Activity Limitation due to a Fear of Falling in Older Adults with Eye Disease

Abstract

PURPOSE.To examine whether patients with age-related macular degeneration (AMD), glaucoma, or Fuchs corneal dystrophy report limiting their activity due to a fear of falling as compared with a control group of older adults with good vision. METHODS.We recruited 345 patients (93 with AMD, 57 with Fuchs, 98 with glaucoma, and 97 controls) from the ophthalmology clinics of Maisonneuve-Rosemont Hospital (Montreal, Canada) to participate in a cross-sectional study from September 2009 until July 2012. Control patients who had normal visual acuity and visual field were recruited from the same clinics. Participants were asked if they limited their activity due to a fear of falling. Visual acuity, contrast sensitivity, and visual field were measured and the medical record was reviewed.RESULTS. Between 40% and 50% of patients with eye disease reported activity limitation due to a fear of falling compared with only 16% of controls with normal vision. After adjustment for age, sex, race, number of comorbidities, cognition, and lens opacity, the Fuchs groups was most likely to report activity limitation due to a fear of falling (odds ratio [OR] ¼ 3.07; 95% confidence interval [CI], 1.33-7.06) followed by the glaucoma group (OR ¼ 2.84; 95% CI, 1.36-5.96) and the AMD group (OR ¼ 2.42; 95% CI, 1.09-5.35). Contrast sensitivity best explained these associations.CONCLUSIONS. Activity limitation due to a fear of falling is very common in older adults with visually impairing eye disease. Although this compensatory strategy may protect against falls, it may also put people at risk for social isolation and disability. (Invest Ophthalmol Vis Sci. 2012;53:7967-7972)

How does age-related macular degeneration affect real-world visual ability and quality of life? A systematic review

“…Two cross-sectional studies found that individuals with AMD have greater falls risk than those without53 and that fear of falling results in activity limitation 54. One case–control study55 used eye tracking and audio feedback while participants watched video simulations of walking through a building: AMD volunteers made more comments and more fixations than controls.…”

Trabeculectomy in Patients With Glaucoma Over 80 Years of Age

“…The disease may affect an elderly person's quality of life negatively, causing mobility limitations, 19 fear of falling, 20 and depressive symptoms. 21 The need for surgery depends on the severity of glaucoma, on the needs of the patient, and the likelihood that successful surgery will halt glaucoma progression and improve health-related quality of life.…”

Physical activity restriction in age-related eye disease: a cross-sectional study exploring fear of falling as a potential mediator

“…al. that FoF potentially mediates the relationship between vision loss and physical activity restriction [28]. In that study, the authors found that patients with AMD, Fuchs, and glaucoma were more likely to respond that they had restricted their activity as a result of FoF.…”

“…Studies using questionnaires to estimate level of physical activity such as the Short Form 36 (SF-36) Health Survey or the Yale Physical Activity Survey have shown that FoF is associated with a decrease in physical activity and physical health [23–25]. To further study the association between vision and decreased physical activity [3, 26, 27], one prior study which sought to determine if FoF is a driver of physical activity restriction in individuals with vision loss found that those with eye disease were more likely to report activity restriction as a result of FoF than normally-sighted individuals [28]. This study, however, did not define whether the activities restricted related to physical activity or to other activities of daily living, and the study conclusions about mediation were based upon self-report of activity restriction alone.…”