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Aleksandra Mihailovic, Jian-Yu E, Pei-Lun Kuo, Sheila K West, David S Friedman, Laura Gitlin, Tianjing Li, Jennifer Schrack, Pradeep Y Ramulu; Characterizing the impact of fear of falling on future falls and physical activity among older adults with glaucoma: a longitudinal prospective cohort study. Invest. Ophthalmol. Vis. Sci. 2020;61(7):2770.
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© ARVO (1962-2015); The Authors (2016-present)
Fear of falling (FoF) may alter mobility in older adults, which may be accentuated in older adults with visual impairment. Using a longitudinal prospective cohort of older glaucoma patients, we investigate whether and how FoF is associated with future falls and physical activity.
Study participants with glaucoma or suspected glaucoma were recruited as part of the Falls in Glaucoma Study (FIGS), a single-center, 3 years long, prospective cohort study conducted at the Johns Hopkins Wilmer Eye Institute. FoF was measured annually over a 3-year period using the University of Illinois at Chicago FoF Questionnaire, with lower FoF scores indicating less fear. Participants recorded falls prospectively over the 3-year period using monthly mail-in calendars. Daily steps were collected annually over 7-days using an accelerometer (Actical). Visual field (VF) sensitivity was derived by combing sensitivities from monocular VF results. Participants completed questionnaires to determine other demographic/health characteristics. We used multivariate random-effect models to evaluate within-participant changes in fall rates and physical activity across study years.
We tabulated the characteristics of the study population in Table 1. At lower FoF levels (FoF≤0), each one-unit worsening in FoF score across study years was associated with 2.73 times higher odds of reporting at least one fall in the next year (95% CI: 1.55, 4.81) and independent of average daily steps (p = 0.44) (Table 2). Similar results were seen for falls per steps taken. At higher FoF levels (FoF>0), inter-year changes in FoF scores were not significantly associated with reporting a fall in the next year (p = 0.78); but were associated with 407 fewer average daily steps per one-unit change in FoF (95% CI: -743, -71) (Table 2).
FoF is an important driver of mobility in glaucoma patients, though the specific aspects of mobility (i.e. fall rates vs. activity levels) varied by the degree of FoF. Our findings emphasize the importance of customizing behavioral interventions for older adults to address falls vs. physical activity based on their levels of FoF.
This is a 2020 ARVO Annual Meeting abstract.
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