Falls are the leading cause of accidental injury and death among older adults. One of three adults over the age of 65 years falls annually. As the size of elderly population increases, falls become a major concern for public health and there is a pressing need to understand the causes of falls thoroughly. While it is well documented that visual functions such as visual acuity, contrast sensitivity, and stereo acuity are correlated with fall risks, little attention has been paid to the relationship between falls and the ability of the visual system to perceive motion in the environment. The omission of visual motion perception in the literature is a critical gap because it is an essential function in maintaining balance. In the present article, we first review existing studies regarding visual risk factors for falls and the effect of ageing vision on falls. We then present a group of phenomena such as vection and sensory reweighting that provide information on how visual motion signals are used to maintain balance. We suggest that the current list of visual risk factors for falls should be elaborated by taking into account the relationship between visual motion perception and balance control.

/pdf/ageing-vision-and-falls-a-review-3hru9o5wxj.pdf

Ageing vision and falls: a review.

PURPOSE: To assess the impact of visual impairment on the incidence of falls and fractures in older persons. METHODS: Of 3654 baseline participants, 2334, 1952 and 1149 were re-examined after 5, 10 and 15-years. Presenting visual acuity (VA) was measured at each examination. Bilateral and unilateral visual impairment was defined as VA RESULTS: The proportions of participants reporting ≥2 falls ranged 10%-14%, and proportions reporting fractures ranged 12%-21%, across the three follow-up visits. Participants with incident visual impairment were more likely to report ≥2 falls in 5 years, OR 1.46, 95% CI 1.04-2.04 (bilateral visual impairment) and OR 1.22, 95% CI 0.98-1.51 (unilateral). Compared to participant with normal vision, those with incident unilateral visual impairment had a higher incidence of fractures over 5 years (OR 1.27, 95%CI 0.98-1.51). No increased incidence of falls or fractures was evident after 5+ years among participants with any visual impairment. CONCLUSIONS: In this older cohort, more recent development of visual impairment was associated with increased likelihood of subsequent falls and fractures in the next 5 years, independent of co-morbidities. Language: en

Visual impairment and the incidence of falls and fractures among older people: longitudinal findings from the Blue Mountains Eye Study.

BACKGROUND: concurrent vision and hearing loss are common in older adults; however, epidemiological data on their relationship with the incidence of falls are lacking. OBJECTIVE: we assessed the association between dual sensory impairment (DSI) and incidence of falls. We examined the influence of self-perceived hearing handicap and hearing aid use and risk of falls. DESIGN: a population-based, cohort study of participants followed over 5 years. SETTING: Blue Mountains, west of Sydney, Australia. SUBJECTS: one thousand four hundred and seventy-eight participants aged 55 and older at baseline were included in longitudinal analyses. METHODS: visual impairment was defined as presenting or best-corrected visual acuity less than 20/40 (better eye), and hearing impairment as average pure-tone air conduction threshold >25 dB HL (500-4,000 Hz, better ear). The shortened version of the hearing handicap inventory for the elderly was administered. Incident falls were assessed over the 12 months before each visit. Cognitive impairment was determined using the Mini-Mental State Examination. RESULTS: five-year incidence of falls was 10.4%. Participants with severe self-perceived hearing handicap versus no hearing handicap had increased risk of incident falls, multivariable-adjusted OR 1.93 (95% confidence intervals, CI, 1.02-3.64). Hearing aid users versus non-users had 75% increased likelihood of incident falls. Participants with co-existing best-corrected visual impairment and mild hearing loss (>25 to ≤40 dB HL) had higher odds of incident falls, OR 2.19 (95% CI 1.03-4.67). After excluding persons with cognitive impairment, this association did not persist. CONCLUSION: these epidemiological data show that DSI in older adults could significantly increase their risk of falling.© The Author 2016. Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved. For Permissions, please email: journals.permissions@oup.com. Language: en

Hearing and vision impairment and the 5-year incidence of falls in older adults

A large number of studies have demonstrated a positive effect of increased physical activity (PA) on various health outcomes. In all large geriatric studies, however, PA has only been assessed by interview-based instruments which are all subject to substantial bias. This may represent one reason why associations of PA with geriatric syndromes such as falls show controversial results. The general aim of the Active-Ulm study was to determine the association of accelerometer-based physical activity with different health-related parameters, and to study the influence of this standardized objective measure of physical activity on health- and disability-related parameters in a longitudinal setting. We have set up an observational cohort study in 1500 community dwelling older persons (65 to 90 years) stratified by age and sex. Addresses have been obtained from the local residents registration offices. The study is carried out jointly with the IMCA - Respiratory Health Survey in the Elderly implemented in the context of the European project IMCA II. The study has a cross-sectional part (1) which focuses on PA and disability and two longitudinal parts (2) and (3). The primary information for part (2) is a prospective 1 year falls calendar including assessment of medication change. Part (3) will be performed about 36 months following baseline. Primary variables of interest include disability, PA, falls and cognitive function. Baseline recruitment has started in March 2009 and will be finished in April 2010. All participants are visited three times within one week, either at home or in the study center. Assessments included interviews on quality of life, diagnosed diseases, common risk factors as well as novel cognitive tests and established tests of physical functioning. PA is measured using an accelerometer-based sensor device, carried continuously over a one week period and accompanied by a prospective activity diary. The assessment of PA using a high standard accelerometer-based device is feasible in a large population-based study. The results obtained from cross-sectional and longitudinal analyses will shed light on important associations between PA and various outcomes and may provide information for specific interventions in older people.

/pdf/accelerometer-based-physical-activity-in-a-large-5d0ocdnd7a.pdf

Accelerometer-based physical activity in a large observational cohort--study protocol and design of the activity and function of the elderly in Ulm (ActiFE Ulm) study.

https://escholarship.org/content/qt5tq1g81v/qt5tq1g81v.pdf?t=o5kd4a

Management of advanced glaucoma: Characterization and monitoring.

Falls are an alarming health problem and a major cause of injury among the elderly. The healthcare cost associated with falls is considerable. Visual acuity has been found to be an independent risk factor for falls; however, the results are not unanimous. Moreover, other aspects of visual function such as visual field, contrast sensitivity and depth perception have not been adequately investigated in relation to falls. The aim of this study, therefore, was to determine the relationship between visual function, duration, and main causes of visual impairment, and falls in individuals with low vision. This was a cross-sectional study involving participants attending a public tertiary eye care hospital. Participants were mobile, aged 60 years or above, and had low vision (visual acuity >0.3 LogMAR in the better eye). Details about falls in the previous 12 months and other information were collected, and patients completed a questionnaire about activities of daily living. The duration and main causes of visual impairment, visual acuity, contrast sensitivity, depth perception, and visual field were assessed. Descriptive statistical analyses were performed to characterize the participants’ sociodemographic and clinical data. One hundred and twenty seven patients (53%; 67 males) with a mean age of 76.3 ± 8.3 years were recruited. Thirty seven percent of the participants (n = 47) had mild, 50% (n = 64) moderate and 13% (n = 16) severe visual impairment (>0.3–0.5; >0.5–1.0; and >1.0 LogMAR respectively). The frequencies of single and multiple falls were 42.5% and 12.6% respectively. Visual acuity, contrast sensitivity, depth perception, visual field, main cause, and duration of visual impairment were not significantly associated with falls (p > 0.05). In multiple regression analyses, physical inactivity remained the only variable independently associated with falls in all models except for visual field. Overall, visually impaired people were three times more likely to fall if they were physically inactive. Visual function, duration and main causes of visual impairment are not independently associated with falls in people with low vision. However, a significant relationship between non-participation in physical activity and falls was found. Further work is required to investigate the association between vision-related factors and falls in older people with visual impairment.

Satu Salonen

Papers

The relationship between visual function, duration and main causes of vision loss and falls in older people with low vision.