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Wieczorek M, Isler M, Landau K, Becker MD, Dawson-Hughes B, Kressig RW, Vellas B, Orav EJ, Rizzoli R, Kanis JA, Armbrecht G, Da Silva JAP, Egli A, Freystätter G, Bischoff-Ferrari HA. Association Between Visual Acuity and Prospective Fall Risk in Generally Healthy and Active Older Adults: The 3-Year DO-HEALTH Study. J Am Med Dir Assoc 2024; 25:789-795.e2. [PMID: 38640962 DOI: 10.1016/j.jamda.2024.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 03/08/2024] [Accepted: 03/12/2024] [Indexed: 04/21/2024]
Abstract
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.
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Affiliation(s)
- Maud Wieczorek
- Centre on Aging and Mobility, University of Zurich and City Hospital Zurich, Zurich, Switzerland; Department of Aging Medicine and Aging Research, University of Zurich, Zurich, Switzerland
| | - Marlis Isler
- Centre on Aging and Mobility, University of Zurich and City Hospital Zurich, Zurich, Switzerland
| | - Klara Landau
- Department of Ophthalmology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Matthias D Becker
- Department of Ophthalmology, City Hospital Zurich, Zurich, Switzerland; Department of Ophthalmology, University of Heidelberg, Heidelberg, Germany; Spross Ophthalmology Research Institute, City Hospital Zurich, Zurich, Switzerland
| | - Bess Dawson-Hughes
- Jean Mayer USDA Human Nutrition Research Centre on Aging, Tufts University, Boston, MA, USA
| | - Reto W Kressig
- University Department of Geriatric Medicine FELIX PLATTER, and University of Basel, Basel, Switzerland
| | - Bruno Vellas
- Gérontopôle de Toulouse, Institut du Vieillissement, Centre Hospitalo-Universitaire de Toulouse, Toulouse, France; UMR INSERM 1027, University of Toulouse III, Toulouse, France
| | - Endel John Orav
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - René Rizzoli
- Division of Bone Diseases, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - John A Kanis
- Centre for Metabolic Diseases, University of Sheffield Medical School, Sheffield, United Kingdom; Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Victoria, Australia
| | - Gabriele Armbrecht
- Klinik für Radiologie, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - José António P Da Silva
- Institute for Clinical and Biomedical Research (iCBR), Faculty of Medicine, University of Coimbra and Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Andreas Egli
- Centre on Aging and Mobility, University of Zurich and City Hospital Zurich, Zurich, Switzerland
| | - Gregor Freystätter
- Centre on Aging and Mobility, University of Zurich and City Hospital Zurich, Zurich, Switzerland; Department of Aging Medicine and Aging Research, University of Zurich, Zurich, Switzerland
| | - Heike A Bischoff-Ferrari
- Centre on Aging and Mobility, University of Zurich and City Hospital Zurich, Zurich, Switzerland; Department of Aging Medicine and Aging Research, University of Zurich, Zurich, Switzerland; University Hospital Toulouse, IHU HealthAge Toulouse, France.
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Rosenblatt TR, Vail D, Ludwig CA, Al-Moujahed A, Pasricha MV, Ji MH, Callaway NF, Moshfeghi DM. Fall risk in patients with pseudophakic monovision. CANADIAN JOURNAL OF OPHTHALMOLOGY 2023; 58:11-17. [PMID: 34419423 DOI: 10.1016/j.jcjo.2021.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 07/12/2021] [Accepted: 07/24/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Vision changes can precipitate falls in the elderly resulting in significant morbidity and mortality. We hypothesized that pseudophakic monovision and ensuing anisometropia and aniseikonia impact elderly fall risk. This study assessed fall risk in patients with pseudophakic monovision, pseudophakic single vision distance (classic cataract surgery), and cataracts with no surgery. DESIGN Retrospective single-institution cohort study PARTICIPANTS: Patients with bilateral cataracts diagnosed at 60 years of age or older who underwent bilateral cataract surgery (monovision or single vision distance) or did not undergo any cataract surgery (n = 13 385). Patients with unilateral surgery or a fall prior to cataract diagnosis were excluded. METHODS Data were obtained from the Stanford Research Repository. Time-to-fall analysis was performed across all 3 groups. Primary outcome was hazard ratio (HR) for fall after second eye cataract surgery or after bilateral cataract diagnosis. RESULTS Of 13 385 patients (241 pseudophakic monovision, 2809 pseudophakic single vision, 10 335 no surgery), 850 fell after cataract diagnosis. Pseudophakic monovision was not associated with fall risk after controlling for age, sex, and myopia. Pseudophakic single-vision patients had a decreased time to fall compared with no-surgery patients (log rank, p < 0.001). Older age at cataract diagnosis (HR =1.05, 95% confidence interval [CI] 1.04-1.06, p < 0.001) or at time of surgery (HR = 1.05, 95% CI 1.03-1.07, p < 0.001) increased fall risk, as did female sex (HR = 1.29, 95% CI 1.10-1.51, p = 0.002) and preexisting myopia (HR = 1.31, 95% CI 1.01-1.71, p = 0.046) among nonsurgical patients. CONCLUSIONS Pseudophakic monovision did not impact fall risk, but pseudophakic single vision may increase falls compared with patients without cataract surgery.
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Affiliation(s)
- Tatiana R Rosenblatt
- Department of Ophthalmology, Byers Eye Institute, Stanford School of Medicine, Palo Alto, CA.
| | - Daniel Vail
- Department of Ophthalmology, Byers Eye Institute, Stanford School of Medicine, Palo Alto, CA
| | - Cassie A Ludwig
- Department of Ophthalmology, Byers Eye Institute, Stanford School of Medicine, Palo Alto, CA; Retina Service, Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA
| | - Ahmad Al-Moujahed
- Department of Ophthalmology, Byers Eye Institute, Stanford School of Medicine, Palo Alto, CA
| | | | - Marco H Ji
- Department of Ophthalmology, Byers Eye Institute, Stanford School of Medicine, Palo Alto, CA; Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Natalia F Callaway
- Department of Ophthalmology, Byers Eye Institute, Stanford School of Medicine, Palo Alto, CA
| | - Darius M Moshfeghi
- Department of Ophthalmology, Byers Eye Institute, Stanford School of Medicine, Palo Alto, CA
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Paiva EPD, Costa MAD, Souza TC, Almeida MCD, Silva MCMND, Loures FB. Association between falls in older adults and prevention group. Rev Bras Enferm 2022; 75Suppl 4:e20200207. [PMID: 35674544 DOI: 10.1590/0034-7167-2020-0207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 01/18/2022] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES to assess the effectiveness of guidelines on fall prevention in a group of older adults in Primary Health Care. METHODS a cross-sectional study, carried out with older adults selected by a simple random sample (274; N=1,234). Data covered sociodemographic and socioeconomic variables, marital status, health conditions, factors associated with falls and participation in the prevention group. Student's t test was used, and dichotomous variables were used by the chi-square test. The project met ethical requirements. RESULTS sample with female profile (61.7%), married, with low education, mean age of 71.69 years. The factors associated with falls identified were female sex, medicalization and participation in the prevention group. There was no protective association between participation in a fall prevention group in older adults and a decrease in the number of falls. CONCLUSIONS based on evidence, a personalized intervention during the nursing visit is suggested as a strategy to prevent falls.
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Affiliation(s)
| | | | - Tamara Costa Souza
- Universidade Federal de Juiz de Fora. Juiz de Fora, Minas Gerais, Brazil
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Paiva EPD, Costa MAD, Souza TC, Almeida MCD, Silva MCMND, Loures FB. Associação entre quedas em idosos e grupo de prevenção. Rev Bras Enferm 2022. [DOI: 10.1590/0034-7167-2020-0207pt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
RESUMO Objetivos: avaliar a efetividade das orientações sobre prevenção de quedas em um grupo de idosos na Atenção Básica à Saúde. Métodos: estudo transversal, realizado com idosos selecionados por amostra aleatória simples (274; N=1.234). Os dados abrangeram variáveis sociodemográficas, socioeconômicas, estado civil, condições de saúde, fatores associados a quedas e participação no grupo de prevenção. Utilizou-se a técnica estatística descritiva teste t de Student, e as variáveis dicotômicas, pelo Teste do Qui-Quadrado. O projeto atendeu às exigências éticas. Resultados: amostragem com perfil feminino (61,7%), casados, apresentando baixa escolaridade, idade média de 71,69 anos. Os fatores associados a quedas identificados foram sexo feminino, medicalização e participação no grupo de prevenção. Não houve associação protetora entre realização de grupo de prevenção de quedas em idosos e diminuição do número de quedas. Conclusões: baseado nas evidencias, sugere-se uma intervenção personalizada durante a visita de enfermagem como estratégia para prevenção das quedas.
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Abstract
Presbyopia is an age-related condition that affects approximately 1.8 billion people worldwide. Strategies to correct presbyopia include both nonsurgical and surgical approaches. Although eye care providers assume that multifocal spectacles and monovision have lower risks than surgical interventions, there is evidence to suggest that the use of these nonsurgical approaches in the older population increases the risk for trips and falls. Each year, fall-related injuries and deaths are reported in a substantial portion of the population, both globally and in the United States. Previous studies have shown a link between visual acuity, contrast sensitivity, stereoacuity, and visual field impairments and falls. More recent mechanistic and epidemiological studies have shown that multifocal spectacles and monovision can increase the risk for falls as well. Although evidence on the financial burden of falls related to multifocal spectacles or monovision is limited, total direct medical costs related to falls associated with multifocal spectacles are estimated to be approximately $11 billion annually in the United States. Therefore, it is important that eye care providers consider the risk for falls associated with multifocal spectacles and monovision when making decisions on the best strategy for correcting presbyopia in older adults. [J Refract Surg. 2021;37(6 Suppl):S12-S16.].
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Gashaw M, Janakiraman B, Minyihun A, Jember G, Sany K. Self-reported fall and associated factors among adult people with visual impairment in Gondar, Ethiopia: a cross-sectional study. BMC Public Health 2020; 20:498. [PMID: 32295572 PMCID: PMC7161228 DOI: 10.1186/s12889-020-08628-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Accepted: 03/31/2020] [Indexed: 12/19/2022] Open
Abstract
Background Fall is a major public health problem and potentially disabling issue. A vast burden of visually impaired live in low-middle income countries particularly in Sub-Saharan Africa. Limited ability to detect environmental hazards puts visually impaired at a greater risk of falls and unintentional injuries. Falls among visually impaired is associated with considerable disability, health care cost, loss of independence, and socio-economic consequences. Ethiopia lacked estimates of fall among any vulnerable population, particularly among visually impaired people. Therefore, this study aimed to estimate the prevalence of falls and factors associated among adult people with medically diagnosed visual impairment in Ethiopia. Methods An institutional-based cross-sectional study was conducted among visually impaired adults who attended the ophthalmology clinic at the University of Gondar comprehensive specialized hospital during the study period. Data were collected by interview method using structured questionnaires, patient medical record reviews, and physical measurements. Bivariate and multivariable binary logistic regression model analysis was used to identify factors associated with falls. Adjusted odds ratio with corresponding 95% confidence intervals were computed to show the strength of association. Results A total of 328 adults medically diagnosed with visual impairment participated in the study (97.3% response rate). The age of the participants ranged from 25 to 89 years with a mean age of (56.46 ± 14.2 years). The overall cumulative prevalence of self-reported falls among adults with visual impairment was 26.8% with 95%CI (22.7, 32.4%). The major associated factors of fall identified by multivariate analysis were; visual impairment in both eye (AOR 3.21, 95% CI 1.11, 9.29), fear of falling: some concerned: (AOR, 4.12; 95%CI, 1.44, 11.76), very concerned fear (AOR 10.03; 95% CI, 3.03, 33.21), medications: (AOR 4.63; 95% CI 2.14, 10.00) and self-reported depression: (AOR 3.46; 95% CI 1.11, 10.79). Conclusion The result of this study indicates a moderate self-reported prevalence of fall among adult people with medically diagnosed visual impairment. Identifying sub-groups at risk of falls among visually impaired, modifiable risk factors, implementation of precaution measures to avoid fall and fall-related injuries, and most importantly measures that would reduce the fear of falls in visually impaired people deserves immediate attention.
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Affiliation(s)
- Moges Gashaw
- Department of Physiotherapy, School of Medicine, College of Medicine and Health Sciences, University of Gondar comprehensive specialized hospital, University of Gondar, P.O. Box: 196, Gondar, Ethiopia.
| | - Balamurugan Janakiraman
- Department of Physiotherapy, School of Medicine, College of Medicine and Health Sciences, University of Gondar comprehensive specialized hospital, University of Gondar, P.O. Box: 196, Gondar, Ethiopia
| | - Amare Minyihun
- Department of Health Systems and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Gashaw Jember
- Department of Physiotherapy, School of Medicine, College of Medicine and Health Sciences, University of Gondar comprehensive specialized hospital, University of Gondar, P.O. Box: 196, Gondar, Ethiopia
| | - Kedir Sany
- Department of Physiotherapy, School of Medicine, College of Medicine and Health Sciences, University of Gondar comprehensive specialized hospital, University of Gondar, P.O. Box: 196, Gondar, Ethiopia
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