Falls and Multiple Falls among United States Older Adults with Vision Impairment

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ObjectiveTo examine the cross-sectional and longitudinal associations between visual impairment (VI) and falls in United States (US) older adults. DesignRetrospective cross-sectional and cohort study. SettingNational Health and Aging Trends Study (NHATS) 2021 and 2022. ParticipantsMedicare beneficiaries ≥71 years. Cross-sectional analysis of VI and baseline falls/multiple falls was limited to 2,822 community-dwelling older adults who had complete vision and falls data in 2021. Longitudinal analysis was limited to those who had complete vision and falls data at follow-up (n=2,367). Exposure(s)Any VI; defined as distance VI [>0.3 logMAR], near VI [>0.3 logMAR], or contrast sensitivity [CS] impairment [<1.55 logCS]. Changes in distance visual acuity ([DVA], logMAR/year), near visual acuity ([NVA], logMAR/year), or CS (logCS/year). Main Outcome MeasuresSelf-reported falls defined as any fall in the past 12 months. Participants who reported falling more than one time were classified as having multiple falls. ResultsOf the 2,822 participants included, mean age was 78.5 (SD=5.6) years, a majority was female (54.7%) and non-Hispanic White (81.7%). 35.4% reported a fall in the past 12 months, of whom, 44.6% reported multiple falls. At baseline, adults with any VI had greater rates of falls (rate ratio =1.16,95%CI=1.04-1.30) and multiple falls (rate ratio =1.23,95%CI=1.01-1.49) than peers without VI. In longitudinal analysis, adults with any VI at baseline did not have a greater risk of falls or multiple falls in the following year compared to peers without VI; only worse CS (hazard ratio [HR]=1.03,95%CI=1.01-1.06, per 0.1 logCS worse) and DVA (HR=1.11,95%CI=1.04-1.18, per 0.1 logMAR worse) were associated with a greater risk of falls and multiple falls, respectively. However, in other models, change in NVA (HR=1.04,95%CI=1.01-1.08, per 0.1 logMAR worse/year) was associated with greater fall risk over the follow-up period. Further, change in CS (HR=1.11,95%CI=1.05-1.18, per 0.1 logCS worse/year) was associated with a greater risk of multiple falls, while changes in DVA and NVA were not. ConclusionsOlder US adults with VI are more likely to experience a fall, with various components of their vision influencing the fall risk.