Vision and Falls in Older People: Risk Factors and Intervention Strategies
Section snippets
Vision, balance, and gait
Accurate control of posture, balance, and locomotion through the environment involves a coordinated set of sensorimotor processes that continually encode and compare information from visual, vestibular, proprioceptive, and sensorimotor feedback and cognitive sources. The extent to which visual information dominates this process is best demonstrated when people stand with their eyes closed; postural sway increases by between 20% and 70%.1, 2, 3 Similarly, the compelling illusion of self-motion
Vision, falls, and fractures
Prospective studies of the risk of falls using tests of visual acuity, edge-contrast sensitivity, stereopsis or depth perception, and visual field loss have included visual impairment as a possible risk factor. Although there have been some inconsistencies, research findings generally indicate that reductions in each of these visual measures increase the risk of falls in older people. Impaired distance visual acuity, that is, poor fine-detail vision, has been identified as a risk factor for
Inappropriate glasses
Many older people who wear glasses with outdated prescriptions or who wear no glasses at all may benefit from wearing new glasses with correct prescriptions,70, 71, 72 indicating that older people are not aware of their declining vision and/or do not perceive the benefits of regular vision assessments and that updated glasses outweigh risks to safety and lifestyle. Reduced access to eye care may also constitute an important barrier for some frail older people.
Elliott and Chapman73 demonstrated
Visual interventions for preventing falls
Two related trials have examined the effects of expedited cataract surgery in reducing fall rates. The first study involving 306 women 70 years and older examined the efficacy of cataract surgery on the first eye.79 Participants were randomized to either expedited (approximately 4 weeks) or routine (12 months’ wait) surgery. Vision, visual disability, levels of physical activity, anxiety, depression, and balance confidence improved significantly in the operated group at the 6-month retest and
Summary
Vision makes an important contribution to balance, and impaired vision resulting from eye disease is a significant independent risk factor for falls and fractures in older people. Reduced ability to detect low-contrast hazards, judge distances, perceive spatial relationships, and process moving visual information all seem to be the major visual risk factors for falls. Multifocal glasses can add to the risk of falls because their near-vision lenses impair distance-contrast sensitivity and depth
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