title: Improving vision to prevent falls in frail older people: a randomized trial.
abstract: 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.
authors.affiliation: School of Public Health, University of Sydney, Sydney, Australia. bobc@health.usyd.edu.au
authors.forename: Robert G
authors.initials: RG
authors.lastname: Cumming
authors.forename: Rebecca
authors.initials: R
authors.lastname: Ivers
authors.forename: Lindy
authors.initials: L
authors.lastname: Clemson
authors.forename: John
authors.initials: J
authors.lastname: Cullen
authors.forename: Maggie F
authors.initials: MF
authors.lastname: Hayes
authors.forename: Michael
authors.initials: M
authors.lastname: Tanzer
authors.forename: Paul
authors.initials: P
authors.lastname: Mitchell
mesh_terms: 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