Ophthalmic Interventions to Help Prevent Falls
Ophthalmic Interventions to Help Prevent Falls
There is mounting evidence that visual impairment is significantly associated with the increased incidence of falling in the older adult. Surprisingly, the leading causes of visual impairment in the aging adult population are correctable and due to undercorrected refractive errors and/or cataract. This highlights that, to reduce fall risk, older people should be encouraged to have regular eye examinations to detect and subsequently correct such problems as early as possible.
While accepting that the causes of falls are multifactorial, this article will highlight how and why visual impairment is associated with increased risk of falling. The focus of this article is to emphasize the ophthalmic interventions and advice that optometrists and associated health care practitioners should consider to minimize the risk of falling in their older patients.
The prevalence of visual impairment increases with advancing age. By age 65 up to 30% of adults have impaired vision. Impaired vision is classified as vision below that which an individual requires for his or her everyday tasks. It is typically defined as binocular visual acuity (ability to perceive fine detail and the traditional measure of vision using a letter chart) worse than 6/12 (6/12 letters are twice the size as those read by older people with normal visual acuity, [i.e., 6/6 or 20/20 vision]). The prevalence of falling also increases with age, and several epidemiological studies suggest that visual impairment is one of the associated risk factors. For example, in retrospective studies, reduced visual acuity or the presence of cataract and/or reduced contrast sensitivity (ability to detect objects that differ in brightness) is significantly associated with the incidence of falling. In prospective studies, visual acuity decreases of two or more lines (letter rows on an eye chart) over a four-to-six year period and/or baseline distance visual acuity worse than 20/60 have been significantly associated with future risk of injurious falls, while reductions in contrast sensitivity have been shown to nearly double the chance of a future fall. One surprising statistic highlighted by one of these retrospective studies is that most (approximately 80%) of the visual impairment in patients admitted following a fall is correctable, either by the updating of an individual's spectacle prescription (correction of refractive errors) or the surgical removal of cataract. Epidemiological studies have shown that uncorrected refractive error and cataract are surprisingly common in the older population. This suggests that ophthalmic interventions could significantly reduce the number of falls occurring in older people.
Abstract and Introduction
Abstract
There is mounting evidence that visual impairment is significantly associated with the increased incidence of falling in the older adult. Surprisingly, the leading causes of visual impairment in the aging adult population are correctable and due to undercorrected refractive errors and/or cataract. This highlights that, to reduce fall risk, older people should be encouraged to have regular eye examinations to detect and subsequently correct such problems as early as possible.
Introduction
While accepting that the causes of falls are multifactorial, this article will highlight how and why visual impairment is associated with increased risk of falling. The focus of this article is to emphasize the ophthalmic interventions and advice that optometrists and associated health care practitioners should consider to minimize the risk of falling in their older patients.
The prevalence of visual impairment increases with advancing age. By age 65 up to 30% of adults have impaired vision. Impaired vision is classified as vision below that which an individual requires for his or her everyday tasks. It is typically defined as binocular visual acuity (ability to perceive fine detail and the traditional measure of vision using a letter chart) worse than 6/12 (6/12 letters are twice the size as those read by older people with normal visual acuity, [i.e., 6/6 or 20/20 vision]). The prevalence of falling also increases with age, and several epidemiological studies suggest that visual impairment is one of the associated risk factors. For example, in retrospective studies, reduced visual acuity or the presence of cataract and/or reduced contrast sensitivity (ability to detect objects that differ in brightness) is significantly associated with the incidence of falling. In prospective studies, visual acuity decreases of two or more lines (letter rows on an eye chart) over a four-to-six year period and/or baseline distance visual acuity worse than 20/60 have been significantly associated with future risk of injurious falls, while reductions in contrast sensitivity have been shown to nearly double the chance of a future fall. One surprising statistic highlighted by one of these retrospective studies is that most (approximately 80%) of the visual impairment in patients admitted following a fall is correctable, either by the updating of an individual's spectacle prescription (correction of refractive errors) or the surgical removal of cataract. Epidemiological studies have shown that uncorrected refractive error and cataract are surprisingly common in the older population. This suggests that ophthalmic interventions could significantly reduce the number of falls occurring in older people.
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