Improving Vision to Prevent Falls in Frail Older People: A Randomized Trial

Authors

  • Robert G. Cumming PhD,

    1. From the *School of Public Health, School of Occupation and Leisure Sciences, and Center for Vision Research, Department of Ophthalmology, University of Sydney, Sydney, Australia§Center for Education and Research on Aging, Concord Hospital, Sydney, AustraliaThe George Institute for International Health, Sydney, Australia.
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  • Rebecca Ivers PhD,

    1. From the *School of Public Health, School of Occupation and Leisure Sciences, and Center for Vision Research, Department of Ophthalmology, University of Sydney, Sydney, Australia§Center for Education and Research on Aging, Concord Hospital, Sydney, AustraliaThe George Institute for International Health, Sydney, Australia.
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  • Lindy Clemson PhD,

    1. From the *School of Public Health, School of Occupation and Leisure Sciences, and Center for Vision Research, Department of Ophthalmology, University of Sydney, Sydney, Australia§Center for Education and Research on Aging, Concord Hospital, Sydney, AustraliaThe George Institute for International Health, Sydney, Australia.
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  • John Cullen MB, BS,

    1. From the *School of Public Health, School of Occupation and Leisure Sciences, and Center for Vision Research, Department of Ophthalmology, University of Sydney, Sydney, Australia§Center for Education and Research on Aging, Concord Hospital, Sydney, AustraliaThe George Institute for International Health, Sydney, Australia.
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  • Maggie F. Hayes MPH,

    1. From the *School of Public Health, School of Occupation and Leisure Sciences, and Center for Vision Research, Department of Ophthalmology, University of Sydney, Sydney, Australia§Center for Education and Research on Aging, Concord Hospital, Sydney, AustraliaThe George Institute for International Health, Sydney, Australia.
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  • Michael Tanzer BOptom,

    1. From the *School of Public Health, School of Occupation and Leisure Sciences, and Center for Vision Research, Department of Ophthalmology, University of Sydney, Sydney, Australia§Center for Education and Research on Aging, Concord Hospital, Sydney, AustraliaThe George Institute for International Health, Sydney, Australia.
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  • Paul Mitchell MD

    1. From the *School of Public Health, School of Occupation and Leisure Sciences, and Center for Vision Research, Department of Ophthalmology, University of Sydney, Sydney, Australia§Center for Education and Research on Aging, Concord Hospital, Sydney, AustraliaThe George Institute for International Health, Sydney, Australia.
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Address correspondence to Robert G. Cumming, Center for Education and Research on Aging, Building 18, Concord Hospital, Concord NSW 2139, Australia. E-mail: bobc@health.usyd.edu.au

Abstract

OBJECTIVES: To determine the efficacy of vision and eye examinations, with subsequent treatment of vision problems, for preventing falls and fractures in frail older people.

DESIGN: Randomized, controlled trial.

SETTING: Community in Sydney, Australia.

PARTICIPANTS: Six hundred sixteen men and women aged 70 and older (mean age 81) recruited mainly from people attending outpatient aged care services.

INTERVENTIONS: The intervention group received comprehensive vision and eye examinations conducted by a study optometrist. The optometrist arranged for new eyeglasses for 92 subjects and referred 24 for a home visit with an occupational therapist, 17 for glaucoma management, and 15 for cataract surgery. The control group received usual care.

MEASUREMENTS: Falls and fractures during 12 months of follow-up were ascertained according to self-report using a monthly postcard system.

RESULTS: Fifty-seven percent of subjects fell at least once during follow-up. Falls occurred more frequently in the group randomized to receive the vision intervention (65% fell at least once; 758 falls in total) than in the control group (50% fell at least once; 516 falls in total). The falls rate ratio using the negative binomial model was 1.57 (95% confidence interval (CI)=1.20–2.05, P=.001). Fractures were also more frequent in the intervention group (31 fractures) than the control group (18 fractures; relative risk from proportional hazards model 1.74, 95% CI=0.97–3.11, P=.06).

CONCLUSION: In frail older people, comprehensive vision and eye assessment, with appropriate treatment, does not reduce, and may even increase, the risk of falls and fractures.

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