Improving Vision to Prevent Falls in Frail Older People: A Randomized Trial

Authors: Cumming, Robert G.; Ivers, Rebecca¹; Clemson, Lindy²; Cullen, John³; Hayes, Maggie F.; Tanzer, Michael; Mitchell, Paul⁴

Source: Journal of the American Geriatrics Society, Volume 55, Number 2, February 2007 , pp. 175-181(7)

Publisher: Wiley-Blackwell

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Abstract:

OBJECTIVES:

To determine the efficacy of vision and eye examinations, with subsequent treatment of vision problems, for preventing falls and fractures in frail older people. DESIGN:

Randomized, controlled trial. SETTING:

Community in Sydney, Australia. PARTICIPANTS:

Six hundred sixteen men and women aged 70 and older (mean age 81) recruited mainly from people attending outpatient aged care services. INTERVENTIONS:

The intervention group received comprehensive vision and eye examinations conducted by a study optometrist. The optometrist arranged for new eyeglasses for 92 subjects and referred 24 for a home visit with an occupational therapist, 17 for glaucoma management, and 15 for cataract surgery. The control group received usual care. MEASUREMENTS:

Falls and fractures during 12 months of follow-up were ascertained according to self-report using a monthly postcard system. RESULTS:

Fifty-seven percent of subjects fell at least once during follow-up. Falls occurred more frequently in the group randomized to receive the vision intervention (65% fell at least once; 758 falls in total) than in the control group (50% fell at least once; 516 falls in total). The falls rate ratio using the negative binomial model was 1.57 (95% confidence interval (CI)=1.20-2.05, P=.001). Fractures were also more frequent in the intervention group (31 fractures) than the control group (18 fractures; relative risk from proportional hazards model 1.74, 95% CI=0.97-3.11, P=.06). CONCLUSION:

In frail older people, comprehensive vision and eye assessment, with appropriate treatment, does not reduce, and may even increase, the risk of falls and fractures.

Keywords: accidental falls; aged 80 and older; randomized; controlled trials; vision disorders

Document Type: Research article

DOI: http://dx.doi.org/10.1111/j.1532-5415.2007.01046.x

Affiliations: 1: The George Institute for International Health, Sydney, Australia. 2: School of Occupation and Leisure Sciences, and 3: Center for Education and Research on Aging, Concord Hospital, Sydney, Australia; and 4: Center for Vision Research, Department of Ophthalmology, University of Sydney, Sydney, Australia;

Publication date: 2007-02-01

Improving Vision to Prevent Falls in Frail Older People: A Randomized Trial

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