Abstract
Purpose :
Both vision impairment and FOF can be risk factors for falls in older adults. Beyond simply asking a patient “Are you afraid of falling?”, it is informative to ask about the degree of FOF in various situations, such as walking indoors vs. outdoors. Self-report data were analyzed here to determine the situations most likely to evoke FOF in older adults with AMD.
Methods :
Inclusion criteria: ≥ 50 years old; no eye diseases except AMD. The Independent Mobility Questionnaire (IMQ, Turano et al, 1999) and the Balance Self-Efficacy Scale (BSE, Gunter et al, 2003) were administered over the phone or face-to-face. The IMQ comprises questions about difficulty in different mobility situations, and about falls and FOF in the past year. The BSE asks questions about confidence in maintaining one's balance. Monocular visual acuities (VAs) were recorded from medical records or directly measured; better-eye VAs were used as estimates of functional vision.
Results :
The gender groups (27 men, 14 women) did not differ significantly in age (p=0.50; range 63 –94 years) or VA (p=0.94; range -0.06 –1.58 logMAR ), or in rate of falls (p=0.16, ≥51%). Overall, the IMQ items that were rated as most difficult were #9 (walking at night), #32 (avoiding tripping) and #23 (walking in dim light indoors); BSE items #15 (walking on uneven ground at night), #9 (walking down a flight of stairs without using a handrail) and #17 (standing on one leg) had the lowest confidence ratings. The averaged ratings per subject did not differ significantly between genders on the BSE (p=0.13) or on the IMQ (p=0.054). The pattern of ratings for individual items were similar between men and women on both questionnaires, with the few significant differences (greater difficulty and/or lower confidence for women) occurring for the most-challenging items, such as IMQ #9.
Conclusions :
These results confirm that FOF among those with vision loss is heightened under dim-light conditions, as shown with the IMQ in retinitis pigmentosa and glaucoma (Turano et al, 1999, 2002) and with the UIC FOF questionnaire in AMD (van Landingham et al, 2014). Men and women with AMD report increased difficulty and reduced balance confidence for similar situations, with more-extreme ratings by women for the particularly demanding situations. As FOF increases fall risk, establishing interventions to reduce FOF in people with AMD should be a priority.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.