Falls and Visual Impairment in Older White Women

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Falls and Visual Impairment in Older White Women

• Gergana Kodjebacheva
• Anne L. Coleman, MD, PhD
• Study of Osteoporotic Fractures (SOF) Research
  Group
• CHS 286
• May 15, 2006

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Presentation Overview

• Significance Falls as a major cause of increased
  morbidity and mortality
• Racial and gender disparities in falling
• Vision impairment as a predictor of falls
• Study of Osteoporotic Fractures association
  between vision and falls
• Implications Need for public health
  interventions that reduce falls

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Significance of Falls Major Health Concern
Among the Elderly

• Falls were the leading cause of injury death
  (2003)
• 30-50 of older adults experience falls each year
• 20-30 of older adults who fall suffer moderate
  to severe injuries
• Acute care costs of falls among older adults
  (2003) 8 billion
• White female gender doubles the risk of falls

Roudsari et al, 2005 Chang et al, 2004 CDC,
2003 Abdelhafiz and Austin, 2003 Legood et al,
2002.
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CDC, 2003
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Gender and Racial Disparities in Falling
CDC, 2003
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Vision Impairment and Falls

• Cause of falls usually multi-factorial
• Visual impairment may compound or cause falls
• CDC recommends annual eye exams to reduce the
  risk of falls
• Higher level of awareness among older adults
  needed

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Geospatial Distribution of Elderly with Visual
Impairment
Visual impairment is a significant problem
among older adults.
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Contrast Sensitivity
Surgical Eyes, 2006
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Visual Acuity
Normal Visual Acuity
Low Visual Acuity
Mercer, 2006
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Binocular Visual Field Loss
Peripheral visual field loss/ "tunnel vision
No Visual Field Loss
Central visual field loss
Central visual field loss and reduced visual
acuity
Scattered visual field loss
Mercer, 2006
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Gaps in the Literature

• No AGS/CDC recommendations on what components of
  vision should be assessed to best predict risk of
  falls
• Effect of visual acuity Conflicting study
  results
• Effect of contrast sensitivity Elevated risk
• Effect of visual field loss Limited and
  inconclusive
• Effect of binocular visual field loss No studies

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Research Question

• What is a stronger risk factor for falls among
  older white women
• Contrast sensitivity?
• Visual acuity?
• Binocular visual field loss?

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Methods

• Study of Osteoporotic Fractures (SOF)
  prospective longitudinal cohort study
• Four clinic centers Baltimore, Maryland
  Minneapolis, Minnesota Portland, Oregon and the
  Monongahela Valley, Pennsylvania
• 1997-1998 4,820 women attended a clinic visit
  including an eye exam
• 4,071 (84) had reliable visual field tests in
  both eyes and provided information regarding
  frequent falling

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Results Association between binocular visual
field loss (BVFL) and the risk of at least two
falls (N4,071)
Model 1 Unadjusted risk of at least two falls
for binocular visual field loss. Model 2
Adjusted for age and study site. Model 3
Adjusted for age, study site, contrast
sensitivity and visual acuity. Model 4 Adjusted
for age, study site, contrast sensitivity, visual
acuity and cognitive function.
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Results Association Between Various Vision
Components and At Least Two Falls (N4,071)
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Discussion Risk Factors for Falling
Results of Univariate Analysis of Most Common
Risk Factors for Falls in 16 Published Studies
AGS, 2001
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Discussion Multifactorial Intervention

• Multifactorial interventions include (AGS, 2001
  Gillespie Review, 2003)
• Vision Correction
• Gait training
• Advice on the appropriate use of assistive
  devices
• Review and modification of medications
• Exercise programs
• Environmental hazards modification
• Treatment of cardiovascular disorders

Slide adopted from L. Moncada, MD
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Limitations

• Lack of generalizeability to other demographic
  groups
• Highly motivated participants with relatively
  good self-rated health status
• Depth perception not studied

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Conclusions

• Binocular visual field loss increases the risk of
  falls in older white women.
• The more severe the visual field loss, the
  greater the risk of frequent falling.
• The association was independent of other types of
  visual impairment.
• 30.6 of falls in women with severe BVFL is
  attributable to visual field loss.

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Public Health Implications

• Vision interventions might decrease fall-related
  injuries and deaths
• Association between vision intervention programs
  and risk of falls a top research priority (AGS,
  2001)
• Assessment of risk is key to prevention
• Increased awareness of the association between
  BVFL and falls is needed
• Physicians and public health professionals can
  play a major role in the reduction of falls

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Thank you.Email smolian1_at_yahoo.com