Association between visual acuity and prospective fall risk in generally healthy and active older adults: the 3-year DO-HEALTH study

Authors: WIECZOREK, MICHAL - University Of Zurich; ISLER, MICHAEL - University Of Zurich; LANDAU, KLARA - University Of Zurich; BECKER, MATTHIAS - Zurich City Hospital; DAWSON-HUGHES, BESS - Jean Mayer Human Nutrition Research Center On Aging At Tufts University; KRESSIG, RETO - University Of Basel; VELLAS, BRUNO - University Of Toulouse; ORAV, E - Harvard University; RIZZOLI, RENE - Geneva University Hospital; KANIS, JOHN - University Of Sheffield Medical School; ARMBRECHT, GABI - Charite' University Hospital Berlin; DA SILVA, JOSE - University Of Coimbra; EGLI, ANDREAS - University Of Zurich; FREYSTATTER, GREGOR - University Of Zurich; BISCHOFF-FERRARI, HEIKE - University Of Zurich

Submitted to: Journal of the American Medical Directors Association - Post-Acute and Long Term Care Medicine
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 4/15/2024
Publication Date: 5/31/2024
Citation: Wieczorek, M., Isler, M., Landau, K., Becker, M.D., Dawson-Hughes, B., Kressig, R.W., Vellas, B., Orav, E.J., Rizzoli, R., Kanis, J.A., Armbrecht, G., da Silva, J.A., Egli, A., Freystatter, G., Bischoff-Ferrari, H. 2024. Association between visual acuity and prospective fall risk in generally healthy and active older adults: the 3-year DO-HEALTH study. Journal of the American Medical Directors Association - Post-Acute and Long Term Care Medicine. https://doi.org/10.1016/j.jamda.2024.03.005.
DOI: https://doi.org/10.1016/j.jamda.2024.03.005

Interpretive Summary: Aging adversely affects vision and aging leads to increased risk of falling; however, the extent to which poor vision contributes to fall risk in older adults is not clear. This study was done to determine the extent to which poor vision was associated with risk of falling and with risk of fall-related injuries. The study was carried out in 2131 community-dwelling adults, age 70 years and older, who were followed for 3 years. At baseline, 69% of the participants had impaired vision and 31% had normal vision. The risk of falling was 20% higher among participants with impaired vision than among those with normal vision at baseline. Similarly, the risk of having a fall-related injury was 20% greater among participants with impaired vision. These findings suggest that the burden of falling can be reduced by correcting impaired vision in older adults.

Technical Abstract: Background: While aging has a strong impact on both visual acuity (VA) and falls, their interaction is understudied in generally healthy older adults. Objective: To examine if and to what extent baseline VA is associated with an increased risk of all and injurious falls over three years in generally healthy community-dwelling older adults. Methods: This is an observational analysis of DO-HEALTH, a double-blind, randomized controlled trial among 2157 community-dwelling generally healthy adults aged 70 years and older. The numbers of all and injurious falls were recorded prospectively by diary and in-person assessment every three months over three years. Decreased VA at baseline was defined as better eye VA lower than 1.0. We applied negative binomial regression models for all and injurious falls, adjusted for age, sex, prior falls, treatment allocation, study site, baseline body mass index and use of walking aids. Results: Among the 2131 participants included in this analysis (mean age: 74.9 years, 61.7% were women, 82.6% at least moderately physically active), 1464 (68.7%) had decreased VA. In total, 3290 falls including 2116 injurious falls were recorded over 3 years. Decreased VA at baseline was associated with a 22% increased incidence rate of all falls (adjusted incidence rate ratio (aIRR)=1.22, 95% Confidence Intervals [CI] 1.07-1.38, p=0.003) and 20% increased incidence rate of injurious falls (aIRR=1.20, 95% CI 1.05-1.37, p=0.007). Conclusion: Our findings suggest that even in generally healthy and active older adults, decreased VA is an independent predictor of an about 20% increased risk of all and injurious falls.