Characterizing Longitudinal Change in Physical Activity and Fear of Falling in Glaucoma

Abstract

Background: Older adults with visual impairments experience a higher risk of falling, and are more vulnerable to adverse health consequences associated with falls than those with normal vision. This study aims to characterize the longitudinal changes of objectively measured physical activity and self-reported fear of falling (FoF) related to types of falls in visually impaired older adults. Methods: We obtained data from the Falls in Glaucoma Study (FIGS), a prospective cohort study that recruited 234 participants at the Johns Hopkins Wilmer Eye Institute from 2013 to 2015. Falls were defined as unintentionally coming to rest on the ground or a lower level, and injurious falls were determined though follow-up calls. Study participants were categorized into three groups – fallers with injurious consequences, fallers without injurious consequences, and non-fallers based on fall status in the first year. Physical activity was assessed using a waist-bound accelerometer (Actical). FoF was evaluated by questionnaire, with Rasch modeling generating FoF scores where higher scores reflected worse FoF. The three-year longitudinal changes of physical activity and FoF were modeled using mixed-effects models. Results: In linear models fully adjusted for visual field damage and other covariates, physical activity among injurious fallers declined 425 steps/year (95% confidence interval [CI]: -793, -57), 13 active minutes/year (95% CI: -21, -6), and 3 minutes/year of moderate/vigorous activity (95% CI: -5, 0) more over the three-year study period compared to non-fallers; however, physical activity did not decline among non-injurious fallers. No longitudinal increases in FoF scores were observed in injurious or non-injurious fallers.Conclusions: Among visually impaired older adults, injurious falls identified prospectively over 12 months contributed to a significant decline in physical activity over a three-year period, while no significant increases were observed for FoF. Further longitudinal research is warranted to better understand how different groups respond to falls, either via behavioral changes and/or changes in FoF, and to characterize the impact of reduced physical activity in fallers.

The Impact of Weather and Seasons on Falls and Physical Activity among Older Adults with Glaucoma: A Longitudinal Prospective Cohort Study

“…In addition to falls, another important issue for the overall health, disease prevention, quality of life, and healthcare burden for older adults is physical activity [ 7 ]. Falls can negatively impact physical activity [ 8 ]. Maintaining physical activity is particularly important in older adults, as physical activity declines with age and many older adults do not meet recommended physical activity levels [ 9 ].…”