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BE Munoz, SM Friedman, K Turano, AT Broman, GS Rubin, LP Fried, SK West; Vision and Incident Falls in a Cohort of Older, Community Dwelling Persons: The Salisbury Eye Evaluation . Invest. Ophthalmol. Vis. Sci. 2002;43(13):877.
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© ARVO (1962-2015); The Authors (2016-present)
Background: Falls are a common cause of serious injuries among older adults. Some studies have reported poor vision as one of the contributing factors, but the impact of various types of vision loss on incident falls is not clear. Purpose: To determine the risk of incident falls associated with different measures of visual function. Methods: A population based sample of 2520 persons aged 65-84 years were enrolled in Salisbury Eye Evaluation, of whom 2375 or 94% were enrolled in the falls study. Falls were ascertained monthly using a falls calendar for a period of 20 months. At baseline, participants were administered an extensive questionnaire and underwent a comprehensive clinic exam that included vision assessment. Visual acuity was tested with habitual correction using ETDRS charts, contrast sensitivity with a Pelli-Robson chart, stereo acuity with the Randot Circles test, and visual fields with the 81 point screening test of the Humphrey Field analyzer. The primary outcome was the number of months in which at least one fall occurred among the total number of months of observation. To determine the probability of falls as well as the clustering of falls within individuals a logistic regression model with random effects was used. Results: During a median follow-up period of 19 months, 680 (28%) of participants reported at least one fall. In the multivariate analysis, factors associated with falls included: older age, White race, depression symptoms, weaker grip strength, balance problems, slower walking speed, history of stroke, of Parkinson disease, and of arthritis. After adjusting for the above factors, loss of visual field was significantly associated with reporting falls, OR (95% CI) 1.10 (1.04-1.16) for each additional 10 points missing. No other measure of vision was associated with incident falls. Falls did significantly cluster within individuals, and the clustering significantly increased by the presence of depression and history of stroke. An alternative analysis using time to the first fall yielded similar inferences. Conclusion: Visual field loss is a predisposing factor for incident falls and time to first fall in older persons, and should be taking into consideration in intervention programs that aim to reduce falls and their associated morbidity.
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