Peripheral visual field loss significantly increased the risk of falling in older adults, according to data from 2,375 community-dwelling adults aged 65 to 84 years.
Poor vision has been implicated in falls in previous studies, and many interventions to prevent falls in the elderly have included vision assessments. But few studies have examined the specific types of vision loss that contribute most to the risk of falling, according to the Salisbury Eye Evaluation (SEE) study.
Ellen E. Freeman, Ph.D., of the Wilmer Eye Institute at Johns Hopkins University in Baltimore, Md., and her colleagues tested the vision of community-dwelling elderly SEE participants and then prospectively collected their reports of falls for up to 20 months. The average follow-up period was 17 months (Invest. Ophthalmol. Vis. Sci. 2007;48:4445–50).
At least 4 months of follow-up data were available for 2,312 participants, of whom 680 (29%) reported at least one fall during the follow-up period.
Total visual field loss was the only visual element that significantly increased the risk of falling. For every 10% loss in visual field, the participants were 8% more likely to fall after adjusting for demographic and health variables. When visual field loss was broken down into central and peripheral, only peripheral visual field loss remained significantly associated with fall risk (participants were 6% more likely to fall). Central visual field loss was associated with increased fall risk but did not reach statistical significance. The researchers were not able to determine whether the upper or lower peripheral visual field was more important.
Neither visual acuity nor contrast sensitivity was significantly associated with increased fall risk. Nonvision variables that were independently associated with fall risk when combined with total visual field loss included poor balance, depression, sedative use, a history of stroke, Parkinson's disease, or arthritis, and being white and female.
The circumstances of the first reported falls were available for 743 participants. Of these, 50% said they were performing a “mildly displacing” activity such as standing or walking, compared with 46% who said that they were reaching, bending, or stepping (a “moderately displacing” activity) when the falls occurred. And 4% reported that the falls occurred during a “markedly displacing” activity such as climbing or participating in sports. The proportion of individuals in the study who had at least one fall in the study was consistent with findings in other community-based studies, according to the researchers.
“Visual field reduction is most likely related to the risk of falls, at least in part, through its effects on postural stability and the ability to maneuver around objects,” they wrote. “Persons with such deficits may benefit from mobility training to navigate the environment more safely and reduce the risk of falling.”
The researchers had no financial conflicts to disclose.