Poor vision may be a key risk factor in hospital falls

Wednesday, April 4, 2018

A hospital patient wearing a fall risk bracelet and using a walker.According to a recent study by University of Waterloo and Western University, nearly 90 per cent of hospitalized patients have poor vision putting them at serious risk for falls.  

Sue Leat“We know poor vision is a major cause for falls, particularly in older adults, but there are almost no studies of the role that vision plays in hospital falls,” said Dr. Susan Leat, lead researcher on the study and a professor at the School of Optometry and Vision Science at Waterloo.”It’s a serious problem, not only in Canada, but around the world."

Other studies have found that falls are a significant problem as they are responsible for 40 to 90 per cent of accidents in hospitals, with severe fall injuries costing the Canadian health care system an additional $30,000 per patient.

The study, which appears in Ophthalmic & Physiological Optics, tracked 115 patients aged 30 to 90+ during their stay in general medicine units at an Ontario hospital.

Among the study cohort, 89 per cent tested positive for at least one type of vision impairment outside their age-norm, indicating poor vision is a common risk factor across all patients being admitted to hospital, in particular patients above the 40-50 year-old age bracket.

Another key finding was that 100 per cent of patients who experienced a fall during the study while in hospital had reduced vision as compared to 58 per cent of the non-fallers.

“This is a significant difference which indicates the contribution of vision to falls,” said Leat.

Leat and her team tested patients for visual acuity (detailed vision), contrast sensitivity, visual field (peripheral vision) and depth perception and then grouped those with vision loss from abnormally poor to legally blind. Most vision loss impacted patient’s visual acuity and depth perception, which as expected worsened with age.

Key to the study was testing patients with whatever spectacles or contact lenses they normally wear, in order to understand the role their everyday vision could be having on their ability to get around.

Leat notes that hospitals currently do not conduct vision assessments at patient admission, an important tool which could identify those most at risk and prevent falls in the first place.

“Asking patients is not enough. When we surveyed patients about any ocular diagnoses or disease, only 30 per cent reported they had an eye disease which would result in vision loss. This is far below the 89 per cent rate of vision loss we confirmed with testing.”

Leat plans to repeat the study in a neurological ward, where stroke and accident victims likely have experienced damage to their primary visual cortex, the part of the brain that processes visual information. Damage in that area of the brain often results in significant visual field loss.

The paper’s co-authors include Alexis Keeling, Denise Hileeto and Tammy Labreche of the School of Optometry and Vision Science at the University of Waterloo, Aleksandra Zecevic of the School of Health Studies at Western University, and Christopher Brymer of the Department of Medicine at Western University.

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