Evaluation of balance and fear of falling in elderly individuals before and after senile cataract surgery

Abstract

Introduction: During aging there is a close relationship between visual deficits, imbalance and falls, and eye surgery can be an efficient treatment option for elderly persons. Objective: Evaluate the influence of visual conditions on patients suffering from senile cataract with increasing imbalance. Method: A descriptive and analytical study using a quantitative longitudinal cohort technique was conducted. The study included 30 individuals who were evaluated before and 30 and 60 days after surgery. The Mini Mental State Examination (MMSE), Berg Balance Scale (BBS), Short Physical Performance Battery (SPPB), International Falls Efficacy Scale adapted for Brazil (FES-I) and a medical history questionnaire were used to collect data. Statistical analysis involved the Chi-squared, Student's t and Mann-Whitney tests. Values of p<0.05 were considered significant. Results: The SPPB found that of 15 elderly women, 13 (87%) achieved moderate performance of the lower limbs while the performance of two (13%) remained poor, after 60 postoperative days. The FES-I revealed that three (20%) elderly persons were mildly worried about falls 60 days post-surgery. Of the 15 elderly male subjects evaluated by BBS, before and at 30 and 60 days after surgery, one (7%), managed to maintain some balance but needed assistance; while 14 (93%) maintained good balance. The SPPB found that the performance of five elderly persons (33%) was moderate and that of nine (67%) was good. Conclusion: Senile cataract surgery had positive preventative effects on lower limb performance, balance and fear of falling among the elderly studied, preventing the falls and fractures that are common during aging.

Factors associated with the occurrence of falls among older people with and without cataracts: Structural equation modelling analysis

“…Vision impairment can cause psychological distress such as depression (Zhang et al, 2018), which can be explained in part by the fear of falling (Palagyi, Rogers, et al, 2016). This feeling is related to physical decline, ability to perform ADL, deficits in balance and gait (Pinheiro et al, 2016) and may cause falls. In this perspective, screening for depressive symptoms in the initial stage of cataracts and referral to support mental health, aiming to avoid the evolution of the condition and increase psychological distress (Palagyi, Rogers, et al, 2016), can contribute to reduce the occurrence of falls.…”

“…Other investigations indicate an improvement in physical performance after cataract correction surgery. National research found that the physical performance of older people improved significantly in the period of 30 ( p = .030) and 60 days ( p < .001) after cataract surgery (Pinheiro et al, 2016). The same was observed in an international study carried out among people aged 65 and over, in which there was a reduction in the risk of falls due to improved balance and visual acuity (Duman et al, 2019).…”

“…The decrease in visual acuity, caused by cataracts, can lead to reduced balance and mobility, which generates worse physical performance, and consequently greater propensity for falls (Duman et al, 2019; Palagyi, Ng, et al, 2017; Paz et al, 2018; Pinheiro et al, 2016).…”

“…Several factors, described in the scientific literature, can influence the occurrence of falls: female gender; age group of 80 years or more; functional disability for advanced activities of daily living (AADL), instrumental activities of daily living (IADL) and basic activities of daily living (basic ADL); fragility; worse physical performance; and depressive symptoms and low visual acuity (Araújo et al, 2019; Chini et al, 2019; Duman et al, 2019; Krishnaiah & Ramanathan, 2018; Leitão et al, 2018; Pinheiro et al, 2016).…”

“…According to studies carried out among the older people, there is evidence about the association of one or more falls with the presence of cataracts, due to reduced visual acuity and sensitivity to contrast (Chini et al, 2019; Duman et al, 2019; Krishnaiah & Ramanathan, 2018; Pinheiro et al, 2016). However, it is necessary to consider additional factors, such as lifestyle; polypharmacy, polymorbidity and the use of multifocal glasses, which can influence the occurrence of falls in older people, even after cataract surgery and vision recovery (Palagyi, McCluskey, et al, 2016; Palagyi, Morlet, et al, 2017).…”