Visually Impaired OLder people’s Exercise programme for falls prevenTion (VIOLET): a feasibility study

Visual Impairment and Objectively Measured Physical Activity in Middle-Aged and Older Adults

BACKGROUND

Vision loss is associated with increased risk of falls and restricted physical activity, yet the relationship between multiple vision measures and objectively measured physical activity, especially activity patterns, in mid-to-late life is not well understood.

METHOD

This study included 603 participants aged 50 years and older (mean age = 73.5) in the Baltimore Longitudinal Study of Aging who had the following assessments: presenting and best-corrected visual acuity, contrast sensitivity, visual fields, stereo acuity, and free-living physical activity using a wrist-worn ActiGraph accelerometer for 7 days. Linear regression models were used to examine the association between vision measures and daily activity counts, active minutes, and activity fragmentation (defined as an active-to-sedentary transition probability), adjusting for potential confounders. Mixed-effects models estimated differences in activity by time of day comparing those with and without each visual impairment.

RESULTS

In the fully adjusted model, worse presenting visual acuity, contrast sensitivity, and visual fields were associated with fewer activity counts, less active time, and more fragmented activity patterns (p < .05 for all). Participants with presenting or best-corrected visual acuity impairment had 19.2 and 29.3 fewer active minutes (p = .05 and p = .03, respectively) per day. Visual field impairment was associated with 268 636 fewer activity counts (p = .02), 46.2 fewer active minutes (p = .02) per day, and 3% greater activity fragmentation (p = .009). Differences in activity levels tended to be greatest from 6 am to 6 pm (p < .05).

CONCLUSIONS

Older adults with visual impairment have restricted and more fragmented patterns of daily activity. Longitudinal studies to quantify the long-term impacts of visual impairments on activity decline are warranted.

Determinants of concern about falling in adults with age-related macular degeneration

PURPOSE

To investigate the prevalence and level of concern about falling (CF) among older people with vision impairment due to age-related macular degeneration (AMD) compared to a visually normal control group, and to identify determinants of CF for the AMD group.

METHODS

Participants included 133 older people: 77 with AMD (mean age = 80.5 ± 6.2 years), and 56 controls (mean age = 75.4 ± 5.3 years). Binocular visual acuity, contrast sensitivity and visual fields were measured, and CF was assessed using the Falls Efficacy Scale - International (FES-I). Data were also collected for sensorimotor function (postural sway, sit-to-stand, knee extensions, walking speed, proprioception), and neuropsychological function (reaction time, symptoms of anxiety and depression) using validated tests and scales.

RESULTS

Concern about falling scores were higher for AMD participants compared to control participants (mean ± S.D. 24.6 ± 8.0 vs 21.6 ± 5.7, p = 0.02, respectively), although these findings failed to reach significance when adjusted for age (p = 0.16). Among AMD participants, multivariable models showed that greater CF was associated with reduced contrast sensitivity (p = 0.02), slower sit-to-stand times (p < 0.001) and higher anxiety scores (p < 0.001); these factors explained 40% of the variance in CF (p < 0.01).

CONCLUSION

Levels of CF in older people with AMD were not found to be elevated by their disease status alone, but rather by the extent of vision loss. Levels of CF in those with AMD were associated with various visual, sensorimotor and neuropsychological factors. These findings will assist clinicians in identifying those at greatest risk of developing high CF and inform the design of future intervention programmes for this population.

Stakeholder perspectives of fall prevention for older Australians with vision impairment: "it's just a matter of adapting them accordingly"

AIM

To investigate stakeholders' perspectives of fall prevention programs for older adults with vision impairment.

METHODS

Twenty-two stakeholders (client facing professionals, service managers, and policy makers), with expertise in fall prevention or vision impairment, from organisations in south-eastern Australia, participated in this study. Individual semi-structured interviews were conducted over-the-phone (n = 19) and face-to-face (n = 3), and analysed deductively using content analysis into the following system level factors for health promotion interventions seen within the behaviour change wheel: Fiscal measures; Guidelines; Communication and marketing; and Service provision.

RESULTS

Five key themes were identified: (1) insufficient guidelines or referral pathways; (2) ongoing funding to secure service delivery and best practice implementation; (3) marketing approach: honouring consumer's perceptions of themselves; (4) practical suggestions for program delivery; and (5) incorporation into existing services. Stakeholders considered fall prevention for those with vision impairment as essential in preventative healthcare, but did not have a clear understanding of where to refer or how to deliver a fall prevention service for this population.

CONCLUSIONS

This study supports the delivery of fall prevention programs in older adults with vision impairment, but highlights the need to incorporate stakeholder perspectives into the design and delivery of such programs to ensure barriers to implementation in real world settings.Implications for RehabilitationOlder adults with vision impairment are at a high risk of falls but currently have very little access to fall prevention programs.Results support the delivery of fall prevention programs to older adults with vision impairment through existing services, as long as professionals are provided with adequate service delivery guidelines, referral pathways, and fall prevention specific education and professional development opportunities.A variety of service provision, such as group and home-based programs, or using technology, may be cost-effective and improve older adults with vision impairments' adherence to fall prevention programs.