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Ursula White, Alex A Black, Joanne M Wood, Kim Delbaere; Progressive central vision impairment and concern about falling: a longitudinal study. Invest. Ophthalmol. Vis. Sci. 2019;60(9):4262. doi: https://doi.org/.
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Fear or concern about falling is an important problem among older people with age-related macular degeneration (AMD), potentially contributing to activity restriction, physical deconditioning, psychological distress and reduced quality of life. This study was the first to explore the longitudinal impact of central vision changes on concern about falling over a 12-month period.
This longitudinal, observational study included 60 community-dwelling older people (age 80.5±6.2 years) with central vision impairment due to AMD. Visual function (high-contrast visual acuity (VA), Melbourne Edge Test contrast sensitivity (CS), binocular 30-2 visual fields), physical function (Sit to Stand test) and anxiety (Geriatric Anxiety Inventory) were assessed at baseline and 12 months. Concern about falling was assessed at both time points using the Falls Efficacy Scale-International (FES-I) and monthly falls diaries were completed over the 12 month follow-up. Multi-level linear models investigated the relationship between FES-I and vision function (VA, CS, visual fields) at both baseline and 12 months. Generalised linear models examined how changes in vision function (VA, CS, visual fields) were related to changes in FES-I scores at 12 months.
At baseline, high levels of concern about falling (FES-I score ≥23; higher scores reflect more concern) were reported by 48% of participants, increasing to 65% at 12 months. FES-I scores increased by a small but significant amount over the 12 months (p=.032). At all time-points, poorer CS and poorer VA were strongly associated with greater concern about falling (p=.001, and p=.013 respectively), after adjustment for age, sex, comorbidities, physical function and anxiety. Decline in CS was significantly associated with increased concern about falling (p=.033), independent of falls history and baseline CS.
Higher levels of concern about falling are common in older people with AMD and are associated with central vision loss. In addition, declines in CS over 12 months were linked to increased levels of concern about falling. These findings highlight the need for monitoring of concern about falling among older people with AMD, particularly those with progressive vision loss. Regular assessment of CS could assist in identifying those at greatest risk of developing higher levels of concern about falling.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.
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