Vision and falls

Association Between Visual Acuity and Prospective Fall Risk in Generally Healthy and Active Older Adults: The 3-Year DO-HEALTH Study

OBJECTIVE

Although aging has a strong impact on visual acuity (VA) and falls, their interaction is understudied in generally healthy older adults. This study aimed to examine if and to what extent baseline VA is associated with an increased risk of all and injurious falls over 3 years in generally healthy community-dwelling older adults.

DESIGN

Observational analysis of DO-HEALTH, a double-blind, randomized controlled trial.

SETTING AND PARTICIPANTS

Multicenter trial with 7 European centers: Zurich, Basel, Geneva (Switzerland), Berlin (Germany), Innsbruck (Austria), Toulouse (France), and Coimbra (Portugal), including 2157 community-dwelling adults aged 70 years and older without any major health events in the 5 years prior to enrollment, sufficient mobility, and good cognitive status.

METHODS

The numbers of all and injurious falls were recorded prospectively by diary and in-person assessment every 3 months. Decreased VA at baseline was defined as better-eye VA lower than 1.0. We applied negative binomial regression models for all and injurious falls, adjusted for age, sex, prior falls, treatment allocation, study site, baseline body mass index, and use of walking aids.

RESULTS

Among the 2131 participants included in this analysis (mean age: 74.9 years, 61.7% were women, 82.6% at least moderately physically active), 1464 (68.7%) had decreased VA. Overall, 3290 falls including 2116 injurious falls were recorded over 3 years. Decreased VA at baseline was associated with a 22% increased incidence rate of all falls [adjusted incidence rate ratio (aIRR) = 1.22, 95% CI 1.07, 1.38, P = .003] and 20% increased incidence rate of injurious falls (aIRR = 1.20, 95% CI 1.05, 1.37, P = .007).

CONCLUSIONS AND IMPLICATIONS

Our findings suggest that decreased VA is an independent predictor of an about 20% increased risk of all and injurious falls, highlighting the importance of regular eye examinations and VA measurements for fall prevention, even in generally healthy and active older adults.

The association between visual impairment and mental disorders

To determine the association between visual impairment (VI) and some mental disorders using the general health questionnaire (GHQ) in individuals aged 60 years and above in Tehran, Iran. The present population-based cross-sectional study was conducted on people aged 60 and older in Tehran, Iran using multi-stage cluster sampling. After selecting the samples, examinations including visual acuity measurement, refraction, and slit-lamp biomicroscopy were performed for all participants. The GHQ was used to examine mental disorders. Simple and multiple linear regressions were used to investigate the association between VI and mental disorders. Of the 3740 invitees, 3310 participated in the study (response rate: 88.50%). After applying the exclusion criteria, 2789 individuals were analyzed for this report. Mean score of physical, anxiety, social and depression disorders in people with and without VI was 3.74 ± 2.03, 5.81 ± 2.79, 7.56 ± 1.91, 1.32 ± 1.90, and 3.14 ± 1.76, 4.93 ± 2.71, 8.09 ± 1.99, 0.91 ± 1.38, respectively. The total score of GHQ in participants with and without VI was 18.43 ± 4.75 and 17.07 ± 4.19, respectively. The association between GHQ subscales and total GHQ score with VI by multiple linear regression showed that VI had a statistically significant direct association with physical symptoms (β = 0.37; 95% CI 0.12 to 0.62) and anxiety (β = 0.48; 95% CI 0.16 to 0.81). Nevertheless, depression had a borderline association with VI (β = 0.21; 95% CI - 0.03 to 0.45) and social dysfunction did not have a statistically significant association with VI in the final linear regression model and did not remain in the model. Total GHQ score had a statistically significant association with VI (β = 1.02; 95% CI 0.39 to 1.64) in the presence of covariates. Regarding the association between VI and GHQ components, the physical symptoms had the highest R2 (R2 = 0.159). Patients with VI suffer more from anxiety, depression, and physical symptoms regardless of age, sex, education, and other effective variables. The coincidence of aging with VI and the association of VI with mental disorders emphasizes the importance of a broader view of the elderly and the aging process.

Barriers and enablers to low vision care and rehabilitation in sub-Saharan Africa within a global context

Low vision is an uncorrectable form of visual impairment that affect millions of people worldwide. Low vision care and rehabilitation are essential to improving the independence of affected individuals. Even though sub-Saharan Africa has one of the highest burdens of low vision globally, there are inadequate care and rehabilitation services in most countries and in some cases they are non-existent This scoping review aimed to identify the barriers and enablers to low vision care and rehabilitation in sub-Saharan Africa and assess these within the global context. The review was conducted using the five-step Arksey and O'Malley framework. Search terms were formulated based on the research questions and a search strategy was designed to search for eligible research articles from electronic databases; Pubmed, Ovid, Medline, and Embase. The data was screened by two members of the research team in accordance with set inclusion and exclusion criteria. Twenty-five out of 260 articles satisfied the inclusion criteria for the study. Inadequate low vision care infrastructure and supplies, non-standardised training of low vision care providers, health system failure and poor awareness of low vision care were the main barriers noted by eye care practitioners. Patients living with low vision cited the cost and availability of low vision aids, societal stigma, and poor awareness of services as the main barriers. No direct enablers were identified in sub-Saharan Africa; however, practitioners suggested improved training in low vision as a potential enabler. The barriers to low vision care and rehabilitation services identified were not unique to sub-Saharan Africa when viewed within a global context. Adopting and adapting solutions from other countries may therefore assist in improving low vision care and rehabilitation in sub-Saharan Africa.

Associations between visual impairment, incident falls and fall frequency among older asians: longitudinal findings from the Singapore Epidemiology of Eye Diseases study

BACKGROUND

Association between baseline visual impairment (VI) bilaterality and severity, and associated causes; and incident and frequent falls at 6 years in a multiethnic Asian population aged ≥60 years.

METHODS

It is a population-based prospective cohort study. Visual acuity was clinically measured at both visits. Self-reported incidence and frequency of falls were defined as having no fall at baseline but having one fall and ≥2 incident falls in the 12 months prior to the follow-up visit, respectively.

RESULTS

Of the 1972 older participants (mean age (SD): 67.37 (5.4) years), 253 (12.8%) and 69 (3.5%) reported at least one fall and ≥2 falls, respectively, at a 6-year follow-up. After multivariable adjustments, baseline bilateral VI, but not unilateral, was associated with higher odds of any incident falls (mild bilateral VI: OR=1.79, 95% CI 1.07 to 2.98; moderate-severe VI in one eye and mild VI in the other eye: OR=1.58, 95% CI 1.01 to 2.47). However, having any form of bilateral VI (OR ranging between 2.46 and 4.32; all p<0.05) and even unilateral mild VI (OR=2.34, 95% CI 1.09 to 5.03) significantly increased the odds of incident frequent falls, compared with bilateral normal vision. VI caused by correctable (OR=2.02, 95% CI 1.19 to 3.44) and uncorrectable (OR=3.09, 95% CI 1.08 to 8.80) eye conditions were both associated with greater odds of incident frequent falls, compared with no VI.

CONCLUSIONS

Baseline bilateral but not unilateral VI conferred nearly two-fold higher odds of incident fall. Importantly, even mild unilateral VI conferred a substantially greater likelihood of frequent falls from correctable and uncorrectable conditions.

Impact of vision on generic health-related quality of life - A systematic review

The aim of the study was to provide an overview on the relation between vision and generic health-related quality of life (HRQoL) in general populations worldwide. We conducted a systematic review to identify articles that have evaluated the relation of binocularly measured distance visual acuity (VA) and HRQoL in adults at population level around the world. Used search terms were related to visual acuity, vision loss, visual impairment and HRQoL. We identified 780 articles, of which 12 satisfied the eligibility criteria. The studies were conducted in the USA, Europe, Asia and Australia. Generic HRQoL was measured using EQ-5D, 15D, SF-36, SF-12 and/or WHOQoL. Nine studies reported a trend between decreasing VA and deteriorating HRQoL of at least some degree. Vision loss was mostly associated with dimensions related to physical health and capability, including self-care, mobility and usual activities. Mental dimensions - vitality and social functioning in particular - were also affected, although the results were inconsistent. Six studies compared the impact of different medical conditions on HRQoL, all of which reported that the impact of visual impairment was equal or stronger compared with other major medical conditions. In conclusion, generic HRQoL instruments are sensitive to detect the relation between vision and HRQoL, as they cover dimensions influenced by vision. Declining vision is associated with reduced functioning, which leads to dependence and isolation - both major factors in an individual's well-being. This phenomenon showed surprising similarity around the world and therefore emphasises the global burden of vision loss at both individual and societal level and encourages its prevention and treatment.

Are wearable electronic vision enhancement systems (wEVES) beneficial for people with age-related macular degeneration? A scoping review

INTRODUCTION

Age-related macular degeneration (AMD) is the most common cause of irreversible visual impairment in the United Kingdom. It has a wide-ranging detrimental impact on daily living, including impairment of functional ability and quality of life. Assistive technology designed to overcome this impairment includes wearable electronic vision enhancement systems (wEVES). This scoping review assesses the usefulness of these systems for people with AMD.

METHODS

Four databases (Cumulative Index to Nursing and Allied Health Literature, PubMed, Web of Science and Cochrane CENTRAL) were searched to identify papers that investigated image enhancement with a head-mounted electronic device on a sample population that included people with AMD.

RESULTS

Thirty-two papers were included: 18 studied the clinical and functional benefits of wEVES, 11 investigated use and usability and 3 discussed sickness and adverse effects.

CONCLUSIONS

Wearable electronic vision enhancement systems provide hands-free magnification and image enhancement producing significant improvements in acuity, contrast sensitivity and aspects of laboratory-simulated daily activity. Adverse effects were infrequent, minor and spontaneously resolved with the removal of the device. However, when symptoms arose, they sometimes persisted with continued device usage. There are multi-factorial influences and a diversity of user opinions on promotors to successful device use. These factors are not exclusively driven by visual improvement and incorporate other issues including device weight, ease of use and inconspicuous design. There is insufficient evidence of any cost-benefit analysis for wEVES. However, it has been shown that a user's decision to make a purchase evolves over time, with their estimates of cost falling below the retail price of the devices. Additional research is needed to understand the specific and distinct benefits of wEVES for people with AMD. Further patient-centred research should assess the benefits of wEVES in user-led activities when directly compared with alternative coping strategies, allowing professionals and users to make better prescribing and purchasing decisions.

Concept Mapping to Identify Content for a Performance-Based Measure of Low Luminance Vision-Related Activities of Daily Living

Purpose

The purpose of this study was to identify low luminance activities of daily living (ADL) relevant to adults with vision impairment using a concept-mapping approach.

Methods

“Group concept mapping” was utilized to identify specific ADLs that persons with vision impairment find challenging under low light conditions. In the first “brainstorming” phase, 24 adults with vision impairment from a range of eye conditions (mean age = 73 years, SD = 14 years) and 26 international low vision experts (mean experience = 22, SD = 11 years) generated statements to the focus prompt, “Thinking as broadly as possible, generate a list of statements detailing specific day-to-day activities a person with vision impairment might find challenging under low light conditions, such as in a poorly lit room or outside at dusk.” In the second phase, participants sorted activities by similarity and rated the importance of each activity. Multidimensional scaling and hierarchical cluster analysis were applied to produce concept maps showing clusters of prioritized activities.

Results

One hundred thirteen unique ideas/activities were generated, rated and sorted. Eight clusters were identified (from highest to lowest importance): hazard detection and safety outside; social interactions; navigation; near reading; selfcare and safety at home; distance spotting; searching around the home; and cooking and cleaning.

Conclusions

The conceptual framework and low luminance ADLs identified (the most important being hazard detection and safety outside, and social interactions) provide a basis for developing a performance-based measure of low luminance visual function.

Translational Relevance

A performance-based measure of low luminance vision-related ADLs is required for comprehensively and objectively assessing efficacy of eye treatments and low vision rehabilitation outcomes in adults with vision impairment.

The psychological impact of instrumental activities of daily living on people with simulated age-related macular degeneration

BACKGROUND

People with age-related macular degeneration (AMD) can report reduced mental health. There is also evidence that they struggle with daily tasks because of vision loss.

AIMS

The purpose of this study was to assess the psychological impact of instrumental activities of daily living on people with simulated AMD.

METHOD

Twenty-four normally sighted participants completed 12 household tasks, in a simulated home environment, under a moderate-to-severe AMD simulation. Participants' psychological state was measured through self-report questionnaires and physiological measurements related to anxiety and stress. Tasks were completed twice, under counterbalanced vision conditions (normal and simulated AMD).

RESULTS

Linear mixed models on vision condition (normal versus simulated AMD) and trial order (trial 1 versus trial 2) revealed a significant large negative effect of the AMD simulation on time to complete tasks, and the anxiety, task engagement and distress self-reports (all P < 0.024, all ω² > 0.177). There were also significant medium-large effects of trial order on time, task incompletion, task errors, and the anxiety and task engagement self-reports (all P < 0.047, all ω² > 0.130), whereby the results improved during the second attempt at the tasks. No physiological measures were significant (all P > 0.05).

CONCLUSIONS

Completing instrumental activities of daily living under an AMD simulation had a negative impact on participants' self-reported mental state. The observed trial order effects also illuminated how practice with tasks could ease anxiety and stress over time.

Age-Related Changes in Accuracy and Speed of Lateral Crossing Motion: Focus on Stepping from Leaning Position

Fall incidents are increasing every year and prevention is necessary. Preventing falls can increase the quality of life of the elderly and decrease medical costs. Stumbling and tripping are the main causes of falls and falls in the lateral direction, causing the hip fracture. This study aimed to analyze the accuracy and speed of lateral obstacle crossing in the elderly, especially from leaning posture. Twenty healthy older adults (6 men and 14 women, aged 71.7 ± 1.5 years) and 20 healthy young adults (5 men and 15 women, aged 21.4 ± 1.2 years) participated in this study. We set four conditions (normal, fast, leaning, and leaning fast), and participants crossed the obstacle laterally ten times under each condition. The crossing motion was captured using a three-dimensional analysis system. The trajectory of the foot, landed position, step time, center of gravity of the body, and moment of the lower extremity during the swing phase were calculated and compared between older and younger adults. In the leaning condition, the step time and knee moment of the elderly were significantly longer and larger than those of young adults. From the results of the trajectory of the foot and landed position in the leaning condition, motion inconsistency of the foot was found in the elderly. We believe that it is difficult for the elderly to perform the intended crossing motion and swing quickly because of aging. This inconsistency in motion is a serious cause of falls in the elderly.

Changes in Postural Control Ability after Wearing Corrective Glasses for Distance in Older Adults and Their Causes

Deterioration of postural control in older adults is unavoidable due to age-associated degeneration of the visual system. Our study objective was therefore to verify whether there is a positive effect on postural control ability after providing older adults, whose postural control function had deteriorated, with corrective glasses to correct refractive errors. Twenty-seven participants, 66 to 90 years of age, were included in this study. Stability index, synchronization index, and sway power index were measured by using the TETRAX balance system and comparatively analyzed before and after wearing the corrective glasses for distance. The stability index after wearing corrective glasses significantly decreased compared to before wearing them (p < 0.05). Four synchronization areas, among six, showed a significant increase in the synchronization index after wearing corrective glasses compared to before wearing them (p < 0.05). The sway power index significantly decreased in the mid−high and the high frequency after wearing the corrective glasses (p < 0.05). Optimal visual information can be obtained through the correction of residual refractive errors, eliciting a positive effect on the overall posture control by improving the sensory integration ability with the somatic nervous system responsible for posture control, maximizing the lower extremity motor function of the elderly.

Comparison of the incidence rates of hip and vertebral fragility fractures according to cataract surgery in elderly population: a nationwide cohort study

Elderly patients who underwent cataract surgery showed lower prevalence and cumulative incidence rates of hip and vertebral fragility fractures than those who did not. Therefore, cataract surgery in elderly patients may reduce the incidence of hip and vertebral fragility fractures.

PURPOSE

The purpose of this study was to compare the incidence rates of hip and vertebral fragility fractures between patients who underwent cataract surgery and those who did not, and to investigate the effect of cataract surgery on the incidence of fragility fracture in elderly population using nationwide claims data.

METHODS

A total of 558,147 participants from the National Health Insurance Service - Senior cohort were included. The participants were set into the hip fracture group (507,651) and vertebral fracture group (507,899) depending on the type of fracture.

RESULTS

The number of hip fractures that occurred in the non-cataract surgery (NC) group was 36,971 (9.9%), while 8850 (6.6%) hip fractures occurred in the cataract surgery (C) group. The number of vertebral fractures that occurred in the NC group was 38,689 (10.3%), while 10,112 (7.6%) vertebral fractures occurred in the C group (all p < .001). The hazard ratios of hip and vertebral fractures were 0.58 and 0.60 for the total population that had undergone cataract surgery (all p < .001). The cumulative incidence rates of both fractures in the cataract surgery group were significantly lower than those in the non-cataract surgery group during 10 years (all p < .0001).

CONCLUSION

Elderly patients who underwent cataract surgery showed a lower prevalence of hip and vertebral fragility fractures than those who did not. In addition, the cumulative incidence rates of both fractures in the cataract surgery group were lower than those in the non-cataract surgery group. Therefore, cataract surgery in elderly patients may reduce the incidence of hip and vertebral fragility fractures.

Thyroid Eye Disease With Divergence Insufficiency Causing Recurrent Falls in an Elderly Patient

Recurrent falls are a common cause of morbidity in the elderly population, as more than one-third of individuals aged 65 years or older experience falls each year. Falls remain a multifactorial phenomenon that can potentially result in devastating debilitation and hence require proper medical attention and management. In an elderly patient presenting with recurrent falls, the workup for differential diagnoses remains wide with various causes such as postural hypotension, syncope, seizures, arrhythmia, medication-induced, and cognitive impairment. In this report, we discuss an interesting case of recurrent falls in an elderly woman with hyperthyroidism who was repeatedly found to have unremarkable lab results and negative imaging studies. She was later diagnosed with divergence insufficiency with intermittent esotropia secondary to thyroid ophthalmopathy, which was the cause of her underlying horizontal diplopia contributing to her falls. This can cause blurry vision at further distances, which is observed especially in individuals older than 50 years. Treatment typically involves prism therapy, surgery in refractory patients, and, currently, novel therapy using teprotumumab infusion. The patient was referred to see a strabismus specialist for prism prescription and possible surgical intervention. In elderly patients with a history of recurrent falls, a comprehensive visual exam should be strongly considered, especially for individuals with repeated negative workups, to prevent further testing or procedures.

Reviewing the Role of Outdoor Lighting in Achieving Sustainable Development Goals

The Sustainable Development Goals (SDGs) aim at providing a healthier planet for present and future generations. At the most recent SDG summit held in 2019, Member States recognized that the achievements accomplished to date have been insufficient to achieve this mission. This paper presents a comprehensive literature review of 227 documents contextualizing outdoor lighting with SDGs, showing its potential to resolve some existing issues related to the SDG targets. From a list of 17 goals, six SDGs were identified to have relevant synergies with outdoor lighting in smart cities, including SDG 3 (Good health and well-being), SDG 11 (Sustainable cities and communities), SDG 14 (Life below water) and SDG 15 (Life on land). This review also links efficient lighting roles partially with SDG 7 (Affordable and clean energy) and SDG 13 (Climate action) through Target 7.3 and Target 13.2, respectively. This paper identifies outdoor lighting as a vector directly impacting 16 of the 50 targets in the six SDGs involved. Each section in this review discusses the main aspects of outdoor lighting by a human-centric, energy efficiency and environmental impacts. Each aspect addresses the most recent studies contributing to lighting solutions in the literature, helping us to understand the positive and negative impacts of artificial lighting on living beings. In addition, the work summarizes the proposed solutions and results tackling specific topics impacting SDG demands.

Prevalence of Falls in Patients Presenting to an Ophthalmic Outpatients Department- A Surveillance Study

Introduction:

Approximately 1 in 3 adults aged 65 and over experience a fall each year. Poor vision is an identified risk factor. The aim of this cross-sectional public health surveillance audit was to determine the prevalence of falls experienced in the previous 12 months by adult patients presenting to an ophthalmology department.

Methods:

A short questionnaire was given to consecutive patients attending an ophthalmology department at two trusts in the North West to determine whether they had experienced a fall in the previous 12 months, whether they had suffered a fracture, their eye condition and the type of glasses worn.

Results:

Data was collected for 585 patients (mean age: 69 years, SD: 13.8). Falls in the previous 12 months were reported by 96 (16.4%) patients, and a significant proportion of these were aged 60 years and over (82%, p < 0.0001, one-sample binomial test). Half of the respondents were unaware of their eye health condition for which they were attending the department. Glaucoma was the most prevalent condition in those who had experienced a fall (43%). A significant proportion of the individuals who reported a fall wore single-vision glasses (43%, p < 0.0001, one-sample chi-square test).

Conclusion:

In an ophthalmology outpatient department, the proportion of older adults who experienced a fall in the previous 12 months was lower than the reported prevalence in the general population. There is a need for health literacy to educate patients about their eye condition, the potential effects on their visual function and, consequently, managing falls risk.

Gait characteristics during crossing over obstacle in patients with glaucoma using insole foot pressure

BACKGROUND

Glaucoma, is the most common cause of irreversible visual deficits, presents as an injury to the optic nerve and it is mainly associated with elevated intraocular pressure. The main symptom of glaucoma is a reduction of the visual field, which is usually a source of complaint at the advanced stage of disease. Because of visual deficit, gait dysfunctions, including low gait speed and increased bumping into objects, postural sway, and falling are occurred. Many studies have used stopwatch or motion-sensing devices to report on gait function following glaucoma. However, there are few reports on gait dysfunction assessed by examining foot pressure. This study investigated gait ability following glaucoma according to different gait conditions by assessing foot pressure.

METHODS

Thirty older adults (15 in the sex- and age-matched normal group and 15 in the glaucoma group) were recruited for this study. All participants were walked under 2 different gait conditions in an F-scan system and the subject' assessments were randomly assigned to rule out the order effect. Conditions included: gait over an obstacle in a straight 6 m path, gait in a straight path without an obstacle in the 6 m path. Gait variables included cadence, gait cycle, stance time, center of force (COF) deviation, and COF excursion. About 10 minutes were taken for gait evaluation.

RESULTS

When walking without an obstacle on a 6 m path, there were significant differences between the 2 groups in gait speed, cadence, gait cycle, and stance time (P < .05). There were significant differences when walking with an obstacle on a 6 m path (P < .05). Two-way analysis of variance showed significant effects associated with "glaucoma" not gait condition on all outcomes except for COF deviation and excursion. Also, there was no the interaction effect between "glaucoma" and "gait condition."

CONCLUSION

We demonstrated that glaucoma patients selected the gait strategy such as lower gait function in both gait conditions particularly, slower gait speed and cadence and longer gait cycle and stance time, as determined by examining foot pressure. We believe that our results could help to improve the quality of life of patients with glaucoma.

Preoperative screening in patients having elective shoulder surgery reveals a high rate of fall risk

INTRODUCTION

Fall risk is an acknowledged but relatively understudied concern for older patients undergoing shoulder surgery. The cause is multifactorial, and it includes advanced age, impaired upper extremity function, use of shoulder abduction braces, and postoperative use of opioid medications. No previous study has examined preoperative fall risk in patients undergoing elective shoulder surgery. Previous literature looking at fall risk in elective orthopedic procedures has predominantly focused on falls occurring in the hospital setting, although falls have also been shown to occur in the outpatient setting. Gait speed and Timed Up and Go (TUG) are well-researched functional measures in the aging population with established cutoff scores indicating increased fall risk. The purpose of this study was to quantify gait speed and TUG scores in a series of patients who were scheduled to undergo either rotator cuff repair (RCR) or total shoulder arthroplasty (TSA) in order to assess overall risk of fall in these populations.

METHODS

A total of 198 patients scheduled for TSA or RCR surgery were evaluated preoperatively from multiple outpatient physical therapy clinics within Greenville, South Carolina. The TUG score (>14 seconds considered high fall risk) and 10 Meter Walk test (<0.7 m/s considered high risk for falls) were recorded for each patient. Patient-reported outcomes were also collected, including Veteran's Rand 12 Physical Component and Mental Component Scores, American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form score, and the Single Assessment Numeric Evaluation.

RESULTS

Patients undergoing TSA (n = 80; 65.4 ± 11.4 years) were older than those undergoing RCR (n = 118; 59.0 ± 14.2 years). Fifty-nine percent of all patients were classified as being a high risk for falls based on gait speed <0.7 m/s. Patients in the TSA group were more likely to display preoperative fall risk compared to patients in the RCR group (62% vs. 38%; χ² = 8.9, P = .03). There were no significant differences in ambulatory status, Veteran's Rand 12 Physical Component and Mental Component Scores, American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form, or Single Assessment Numeric Evaluation scores between groups (P = .11).

DISCUSSION

Both patient groups demonstrated a high rate of fall risk in preoperative evaluation. Patients undergoing TSA more often displayed fall risk compared with patients undergoing RCR. Although patients in the TSA group were older, there was no association between age or ambulatory status and fall risk.

CONCLUSION

Our results suggest that fall risk screening may be important for patients undergoing TSA and RCR surgeries. The higher fall risk in the TSA group may be an important consideration as this procedure shifts toward outpatient status.

The association between visual attention and body movement-controlled video games, balance and mobility in older adults

Background

Body movement-controlled video games involving physical motion and visual attention may have the potential to train both abilities simultaneously. Our purpose was to determine the associations between performance in these games and visual attention, balance and mobility in a group of older adults. The long-term goal is to identify the optimal type of interactive games with regards to training potential.

Methods

Fifty healthy adults aged 65+ years participated in this cross-sectional study. Visual attention was measured with static and dynamic versions of a useful field of view (UFV) and a multiple object tracking (MOT) test. Balance was measured with a force plate in bi-pedal quiet stance test (QST) and one-legged stance (OLST). Gait variability and walking speed were assessed with the Five Meter Walk Test (5MWT). Four Microsoft™ Xbox® 360 Kinect™ interactive video games were chosen based on the apparent levels of visual attention demand.

Results

Visual attention (UFV and MOT) was significantly associated with performance in Xbox® Kinect™ games that appeared to have a high visual attention demand (p < 0.05), while there was minimal or no significant association with games with apparent low visual attention demand. Balance and mobility show correlations with visual attention, and with Xbox games.

Conclusion

The results suggest that there are relationships between visual attention, balance, mobility and Xbox® Kinect™ game performance. Since different Xbox® games were associated with different balance, mobility and visual attention scores, a variety of such games, rather than a single game, may be most effective for training for falls prevention.

Clinical outcomes of the Centre for Eye Health: an intra-professional optometry-led collaborative eye care clinic in Australia

Clinical relevance: This novel clinical model is the first of its kind in Australia and was designed to help reduce unnecessary referrals into overburdened public systems by utilising pre-existing community-based resources.Background: The Centre for Eye Health (CFEH) is an intra-professional optometry-led care clinic offering an alternative pathway to traditional ophthalmology-based pathways (public hospital clinics or private practices) for 'at-risk' patients requiring ocular imaging, diagnostic and management services. This study evaluates the CFEH integrated eye-care model in the identification of chronic eye diseases within the community.Methods: A retrospective random clinical audit of over 750 medical records of patients referred to the CFEH between July 2016 and June 2019 was conducted. Demographics of patients, referral type, final diagnosis and recommended management plans were extracted from this subset. Clinic key performance indicators (referral turnaround time, and net cost per patient appointment) were also extracted.Results: Of the 755 referrals associated with the audited records, 77.4% resulted in the identification of patients with or at-risk of developing eye diseases with 73.5% of this cohort requiring ongoing monitoring at CFEH or referral to ophthalmology. Although the CFEH model is not designed to diagnose or manage acute conditions, 1.5% of patients in this pathway required same day ophthalmological or medical intervention. The cost per patient was equivalent to hospital eye departments costs.Conclusion: This integrated care pathway has the potential to reduce unnecessary referrals from optometrists to hospital ophthalmological service by offering a safe and effective alternate pathway. The majority of patients seen within this pathway were able to be monitored within optometry-led services. This is a unique clinical model utilising inter-professional referrals within optometry which has the potential to reduce preventable blindness within the community through the early detection of eye diseases.

Special Report from the CDC Antidepressant subclass use and fall risk in community-dwelling older Americans

INTRODUCTION

Falls among older adults are a significant health concern affecting more than a quarter of older adults (age 65+). Certain fall risk factors, such as medication use, increase fall risk among older adults (age 65+).

AIM

The aim of this study is to examine the association between antidepressant-medication subclass use and self-reported falls in community-dwelling older adults.

METHODS

This analysis used the 2009-2013 Medicare Current Beneficiary Survey, a nationally representative panel survey. A total of 8,742 community-dwelling older adults, representing 40,639,884 older Medicare beneficiaries, were included. We compared self-reported falls and psychoactive medication use, including antidepressant subclasses. These data are controlled for demographic, functional, and health characteristics associated with increased fall risk. Descriptive analyses and multivariate logistic regression analyses were conducted using SAS 9.4 and Stata 15 software.

RESULTS

The most commonly used antidepressant subclass were selective serotonin reuptake inhibitors (SSRI) antidepressants (13.1%). After controlling for characteristics associated with increased fall risk (including depression and concurrent psychoactive medication use), the risk of falling among older adults increased by approximately 30% among those who used a SSRI or a serotonin-norepinephrine reuptake inhibitors (SNRI) compared to non-users. The adjusted risk ratio (aRR) for SSRI was 1.29 (95% CI = 1.13, 1.47) and for SNRI was 1.32 (95% CI = 1.07, 1.62).

CONCLUSION

SSRI and SNRI are associated with increased risk of falling after adjusting for important confounders. Medication use is a modifiable fall risk factor in older adults and can be targeted to reduce risk of falls. Practical Applications: Use of selective serotonin reuptake inhibitors and serotonin-norepinephrine reuptake inhibitors increased the risk of falling in older adults by approximately 30%, even after controlling for demographic, functional, and health characteristics, including depression. Health care providers can work towards reducing fall risk among their older patients by minimizing the use of certain medications when potential risks outweigh the benefits.

Test-Retest Reliability and Minimal Detectable Change of the Instrumented Modified Clinical Test of Sensory Interaction on Balance in Healthy, Older Adults

BACKGROUND AND PURPOSE

Test-retest reliability has not been previously reported for the instrumented modified Clinical Test of Sensory Interaction on Balance (i-mCTSIB) utilizing the Neurocom Very Simple Rehab (VSR) Sport force plate. The VSR Sport is a portable, relatively inexpensive force plate system utilized to assess postural stability in various populations. Therefore, the purpose of this study is to determine the test-retest reliability, standard error of measurement (SEM), and minimal detectable change (MDC) of the i-mCTSIB when assessed using the VSR Sport in a sample of healthy, older adults.

METHODS

This was a methodological study with 20 healthy, older adults between the ages of 65 and 85 years. Participants were tested twice in a single session on the i-mCTSIB utilizing the VSR Sport force plate. The mean sway velocity (°/s) measurements for the 2 trials were compared for each test condition to compute intraclass correlation coefficients (ICCs) for each measurement. Standard error of measurements and minimal detectable change at the 90% confidence level (MDC90) were also calculated.

RESULTS AND DISCUSSION

The test-retest reliability for each of the test conditions ranged from 0.762 to 0.909, which can be broadly interpreted as good-to-excellent reliability. The ICC(2,k) value of 0.898 for the composite score can also be interpreted as excellent reliability. Our results revealed small SEM for all test conditions (SEM = 0.060-0.101) except for the foam surface, eyes closed condition, with an SEM of 0.481. The MDC90 results for all testing conditions ranged from 0.140 to 0.285 except for the foam surface, eyes closed condition, which had an MDC90 = 1.12.

CONCLUSIONS

The i-mCTSIB measurements utilizing the VSR Sport demonstrated good-to-excellent test-retest reliability. The clinical relevance of this study is that it demonstrates that the VSR Sport is a feasible alternative to other more expensive computerized systems used for the assessment of postural sway. MDC90 scores allow interpretation of change in i-mCTSIB scores following intervention. Practice effects may have contributed to the larger MDC90 for sway scores in the foam surface, eyes closed condition.

Cost-effectiveness of basic vision rehabilitation (The basic VRS-effect study): study protocol for a randomised controlled trial

PURPOSE

To investigate the cost-effectiveness of a basic vision rehabilitation service (basic-VRS) in Portugal. We designed a parallel group, randomised controlled trial whose aim is to compare the effects and costs of 'usual low vision care' with a 'basic-VRS intervention' on self-reported visual ability and other psychosocial and health-related quality-of-life outcomes.

METHODS

The trial will recruit participants that meet the following inclusion criteria: (1) visual acuity between 0.4-1.0 logMAR in the better-seeing eye, (2) cause of vision loss is diabetic retinopathy or age-related macular degeneration, (3) 18 years or older and iv) live in the community (not in nursing homes or other type of institution). Participants will be randomised to one of the study arms consisting of immediate intervention and delayed intervention. The delayed intervention group will receive 'usual care' or no intervention in the first 12 weeks. Visual acuity, contrast sensitivity and retinal structure will be assessed during the study.

RESULTS

The primary outcome measure is visual ability, which will be evaluated with the Massof Activity Inventory, we expect that the intervention will raise the overall person measure or visual ability. Reading, health-related quality-of-life, anxiety and depression and social support will be also assessed. The analysis will be undertaken on an intention-to-treat basis. A cost-effectiveness analysis will be performed to provide information about the cost per unit of utility. To evaluate the cost-effectiveness of the intervention we will adopt the perspective of the healthcare system.

CONCLUSION

This study will provide additional evidence about the effects of basic-VRS on self-reported visual ability. Findings from this study should also contribute to better planning of low vision provision and, consequently, may contribute to reduce barriers to basic-VRS.

The higher they go the harder they could fall: The impact of risk-glorifying commercials on risk behavior

Previous research on risk-glorifying media has provided encompassing evidence for a positive connection between risk-glorifying contents and (a) risk-positive emotions, (b) risk-positive cognitions and attitudes, and (c) risk-positive behavioral inclinations. Nevertheless, little evidence shows whether risk-glorifying content increases actual risk behavior. We conducted three experimental studies to assess whether risk-glorifying commercials increase risk behavior. In all studies, participants were randomly assigned to a risk-glorifying or a neutral commercial. Additionally, in Study 2 participants were randomly assigned to an arousal or a non-arousal condition to test the mediating effect of arousal. In Study 3, we tested the mediating effect of the accessibility to risk-positive cognitions. We measured participants’ risk behavior via the risk assessment ramp (RAR). Our results revealed that participants who watched the risk-glorifying commercial walked faster to the jumping-off point (Studies 1, 2, & 3) and would have jumped from a higher level (Studies 2 & 3), thus, indicating the exposure to risk-glorifying media content increases people’s risk behavior. Neither arousal nor the accessibility to risk-positive cognitions mediated the effect of risk-glorifying media content. Beyond our findings, we offer a new tool to assess risk behavior that is effective and easy to apply.

Low vision status and declining vision decrease Health-Related Quality of Life: Results from a nationwide 11-year follow-up study

PURPOSE

The impact of visual acuity (VA) on Health-Related Quality of Life (HRQoL) and the cross-sectional and longitudinal differences in HRQoL during the 11-year follow-up were investigated. The aim was to examine the impact declining vision has on HRQoL and to provide comparable data to facilitate the allocation of health-care resources.

METHODS

We utilized nationwide health examination surveys carried out by the National Institute for Health and Welfare in 2000 and 2011, providing a representative sampling of the Finnish adult population aged 30 and older. VA was assessed through Snellen E test, and HRQoL scores were evaluated using EQ-5D and 15D questionnaires. Multiple imputations with Markov chain Monte Carlo method was used to utilize the data more effectively. Regression analyses were conducted to assess the impact of declining VA on HRQoL, adjusted for incident comorbidities.

RESULTS

Lower VA status was associated with significantly lower HRQoL at both time points, most clearly observable below the VA level of 0.5. Declining VA resulted in statistically significant decline in HRQoL during the follow-up, greater with distance than near VA. 15D impairment associated with decline in the distance VA was also clinically meaningful and greater than that associated with any of the examined comorbidities.

CONCLUSIONS

HRQoL was significantly and meaningfully impaired even before the threshold of severe vision loss or blindness was reached. The results encourage the improvement of available treatment options aiming to postpone the onset of visual impairment or declining VA, to maintain better quality of life among the population.

Improved indoor lighting improved healthy aging at home - an intervention study in 77-year-old Norwegians

Introduction: Healthy aging and good quality of life is important to allow older people to live at home. Lighting is a significant environmental attribute promoting visual, physical, and mental health. Due to normal visual age changes, older people need more light, but improving indoor lighting levels receives little attention. Objective: To investigate the impact of improved home lighting on abilities to perform activities of daily living (ADLs) and quality of life in healthy older people. Methods: Sixty healthy 77 years old living at home participated during the 4-month dark winter period. In the intervention group (IG, n=30), the living room lighting was optimized by providing lamps and a basic control system with three preset levels (normal, medium, low). Participants chose the light level and kept a diary. No change was implemented for the control group (CG, n=30). A questionnaire measured self-reported visual and general health and ability to perform ADL in regards to lighting before and after the intervention in both groups. Results: In the IG, lighting levels significantly improved self-assessed lighting levels, abilities to perform ADLs, and read and write in the living room (all p<0.03). In the CG the only change was a deterioration in performing ADLs ( p<0.05). The difference in change was significant between the IG and CG (all p<0.02). "Normal" lighting was the preferred level and increased comfort and well-being. The IG also resumed visually demanding tasks, and acknowledged that avoiding these tasks were mainly due to poor lighting. Conclusions: Good vision is essential in promoting healthy aging at home and require adequate lighting. This can easily be achieved using a basic light system. Adopting to higher lighting levels evolves quickly. Our results suggest that improved quality of light could improve quality of life, and lighting should be included as a factor promoting healthy aging at home.

Association Between Cataract and Risks of Osteoporosis and Fracture: A Nationwide Cohort Study

OBJECTIVES

To evaluate the association between cataract and cataract surgery and risks of osteoporosis and fracture.

DESIGN

Nationwide population-based retrospective cohort study.

SETTING

Taiwan's National Health Insurance Research Database.

PARTICIPANTS

Individuals with (n=57,972) and without (n=57,972) cataracts.

MEASUREMENTS

Individuals with and without cataracts were matched 1:1 for age, sex, and index year. Those with cataracts were further divided into cataract surgery and nonsurgery groups. Incidences and hazard ratios (HR) for risks of developing osteoporosis and fracture were calculated using Cox proportional hazard regression models.

RESULTS

During mean follow-up of 6.4 years, 17,450 participants with cataracts and 12,627 without developed osteoporosis or fractures. Having cataracts was significantly associated with risk of developing osteoporosis or fracture (adjusted HR (aHR) = 1.29, 95% confidence interval (CI) = 1.25-1.32, p < .001). In analyses for each event, cataract was significantly associated with greater likelihood of all outcomes (osteoporosis: aHR = 1.43, 95% CI = 1.37-1.50, p < .001; hip fracture: aHR = 1.16, 95% CI = 1.07-1.26, p < .001; vertebral fracture: (aHR = 1.25, 95% CI = 1.18-1.33, p < .001; other fractures: aHR = 1.24, 95% CI = 1.20-1.28, p < .001). Participants who underwent cataract surgery were at significantly lower risk of osteoporosis or fracture (aHR = 0.58, 95% CI = 0.56-0.59, p < .001), than those who did not. Undergoing cataract surgery was also associated with lower risks of all individual events (osteoporosis; hip, vertebral, other fracture).

CONCLUSION

Cataract was independently associated with increased risks of osteoporosis and fracture. There might be an association between cataract surgery and lower risks of osteoporosis and fracture. J Am Geriatr Soc 67:254-260, 2019.

Development and validation of Visual Impairment as a Risk for Falls Questionnaire

Purpose

visual impairment is associated with an increased risk of falls, yet eye care professionals are infrequently members of falls prevention clinics. The aim of this preliminary study was to validate a newly created Visual Impairment as a Risk for Falls Questionnaire intended to be used by those professionals not involved in eye care.

Methods

about 53 participants with various visual impairments known to be associated with falls and 33 participants with normal sight were contacted within 4 months of a full oculo-visual assessment and were asked the questions from the current questionnaire pertaining to their visual function. A retrospective file review was undertaken and the sensitivity and specificity of participants' responses were calculated compared to the actual vision impairment based on the findings from their visual assessment.

Results

the question regarding ability to read was included to identify people with central vision loss, a risk factor for falling. It was found to have sensitivity of 74% and specificity of 87%. Both sensitivity and specificity improved when participants with cognitive impairment were excluded. The question on recognising facial features gave sensitivity of 73% and specificity of 97% for this subgroup. However, questions related to impairments in stereopsis and peripheral fields were not useful.

Conclusion

the study demonstrates that several questions of the new questionnaire are useful; however, further testing with a larger population is needed to fully validate the questionnaire for use by health care professionals.

Association between vision-specific quality of life and falls in community-dwelling older adults: LOHAS

Background

Falls and fall-related fractures are a major public health problem among the older adults. Although objective measures of poor vision have been reported to be associated with falls, the association of self-reported visual function and vision-specific quality of life (QOL) with falls has been inconsistent across several studies. We investigated the association of self-reported visual function and vision specific QOL with falls in community-dwelling older adults.

Methods

We conducted a cross-sectional analysis using the baseline data from participants of the Locomotive Syndrome and Health Outcome in Aizu Cohort Study (LOHAS), which is an ongoing population-based cohort study to evaluate the association of physical dysfunction with the clinical outcomes in community-dwelling people. In the present study, the participants aged over 65 years in 2010 were eligible. The exposure variable was the composite score of the VFQ-J11, which was newly developed using item response theory to evaluate vision specific QOL, and the self-reported outcomes were any fall and frequent falls (≥2) over a 1-month period. We estimated odds ratios using separate logistic regression models adjusted for relevant confounding factors.

Results

Among 1624 participants, the median (interquartile range) composite score of VFQ-J11 was 86.8 (76.0–95.9). Any fall and frequent falls were reported by 13.9% and 5.4% of participants, respectively. The composite score of the VFQ-J11 was significantly associated with both frequent falls (adjusted ORs per 10 points, 0.80; 95% CI, 0.68–0.93) and any fall (adjusted ORs per 10 points, 0.84; 95% CI, 0.76–0.94).

Conclusions

We found that the composite score of the VFQ-J11 was associated with falls in community-dwelling older adults. Detecting individuals with visual impairments associated with falls using the VFQ-J11 and improvement in the score by interventions could prevent falls. We may consider adding self-reported visual function and vision-specific QOL to conventional risk factors for fall among older adults.

Ageing vision and falls: a review

Background

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.

Main body of the abstract

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.

Conclusion

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.

Pedestrian falls: A review of the literature and future research directions

INTRODUCTION

Pedestrian falls (PFs) - falls in public spaces without collisions with other road users - are a significant cause of serious transport-related injuries, amounting to three-quarters of all pedestrians admitted to hospital.

METHODS

This scoping review examined peer-reviewed research on PFs published between 1995 and 2015. Electronic databases (Scopus, SafetyLit, and PubMed) were used to find studies identifying PFs or outdoor falls (the latter also including falls in gardens).

RESULTS

We identified only 28 studies reporting relevant information on PFs (i.e., 15 prospective, 10 retrospective, and 3 intervention studies). The results show that more walking is related to a lower risk of PFs. Older people, especially older women, have a higher risk of (injurious) PFs. Outdoor fall victims have equally good or better health characteristics and scores on balance tests compared to those who have not experienced such falls. Road factors such as uneven surfaces, busy junctions, stairs, and slippery surfaces seem to play an important role in PFs, but much of the research on these factors is of a qualitative nature.

CONCLUSIONS

PF victims are generally in good health (apart from normal age-related problems) but at risk due to road factors.

PRACTICAL APPLICATIONS

We recommend to adopt a human factors approach. The road system should be adapted to human capabilities and limitations including those of pedestrians. Measures such as preventing uneven surfaces and good winter maintenance seem to be effective. However, we advise more quantitative research on road factors to inform design guidelines and standards for public space authorities given the qualitative nature of current research on road factors.

A Non Linear Scoring Approach for Evaluating Balance: Classification of Elderly as Fallers and Non-Fallers

Almost one third of population 65 years-old and older faces at least one fall per year. An accurate evaluation of the risk of fall through simple and easy-to-use measurements is an important issue in current clinic. A common way to evaluate balance in posturography is through the recording of the centre-of-pressure (CoP) displacement (statokinesigram) with force platforms. A variety of indices have been proposed to differentiate fallers from non fallers. However, no agreement has been reached whether these analyses alone can explain sufficiently the complex synergies of postural control. In this work, we study the statokinesigrams of 84 elderly subjects (80.3+− 6.4 years old), which had no impairment related to balance control. Each subject was recorded 25 seconds with eyes open and 25 seconds with eyes closed and information pertaining to the presence of problems of balance, such as fall, in the last six months, was collected. Five descriptors of the statokinesigrams were computed for each record, and a Ranking Forest algorithm was used to combine those features in order to evaluate each subject’s balance with a score. A classical train-test split approach was used to evaluate the performance of the method through ROC analysis. ROC analysis showed that the performance of each descriptor separately was close to a random classifier (AUC between 0.49 and 0.54). On the other hand, the score obtained by our method reached an AUC of 0.75 on the test set, consistent over multiple train-test split. This non linear multi-dimensional approach seems appropriate in evaluating complex postural control.

Standing Balance and Spatiotemporal Aspects of Gait Are Impaired Upon Nocturnal Awakening in Healthy Late Middle-Aged and Older Adults

STUDY OBJECTIVES

Nocturnal awakenings may constitute a unique risk for falls among older adults. We describe differences in gait and balance between presleep and midsleep testing, and whether changes in the lighting environment during the midsleep testing further affect gait and balance.

METHODS

Twenty-one healthy, late middle-aged and older (64.7 ± 8.0 y) adults participated in this repeated-measures design consisting of four overnight laboratory stays. Each night, participants completed baseline visual acuity, gait, and balance testing. After a 2-h sleep opportunity, they were awakened for 13 min into one of four lighting conditions: very dim white light (< 0.5 lux); dim white light (∼28.0 lux); dim orange light (∼28.0 lux); and white room-level light (∼200 lux). During this awakening, participants completed the same sequence of testing as at baseline.

RESULTS

Low-contrast visual acuity significantly decreased with decreasing illuminance conditions (F(3,45) = 98.26, p < 0.001). Our a priori hypothesis was confirmed in that variation in stride velocity and center of pressure path length were significantly worse during the mid-sleep awakening compared to presleep baseline. Lighting conditions during the awakening, however, did not influence these parameters. In exploratory analyses, we found that over one-third of the tested gait and balance parameters were significantly worse at the midsleep awakening as compared to baseline (p < 0.05), and nearly one-quarter had medium to large effect sizes (Cohen d ≥ 0.5; r ≥ 0.3).

CONCLUSIONS

Balance and gait are impaired during midsleep awakenings among healthy, late middle-aged and older adults. This impairment is not ameliorated by exposure to room lighting, when compared to dim lights.

Effect of rehabilitation worker input on visual function outcomes in individuals with low vision: study protocol for a randomised controlled trial

Background

Visual Rehabilitation Officers help people with a visual impairment maintain their independence. This intervention adopts a flexible, goal-centred approach, which may include training in mobility, use of optical and non-optical aids, and performance of activities of daily living. Although Visual Rehabilitation Officers are an integral part of the low vision service in the United Kingdom, evidence that they are effective is lacking. The purpose of this exploratory trial is to estimate the impact of a Visual Rehabilitation Officer on self-reported visual function, psychosocial and quality-of-life outcomes in individuals with low vision.

Methods/design

In this exploratory, assessor-masked, parallel group, randomised controlled trial, participants will be allocated either to receive home visits from a Visual Rehabilitation Officer (n = 30) or to a waiting list control group (n = 30) in a 1:1 ratio. Adult volunteers with a visual impairment, who have been identified as needing rehabilitation officer input by a social worker, will take part. Those with an urgent need for a Visual Rehabilitation Officer or who have a cognitive impairment will be excluded. The primary outcome measure will be self-reported visual function (48-item Veterans Affairs Low Vision Visual Functioning Questionnaire). Secondary outcome measures will include psychological and quality-of-life metrics: the Patient Health Questionnaire (PHQ-9), the Warwick-Edinburgh Mental Well-being Scale (WEMWBS), the Adjustment to Age-related Visual Loss Scale (AVL-12), the Standardised Health-related Quality of Life Questionnaire (EQ-5D) and the UCLA Loneliness Scale. The interviewer collecting the outcomes will be masked to the group allocations. The analysis will be undertaken on a complete case and intention-to-treat basis. Analysis of covariance (ANCOVA) will be applied to follow-up questionnaire scores, with the baseline score as a covariate.

Discussion

This trial is expected to provide robust effect size estimates of the intervention effect. The data will be used to design a large-scale randomised controlled trial to evaluate fully the Visual Rehabilitation Officer intervention. A rigorous evaluation of Rehabilitation Officer input is vital to direct a future low vision rehabilitation strategy and to help direct government resources.

Trial registration

The trial was registered with (ISRCTN44807874) on 9 March 2015.

Feasibility of a stepped wedge cluster RCT and concurrent observational sub-study to evaluate the effects of modified ward night lighting on inpatient fall rates and sleep quality: a protocol for a pilot trial

Background

Falls among hospitalised patients impose a considerable burden on health systems globally and prevention is a priority. Some patient-level interventions have been effective in reducing falls, but others have not. An alternative and promising approach to reducing inpatient falls is through the modification of the hospital physical environment and the night lighting of hospital wards is a leading candidate for investigation. In this pilot trial, we will determine the feasibility of conducting a main trial to evaluate the effects of modified night lighting on inpatient ward level fall rates. We will test also the feasibility of collecting novel forms of patient level data through a concurrent observational sub-study.

Methods/design

A stepped wedge, cluster randomised controlled trial will be conducted in six inpatient wards over 14 months in a metropolitan teaching hospital in Brisbane (Australia). The intervention will consist of supplementary night lighting installed across all patient rooms within study wards. The planned placement of luminaires, configurations and spectral characteristics are based on prior published research and pre-trial testing and modification. We will collect data on rates of falls on study wards (falls per 1000 patient days), the proportion of patients who fall once or more, and average length of stay. We will recruit two patients per ward per month to a concurrent observational sub-study aimed at understanding potential impacts on a range of patient sleep and mobility behaviour. The effect on the environment will be monitored with sensors to detect variation in light levels and night-time room activity. We will also collect data on possible patient-level confounders including demographics, pre-admission sleep quality, reported vision, hearing impairment and functional status.

Discussion

This pragmatic pilot trial will assess the feasibility of conducting a main trial to investigate the effects of modified night lighting on inpatient fall rates using several new methods previously untested in the context of environmental modifications and patient safety. Pilot data collected through both parts of the trial will be utilised to inform sample size calculations, trial design and final data collection methods for a subsequent main trial.

Trial registration

Australian New Zealand Clinical Trials Register (ANZCTR): ACTRN12614000615684 (cluster RCT) and ACTRN12614000616673 (observational sub-study).

Date Registered: 10 June 2014 (both studies).

Protocol version: 1.2 (Dated: 01 June 2014)

Anticipated completion: September 2015

Role of Trial Sponsor: The named sponsor for this investigator-initiated trial was the Director of the Royal Brisbane and Women’s Hospital (RBWH) Safety and Quality Unit (Therese Lee, Phone: +61 7 3646 8111). The principal investigators, SC and MA, are employed by the RBWH Safety and Quality Unit. The trial sponsor has no involvement in any aspects of study design, conduct or decision to submit the report for publication. AM and MD are employed by other departments in the same organisation.

Dizziness, but not falls rate, improves after routine cataract surgery: the role of refractive and spectacle changes

Purpose

To determine whether dizziness and falls rates change due to routine cataract surgery and to determine the influence of spectacle type and refractive factors.

Methods

Self‐reported dizziness and falls were determined in 287 patients (mean age of 76.5 ± 6.3 years, 55% females) before and after routine cataract surgery for the first (81, 28%), second (109, 38%) and both eyes (97, 34%). Dizziness was determined using the short‐form of the Dizziness Handicap Inventory. Six‐month falls rates were determined using self‐reported retrospective data.

Results

The number of patients with dizziness reduced significantly after cataract surgery (52% vs 38%; χ² = 19.14^,p < 0.001), but the reduction in the number of patients who fell in the 6‐months post surgery was not significant (23% vs 20%; χ² = 0.87, p = 0.35). Dizziness improved after first eye surgery (49% vs 33%, p = 0.01) and surgery on both eyes (58% vs 35%, p < 0.001), but not after second eye surgery (52% vs 45%, p = 0.68). Multivariate logistic regression analyses found significant links between post‐operative falls and change in spectacle type (increased risk if switched into multifocal spectacles). Post‐operative dizziness was associated with changes in best eye visual acuity and changes in oblique astigmatic correction.

Conclusions

Dizziness is significantly reduced by first (or both) eye cataract surgery and this is linked with improvements in best eye visual acuity, although changes in oblique astigmatic correction increased dizziness. The lack of improvement in falls rate may be associated with switching into multifocal spectacle wear after surgery.

Fear of falling in vision impairment

Falls are the leading cause of injury-related morbidity and mortality among older adults. In addition to the resulting physical injury and potential disability after a fall, there are also important psychological consequences, including depression, anxiety, activity restriction, and fear of falling. Fear of falling affects 20 to 43% of community-dwelling older adults and is not limited to those who have previously experienced a fall. About half of older adults who experience fear of falling subsequently restrict their physical and everyday activities, which can lead to functional decline, depression, increased falls risk, and reduced quality of life. Although there is clear evidence that older adults with visual impairment have higher falls risk, only a limited number of studies have investigated fear of falling in older adults with visual impairment and the findings have been mixed. Recent studies suggest increased levels of fear of falling among older adults with various eye conditions, including glaucoma and age-related macular degeneration, whereas other studies have failed to find differences. Interventions, which are still in their infancy in the general population, are also largely unexplored in those with visual impairment. The major aims of this review were to provide an overview of the literature on fear of falling, its measurement, and risk factors among older populations, with specific focus on older adults with visual impairment, and to identify directions for future research in this area.

Evaluation of a Smartphone-based audio-biofeedback system for improving balance in older adults--a pilot study

This study was designed to assess the effectiveness of a Smartphone-based audio-biofeedback (ABF) system for improving balance in older adults. This so-called "iBalance-ABF" system that we recetly developed is "all-inclusive" in the sense that its three main components of a balance prosthesis, (i) the sensory input unit, (ii) the processing unit, and (iii) the sensory output unit, are entirely embedded into the Smartphone. The underlying principle of this system is to supply the user with supplementary information about the medial-lateral (ML) trunk tilt relative to a predetermined adjustable "dead zone" through sound generation in earphones. Six healthy older adults voluntarily participated in this pilot study. Eyes closed, they were asked to stand upright and to sway as little as possible in two (parallel and tandem) stance conditions executed without and with the use of the iBalance-ABF system. Results showed that, without any visual information, the use of the Smartphone-based ABF allowed the older healthy adults to significantly decrease their ML trunk sway in the tandem stance posture and to mitigate the destabilizing effect induced by this particular stance. Although an extended study including a larger number of participants is needed to confirm these data, the present results are encouraging. They do suggest that Smartphone-based ABF system could be used for balance training and rehabilitation therapy in older adults.

Biology-Driven Gene-Gene Interaction Analysis of Age-Related Cataract in the eMERGE Network

Bioinformatics approaches to examine gene-gene models provide a means to discover interactions between multiple genes that underlie complex disease. Extensive computational demands and adjusting for multiple testing make uncovering genetic interactions a challenge. Here, we address these issues using our knowledge-driven filtering method, Biofilter, to identify putative single nucleotide polymorphism (SNP) interaction models for cataract susceptibility, thereby reducing the number of models for analysis. Models were evaluated in 3,377 European Americans (1,185 controls, 2,192 cases) from the Marshfield Clinic, a study site of the Electronic Medical Records and Genomics (eMERGE) Network, using logistic regression. All statistically significant models from the Marshfield Clinic were then evaluated in an independent dataset of 4,311 individuals (742 controls, 3,569 cases), using independent samples from additional study sites in the eMERGE Network: Mayo Clinic, Group Health/University of Washington, Vanderbilt University Medical Center, and Geisinger Health System. Eighty-three SNP-SNP models replicated in the independent dataset at likelihood ratio test P < 0.05. Among the most significant replicating models was rs12597188 (intron of CDH1)-rs11564445 (intron of CTNNB1). These genes are known to be involved in processes that include: cell-to-cell adhesion signaling, cell-cell junction organization, and cell-cell communication. Further Biofilter analysis of all replicating models revealed a number of common functions among the genes harboring the 83 replicating SNP-SNP models, which included signal transduction and PI3K-Akt signaling pathway. These findings demonstrate the utility of Biofilter as a biology-driven method, applicable for any genome-wide association study dataset.

Spatial learning while navigating with severely degraded viewing: The role of attention and mobility monitoring

The ability to navigate without getting lost is an important aspect of quality of life. In 5 studies, we evaluated how spatial learning is affected by the increased demands of keeping oneself safe while walking with degraded vision (mobility monitoring). We proposed that safe low vision mobility requires attentional resources, providing competition for those needed to learn a new environment. In Experiments 1 and 2, participants navigated along paths in a real-world indoor environment with simulated degraded vision or normal vision. Memory for object locations seen along the paths was better with normal compared with degraded vision. With degraded vision, memory was better when participants were guided by an experimenter (low monitoring demands) versus unguided (high monitoring demands). In Experiments 3 and 4, participants walked while performing an auditory task. Auditory task performance was superior with normal compared with degraded vision. With degraded vision, auditory task performance was better when guided compared with unguided. In Experiment 5, participants performed both the spatial learning and auditory tasks under degraded vision. Results showed that attention mediates the relationship between mobility-monitoring demands and spatial learning. These studies suggest that more attention is required and spatial learning is impaired when navigating with degraded viewing.

Visual impairment is associated with physical and mental comorbidities in older adults: a cross-sectional study

BACKGROUND

Visual impairment is common in older people and the presence of additional health conditions can compromise health and rehabilitation outcomes. A small number of studies have suggested that comorbities are common in visual impairment; however, those studies have relied on self-report and have assessed a relatively limited number of comorbid conditions.

METHODS

We conducted a cross-sectional analysis of a dataset of 291,169 registered patients (65-years-old and over) within 314 primary care practices in Scotland, UK. Visual impairment was identified using Read Code ever recorded for blindness and/or low vision (within electronic medical records). Prevalence, odds ratios (from prevalence rates standardised by stratifying individuals by age groups (65 to 69 years; 70 to 74; 75 to 79; 80 to 84; and 85 and over), gender and deprivation quintiles) and 95% confidence intervals (95% CI) of 37 individual chronic physical/mental health conditions and total number of conditions were calculated and compared for those with visual impairment to those without.

RESULTS

Twenty seven of the 29 physical health conditions and all eight mental health conditions were significantly more likely to be recorded for individuals with visual impairment compared to individuals without visual impairment, after standardising for age, gender and social deprivation. Individuals with visual impairment were also significantly more likely to have more comorbidities (for example, five or more conditions (odds ratio (OR) 2.05 95% CI 1.94 to 2.18)).

CONCLUSIONS

Patients aged 65 years and older with visual impairment have a broad range of physical and mental health comorbidities compared to those of the same age without visual impairment, and are more likely to have multiple comorbidities. This has important implications for clinical practice and for the future design of integrated services to meet the complex needs of patients with visual impairment, for example, embedding depression and hearing screening within eye care services.

A randomised controlled trial to compare the clinical and cost-effectiveness of prism glasses, visual search training and standard care in patients with hemianopia following stroke: a protocol

INTRODUCTION

Homonymous hemianopia is a common and disabling visual problem after stroke. Currently, prism glasses and visual scanning training are proposed to improve it. The aim of this trial is to determine the effectiveness of these interventions compared to standard care.

METHODS AND ANALYSIS

The trial will be a multicentre three arm individually randomised controlled trial with independent assessment at 6 week, 12 week and 26 week post-randomisation. Recruitment will occur in hospital, outpatient and primary care settings in UK hospital trusts. A total of 105 patients with homonymous hemianopia and without ocular motility impairment, visual inattention or pre-existent visual field impairment will be randomised to one of three balanced groups. Randomisation lists will be stratified by site and hemianopia level (partial or complete) and created using simple block randomisation by an independent statistician. Allocations will be disclosed to patients by the treating clinician, maintaining blinding for outcome assessment. The primary outcome will be change in visual field assessment from baseline to 26 weeks. Secondary measures will include the Rivermead Mobility Index, Visual Function Questionnaire 25/10, Nottingham Extended Activities of Daily Living, Euro Qual-5D and Short Form-12 questionnaires. Analysis will be by intention to treat.

ETHICS AND DISSEMINATION

This study has been developed and supported by the UK Stroke Research Network Clinical Studies Group working with service users. Multicentre ethical approval was obtained through the North West 6 Research ethics committee (Reference 10/H1003/119). The trial is funded by the UK Stroke Association. Trial Registration: Current Controlled Trials ISRCTN05956042. Dissemination will consider usual scholarly options of conference presentation and journal publication in addition to patient and public dissemination with lay summaries and articles.

TRIAL REGISTRATION

Current Controlled Trials ISRCTN05956042.

The Glenn A. Fry award lecture 2013: blurred vision, spectacle correction, and falls in older adults

This article reviews the literature on how blurred vision contributes to falls, gait, and postural control and discusses how these are influenced by spectacle correction. Falls are common and represent a very serious health risk for older people. They are not random events as studies have shown that falls are linked to a range of intrinsic and extrinsic risk factors. Vision provides a significant input to postural control in addition to providing information about the size and position of hazards and obstacles in the travel pathway and allows us to safely negotiate steps and stairs. Many studies have shown that reduced vision is a significant risk factor for falls. However, randomized controlled trials of optometric interventions and cataract surgery have not shown the expected reduction in falls rate, which may be due to magnification changes (and thus vestibulo-ocular reflex gain) in those participants who have large changes in refractive correction. Epidemiological studies have also shown that progressive addition lens and bifocal wearers are twice as likely to fall as non-multifocal wearers, laboratory-based studies have shown safer adaptive gait with single-vision glasses than progressive addition lenses or bifocals, and a randomized controlled trial has shown that an additional pair of distance vision single-vision glasses for outdoor use can reduce falls rate. Clinical recommendations to help optometrists prevent their frail, older patients from falling are suggested.

Sensory impairments in community health care: a descriptive study of hearing and vision among elderly Norwegians living at home

Background

Hearing and vision impairments increase with age and are common risk factors for functional decline reduced social participation and withdrawal.

Objective

Describe the hearing and vision of home care patients older than 80 years.

Methods

Ninety-three older adults (80+ years) receiving home care were screened for hearing and vision in their homes. Data were collected using a HEINE Mini 3000^® Otoscope to examine the eardrum and presence of earwax, an Entomed SA201-IV portable pure-tone audiometer to measure the pure-tone average (PTAV), a logarithm of the minimum angle of resolution chart to measure visual acuity (VA), and the Combined Serious Sensory Impairment interview guide.

Results

Slight and moderate hearing impairments were found in 41% and 47% of the population, respectively (mean PTAV =40.4 dB for the better ear), and 40% and 56% had impaired and slightly impaired vision, respectively (mean VA =0.45 for the better eye). The participants’ self-assessments of hearing and vision were only weakly correlated with PTAV and VA values. The visual function was significantly worse in men than in women (P=0.033). Difficulty in performing instrumental activities of daily living because of hearing and vision impairments was experienced by 17% of the participants, whereas 76% experienced no difficulties. When many people were present, 72% of the participants found it difficult to understand speech. Nearly 30% found it tiring to read, and 41% could not read very small print.

Conclusion

The patients’ self-assessments of their hearing and vision did not correlate strongly with their VA and PTAV scores. Asking the elderly about their overall hearing and vision ability is not sufficient for detecting sensory impairment, and asking more specific questions about what they could not hear and see was not an adequate indicator of the patients’ hearing and vision problems. To detect hearing and vision impairments among elderly home care patients, standardized measurements of their hearing and vision are necessary.

Medo de cair e qualidade de vida em idosos com catarata

INTRODUÇÃO: O medo de cair é definido como baixa autoeficácia ou confiança no próprio equilíbrio para evitar quedas, causando declínio no desempenho físico e funcional, alterações no equilíbrio e na marcha dos idosos, tendo impacto negativo na qualidade de vida. Vários estudos têm identificado o déficit visual como fator contributivo para a ocorrência de quedas e do medo de cair em idosos. OBJETIVOS: Avaliar a associação entre o medo de cair e as alterações na visão funcional e na qualidade de vida relacionada à visão de idosos com catarata. MÉTODOS: Trata-se de estudo observacional com 139 idosos com catarata (71,4±6,2 anos). A qualidade de vida relacionada à visão foi avaliada pelo Visual Function Questionnaire (VFQ) e a preocupação com a possibilidade de quedas foi avaliada pela Falls Efficacy Scale International (FES-I-Brasil). RESULTADOS: Idosos que relataram algum grau de medo de cair apresentaram médias mais altas na escala FES-I-Brasil, quando comparados aos que não o relataram, indicando maior preocupação com a possibilidade de cair (p=0,000; Kruskal-Wallis). Com relação à visão funcional (VFQ) e à qualidade de vida relacionada à visão, quanto maior o medo de cair, piores eram a visão e a qualidade de vida (p=0,003; Kruskal-Wallis). CONCLUSÃO: Idosos com catarata e com relato de medo de cair apresentaram menor confiança no seu equilíbrio para evitar quedas e pior qualidade na visão funcional e na qualidade de vida relacionada à visão.