For more information contact Visibility on 0141 332 4632 or visit  www.visibility.org.uk

Older people should be encouraged to participate in falls prevention programmes and receive information in an appropriate format

Visual impairment affects about 10% of people aged 65-75, and 20% of those aged 75 and older. And It is estimated that about a third of people aged 65 and over will fall at least once a year. Older people with sight problems are not only more likely to fall, but are at a greater risk of multiple falls compared to their fully sighted peers.

Several age-related changes in vision place older people at risk of falling. The ability of the eyes to adjust to varying light levels diminishes with age and a greater sensitivity of the ageing eye to glare can lead to a restriction of the visual field.

A loss of visual acuity and contrast sensitivity can make the perception of objects in the environment more difficult. When an eye condition such as glaucoma occurs in combination with age-related changes in vision, there will be a further loss of visual function.

There is a major problem of preventable or treatable visual problems - such refractive errors and cataract - in the older population. Older people have a higher level of eye disease than other age groups and untreated visual impairment affects a considerable number of people.

It can be difficult for health and social care staff to know if the functional vision of their clients/patients is problematic. If professionals working with older people are unaware of sight problems in their clients/patients, it is possible that those at an increased risk of falls may be overlooked. Increasingly, people are expected to be proactive with their health care. Older people, however, are less likely than younger patients to make demands of those working in health and social care and may not follow up issues which arise for them.

Many older people who fall do not require medical attention and therefore their fall goes unreported. Health and social care professionals have a key role in identifying those at risk of falling and in identifying clients with failing vision. Simple verbal questioning about visual health would be a beneficial starting point. Professionals working with older people can promote the importance of regular eye examinations to ensure early detection of eye disease and make referrals where appropriate to the local social work sensory impairment team or voluntary organisation.

It is recommended that:

• Older people attending primary care and/or an accident & emergency department after a fall are routinely questioned on their vision
  
• Older people in contact with health or social care professionals should be asked routinely about falls.
  
• Older people should be encouraged to attend an optician for an annual eye examination.
  
• A standardised falls assessment tool - which includes a meaningful assessment of vision - needs to be developed and adopted for use by health and social care professionals.
  
• Older people should be routinely questioned by health and social care professionals to identify signs of deteriorating vision. The importance of deteriorating vision as a risk factor for falls should be highlighted.
  
• Home fall prevention teams should be in place and a central coordinating point for advice, information and onward referral should be established.
  
• Visual impairment awareness training should be an integral part of continued professional development for those working in primary care, emergency medicine and social work services. This will enable them to recognise people with visual impairment.
  
• Falls prevention awareness training should include reference to the role of visual impairment and be an integral part of continued professional development for those working with older people.
  
• Awareness campaigns should be implemented jointly across the statutory and voluntary sectors to challenge the stereotypes surrounding visual impairment and blindness.

If you are interested in learning more about the study that these recommendations and information were obtained from, the full report, 'Deteriorating vision, falls and older people: the links' is available from Visibility.
You can contact them on 0141 332 4632 or visitwww.visibility.org.uk.