Improving vision to prevent falls in frail older people: A randomized trial

被引:124
作者
Cumming, Robert G.
Ivers, Rebecca
Clemson, Lindy
Cullen, John
Hayes, Maggie F.
Tanzer, Michael
Mitchell, Paul
机构
[1] Concord Hosp, Ctr Educ & Res Aging, Concord, NSW 2139, Australia
[2] Georgia Inst Int Hlth, Sydney, NSW, Australia
[3] Univ Sydney, Ctr Vis Res, Dept Ophthalmol, Sydney, NSW 2006, Australia
[4] Univ Sydney, Sch Occupat & Leisure Sci, Sydney, NSW 2006, Australia
[5] Univ Sydney, Sch Publ Hlth, Sydney, NSW 2006, Australia
关键词
accidental falls; aged 80 and older; randomized; controlled trials; vision disorders; EYE CATARACT-SURGERY; RISK-FACTORS; HEALTH-STATUS; HIP FRACTURE; COMMUNITY; WOMEN;
D O I
10.1111/j.1532-5415.2007.01046.x
中图分类号
R592 [老年病学]; C [社会科学总论];
学科分类号
03 ; 0303 ; 100203 ;
摘要
OBJECTIVES: To determine the efficacy of vision and eye examinations, with subsequent treatment of vision problems, for preventing falls and fractures in frail older people. DESIGN: Randomized, controlled trial. SETTING: Community in Sydney, Australia. PARTICIPANTS: Six hundred sixteen men and women aged 70 and older (mean age 81) recruited mainly from people attending outpatient aged care services. INTERVENTIONS: 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. MEASUREMENTS: 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). CONCLUSION: 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.
引用
收藏
页码:175 / 181
页数:7
相关论文
共 20 条
[1]   Visual factors should be assessed in older people presenting with falls or hip fracture [J].
Abdelhafiz, AH ;
Austin, CA .
AGE AND AGEING, 2003, 32 (01) :26-30
[2]   The effectiveness of a community-based program for reducing the incidence of falls in the elderly: A randomized trial [J].
Clemson, L ;
Cumming, RG ;
Kendig, H ;
Swann, M ;
Heard, R ;
Taylor, K .
JOURNAL OF THE AMERICAN GERIATRICS SOCIETY, 2004, 52 (09) :1487-1494
[3]   RISK-FACTORS FOR HIP FRACTURE IN WHITE WOMEN [J].
CUMMINGS, SR ;
NEVITT, MC ;
BROWNER, WS ;
STONE, K ;
FOX, KM ;
ENSRUD, KE ;
CAULEY, JC ;
BLACK, D ;
VOGT, TM .
NEW ENGLAND JOURNAL OF MEDICINE, 1995, 332 (12) :767-773
[4]   Randomised factorial trial of falls prevention among older people living in their own homes [J].
Day, L ;
Fildes, B ;
Gordon, I ;
Fitzharris, M ;
Flamer, H ;
Lord, S .
BRITISH MEDICAL JOURNAL, 2002, 325 (7356) :128-131
[5]   Falls and health status in elderly women following second eye cataract surgery: a randomised controlled trial [J].
Foss, AJE ;
Harwood, RH ;
Osborn, F ;
Gregson, RM ;
Zaman, A ;
Masud, T .
AGE AND AGEING, 2006, 35 (01) :66-71
[6]   Interventions for preventing falls in older people living in the community [J].
Gillespie, Lesley D. ;
Robertson, M. Clare ;
Gillespie, William J. ;
Sherrington, Catherine ;
Gates, Simon ;
Clemson, Lindy M. ;
Lamb, Sarah E. .
COCHRANE DATABASE OF SYSTEMATIC REVIEWS, 2012, (09)
[7]   Falls and health status in elderly women following first eye cataract surgery: a randomised controlled trial [J].
Harwood, RH ;
Foss, JE ;
Osborn, F ;
Gregson, RM ;
Zaman, A ;
Masud, T .
BRITISH JOURNAL OF OPHTHALMOLOGY, 2005, 89 (01) :53-59
[8]   Visual problems and falls [J].
Harwood, RH .
AGE AND AGEING, 2001, 30 :13-18
[9]   Fall prevention in residential care: A cluster, randomized, controlled trial [J].
Kerse, N ;
Butler, M ;
Robinson, E ;
Todd, M .
JOURNAL OF THE AMERICAN GERIATRICS SOCIETY, 2004, 52 (04) :524-531
[10]   Changes in visual acuity in a population - The Beaver Dam Eye Study [J].
Klein, R ;
Klein, BEK ;
Lee, KE .
OPHTHALMOLOGY, 1996, 103 (08) :1169-1178