Purchase this article with an account.
Allison Bardes, Jennifer Sivak-Callcott, Charles Chen, John Nguyen; Eye and facial injury from falls in a rural, Appalachian elderly population.. Invest. Ophthalmol. Vis. Sci. 2014;55(13):1673.
Download citation file:
© ARVO (1962-2015); The Authors (2016-present)
One in three adults over age 65 will visit the emergency department (ED) due to a fall. Hospitalization occurs in 25% of these encounters. Mortality is 4.5% in those over 70. Fall risk is higher in patients with visual impairment such as those with wet macular degeneration or glaucomatous visual field loss. Yet, published reports of long term ophthalmic outcome in this population are limited to a few case series. We herein aim to characterize the nature of these eye and orbital injuries and to determine the long term outcome in elderly patients seen for fall at a tertiary center in West Virginia. This knowledge can be used to improve social circumstances that lead to falls.
Retrospective chart review of patients 65 years and older seen in the West Virginia University Hospital’s ED between January 2002 and December 2012 was performed to identify cases of facial or ocular injury. Data including demographics, accident setting, ophthalmic diseases and outcome, skin and bone findings, immediate intervention, and long-term complication were collected. Descriptive statistical analysis was performed.
384 patients were identified. Age ranged from 65-100 years. 28.6% patients were male; 71.4% were female. 3.82% had a history of falls. 92.4% and 4.14% of falls occurred at home and assisted living facilities, respectively. Of those who fell at home, 13.4% were living alone and commonly occurred early morning in the bed room or bathroom. 10.2% had a history of eye diseases including macular degeneration and glaucoma. 36.6% had comorbid conditions including dementia, cardiovascular disease and musculoskeletal disorder. Initial visual acuity ranged from 20/20 to no light perception in the worse seeing eye. Injury varied from soft tissue contusion to ruptured globe with facial fracture. 33.8% of patients had orbital fractures, and 7.43% of patients sustained ruptured globe. 56.5% of ruptured globe patients had concurrent orbital fracture, and 65.1% of ruptured globe patients lived at home. Of these, pre-operative visual acuity ranged from 20/100 to no light perception; 26.1% required additional surgery. 13.1% lost their eye.
Falls in the elderly, especially those living alone with poor vision, have a high likely hood of ruptured globe injury with poor visual outcome. Implementation of fall prevention programs may help decrease these injuries and allow for continued independence in the elderly.
This PDF is available to Subscribers Only