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Neovascular AMD: an overlooked risk factor for injurious falls

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Abstract

Summary

While those with neovascular age-related macular degeneration (NV-AMD) may be at increased risk of injurious falls risk due to poor central vision and suboptimal responses when falling, preserved peripheral vision and decreased activity levels may actually be protective. Compared with control participants, patients with NV-AMD had a significantly greater number of falls and almost twice the risk of injurious falls.

Introduction

Impaired vision, particularly peripheral visual function, is a key risk factor for injurious falls. NV-AMD is a leading cause of severely impaired vision among older adults but is associated with a profound central, rather than peripheral, deficit. The objective was to determine whether older women with NV-AMD are at an increased risk of falls or injurious falls.

Methods

We conducted a 12-month prospective cohort study of community-dwelling older (≥70 years) women, enrolling 114 with NV-AMD and 132 without from a retinal clinic in Vancouver, Canada. Fall incidence was determined through monthly telephone follow-up, with fall severity classified by a blinded reviewer. We compared mean injurious falls per person-year between groups using negative binomial regression.

Results

A mean of 0.37 injurious falls per person-year were experienced among NV-AMD participants, compared to 0.16 injurious falls per person-year among non-NV-AMD participants (p = 0.006). The age-adjusted incidence rate ratio for injurious falls, for an individual with NV-AMD compared to without, was 1.77 (1.07–3.02).

Conclusions

Older women with NV-AMD are at almost twice the risk of injurious falls compared to those without. Clinicians caring for older adults should recognise NV-AMD as an important risk factor for injurious falls.

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Acknowledgements

I affirm that I have listed everyone who contributed significantly to the work and have obtained written consent from all contributors who are not authors but are listed in the “Acknowledgements” section. The authors thank the Centre for Hip Health & Mobility, Vancouver Coastal Health Research Institute, and the Michael Smith Foundation for Health Research for funding. The authors are indebted to Marian Brlecic, BA, Cheryl Claudio, MSc, and Teresa Lee, MScPT, for assistance in recruitment and assessment of participants.

Conflicts of interest

None.

Author information

Authors and Affiliations

  1. School of Population and Public Health & Epidemiology, University of British Columbia, Vancouver, Canada

    S. M. Szabo & P. A. Janssen

  2. Department of Ophthalmology & Visual Sciences, University of British Columbia, Vancouver, Canada

    S. M. Szabo & M. J. Potter

  3. Vancouver Coastal Health Research Institute, Centre for Hip Health & Mobility, Vancouver, Canada

    S. M. Szabo, P. A. Janssen & K. Khan

  4. Prince of Wales Medical Research Institute, UNSW, Sydney, NSW, Australia

    S. R. Lord

  5. Centre for Hip Health and Mobility, 3/F, 2647 Willow St, Willow Chest Centre, Vancouver, BC, V5Z1M9, Canada

    S. M. Szabo

Authors
  1. S. M. Szabo
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  2. P. A. Janssen
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  3. K. Khan
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  4. S. R. Lord
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  5. M. J. Potter
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Corresponding author

Correspondence to S. M. Szabo.

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Author contributions

All authors contributed to the study conception and design, interpretation of the data, and preparation of the manuscript. MJP and SMS were responsible for the acquisition of subjects. SMS was responsible for measurement and interviewing, data collection, and analysis, and developed the primary draft of the manuscript.

Funding: Grant funding for this study was provided by the Michael Smith Foundation for Health Research and the Vancouver Coastal Health Research Institute.

Sponsor role: All sponsorship was provided in the form of awarded peer-reviewed grants; sponsors played no role in study design, recruitment, data collection, analysis, or drafting of the manuscript. SMS received a Junior Graduate Trainee Fellowship from the Michael Smith Foundation for Health Research (MSHFR). Dr. Janssen is a Canadian Institutes for Health Research (CIHR) New Investigator and an MSFHR Career Scholar. Dr. Khan was a CIHR Institutes of Health Research New Investigator. Professor Lord is a Senior Principal Research Fellow at the Prince of Wales Medical Research Institute, Sydney, Australia.

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Szabo, S.M., Janssen, P.A., Khan, K. et al. Neovascular AMD: an overlooked risk factor for injurious falls. Osteoporos Int 21, 855–862 (2010). https://doi.org/10.1007/s00198-009-1025-8

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  • DOI: https://doi.org/10.1007/s00198-009-1025-8

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