Ageing vision and falls: a review

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Abstract

Background

Falls are the leading cause of accidental injury and death among older adults. One of three adults over the age of 65 years falls annually. As the size of elderly population increases, falls become a major concern for public health and there is a pressing need to understand the causes of falls thoroughly.

Main body of the abstract

While it is well documented that visual functions such as visual acuity, contrast sensitivity, and stereo acuity are correlated with fall risks, little attention has been paid to the relationship between falls and the ability of the visual system to perceive motion in the environment. The omission of visual motion perception in the literature is a critical gap because it is an essential function in maintaining balance. In the present article, we first review existing studies regarding visual risk factors for falls and the effect of ageing vision on falls. We then present a group of phenomena such as vection and sensory reweighting that provide information on how visual motion signals are used to maintain balance.

Conclusion

We suggest that the current list of visual risk factors for falls should be elaborated by taking into account the relationship between visual motion perception and balance control.

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Most cited references 111

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Sit-to-stand performance depends on sensation, speed, balance, and psychological status in addition to strength in older people.

S. R. Lord, S M Murray, K. Chapman … (2002)

Sit-to-stand (STS) performance is often used as a measure of lower-limb strength in older people and those with significant weakness. However, the findings of recent studies suggest that performance in this test is also influenced by factors associated with balance and mobility. We conducted a study to determine whether sensorimotor, balance, and psychological factors in addition to lower-limb strength predict sit-to-stand performance in older people. Six hundred and sixty nine community-dwelling men and women aged 75-93 years (mean age 78.9, SD = 4.1) underwent quantitative tests of strength, vision, peripheral sensation, reaction time, balance, health status, and sit-to-stand performance. Many physiological and psychological factors were significantly associated with sit-to-stand times in univariate analyses. Multiple regression analysis revealed that visual contrast sensitivity, lower limb proprioception, peripheral tactile sensitivity, reaction time involving a foot-press response, sway with eyes open on a foam rubber mat, body weight, and scores on the Short-Form 12 Health Status Questionnaire pain, anxiety, and vitality scales in addition to knee extension, knee flexion, and ankle dorsiflexion strength were significant and independent predictors of STS performance. Of these measures, quadriceps strength had the highest beta weight, indicating it was the most important variable in explaining the variance in STS times. However, the remaining measures accounted for more than half the explained variance in STS times. The final regression model explained 34.9% of the variance in STS times (multiple R =.59). The findings indicate that, in community-dwelling older people, STS performance is influenced by multiple physiological and psychological processes and represents a particular transfer skill, rather than a proxy measure of lower limb strength.

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Falls and fear of falling: which comes first? A longitudinal prediction model suggests strategies for primary and secondary prevention.

Susan M. Friedman, Beatriz Adelaida Muñoz, Sheila K. West … (2002)

Previous cross-sectional studies have shown a correlation between falls and fear of falling, but it is unclear which comes first. Our objectives were to determine the temporal relationship between falls and fear of falling, and to see whether these two outcomes share predictors. A 20-month, population-based, prospective, observational study. Salisbury, Maryland. Each evaluation consisted of a home-administered questionnaire, followed by a 4- to 5-hour clinic evaluation. The 2,212 participants in the Salisbury Eye Evaluation project who had baseline and 20-month follow-up clinic evaluations. At baseline, subjects were aged 65 to 84 and community dwelling and had a Mini-Mental State Examination score of 18 or higher. Demographics, visual function, comorbidities, neuropsychiatric status, medication use, and physical performance-based measures were assessed. Stepwise logistic regression analyses were performed to evaluate independent predictors of falls and fear of falling at the follow-up evaluation, first predicting incident outcomes and then predicting fall or fear-of-falling status at 20 months with baseline falling and fear of falling as predictors. Falls at baseline were an independent predictor of developing fear of falling 20 months later (odds ratio (OR) = 1.75; P <.0005), and fear of falling at baseline was a predictor of falling at 20 months (OR = 1.79; P <.0005). Women with a history of stroke were at risk of falls and fear of falling at follow-up. In addition, Parkinson's disease, comorbidity, and white race predicted falls, whereas General Health Questionnaire score, age, and taking four or more medications predicted fear of falling. Individuals who develop one of these outcomes are at risk for developing the other, with a resulting spiraling risk of falls, fear of falling, and functional decline. Because falls and fear of falling share predictors, individuals who are at a high risk of developing these endpoints can be identified.

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Visual Risk Factors for Falls in Older People

Stephen R. Lord, Julia Dayhew (2001)

To determine the tests most predictive of falls in community-dwelling older people from a range of visual screening tests (high and low contrast visual acuity, edge contrast sensitivity, depth perception, and visual field size). To determine whether one or more of these visual measures, in association with measures of sensation, strength, reaction time, and balance, can accurately predict falls in this group. Prospective cohort study of 12 months duration. Falls and Balance Laboratory, Prince of Wales Medical Research Institute. 156 community-dwelling men and women age 63 to 90 (mean age 76.5, standard deviation = 5.1). Screening tests of vision, sensation, strength, reaction time and balance, falls. Of the 148 subjects available at follow-up, 64 (43.2%) reported falling, with 32 (21.7%) reporting multiple falls. Multiple fallers had decreased vision, as indicated by all visual tests, with impaired depth perception, contrast sensitivity, and low-contrast visual acuity being the strongest risk factors. Subjects with good vision in both eyes had the lowest rate of falls, whereas those with good vision in one eye and only moderate or poor vision in the other eye had elevated falling rates-equivalent to those with moderate or poor vision in both eyes. Discriminant analysis revealed that impaired depth perception, slow reaction time, and increased body sway on a compliant surface were significantly and independently associated with falls. These variables correctly classified 76% of the cases, with similar sensitivity and specificity. The study findings indicate that impaired vision is an important and independent risk factor for falls. Adequate depth perception and distant-edge-contrast sensitivity, in particular, appear to be important for maintaining balance and detecting and avoiding hazards in the environment.

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Author and article information

Contributors

Liana Nafisa Saftari: 82-10-3449-8845 , lianasaftari@unist.ac.kr

Oh-Sang Kwon: 82-52-217-2735 , oskwon@unist.ac.kr

Journal

Journal ID (nlm-ta): J Physiol Anthropol

Journal ID (iso-abbrev): J Physiol Anthropol

Title: Journal of Physiological Anthropology

Publisher: BioMed Central (London )

ISSN (Print): 1880-6791

ISSN (Electronic): 1880-6805

Publication date (Electronic): 23 April 2018

Publication date PMC-release: 23 April 2018

Publication date Collection: 2018

Volume: 37

Electronic Location Identifier: 11

Affiliations

ISNI 0000 0004 0381 814X, GRID grid.42687.3f, Department of Human Factors Engineering, , Ulsan National Institute of Science and Technology, ; Ulsan, 44919 South Korea

Article

Publisher ID: 170

DOI: 10.1186/s40101-018-0170-1

PMC ID: 5913798

PubMed ID: 29685171

SO-VID: 0c847415-031b-41ae-be21-77af2c8ff614

License:

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

History

Date received : 17 September 2017

Date accepted : 28 March 2018

Funding

Funded by: FundRef http://dx.doi.org/10.13039/501100003725, National Research Foundation of Korea;

Award ID: 2015R1D1A1A01060520

Award Recipient : Oh-Sang Kwon

Custom metadata

ScienceOpen disciplines: Anthropology

Keywords: falls,ageing,vision,visual motion perception,postural balance,vection

Data availability:

ScienceOpen disciplines: Anthropology

Keywords: falls, ageing, vision, visual motion perception, postural balance, vection

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Ageing vision and falls: a review

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Most cited references 111

Sit-to-stand performance depends on sensation, speed, balance, and psychological status in addition to strength in older people.

Falls and fear of falling: which comes first? A longitudinal prediction model suggests strategies for primary and secondary prevention.

Visual Risk Factors for Falls in Older People

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Cited by 52

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