Randomised controlled trial of prevention of falls in people aged ≥75 with severe visual impairment: the VIP trial

Abstract

Objectives To assess the efficacy and cost effectiveness of a home safety programme and a home exercise programme to reduce falls and injuries in older people with low vision. Design Randomised controlled trial. Setting Dunedin and Auckland, New Zealand. Participants 391 women and men aged ≥ 75 with visual acuity of 6/24 or worse who were living in the community; 92% (361 of 391) completed one year of follow-up. Interventions Participants received a home safety assessment and modification programme delivered by an occupational therapist (n = 100), an exercise programme prescribed at home by a physiotherapist plus vitamin D supplementation (n = 97), both interventions (n = 98), or social visits (n = 96). Main outcome measures Numbers of falls and injuries resulting from falls, costs of implementing the home safety programme. Results Fewer falls occurred in the group randomised to the home safety programme but not in the exercise programme (incidence rate ratios 0.59 (95% confidence interval 0.42 to 0.83) and 1.15 (0.82 to 1.61), respectively). However, within the exercise programme, stricter adherence was associated with fewer falls (P = 0.001). A conservative analysis showed neither intervention was effective in reducing injuries from falls. Delivering the home safety programme cost $NZ650 (£234, 344 euros, $US432) (at 2004 prices) per fall prevented. Conclusion The home safety programme reduced falls and was more cost effective than an exercise programme in this group of elderly people with poor vision. The Otago exercise programme with vitamin D supplementation was not effective in reducing falls or injuries in this group, possibly due to low levels of adherence. Trial registration number ISRCTN15342873.

Falls Among Persons Aged ≥65 Years With and Without Severe Vision Impairment — United States, 2014

“…In the only randomized controlled trial to date that evaluates fall-prevention interventions among older adults with vision impairment, investigators reported that, of the two interventions examined, a home safety intervention (e.g., increasing illumination, removing throw rugs, etc. ), but not a strength and balance training program, significantly reduced falls among persons with vision impairment aged ≥75 years in New Zealand (8).…”

Glaucoma in Patients with Parkinson’s Disease

“…rehabilitation of PD patients. It plays an important role in the prevention of injuries caused by falls which are an important issue directly related to PD [21][22][23][24][25][26]. Lord and Dayhew [27] showed that people with impaired sight fall more often than people with normal vision capability.…”

Potential analysis for research on occupational therapy-led physical exercise programmes and home environment adaptation programmes to prevent falls for elderly people living at home / Potenzialanalyse zu ergotherapeutischen körperlichen Trainingsprogrammen und Wohnraumanpassungen zur Vermeidung von Stürzen bei zu Hause lebenden älteren Menschen

“…Um das Sturzrisiko im häuslichen Umfeld einzuschätzen, wurde in drei Studien das "Westmead Home Safety Assessment" (WeHSA), welches von Clemson (1997) entwickelt wurde, eingesetzt Lannin et al, 2007;Pighills et al, 2011). Darüber hinaus wurden zur Erfassung von Sturzrisikoquellen in der Häuslichkeit Checklisten eingesetzt (Clemson, Roland, & Cumming, 1992;Stevens, Holman, Bennett, & De Klerk, 2001;Pardessus et al, 2002;Lin et al, 2007 (Clemson, 1997;Stevens et al, 2001;Campbell et al, 2005;Lannin et al, 2007;Pighills et al, 2011) vor dem Hintergrund von Kontext-und organisatorischen Rahmenbedingungen in Deutschland in die Praxis implementiert und die Akzeptanz der teilnehmenden Therapeuten/-innen wie auch der Betroffenen maximiert werden kann. Dabei sollen konkrete Maßnahmen zur Sicherstellung der Übertragungsqualität der Intervention in der praktischen Umsetzung erprobt werden.…”