Visual Risk Factors for Falls in Older People

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Risk factors for falls in a community-based prospective study of people 70 years and older.

A. Campbell, M. J. Borrie, G. Spears (1989)

We investigated factors associated with falls in a community-based prospective study of 761 subjects 70 years and older. The group experienced 507 falls during the year of monitoring. On entry to the study a number of variables had been assessed in each subject. Variables associated with an increased risk of falling differed in men and women. In men, decreased levels of physical activity, stroke, arthritis of the knees, impairment of gait, and increased body sway were associated with an increased risk of falls. In women, the total number of drugs, psychotropic drugs and drugs liable to cause postural hypotension, standing systolic blood pressure of less than 110 mmHg, and evidence of muscle weakness were also associated with an increased risk of falling. Most falls in elderly people are associated with multiple risk factors, many of which are potentially remediable. The possible implications of this in diagnosis and prevention are discussed.

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Physiological factors associated with falls in older community-dwelling women.

Stephen R. Lord, John A. Ward, Philippa Williams … (1994)

To determine the prevalence of impaired vision, peripheral sensation, lower limb muscle strength, reaction time, and balance in a large community-dwelling population of women aged 65 years and over, and to determine whether impaired performances in these tests are associated with falls. One-year prospective study. Conducted as part of the Randwick Falls and Fractures Study, in Sydney, Australia. Four hundred fourteen women aged 65 to 99 years (mean age 73.7 years, SD = 6.3) were randomly selected from the community; 341 of these women were included in the 1-year prospective study. The prevalence of impairment in all tests increased with age. In the year following assessment, 207 subjects (60.7%) experienced no falls, 63 subjects (18.5%) fell one time only, and 71 subjects (20.8%) fell on two or more occasions. After controlling for age, multiple falling was associated with low contrast visual acuity and contrast sensitivity, poor vibration sense and proprioception, reduced lower limb strength, slow reaction time, and impaired balance, as indicated by four sway tests and two clinical stability measures. Discriminant function analysis identified visual contrast sensitivity, proprioception in the lower limbs, quadriceps strength, reaction time, and sway on a compliant (foam rubber) surface with the eyes open as the variables that significantly discriminated between subjects who experienced multiple falls and subjects who experienced no falls or one fall only (Wilks' lambda = 0.73 (P < 0.001), canonical correlation = 0.52). This procedure correctly classified 75% of subjects into multiple faller or nonmultiple faller groups. These findings support previous results conducted in retirement village and institutional setting and indicate that the test procedure aids in the identification of older community-dwelling women at risk of falls.

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Postural stability and associated physiological factors in a population of aged persons.

Scott R D Clark, Richard Webster, I W Webster (1991)

A battery of 13 visual, vestibular, sensorimotor, and balance tests was administered to 95 elderly persons (mean age 82.7 years) to examine the relationships between specific sensorimotor functions and measures of postural stability. When subjects stood on a firm surface, increased body sway was associated with poor tactile sensitivity and poor joint position sense. When subjects stood on a compliant surface (which reduced peripheral sensation) with their eyes open, increased body sway was associated with poor visual acuity and contrast sensitivity, reduced vibration sense, and decreased ankle dorsiflexion strength as well as reduced joint position sense. Increased body sway with eyes closed on the compliant surface was associated with poor tactile sensation, reduced quadriceps and ankle dorsiflexion strength, and increased reaction time. Poor performance in two clinical measures of postural stability was associated with reduced sensation in the lower limbs as measured by joint position sense, tactile sensitivity and vibration sense, reduced quadriceps and ankle dorsiflexion strength, and slow reaction times. The prevalence of vestibular impairments was high in this group, but vestibular function was not significantly associated with sway under any of the test conditions. The results suggest that reduced sensation, muscle weakness in the legs, and increased reaction time are all important factors associated with postural instability. An analysis of the percentage increases in sway under conditions where visual and peripheral sensation systems are removed or diminished, compared with sway under optimal conditions, indicated that peripheral sensation is the most important sensory system in the maintenance of static postural stability.

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Author and article information

Journal

Title: Journal of the American Geriatrics Society

Abbreviated Title: Journal of the American Geriatrics Society

Publisher: Wiley-Blackwell

ISSN: 00028614

ISSN (Electronic): 15325415

Publication date Created: May 2001

Publication date (Print): May 2001

Volume: 49

Issue: 5

Pages: 508-515

Article

DOI: 10.1046/j.1532-5415.2001.49107.x

PubMed ID: 11380741

SO-VID: aaf228fe-a2c7-4f04-96dc-467ea24a613d

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http://doi.wiley.com/10.1002/tdm_license_1.1

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