Abstract
Falls are an important health issue. They cause significant morbidity and mortality particularly in older people, and also have marked psychological effects on the individual. The literature focuses particularly on older adults, an age group in which both visual impairment and falls are more prevalent, as is the associated morbidity. In this review, we summarise the current literature and point to further studies which need to be undertaken. The consequences of falls are well recognised, and there has been considerable work into identifying risk factors. Changes in visual components such as visual field, acuity, contrast sensitivity and stereopsis all have a part and the co-existence of other sensory impairments certainly increases the risk of falls. However there remain considerable gaps in our knowledge of the relationship between visual loss and falls, for example in patients with diabetic eye disease. Furthermore, there is also conflicting data as to the importance of different visual components. Various interventions, such as programmed inter-disciplinary involvement, have shown promise, however these need further confirmation of their efficacy and cost effectiveness. An added confounder may be that an intervention (eg, cataract extraction) paradoxically affects an individual's future activity level and behaviour, thereby increasing the risk of falling. With an ageing population the importance of this topic is likely to increase, as will the potential benefits of optimising our assessment and management of these patients.
Similar content being viewed by others
Log in or create a free account to read this content
Gain free access to this article, as well as selected content from this journal and more on nature.com
or
References
Adelhafiz AH, Austin CA . Visual factors should be assessed in older people presenting with falls or hip fracture. Age Ageing 2003; 32: 26–30.
Scuffham P, Chaplin S, Legood R . Incidence and costs of unintentional falls in older people in the United Kingdom. J Epidemiol Community Health 2003; 57: 740–744.
Lawrence TM, White CT, Wrenn R, Moran CG . The current hospital costs of treating hip fractures. Injury 2005; 36: 88–91; discussion 92.
Department of Health. National Service Framework for Older People. DoH: London, 2001.
Moorin RE, Hendrie D . The epidemiology and cost of falls requiring hospitalisation in children in Western Australia: a study using linked administrative data. Accid Anal Prev 2008; 40: 216–222.
Talbot LA, Musiol RJ, Witham EK, Metter EJ . Falls in young, middle-aged and older community dwelling adults: perceived cause, environmental factors and injury. BMC Public Health 2005; 5: 86.
Tideiksaar R . Reducing the risk of falls and injury in older persons: contribution of a falls and immobility clinic. In: LaFont C et al., (eds). Falls, Gait and Balance Disorders in the Elderly: From Successful Aging to Frailty. Springer Publishing Company: New York, 1996, pp 163–182.
Rubenstein LZ . Falls in older people: epidemiology, risk factors and strategies for prevention. Age Ageing 2006; 35 (Suppl 2): ii37–ii41.
Evans JR, Fletcher AE, Wormald RP, Ng ES, Stirling S, Smeeth L, Breeze E et al. Prevalence of visual impairment in people aged 75 years and older in Britain: results from the MRC trial of assessment and management of older people in the community. Br J Ophthalmol 2002; 86: 795–800.
Scott JC . Osteoporosis and hip fractures. Rheum Dis Clin North Am 1990; 16: 717–740.
Sturnieks DL, St George R, Lord SR . Balance disorders in the elderly. Neurophysiol Clin 2008; 38: 467–478.
Manchester D . Visual, vestibular and somatosensory contributions to balance control in the older adult. J Gerontology 1989; 44: 118–127.
Bueno-Cavanillas A, Padilla-Ruiz F, Jiménez-Moleón JJ, Peinado-Alonso CA, Gálvez-Vargas R . Risk factors in falls among the elderly according to extrinsic and intrinsic precipitating causes. Eur J Epidemiol 2000; 16: 849–859.
Masud T, Morris RO . Epidemiology of falls. Age Ageing 2001; 30 (Suppl 4): 3–7.
Campbell AJ, Borrie MJ, Spears GF . Risk factors for falls in a community-based prospective study of people 70 years and older. J Gerontol 1989; 44: M112–M117.
Tinetti ME, Speechley M, Ginter SF . Risk factors for falls among elderly persons living in the community. N Engl J Med 1988; 319: 1701–1707.
Chu LW, Chi I, Chiu AY . Incidence and predictors of falls in the Chinese elderly. Ann Acad Med Singapore 2005; 34: 60–72.
Lord SR . Visual risk factors for falls in older people. Age Ageing 2006; 35 (Suppl 2): ii42–ii45.
Ivers RQ, Cumming RG, Mitchell P, Attebo K . Visual impairment and falls in older adults: the Blue Mountains Eye Study. J Am Geriatr Soc 1998; 46: 58–64.
Coleman AL, Stone K, Ewing SK, Nevitt M, Cummings S, Cauley JA et al. Higher risk of multiple falls among elderly women who lose visual acuity. Ophthalmology 2004; 111: 857–862.
De Boer MR, Pluijm SM, Lips P, Moll AC, Völker-Dieben HJ, Deeg DJ et al. Different aspects of visual impairment as risk factors for falls and fractures in older men and women. J Bone Miner Res 2004; 19: 1539–1547.
Yu PL, Qin ZH, Shi J, Zhang J, Xin MZ, Wu ZL et al. Prevalence and related factors of falls in an urban community of Beijing. Biomed Environ Sci 2009; 22 (3): 179–187.
Woolcott JC, Richardson KJ, Wiens MO, Patel B, Marin J, Khan KM et al. Meta-analysis of the impact of 9 medication classes on falls in elderly persons. Ann Intern Med 2009; 169 (21): 1952–1960.
Nevitt M, Cummings S, Kidd S, Black D . Risk factors for recurrent non-syncopal falls. JAMA 1989; 261: 2663–2668.
Stalenhoef PA, Diederiks JP, Knottnerus JA, Kester AD, Crebolder HF . A risk model for the prediction of recurrent falls in community-dwelling elderly: a prospective cohort study. J Clin Epidemiol 2002; 55: 1088–1094.
Iglesias CP, Manca A, Torgerson DJ . The health-related quality of life and cost implications of falls in elderly women. Osteoporos Int 2008; 20 (6): 869–878.
Keene GS, Parker MJ, Pryor GA . Mortality and morbidity after hip fractures. BMJ 1993; 307: 1248.
Speechley M, Tinetti M . Falls and injuries in frail and vigorous community elderly persons. J Am Geriatr Soc 1991; 39: 46–52.
Ivers RQ, Norton R, Cumming RG, Butler M, Campbell AJ . Visual impairment and hip fracture. Am J Epidemiol 2000; 152: 663–669.
March LM, Chamberlain AC, Cameron ID, Cumming RG, Brnabic AJ, Finnegan TP . et al. How best to fix a broken hip. Fractured Neck of Femur Health Outcomes Project Team. Med J Aust 1999; 170: 489–494.
Goldacre MJ, Roberts SE, Yeates D . Mortality after admission to hospital with fractured neck of femur: database study. BMJ 2002; 325 (7369): 868–869.
Evitt CP, Quigley PA . Fear of falling in older adults: a guide to its prevalence, risk factors, and consequences. Rehabil Nurs 2004; 29: 207–210.
Scheffer AC, Schuurmans MJ, van Dijk N, van der Hooft T, de Rooij SE . Fear of falling: measurement strategy, prevalence, risk factors and consequences among older persons. Age Ageing 2008; 37: 19–24.
Iglesias CP, Manca A, Torgerson DJ . The health-related quality of life and cost implications of falls in elderly women. Osteoporos Int 2009; 20: 869–878.
Wormald RP, Wright LA, Courtney P, Beaumont B, Haines AP . Visual Problems in the elderly population and implications for services. BMJ 1992; 2304 (6836): 1226–1229.
Squirrell DM, Kenny J, Mawer N, Gupta M, West J, Currie ZI et al. Screening for visual impairment in elderly patients with hip fracture: validating a simple bedside test. Eye 2005; 19: 55–59.
Klein BE, Moss SE, Klein R, Lee KE, Cruickshanks KJ . Associations of visual function with physical outcomes and limitations 5 years later in an older population: the Beaver Dam eye study. Ophthalmology 2003; 11: 644–650.
National Institute for Health and Clinical Excellence. Falls: the Assessment and Prevention of Falls in Older People. Clinical guideline 21, NICE, 2004.
British Geriatric Society. Falls. Best Practice Guide 4.5, BGS 2007.
Royal College of Physicians. National Audit of the Organisation of Services for Falls and Bone Health of Older People. National Falls and Bone Health Audit Report, RCP, March 2009.
Coleman AL, Cummings SR, Yu F, Kodjebacheva G, Ensrud KE, Gutierrez P, et al., Study Group of Osteoporotic Fractures. Binocular visual-field loss increases the risk of future falls in older white women. J Am Geriatr Soc 2007; 55: 357–364.
Lord SR, Dayhew J . Visual risk factors for falls in older people. J Am Geriatr Soc 2001; 49: 508–515.
Freeman EE, Muñoz B, Rubin G, West SK . Visual field loss increases the risk of falls in older adults: the Salisbury eye evaluation. Invest Ophthalmol Vis Sci 2007; 48: 4445–4450.
Lord SR, Dayhew J, Howland A . Multifocal glasses impair edge-contrast sensitivity and depth perception and increase the risk of falls in older people. J Am Geriatr Soc 2002; 50: 1760–1766.
Kulmala J, Viljanen A, Sipilä S, Pajala S, Pärssinen O, Kauppinen M et al. Poor vision accompanied with other sensory impairments as a predictor of falls in older women. Age Ageing 2009; 38 (2): 162–167.
Szabo SM, Janssen PA, Khan K, Potter MJ, Lord SR . Older women with age-related macular degeneration have a greater risk of falls: a physiological profile assessment study. J Am Geriatr Soc 2008; 56: 800–807.
Patino CM, McKean-Cowdin R, Azen SP, Allison JC, Choudhury F, Varma R et al. Central and peripheral visual impairment and the risk of falls and falls with injury. Ophthalmology 2010; 117: 199–206.
Radvay X, Duhoux S, Koenig-Supiot F, Vital-Durand F . Balance training and visual rehabilitation of age-related macular degeneration patients. J Vestib Res 2007; 17: 183–193.
Wood JM, Lacherez PF, Black AA, Cole MH, Boon MY, Kerr GK . Postural stability and gait among older adults with age-related maculopathy. Invest Ophthalmol Vis Sci 2009; 50: 482–487.
Gillespie LD, Gillespie WJ, Robertson MC, Lamb SE, Cumming RG, Rowe BH . Interventions for preventing falls in elderly people. Cochrane Database Syst Rev 2003 Issue no. 4. Article no. CD000340.
Black AA, Wood JM, Lovie-Kitchin JE, Newman BM . Visual impairment and postural sway among older adults with glaucoma. Optom Vis Sci 2008; 85: 489–497.
Haymes SA, Leblanc RP, Nicolela MT, Chiasson LA, Chauhan BC . Risk of falls and motor vehicle collisions in glaucoma. Invest Ophthalmol Vis Sci 2007; 48: 1149–1155.
Harwood RH, Foss AJ, Osborn F, Gregson RM, Zaman A, Masud T . Falls and health status in elderly women following first eye cataract surgery: a randomised controlled trial. Br J Ophthalmol 2005; 89: 53–59.
Foss AJ, Harwood RH, Osborn F, Gregson RM, Zaman A, Masud T . Falls and health status in elderly women following second eye cataract surgery: a randomised controlled trial. Age Ageing 2006; 35: 66–71.
Hodge W, Horsley T, Albiani D, Baryla J, Belliveau M, Buhrmann R et al. The consequences of waiting for cataract surgery: a systematic review. CMAJ 2007; 176: 1285–1290.
Paul L, Ellis BM, Leese GP, McFadyen AK, McMurray B . The effect of a cognitive or motor task on gait parameters of diabetic patients, with and without neuropathy. Diabet Med 2009; 26: 234–239.
Nelson JM, Dufraux K, Cook PF . The relationship between glycemic control and falls in older adults. Tighter control increases falls. J Am Geriatr Soc 2007; 55: 2041–2044.
Lord SR, Menz HB . Visual contributions to postural stability in older adults. Gerontology 2000; 46: 306–310.
Vale A, Buckley JG, Elliott DB . Gait alterations negotiating a raised surface induced by monocular blur. Optom Vis Sci 2008; 85: 1128–1134.
Johnson L, Buckley JG, Scally AJ, Elliott DB . Multifocal spectacles increase variability in toe clearance and risk of tripping in the elderly. Invest Ophthalmol Vis Sci 2007; 48: 1466–1471.
Lichtenstein MJ, Shields SL, Shiavi RG, Burger MC . Clinical determinants of biomechanics platform measure of balance in aged women. J Am Geriatr Soc 1998; 36: 996–1002.
Turano K, Rubin GS, Herdman SJ . Visual stabilisation of posture in the elderly: fallers vs. nonfallers. Visual Science 1994; 71: 761–769.
Patel M, Gomez S, Lush D, Fransson PA . Adaptation and vision change the relationship between muscle activity of the lower limbs and body movement during human balance perturbations. Clin Neurophysiol 2009; 120: 601–609.
Brannan S, Dewar C, Sen J, Clarke D, Marshall T, Murray PI . A prospective study of the rate of falls before and after cataract surgery. Br J Ophthal 2003; 57: 860–862.
Lord SR, Tiedemann A, Chapman K, Munro B, Murray SM, Gerontology M et al. The effect of an individualized fall prevention program on fall risk and falls in older people: a randomized, controlled trial. J Am Geriatr Soc 2005; 53: 1296–1304.
Day L, Fildes B, Gordon I, Fitzharris M, Flamer H, Lord S . Randomised factorial trial of falls prevention among older people living in their own homes. BMJ 2002; 325 (7356): 128–131.
Cumming RG, Ivers R, Clemson L, Cullen J, Hayes MF, Tanzer M et al. Improving vision to prevent falls in frail older people: a randomized trial. J Am Geriatr Soc 2007; 55: 175–181.
Wormald RPL, Wright LA, Courtney P, Beaumont B, Haines AP . Visual problems in the elderly population and implications for services. BMJ 1992; 304: 1226–1229.
College of Optometrists and British Geriatric Society. The importance of vision in preventing falls. Best Practice Guide 4.7, BGS, 2003.
Close J, Ellis M, Hooper R, Glucksman E, Jackson S, Swift C . Prevention of falls in the elderly trial (PROFET): a randomised controlled trial. Lancet 1999; 353 (9147): 93–97.
Feldman F, Chaudhury H . Falls and the physical environment: a review and a new multifactorial falls-risk conceptual framework. Can J Occup Ther 2008; 75: 82–95.
Freeman PB . Steady as she goes. Editorial perspective. J Optometry 2009; 80: 161–162.
Project Rainbow. Colour selection and the visually impaired: a design guide for building refurbishment. Second Advisory Paper, University of Reading, 1996.
Campbell AJ, Robertson MC, Gardner MM, Norton RN, Buchner DM . Falls prevention over 2 years: a randomized controlled trial in women 80 years and older. Age Ageing 1999; 28: 513–518.
Sach TH, Foss AJ, Gregson RM, Zaman A, Osborn F, Masud T et al. Falls and health status in elderly women following first eye cataract surgery: an economic evaluation conducted alongside a randomised controlled trial. Br J Ophthalmol 2007; 91: 1675–1679.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Competing interests
The authors declare no conflict of interest.
Rights and permissions
About this article
Cite this article
Dhital, A., Pey, T. & Stanford, M. Visual loss and falls: a review. Eye 24, 1437–1446 (2010). https://doi.org/10.1038/eye.2010.60
Received:
Revised:
Accepted:
Published:
Issue date:
DOI: https://doi.org/10.1038/eye.2010.60
Keywords
This article is cited by
-
Typologies of dependency, household characteristics, and disparity in formal and informal care use: analysis of community-dwelling long-term care insurance claimants in an urban municipality of China
International Journal for Equity in Health (2023)
-
Effect of home-based exercise on falls in community-dwelling older adults: an umbrella review
Sport Sciences for Health (2023)
-
Quality of life in people with visual impairment compared with the general population
Journal of Public Health (2023)
-
Visual impairment and ten-year mortality: the Liwan Eye Study
Eye (2021)
-
Smoking, urinary cotinine levels and incidence of visual impairment
Scientific Reports (2021)
