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Association of Vision Impairment With Increased Prevalence of Falls Among Older US Adults
TAKE-HOME MESSAGE
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This large cross-sectional study involving older adults in the US sought to evaluate the relationship between visual impairment and the prevalence of falls. Contrast sensitivity impairment (difficulty differentiating between shades of light and dark) was associated with recurrent (prevalence ratio, 1.3) and recent falls (prevalence ratio, 1.4). Near-sightedness and far-sightedness were not associated with an increased risk of falls.
- Contrast sensitivity impairment, but not near- or far-sightedness, is associated with an increased risk of falls in older adults.
abstract
This abstract is available on the publisher's site.
Access this abstract nowBACKGROUND
Vision impairment (VI) is associated with falls in older adults. However, past studies have relied on geographically constrained samples with limited generalizability or self-reports of visual difficulty. To date, there have not been nationally representative studies on the association of objective measures of visual function and falls outcomes.
METHODS
We used cross-sectional data from Round 11 of National Health and Aging Trends Study (NHATS), a nationally representative panel study of age-eligible Medicare beneficiaries (N = 2951). We performed Poisson regression to calculate the prevalence and prevalence ratio (PR) of >1 fall in the past year, any fall in the past month, fear of falling (FoF), and activity limitation due to FoF as a function of distance visual acuity, near visual acuity, and contrast sensitivity. Models were adjusted for demographic and health covariates and were weighted to make nationally representative parameter estimates.
RESULTS
The weighted proportion of participants with VI was 27.6% (95% CI, 25.4%-29.9%). Individuals with any VI had a higher prevalence of falls compared with those without VI (18.5% vs. 14.1%, PR = 1.25, 95% CI 1.02-1.53). Specifically, contrast sensitivity impairment was associated with a higher prevalence of recurrent falls (20.8% vs. 14.7%; PR = 1.30, 95% CI 1.01-1.67) and recent falls (17.1% vs. 9.9%; PR = 1.40, 95% CI 1.01-1.94). This relationship existed even independent of near and distance visual acuity. Distance and near visual acuity were not significantly associated with falls. Having any VI was also associated with a higher prevalence of FoF (38.4% vs. 30.5%, PR = 1.17, 95% CI 1.02-1.34).
CONCLUSION
The prevalence of falls is associated with poor contrast sensitivity but not with near or distance visual acuity. Findings suggest greater collaboration between geriatricians and eye care providers may be warranted to assess and address fall risk in older adults with VI.
Additional Info
Disclosure statements are available on the authors' profiles:
Association between vision impairment and increased prevalence of falls in older US adults
J Am Geriatr Soc 2024 Mar 21;[EPub Ahead of Print], H Jin, Y Zhou, BC Stagg, JR EhrlichFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.
This nationally representative questionnaire-based study of 2951 participants found a prevalence of 27.6% for vision impairment. After controlling for confounders of vision impairment such as age, participants with contrast vision impairment had a higher prevalence of recurrent falls (20.8% vs 14.7%; prevalence ratio [PR], 1.30; 95% CI, 1.01–1.67) and recent falls (17.1% vs 9.9%; PR, 1.40; 95% CI, 1.01–1.94) than those with normal vision. Neither distance nor near visual acuity was associated with falls.
This study, over previous literature, is representative of the US Medicare population and relies on objectively measured visual function using a tablet-based test for acuity and contrast sensitivity. It relies on self-reporting of falls asked in a questionnaire, which may underestimate the rate. Many patients are afraid of reporting falls for fear of losing their independence,1 as falls are one of the three leading causes of institutionalization, along with behavior problems in dementia and incontinence.2
Multifactorial interventions have been shown to reduce falls, including strength and balance exercises, stopping anticholinergic and other high-risk medications, and environmental interventions. Improving contrast in the home may help, as 80% of falls occur at home3; putting bright strips on top and bottom steps would be easy to do. Providing more light improves contrast. Cataracts can impair contrast sensitivity, and filters can help, but the percent transmission of the filters and filter color can vary and can be trialed in optometry offices.
Cataract surgery is also helpful, but it increases the risk of falls for 6 months, and the older the person, the higher the risk. Individuals aged 85 years or older have a 6.8-fold higher risk of falls.4 Our brains require time to adjust to a change in vision, even when it is an improvement in vision, and the older an individual is, the less reserve to adapt, and the higher the risk of falls. This may contribute to why visual acuity was not a risk factor for falls as our brains adjust to it, but contrast sensitivity can be less compensated for.
References