As mentioned in the previous articles, falls are a major cause of death and disability in the elderly and costly. One third of adults aged 65 and older fall each year, with 20% – 30% of these patients experiencing moderate to severe injuries, including lacerations, hip fractures, or head traumas when caring for homebound patients.  The cost of falls was between $19 Billion – $179 Billion for fatal and nonfatal falls in 2000 (last year for which data available).  We will examine the role of eye sight or vision and cognition, and complete environmental assessment to identify, educate, and remove potential fall hazards.

Low vision which can be considered vision loss not correctable by prescription eyeglasses, medicine or surgery or blindness affects about 10 million Americans.  Those with these problems are 2-3 times more likely to fall due to blurry vision, depth perception issues, changes from light to dark, or glare.  These factors lead to orientation and mobility problems such as the following:

• Depth perception – person struggles with ability to judge height or depth of steps or curbs
• Loss of contrast – problems distinguishing curbs or steps, or a puddle or a hole in the sidewalk
• Vision spots – struggle to identify landmarks or see obstacles in ones path
• Loss of side vision – making it difficult to navigate to the side with vision loss

Screening for Vision impairment

Identifying homebound patients with vision issues begins with simple screening which can be done without sophisticated equipment, 2 of which are found below:

Amsler Grid – This is a simple screening test. It is a grid with a small dot located in the center. While staring at the dot, look for wavy lines and missing areas.  This test is especially helpful for monitoring vision at home.

Functional Vision Screening Questionnaire (FVSQ) – This instrument can be used by anyone. The

FVSQ is a 15-item yes/no screening tool to help identify vision problems. The questions are about everyday activities such as being able to see newspaper print or having problems seeing the TV. A score of 9 or more on the FVSQ means the patient may need a vision check.

If issues found with these screenings or if uncomfortable, referrals should be made to eye specialists to provide additional perspective into the underlying vision problems.

A few basic interventions which can be implemented with patients with vision problems are:

• Encouraging annual eye exam
• Improve lighting by installing brighter light bulbs
• Hang lightweight curtains or shades to reduce glare
• Encouraging them to pause when moving from lighted to dark areas and vice versa to allow vision to adjust
• Add contrast to home e.g. painting a contrasting color on the top edge of all steps, or use a light colored paint on dark wood

Sources

• Centers for Disease Control and Prevention. Falls Among Older Adults: An Overview – http://www.cdc.gov/HomeandRecreationalSafety/Falls/adultfalls.html