Older adults with self-reported visual difficulty have increased mortality risk, mediated by recurrent falls, according to new research.
Investigators conducted a longitudinal study using 6 years of data from the National Health and Aging Trends Study and followed 7,039 U.S. Medicare beneficiaries aged 65 and older between 2015 and 2020.
Among participants, 8.1% reported difficulty with near or distance vision despite using visual aids. These participants were significantly more likely to experience multiple falls within a year and had a greater risk of death in subsequent years.
Recurrent falls were defined as more than one fall within the past year. Participants with visual difficulty had a 13% increased likelihood of experiencing recurrent falls in the following year. Those falls, in turn, were associated with a 48% increased hazard of all-cause mortality, and the direct effect of visual difficulty on mortality also indicated a 48% higher risk.
Participants with visual difficulty tended to be older, and were more likely to be female, unmarried, non-Hispanic Black or Hispanic, and to have lower educational attainment. They also had higher rates of dementia, heart disease, stroke, lung disease, hypertension, and prior hip fractures—all factors that further contribute to mortality risk.
More than a third (36.1%) of participants with visual difficulty had dementia compared with 12.8% of those who did not have dementia, and more than a quarter (26.9%) of those with visual difficulty experienced recurrent falls. This rate was more than double the 12.5% incidence among those without visual difficulty.
Implications for Care
Visual difficulty should be considered a critical risk factor, not only for falls but also for long-term survival in older adults, suggested investigators. Fall prevention efforts—particularly those aimed at patients with visual impairment—may have broader implications for reducing mortality risk.
“[R]esearch indicates that some older adults with vision loss who experienced falls report they had no choice but to perform essential household tasks on their own, even though they knew it could put them at risk of falling,” wrote Shu Xu, PhD, of the University of Massachusetts Boston and the University of Michigan, with colleagues.
To address this issue, the researchers recommend regular, affordable eye exams and treatment for correctable conditions such as cataracts and glaucoma, environmental modifications in the home and community, and inclusion of visually impaired older adults in balance and strength training programs, such as Tai Chi or physical therapy.
The findings reinforce the "stress process model" in which vision loss may function as a chronic stressor and falls represent a proliferated secondary stressor that exacerbates health decline and mortality risk, noted researchers.
They declared having no conflicts of interest.
Source: Innovations in Aging
