Introduction: Falls are a major cause of morbidity and mortality in older people, and those with reduced visual acuity are twice as likely to fall as those with normal eyesight. Accordingly, NICE guidelines recommend assessment of vision as part of a multi-factorial risk assessment in older people, who present for medical attention, because of a fall.
Methods: We included all patients admitted to a senior health ward at St George’s hospital because of a fall. A baseline audit was conducted in May 2020. Our primary intervention was a departmental teaching session with subsequent first cycle data. We trialled the ‘Lookout! Bedside vision check for falls prevention’ recommended by the Royal College of Physicians. Our secondary intervention was designing an ‘initial assessment’ proforma to include a section for sensory impairment followed by a second cycle data collection.
Results: Our initial results showed that none of the 24 patients admitted with a fall had any form of documented visual assessment. Using a simple bedside vision check tool, we found 22% (n=2) of screened patients had significantly impaired vision. Following our teaching session, 50% (n=7) of patients had some form of visual assessment on admission and after introduction of the proforma, this increased to 56% (n=5). Visual risk factors were identified in multiple patients, including outdated prescriptions for corrective glasses.
Discussion: Identifying reversible visual risk factors may reduce recurrent falls and subsequent complications as well as hospital admissions in older patients. A teaching session was found to be effective, however a ‘proforma’ may encourage more sustainable improvements. The reduction in ophthalmology and optometry services during the Covid-19 pandemic will inevitably increase the prevalence of visual risk factors. Effects including delayed eyesight tests and cataract operations. It is therefore more important now than ever, to ensure bedside assessment of vision in older adults presenting to hospital, with a fall and proactively in falls prevention strategies.
A Global Report on Falls Prevention Epidemiology of Falls A Global Report on Falls Prevention Epidemiology of Falls Sachiyo Yoshida-Intern Ageing and Life Course Family and Community Health World Health Organization.
Prudham D, Evans JG. Factors Associated with Falls in the Elderly: A Community Study. Age and Ageing [Internet]. 1981 Jan 1;10(3):141–6. Available from: https://doi.org/10.1093/ageing/10.3.141
Downton JH, Andrews K. Prevalence, characteristics and factors associated with falls among the elderly living at home. Aging (Milan, Italy) [Internet]. 1991;3(3):219–28. Available from: http://europepmc.org/abstract/MED/1764490
Gill TM, Murphy TE, Gahbauer EA, Allore HG. Association of injurious falls with disability outcomes and nursing home admissions in community-living older persons. American journal of epidemiology [Internet]. 2013/04/01. 2013 Aug 1;178(3):418–25. Available from: https://pubmed.ncbi.nlm.nih.gov/23548756
Abrahamsen B, van Staa T, Ariely R, Olson M, Cooper C. Excess mortality following hip fracture: a systematic epidemiological review. Osteoporosis International [Internet]. 2009;20(10):1633–50. Available from: https://doi.org/10.1007/s00198-009-0920-3
Falls Assessment and prevention of falls in older people NICE guidance number NICE clinical guideline 161 Developed by the Centre for Clinical Practice at NICE [Internet]. 2013. Available from: www.nice.org.uk
Lord SR. Visual risk factors for falls in older people. In: Age and Ageing. 2006.
Legood R, Scuffham P, Cryer C. Are we blind to injuries in the visually impaired? A review of the literature. Injury prevention : journal of the International Society for Child and Adolescent Injury Prevention [Internet]. 2002 Jun;8(2):155–60. Available from: https://pubmed.ncbi.nlm.nih.gov/12120837
Lord SR, Dayhew J, Howland A. Multifocal Glasses Impair Edge-Contrast Sensitivity and Depth Perception and Increase the Risk of Falls in Older People. Vol. 50, CLINICAL INVESTIGATIONS JAGS. 2002.
In association with: National audit of inpatient falls Audit report 2015 [Internet]. 2015. Available from: www.rcplondon.ac.uk
Look out! Bedside vision check for falls prevention In association with.
Evans JR, Fletcher AE, Wormald RPL, Community MRCT of A and M of OP in the. Causes of visual impairment in people aged 75 years and older in Britain: an add-on study to the MRC Trial of Assessment and Management of Older People in the Community. The British journal of ophthalmology [Internet]. 2004 Mar;88(3):365–70. Available from: https://pubmed.ncbi.nlm.nih.gov/14977771
Safadi K, Kruger JM, Chowers I, Solomon A, Amer R, Aweidah H, et al. Ophthalmology practice during the COVID-19 pandemic. BMJ open ophthalmology [Internet]. 2020 Apr 19;5(1):e000487–e000487. Available from: https://pubmed.ncbi.nlm.nih.gov/32432169
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Copyright (c) 2020 Array