, and the program lasted for 10 weeks in United Kingdom and 12 weeks in Canada. A barrier of the program was that adults with vision loss struggled getting to the site. Thus, Kha and colleagues made MINGLE a remote program to avoid this barrier.

MINGLE aimed at improving people’s depression and loneliness, caused by AMD. According to previous research, roughly 15.7 – 44% of people with AMD have depression.^2,3 Also, older adults with vision uses are twice as likely to experience loneliness than adults with normal vision.⁴

Depression and loneliness can lead to unhealthy lifestyle behaviors, such as sedentary behaviors and unhealthy diets. Yet such behaviors are associated with an increased risk of AMD development and progression.¹

In the study, the investigators conduced one-on-one semi-structured interviews in-person and over the phone from November 2021 – January 2022 to inquire about their thoughts on MINGLE, their experience with AMD and how it impacts their daily life, and previous experiences with group programs. Participants (n = 31) had a mean age of 79 ± 7.4 years (range, 58–89) and 58% were female with late-stage AMD (90%) in ≥1 eye.

The investigators examined enablers—reasons people liked and were motivated the program—and barriers—reasons that made getting involved with the program difficult.

Enablers included having the opportunity to meet new people, learn more about AMD, motivation to improve health, the program’s accessibility and structure, and the lack of cost. Meanwhile, barriers consisted of time constraints, access to technology, lack of knowledge about lifestyle risk factors, vision and mobility limitations, and a negative view on social group interactions.

Kha and colleagues wrote that lack of time was a common barrier.

“Time-related barriers are common among other wellbeing programs for older adults,” the team wrote. “Limiting the number of sessions would most likely make the program more appealing and accessible as those with family responsibilities and appointments may be able to join.”

Technology served as an enabler and a barrier. While technology made it easier for some people who couldn’t drive to a site due to vision impairment, technology also hindered other participants for several reasons. For some participants, it was difficult for them to see the Zoom screen. For others, they did not have access to a computer altogether, so they had to make-do by downloading Zoom on a phone or a tablet.

“We suspect that [the lack of computer or Internet access] may be because most of our participants are of low socioeconomic status and therefore, they may not have access to the resources or education to comfortably use technology,” the investigators wrote.

Participants who would be likely to participate in MINGLE are those who understand the importance of socialization, who wanted to learn more about AMD or improving their health in general, and who wanted the opportunity for social contact.

Many of the people in the study who participated in MINGLE especially liked the following aspects of the program—the social interaction, group exercises, and dietary education. While these were the highlights of the program, stated by participants in the interviews, some participants were doubtful that MINGLE would help their condition.

“…Some with moderate to advanced AMD felt that the program would not improve their health since it does not restore sight,” the investigators wrote. “However, research shows that improving lifestyle risk factors is important for people at all stages of AMD to not only reduce the risk of AMD development and its progression, but to improve overall mental and physical health and quality of life.”

References

1. ^{Kha R, Wen Q, Bender N, et al. Understanding barriers and enablers to participation in a proposed online lifestyle intervention for older adults with age-related macular degeneration to guide programme implementation [published online ahead of print, 2023 Oct 15]. J Health Psychol. 2023;13591053231204722. doi:10.1177/13591053231204722}
2. ^{Dawson SR, Mallen CD, Gouldstone MB, et al. (2014) The prevalence of anxiety and depression in people with age-related macular degeneration: A systematic review of observational study data. BMC Ophthalmology 14(1): 78.}
3. ^{Heesterbeek TJ, van der Aa HPA, van Rens GHMB, et al. (2017) The incidence and predictors of depressive and anxiety symptoms in older adults with vision impairment: A longitudinal prospective cohort study. Ophthalmic and Physiological Optics 37(4): 385–398.}
4. ^{Alma MA, Van der Mei SF, Feitsma WN, et al. (2011) Loneliness and self-management abilities in the visually impaired elderly. Journal of Aging and Health 23(5): 843–861.}