Optometry and Fall Prevention

October 25th, 2019 General Optometry No Comments

Reduced vision is a risk factor in fall prevention. So having well-fitted spectacles with the appropriate vision-correcting prescription should help reduce this risk.

However, studies have shown little or no reduction in the number of falls among older adults receiving vision correction such as better glasses or cataract surgery.

Does this mean that vision is not important for fall prevention? No, it means that falls are a complicated issue. And that optometry and fall prevention is more than just glasses.

Falls shouldn’t be considered as accidents but instead a result of a number of contributing risk factors. The more risk factors a person has, the more likely they are to have a fall. Neither should falls be considered as inevitable nor a normal part of ageing.

Facts on falls

  • Around 1 in 3 adults aged 65 and over will have at least one fall per year.
  • Falls are the most common cause of injury-related deaths for people of 75.
  • A person is more likely to fall if they:
    • Take four or more prescription medicines a day
    • Are over 75 years of age
    • Have dementia, arthritis or diabetes
    • Have fallen before  

Consequences of having a fall

Physical Injury

Not every fall results in a physical injury. But injuries such as fractures are common. Seniors are also more likely to receive a head or facial injury than a younger person. This is because they are unable to move their hands quickly enough to protect their themselves during a fall.

Increased risk of falling again

If someone falls, their risk of falling again increases. People often change how they walk after having a fall. This change in gait – to a cautious but less natural movement – that actually contribute to the increased risk. 

Fear of falling

Having a fall can leave a person feeling scared and vulnerable. The fear of falling again can lead to changes in daily activity – such as no longer going for a walk. The reduction in activity levels can then have a negative effect on other aspects of their health.

Social isolation

When a person changes their behaviour following a fall, they often become more socially isolated. The fear of falling when outside may stop them wanting to leave their homes.

Mental health

As a consequence of lower activity levels and fewer social interactions, a person who has suffered a fall is more likely to experience mental health issues, such as loneliness and depression or anxiety.

Decline in health

The first fall a person has can be a tipping point into a more rapid decline in overall health. This is why fall prevention is vital.

Optometry and Fall Prevention: what you can do to help

What is the connection between optometry and fall prevention and what can you do, as an optometrist, to help?

Changing prescription

A person’s risk of falling can increase when their vision prescription changes, especially if its a big change. There is a period of adjustment when someone receives new glasses whether that’s because of a different frame or the lenses themselves.

But for older adults, the period of adjustment increases their fall risk.

In the article “2013 Fry Lecture: Blurred Vision, Spectacle Corr & Falls in Older Adults” published in Optometry and Vision Science (the official journal of the American Academy of Optometry), the author Dr Elliott suggests that “Older frail people have greater difficulty adapting to such changes and be at increased risk of falling during this adaption period”.

Recommendations:

  • Be aware of other factors that may affect a patients risk of falling such as the number of medications they are on, their age, or whether they have fallen before.
  • Don’t prescribe new lenses without proper cause: not every new set of frames needs a new prescription.
  • Consider gradual prescription changes for older adults to give the wearer time to adjust to big magnification changes.

Bifocal and varifocal lenses

Bi- and varifocal lenses present an additional fall risk as swapping from single-focus to multifocal lenses can cause problems.

Specifically, the problem relates to looking down and foot placement when walking. The change in magnification can give blurry vision leading to a stumble or fall.

A study published in the British Medical Journal suggested that single-focus distance glasses could reduce the number of falls when outside by up to 40%. The researchers recommended that older adults who regularly partake in outdoor activities should wear single-focus lens glasses when outside.

However, the authors also recommended a single pair of multifocal glasses for those who don’t do a lot of outdoor activities.

Recommendations:

  • Understand a patients lifestyle and how multifocal lens could affect them.
  • Recommend to people new to bi/varifocal lenses to only use their new glasses indoors to start with.
  • Consider recommending different glasses for different activities.
  • Give advice to new multifocal lens wearers on how to adapt such as tilting their heads to look down, rather than just looking down with their eyes.
  • Discuss the risks of multifocal lenses with existing users and how switching to a single-focal lens may be safer as they get older.

List of fall prevention resources:

College of Optometrists “Focus on Falls” report

College of Optometrist “Ageing Eyes and Falls” leaflet.

NHS page on fall prevention.

Read more of from our optometry blog.


This article was written on behalf of My Locum Choice by Nicola Hasted from Pharmacy Mentor.



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