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Alex Black, Joanne Wood; Fear of falling, activity restriction and self-reported physical function among older adults with glaucoma. Invest. Ophthalmol. Vis. Sci. 2013;54(15):5325. doi: https://doi.org/.
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© ARVO (1962-2015); The Authors (2016-present)
To describe the associations between fear of falling, activity restriction, self-reported physical function and visual impairment among older adults with glaucoma.
This cross-sectional study included 98 community-dwelling older adults (mean age 74 ± 6 years; 60% male) with a range of visual impairment from glaucoma. Vision assessment included tests of binocular high-contrast visual acuity, binocular contrast sensitivity (Pelli-Robson) and integrated visual field (IVF) sensitivity (merged monocular HFA SITA-Standard 24-2). Participants completed questionnaires which assessed fear of falling (Have you been worried or afraid that you might fall in the past 12 months?), activity restriction due to fear of falling (Do you ever limit your activities because you are afraid of falling?) and the 10-item physical function subscale from the Medical Outcomes Study SF-36. Multivariate regression procedures were used to examine associations between the outcome and visual function measures, after controlling for potential covariates (age, gender, previous falls and comorbidities).
In this cohort, 19% expressed fear of falling and 10% reported associated activity restriction. In the multivariate logistic regression models, IVF sensitivity was the strongest visual factor associated with these outcomes. Each 1 dB reduction in IVF sensitivity was associated with higher odds of fear of falling (OR 1.11; 95% CI 1.02-1.20; p=0.021) and activity restriction (OR 1.20; 95% CI 1.06-1.36; p=0.004). In the multivariate linear regression models, greater IVF loss was associated with declines in self-reported physical function (β = -0.09 logits per dB reduction, p=0.012). Moreover, including activity restriction in the model eliminated the significant association between IVF sensitivity and self-reported physical function.
Greater visual field loss among older adults with glaucoma is associated with higher likelihood of fear of falling and associated activity restriction, and declines in self-reported physical function. Activity restriction is a potential mediating factor on the effect of visual field loss on physical function. This highlights the need to prevent excessive activity restriction among older adults with visual impairment from glaucoma to minimise subsequent physical deconditioning, which can increase the risk of future falls and fractures.
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