Improving vision to prevent falls in frail older people: a randomized trial.
OBJECTIVE
To determine the efficacy of vision and eye examinations, with subsequent treatment of vision problems, for preventing falls and fractures in frail older people.


METHODS
Randomized, controlled trial.


METHODS
Community in Sydney, Australia.


METHODS
Six hundred sixteen men and women aged 70 and older (mean age 81) recruited mainly from people attending outpatient aged care services.


METHODS
The intervention group received comprehensive vision and eye examinations conducted by a study optometrist. The optometrist arranged for new eyeglasses for 92 subjects and referred 24 for a home visit with an occupational therapist, 17 for glaucoma management, and 15 for cataract surgery. The control group received usual care.


METHODS
Falls and fractures during 12 months of follow-up were ascertained according to self-report using a monthly postcard system.


RESULTS
Fifty-seven percent of subjects fell at least once during follow-up. Falls occurred more frequently in the group randomized to receive the vision intervention (65% fell at least once; 758 falls in total) than in the control group (50% fell at least once; 516 falls in total). The falls rate ratio using the negative binomial model was 1.57 (95% confidence interval (CI)=1.20-2.05, P=.001). Fractures were also more frequent in the intervention group (31 fractures) than the control group (18 fractures; relative risk from proportional hazards model 1.74, 95% CI=0.97-3.11, P=.06).


CONCLUSIONS
In frail older people, comprehensive vision and eye assessment, with appropriate treatment, does not reduce, and may even increase, the risk of falls and fractures.
Cumming
Robert G
RG
School of Public Health, University of Sydney, Sydney, Australia. bobc@health.usyd.edu.au
Ivers
Rebecca
R
Clemson
Lindy
L
Cullen
John
J
Hayes
Maggie F
MF
Tanzer
Michael
M
Mitchell
Paul
P
D000058:Accidental Falls / Q000517:prevention & control* / Q000706:statistics & numerical data; D000368:Aged; D000369:Aged, 80 and over; D002387:Cataract Extraction; D005139:Eyeglasses; D005260:Female; D005500:Follow-Up Studies; D016330:Frail Elderly; D006801:Humans; D008297:Male; D016016:Proportional Hazards Models; D017211:Treatment Failure; D014786:Vision Disorders / Q000175:diagnosis / Q000628:therapy*; D014792:Visual Acuity