Perceived vision‐related quality of life and risk of falling among community living elderly people

Scand J Caring Sci; 2013; 27; 433–439 Perceived vision‐related quality of life and risk of falling among community living elderly people Falls and fall injuries among the elderly population are common, since ageing is a risk factor of falling. Today, this is a major problem because the ageing population is increasing. There are predictive factors of falling and visual impairment is one of them. Usually, only visual acuity is considered when measuring visual impairment, and nothing regarding a person’s functional visual ability is taken into account. Therefore, the aim of this study was to assess the perceived vision‐related quality of life among the community living elderly using the 25‐item National Eye Institute Visual Function Questionnaire (NEI VFQ‐25) and to investigate whether there was any association among vision‐related quality of life and falls. There were 212 randomly selected elderly people participating in the study. Our study indicated that the participants had an impaired perceived vision‐related health status. General health was the only NEI VFQ‐25 variable significantly associated with falls in both men and women. However, among men, near and distance activities, vision‐specific social functioning, role difficulties and dependency, color and peripheral vision were related to falls.     

Falls and fear of falling among elderly persons living in the community: occupational therapy interventions

Each year, about one third of the population over 65 years of age experiences at least one fall (Perry, 1982). Assessment of the incidence of falls and the prevalence, intensity, and covariates of fear of falling among community-based elderly persons was conducted through interviews of 115 residents in a housing development (mean age = 78 years). Fifty-three percent reported having fallen in recent years, 32% in the last year. Fear of falling ranked first when compared with other common fears. In a logistic regression model predicting limitation of activity independent of risk factors for falling, fear of falling was marginally significant (p = .06). The results of the study show that falls are frequent and fear of falling prevalent among the community-based elderly. A comprehensive program designed to reduce the risk of falls is presented.     

Risk factors for falls among the community-dwelling elderly in Korea

Community-based centres were surveyed to determine the frequency of and risk factors for falls among elderly Koreans. We examined fall-related risk factors, including physiological and physical health, psychosocial functions, self-reported physical capacity and activity, vision, and the use of medication, among 351 elderly people aged 65 years or older, with ambulatory. Forty-two per cent of elderly Korean subjects reported at least one episode of falling in the previous 12 months, 38% of whom had consequences that required either the attention of a physician or hospitalization. Factors significantly associated with an increased risk of falling were a restricted activity during the previous five years (adjusted OR 1.3), use of alternative therapy (adjusted OR 2.7), low knee flexor and extensor-muscle strength (adjusted OR 1.21 and 1.20), and poor balance with closed eyes (adjusted OR 8.32). We conclude that falls among older persons living in the community are common in Korea and that indicator of bad health and frailty or variables directly related to neuromuscular impairment are significant predictors of the risk of falling.     

Falls in hospices: a cancer network observational study of fall rates and risk factors

Falls have been identified as a problem in frail patient populations, but their risk factors have not been studied prospectively in the hospice setting. We calculated fall rates in three hospices in the Yorkshire region, identified risk factors for falls based on previous studies in elderly patients, and then carried out a prospective study of inpatients in two of these hospices. We compared these risk factors in patients who subsequently fell with patients that did not fall during the study period. Information was recorded on 102 admissions. Twelve patients fell, generating 23 falls; six patients fell more than once. Significant risk factors for falling were cognitive impairment, low systolic lying and standing blood pressure, visual impairment and age over 80. Males with these risk factors fell more often than female patients with these risk factors. Strategies to prevent falls in hospice inpatients need to be directed appropriately towards patients with cognitive and visual impairment and low systolic blood pressure.     

Critical period for cross-modal plasticity in blind humans: a functional MRI study

The primary visual cortex (V1) in congenitally blind humans has been shown to be involved in tactile discrimination tasks, indicating that there is a shift in function of this area of cortex, but the age dependency of the reorganization is not fully known. To investigate the reorganized network, we measured the change of regional cerebral blood flow using 3.0 Tesla functional MRI during passive tactile tasks performed by 15 blind and 8 sighted subjects. There was increased activity in the postcentral gyrus to posterior parietal cortex and decreased activity in the secondary somatosensory area in blind compared with sighted subjects during a tactile discrimination task. This suggests that there is a greater demand for shape discrimination processing in blind subjects. Blind subjects, irrespective of the age at onset of blindness, exhibited higher activity in the visual association cortex than did sighted subjects. V1 was activated in blind subjects who lost their sight before 16 years of age, whereas it was suppressed in blind subjects who lost their sight after 16 years of age during a tactile discrimination task. This suggests that the first 16 years of life represent a critical period for a functional shift of V1 from processing visual stimuli to processing tactile stimuli. Because of the age-dependency, V1 is unlikely to be the "entry node" of the cortex for the redirection of tactile signals into visual cortices after blinding. Instead, the visual association cortex may mediate the circuitry by which V1 is activated during tactile stimulation.     

Don’t Assume Deaf Students are Visual Learners

In the education of deaf learners, from primary school to postsecondary settings, it frequently is suggested that deaf students are visual learners. That assumption appears to be based on the visual nature of signed languages—used by some but not all deaf individuals—and the fact that with greater hearing losses, deaf students will rely relatively more on vision than audition. However, the questions of whether individuals with hearing loss are more likely to be visual learners than verbal learners or more likely than hearing peers to be visual learners have not been empirically explored. Several recent studies, in fact, have indicated that hearing learners typically perform as well or better than deaf learners on a variety of visual-spatial tasks. The present study used two standardized instruments to examine learning styles among college deaf students who primarily rely on sign language or spoken language and their hearing peers. The visual-verbal dimension was of particular interest. Consistent with recent indirect findings, results indicated that deaf students are no more likely than hearing students to be visual learners and are no stronger in their visual skills and habits than their verbal skills and habits, nor are deaf students’ visual orientations associated with sign language skills. The results clearly have specific implications for the educating of deaf learners.     

Sensomotorik im Alter

Impaired functioning of the sensorimotor system in otherwise healthy elderly people is considered as a major risk factor for both decreased movement safety and falls. Aging is accompanied by structural changes within the sensorimotor system, such as neuropathy and myopathy. Muscle mass and functional quality decrease with increasing age. Muscle is the final pathway of the sensorimotor system, and in the elderly population muscle strength, endurance and contraction velocity are all decreased. Neuromuscular movement coordination may be impaired with respect to the timing and the fine tuning process of muscle strength between synergistically and antagonistically working muscle groups. Age-related changes may also be observed in the connective tissues of muscle tendons, ligaments and other structures. Alterations of tendon compliance may change the responsiveness and thresholds of receptors and thus contribute to increased delays of automatic muscle responses or altered neuromuscular activation of muscles. Postural balance functions also decrease in the elderly. Altered postural automatic responses following postural perturbations correlate well with an increased risk of falls in the elderly population. Gait performance in the elderly becomes less dynamic, and stride time and step width vary considerably more than in young people.     

Recurrent elderly fallers.

Factors associated with recurrent falling during a one-year period were analysed among elderly Finns (65 yrs and more) seeking medical treatment due to a fall. Recurrent falling in men was independently related to a lesser amount of depressive symptoms and to less severe injury due to the first fall. In women, recurrent falling was independently related to the non-occurrence of a fear of falling. Furthermore, recurrent falling, amount of daily movement, mental capacity, and falling during the previous year were related variables. Here the risk of recurrent falling was high among persons with poor mental capacity, who moved about a large amount daily, and who had had at least one accident during the previous year. In addition, there was an association between poor health and recurrent falling women. Demented women moving about daily, frail women, and incautious men and women seemed to be the main risk groups for repeated falling. What could general practitioners do to prevent repeated falls in the elderly? First, the overall health status and functional capacities of frail elderly women should be improved. Second, all elderly persons, especially those who have fallen, should be informed about how to minimize the risks of falls. Prevention is not easy among the demented population, however.     

Recurrent Elderly Fallers

Factors associated with recurrent failing during a one-year period were analysed among elderly Finns (65 yrs and more) seeking medical treatment due to a fall. Recurrent falling in men was independently related to a lesser amount of depressive symptoms and to less severe injury due to the first fall.

In women, recurrent falling was independently related to the non-occurrence of a fear of falling. Furthermore, recurrent falling, amount of daily movement, mental capacity, and falling during the previous year were related variables. Here the risk of recurrent falling was high among persons with poor mental capacity, who moved about a large amount daily, and who had had at least one accident during the previous year. In addition, there was an association between poor health and recurrent falling in women.

Demented women moving about daily, frail women, and incautious men and women seemed to be the main risk groups for repeated falling. What could general practitioners do to prevent repeated falls in the elderly? First, the overall health status and functional capacities of frail elderly women should be improved. Second, all elderly persons, especially those who have fallen, should be informed about how to minimize the risks of falls. Prevention is not easy among the demented population, however.     

Identification of visual scanning deficits in adults after cerebrovascular accident

Visual scanning deficits can result in the inefficient acquisition of information about one's environment. For adults who have had cerebrovascular accidents (CVAs), such deficits can interfere with the independent performance of many daily activities. The present study examined five tests designed to measure visual scanning deficits in post-CVA adults. Subjects with right and left hemisphere lesions were matched with control subjects by age and sex, and their performances on the tests were compared. The difference between the matched groups was statistically significant for all tests, with the hemiplegic subjects achieving lower scores than their normal counterparts. Deficits in visual scanning speed, identification of visual stimuli in the hemifield on the involved side, use of a systematic scanning pattern, and the ability to reproduce accurate visual designs were identified in the hemiplegic group. Statistically significant correlations were obtained on test-retest and interrater data, which indicates that the tests are reliable measures. The results of this study show that visual scanning deficits are present in post-CVA patients and can be measured with simple clinical evaluations. The presence of scanning deficits may significantly interfere with performance on tests measuring higher level visual-perceptual skills such as visual closure, figure-ground perception, and visual memory. An accurate assessment of visual-perceptual skills cannot be made without prior evaluation of such basic oculomotor functions as scanning. This approach is consistent with the developmental framework applied to most areas of treatment with brain-injured adults but is one that traditionally has not been applied in the evaluation of visual-perceptual skills.     

A neuromuscular test battery for osteoporotic women: a pilot study

OBJECTIVE: To examine the efficacy of a short neuromuscular test battery in elderly women suffering from osteoporosis in accordance with the World Health Organization criteria, with and without a history of fractures. Reduced bone mass and a high likelihood of falling increase the risk of osteoporotic fractures. There is a need for neuromuscular tests to identify individuals at risk for falls and fractures. DESIGN: The women were assessed twice. Forty-two women, with a mean age of 70.0 +/- 5.1 (SD) yr, completed the first assessment. The number of postmenopausal fractures and the women's history with regard to agility and falls were assessed. The women performed neuromuscular tests (one-leg stance, tandem walk, and body sway); bone mineral density of the spine and femoral neck were measured. For the follow-up assessment, 13.2 +/- 1.3 mo later, 39 women were studied. The same outcome measurements were obtained at both evaluations. RESULTS: During the observation period, five women fell once and one woman fell twice; there were only two vertebral fractures and no nonvertebral fracture. Neuromuscular performance did not change during this observation period. The median changes in bone mineral density between the two assessments were clinically not relevant. A comparison between patients suffering from established osteoporosis and osteoporotic patients without a history of postmenopausal fractures showed that both groups of patients did not differ with respect to age, neuromuscular performance, bone mineral density, and fear of falling. CONCLUSION: This neuromuscular test battery is a feasible and practical tool because it is brief and economical to perform. However, its efficacy as a predictor of fractures must be tested in additional studies with a long-term follow-up and a larger group of subjects.     

Impact of soft and hard insole density on postural stability in older adults

A significant predictor of falls in the elderly population is attributed to postural instability. Thus, it is important to identify and implement practical clinical interventions to enhance postural stability in older adults. Shoe insoles have been identified as a mechanism to enhance postural control, and our study aimed to evaluate the impact of 2 shoe insoles on static standing balance in healthy, older adults compared with standing posture while barefoot. We hypothesized that both hard and soft shoe insoles would decrease postural sway compared with the barefoot condition. Indeed, excursion distances and sway areas were reduced, and sway velocity was decreased when wearing insoles. The hard insole was also effective when visual feedback was removed, suggesting that the more rigid an insole, the greater potential reduction in fall risk. Thus, shoe insoles may be a cost-effective, clinical intervention that is easy to implement to reduce the risk of falling in the elderly population.     

Predictors for recurrent falls among the home-dwelling elderly

Objective - Scant attention has been paid to the risk factors for recurrent falls among the home-dwelling elderly, although there are remarkable age and sex differences according to whether or not the falls recur. in this report we describe and analyse the risk factors for recurrent falls by selected clinical variables and the history of falling during the previous year.

Design - A community-based prospective study covering two years.

Setting - All home-dwelling persons (N=1016) aged 70 years or older living in five municipalities in northern Finland.

Outcome measures - the risk factors of recurrent falling by selected clinical variables using cross-tabulations and multivariate analyses.

Results - Previous falls, peripheral neuropathy, use of psychotropic medication and slow walking speed were independent risk factors for recurrent falling. the risk of recurrent falling increased with an increasing number of previous falls.

Conclusions - Early preventive measures should be taken among the elderly persons who are prone to falling. in order to reduce the risk of recurrent falls among the elderly, the attending physician should take a critical view of the use of psychotropic medications, and attempts should be made to treat conditions underlying peripheral neuropathies and abnormal gait.     

Balance score and a history of falls in hospital predict recurrent falls in the 6 months following stroke rehabilitation

OBJECTIVE: To investigate predictors of recurrent falls in adults who return to community dwelling after stroke rehabilitation. DESIGN: Prospective observational study. SETTING: Community. PARTICIPANTS: Fifty-five adults with stroke (mean age +/- standard deviation, 68.1+/-12.8y). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Baseline measures included balance, gait speed, muscle strength and tone, activity level, hemianopia, visual contrast sensitivity, hemineglect, medication use, fear of falling, and depression. Participants kept a 6-month prospective falls diary after discharge from rehabilitation. RESULTS: Twenty-five (45%) participants reported falling, 12 had recurrent falls (> or =2 falls), and 13 fell once. Participants who fell recurrently had histories of falling during hospitalization or rehabilitation, poorer physical function measures, were taking more medications, and were more likely to have hemineglect than participants who fell once or did not fall (P<.05). A history of falling in the hospital or during rehabilitation, combined with poor balance (either Berg Balance Scale score <49 or step test score <7), predicted recurrent falls with sensitivity and specificity values greater than 80%. CONCLUSIONS: Falls are a common occurrence after stroke. The predictive model developed can be used to identify people who are likely to have recurrent falls in the 6 months after stroke rehabilitation.     

A checklist for assessing the risk of falls among the elderly

The purpose of this study was to estimate the risk of falls among elderly citizens by using a checklist. This checklist was initially developed using the Delphi technique, then refined on the basis of research findings. Cross-sectional design and a purposive sample were used, with the sample selected from three sheltered housing projects (n = 302) and from Win-san district (n = 103) in Taipei, comprising 405 participants. On the basis of their experiences of falling in the previous year, participants were classified into two groups: fall (n = 202) and non-fall (n = 203). Participants in the fall group had lower scores on an SPMSQ (Short Portable Mental Status Questionnaire), took longer to complete the Get-up and Go test and were more afraid of falling. Participants who took longer than one second to complete the Get-up and Go test or had urinary frequency or incontinence problems were found to be at greater risks for falls. The elderly who lived in homes with dimly lit kitchens and clutters at entryways (or backyards) were found to be at a considerably greater risk, by 22 or 13 times respectively. This checklist can be used by care providers to identify those providing care to the elderly, those at high risk of falls, and to prevent such falls or, at least lessen the risks of falls.     

Falls in the elderly: what can be done?

AIM: This article gives information about falls in the elderly. BACKGROUND: The evaluation of an older patient who has fallen includes a focused history with an emphasis on medications, risk factors and physical examination. The article also discusses the aetiology and prevention of falls. CONCLUSION: Risk factors for falls in the elderly include increasing age, medication use, cognitive impairment and sensory deficits. To reduce the incidence of patient falls, clinicians and researchers have developed a variety of risk assessment tools to aid in the identification of patients at greater risk of falling.     

Age and falls history effects on antagonist leg muscle coactivation during walking with balance perturbations

BackgroundInspired by a reliance on visual feedback for movement control in older age, optical flow perturbations provide a unique opportunity to study the neuromuscular mechanisms involved in walking balance control, including aging and falls history effects on the response to environmental balance challenges. Specifically, antagonist leg muscle coactivation, which increases with age during walking, is considered a neuromuscular defense against age-associated deficits in balance control. The purpose of this study was to investigate the effects of age and falls history on antagonist leg muscle coactivation during walking with and without optical flow perturbations of different amplitudes.MethodsEleven young adults [mean (standard deviation) age: 24.8 (4.8) years], eleven older non-fallers [75.3 (5.4) years] and eleven older fallers [age: 78 (7.6) years] participated in this study. Participants completed 2-minute walking trials while watching a speed-matched virtual hallway that, in some conditions, included mediolateral optical flow perturbations designed to elicit the visual perception of imbalance.FindingsWe first found that lower leg antagonist muscle coactivation during normal walking increased with age, independent of falls history. We also found that older but not young adults increased antagonist leg muscle coactivation in the presence of optical flow perturbations, with more pervasive effects in older adults with a history of falls.InterpretationOur findings allude to a greater susceptibility to optical flow perturbations in older fallers during walking, which points to a higher potential for risk of instability in more complex and dynamic everyday environments. These findings may also have broader impacts related to the design of innovative training paradigms and neuromuscular targets for falls prevention.     

Medical students' perspectives of blindness, deafness, and deafblindness

PURPOSE: Blindness and deafness are important, and possibly, the least redeemable deficits. This study assessed the perspectives of final year medical students, who had gone through two months Ophthalmology and Otorhinolaryngology clinical postings, regarding these special groups of individuals. METHODS: A pre-tested structured questionnaire was used to collect information on respondents' demographic characteristics and their perception towards people with hearing and visual handicap. RESULTS: Almost 60% considered blindness worse than deafness while only about 6% considered deafness worse. Blindness (29.8%), deaf/blindness (26.1%), mental retardation (15.5%), and quadriplegia (14.3%) were the main handicaps regarded as worst. Only 4(2.5%) thought deafness was the worst handicap. A much greater proportion (53 - 61%) considered blindness had a greater effect on education, social interaction, family relationships, and overall potential development than deafness (6 - 20%). The majority, 80%, knew a blind person who was famous, 29% a deaf person who was famous, and only 14% a deafblind person who was famous. On a three-point grading, 70% had a moderate attitude as to how their life would be different if they were blind, deaf, or deafblind. Only 56.9% responded to this question. CONCLUSION: The students viewed blindness as a far worse disability than deafness; and consider that deaf/blindness has an exponential effect.     

Characteristics of individuals who fell while receiving home health services

BACKGROUND AND PURPOSE: Many patients receiving home health services are at risk for falling, but fall risk factors have not been previously investigated in this population. A retrospective record review was used to describe individuals who fell while being served by a home health agency. SUBJECTS: The 98 individuals who fell while receiving home health services were compared with a random sample of 98 subjects served by the home health agency during the same period who did not report falling. METHODS: Subjects were compared by age, sex, days of receiving home health services, number of falls prior to admission to the home health agency, diagnosis, medication category, home health services received, and type of health care coverage. In the group with falls, causes of falls and interventions were described. RESULTS: The group with falls had comorbidities of neurological and cardiovascular impairment, took more medications associated with increased risk of falling, and had almost 3 times the number of falls prior to admission than the group without falls. DISCUSSION AND CONCLUSION: Home care providers should consider medical history, medication usage, and fall history as risk factors for falls in the home environment.