title: Visual impairment and the incidence of falls and fractures among older people: longitudinal findings from the Blue Mountains Eye Study.
abstract: OBJECTIVE
  We assessed the impact of visual impairment on the incidence of falls and fractures in older persons.
  
  
  METHODS
  Of 3654 baseline participants, 2334, 1952, and 1149 were re-examined after 5, 10, and 15 years. Presenting visual acuity (VA) was measured at each examination. Bilateral and unilateral visual impairment was defined as VA worse than 20/40 in the better and worse eye, respectively. Incident visual impairment was defined in eyes with VA 20/40 or better at baseline, which subsequently developed visual impairment. Incidence of falls was assessed over the 12 months before each visit, whereas incidence of fractures was assessed over the 5 years between two visits. Discrete logistic-regression models with time-dependent variables were used to assess associations between visual impairment and subsequent falls and fractures after adjusting for potential confounding variables.
  
  
  RESULTS
  The proportions of participants reporting ≥2 falls ranged between 10% and 14%, and proportions reporting fractures ranged between 12% and 21%, across the three follow-up visits. Participants with incident visual impairment were more likely to report ≥2 falls in 5 years, OR (odds ratio) 1.46, 95% confidence interval (CI) 1.04 to 2.04 (bilateral), and OR 1.22, 95% CI 0.98 to 1.51 (unilateral). Compared to participants with normal vision, those with incident unilateral visual impairment had a higher incidence of fractures over 5 years (OR, 1.27; 95% CI, 0.98-1.51). No increased incidence of falls or fractures was evident after 5+ years among participants with visual impairment.
  
  
  CONCLUSIONS
  In this older cohort, recent development of visual impairment was associated with increased likelihood of subsequent falls and fractures in the next 5 years, independent of other confounding variables.
authors.affiliation: Centre for Vision Research, Department of Ophthalmology and Westmead Millennium Institute, University of Sydney, Sydney, Australia.
authors.forename: Thomas
authors.initials: T
authors.lastname: Hong
authors.affiliation: Centre for Vision Research, Department of Ophthalmology and Westmead Millennium Institute, University of Sydney, Sydney, Australia.
authors.forename: Paul
authors.initials: P
authors.lastname: Mitchell
authors.affiliation: Centre for Vision Research, Department of Ophthalmology and Westmead Millennium Institute, University of Sydney, Sydney, Australia.
authors.forename: George
authors.initials: G
authors.lastname: Burlutsky
authors.affiliation: Centre for Vision Research, Department of Ophthalmology and Westmead Millennium Institute, University of Sydney, Sydney, Australia.
authors.forename: Chameen
authors.initials: C
authors.lastname: Samarawickrama
authors.affiliation: Centre for Vision Research, Department of Ophthalmology and Westmead Millennium Institute, University of Sydney, Sydney, Australia Centre for Eye Research Australia, University of Melbourne, Melbourne, Australia.
authors.forename: Jie Jin
authors.initials: JJ
authors.lastname: Wang
mesh_terms: D000058:Accidental Falls / Q000706:statistics & numerical data*; D000367:Age Factors; D005260:Female; D005544:Forecasting; D050723:Fractures, Bone / Q000453:epidemiology* / Q000209:etiology; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009517:New South Wales / Q000453:epidemiology; D011159:Population Surveillance / Q000379:methods*; D014786:Vision Disorders / Q000150:complications* / Q000453:epidemiology / Q000503:physiopathology; D014792:Visual Acuity
keywords: falls; fractures; visual impairment