History of falling and visual ability among independently living elderly in Sweden

Purpose

The aim of this study was to assess the performance-based visual ability among independently living elderly subjects and to investigate whether there was any association between visual ability and falls.

Subjects and methods

A total of 298 randomly selected subjects aged 70–85 years were invited for an examination including monocular and binocular visual acuity (VA), contrast sensitivity (CS), stereoscopic vision, and monocular visual fields (VFs), which were integrated to estimate the binocular VFs. Type of lenses used in their habitual correction was noted.

Results

Out of the 212 subjects who were examined, 38% reported at least one fall and 48% of these reported at least two falls during the last 2 years. Most subjects had normal results; 90% had normal binocular VA, 85% had normal binocular CS, and ~80% had positive stereopsis. Twenty-nine subjects had VF defects in the lower quadrants of the binocular VF, and 14 of these reported at least one fall. A significant association was seen between one fall or more and VA better eye, the odds ratio (OR) was 2.26, P=0.013, and between recurrent falls and lack of stereoscopic vision, the OR was 3.23, P=0.002; no other functional test showed any significant association with recurrent falls. The ORs were 1.58 for worse binocular VA, 0.60 for worse binocular CS, and 0.71 for non-normal stereoscopic vision for at least one fall, but wide confidence intervals made it difficult to draw firm conclusions about any association. Bifocal or progressive spectacles were worn by 71% with no significant difference between fallers and nonfallers (P=0.078).

Conclusion

Even though ~40% of the total sample had experienced one or more falls, the only visual function test significantly associated with falls were VA better eye, lack of stereoscopic vision, and recurrent falls. Our results suggest that there may be more powerful predictors of falling than decreased visual ability.

Improving falls risk screening and prevention using an e-learning approach

AIM

This study investigated the impact of an e-learning education programme for nurses on falls risk screening, falls prevention and post-falls management.

BACKGROUND

Falls injury within older inpatients is a major patient safety concern.

METHOD

Using a pre-post design, observation of the patient and environment and patient health care record audits, were conducted following the introduction of a falls e-learning education programme.

RESULTS

Audits of patient health care records (using the Falls Chart Audit Tool), together with observation of practice for 119 (pre) and 99 (post) patients, were undertaken. Initial risk screening was conducted using the Modified Ontario Stratify Scale for most patients (95%). Interventions such as a falls risk flag in the records/on beds, supervision when the patient is mobilising or in the bathroom, area clear of hazards, use of chair/bed alarms, and referral to allied health staff were significantly improved.

CONCLUSIONS

Initial risk screening of patients and improvements in preventive interventions were demonstrated.

IMPLICATIONS FOR NURSING MANAGEMENT

This falls e-learning programme represents a cost-effective method of increasing falls mitigation strategies within large organisations. The Falls Chart Audit Tool provides a valuable monitoring tool for managers. Falls risk screening when the patient's condition changes, requires vigilance by managers or reminders within clinical information systems.