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The Association between Severity of Vision Impairment and Falls among People Aged 65 Years

and Older Living in the Community: Findings from the BRFSS

The Association between Severity of Vision Impairment and Falls among People Aged 65 Years

and Older Living in the Community: Findings from the BRFSS

John E. Crews, DPA

Chiu-Fang Chou, DrPH

Judy A. Stevens, PhD

Xinzhi Zhang, MD, PhD

Jinan Saaddine, MD, MPH

American Public Health Association

San Francisco, California

October 31, 2012

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Presenter DisclosurePresenter Disclosure

John E. Crews, DPA

The following personal financial relationships with commercial interests relevant to this presentation existed during the past 12 months: None.

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Background Falls in USBackground Falls in US

One out of three adults age 65 and older falls each year.

Among older adults (those 65 or older), falls are the leading cause of injury death.

Falls are the most common cause of traumatic brain injuries (TBI). In 2000, TBI accounted for 46% of fatal falls among older adults.

Falls in association with vision impairment well established (Lord, 2001).

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ObjectiveObjective

To assess the prevalence of self-reported falls in the past three months among community dwelling older adults (aged 65 years and older) by vision impairment status

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Methods Data Set: BRFSSMethods Data Set: BRFSS

Established 1984 Sampled 350,000 people World’s largest random-digit

dialed telephone survey Core question in all fifty states

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BRFSS: Vision ModuleBRFSS: Vision Module

Administered in 23 states 10 questions—function, access, condition Provides state level data Began 2005; Discontinued for 2012.

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Methods (Cont.)Methods (Cont.) Data source and Sample Size: – 2006, 2008, & 2010 BRFSS from 19 states – N=48,585 adults aged 65 and older

Outcome Variable: Self reported fall in the past 3 months

Exposure Variable: Vision impairment status– no difficulty to both question, – little difficulty to either question, and– moderate or extreme difficulty or unable to do to

either question.

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Methods (Cont.)Methods (Cont.)

Covariates:– Race/ethnicity (Non-Hispanic white, Non-Hispanic

black, Hispanic, and other)– Educational attainment (<HS, HS, and >HS)– Income (< $ 35,000, ≥ $ 35,000)– Age and sex

Statistical methods: Cross-tabulation; multivariate logistic regression– SAS version 9.2 with SUDAAN and Stata version

10.1. to take account of the complex survey design

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Methods (Cont.) Vision QuestionsMethods (Cont.) Vision Questions

How much difficulty, if any, do you have reading print in newspaper, magazine, recipe, menu, or numbers on the telephone?

How much difficulty, if any, do you have in recognizing a friend across the street?

Response categories: No difficulty, little difficulty, moderate difficulty, extreme difficulty, unable to do because of eyesight

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Methods (Cont.) Falls QuestionMethods (Cont.) Falls Question

Administered in core in even years In the past 3 months, how many times have

you fallen? Response: Number of falls Case definition: any self reported fall

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Self reported no, little, & moderate/extreme difficulty seeing by age

Self reported no, little, & moderate/extreme difficulty seeing by age

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Falls among all older people by age group

Falls among all older people by age group

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Percent of Falls by Age Group & Severity of VI

Percent of Falls by Age Group & Severity of VI

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Prevalence of falls among people reporting no, little, moderate/extreme difficulty seeing by education &

income

Prevalence of falls among people reporting no, little, moderate/extreme difficulty seeing by education &

incomeNo Little Moderate/

Extreme

Educational Attainment

Less than high school

16.5 20.6 26.2

High school 12.8 16.2 21.4

More than high school

13.2 16.2 22.5

Income

Less than $35,000

15.2 19.7 23.1

More than $35,000

12.1 12.7 19.4

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Self- reported fair poor health among people age 65+ who have fallen with

No, Little, & Moderate/Severe Vision Impairment

Self- reported fair poor health among people age 65+ who have fallen with

No, Little, & Moderate/Severe Vision Impairment

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Falls among people with no, little, and moderate/extreme difficulty seeing reporting comorbid conditions—diabetes, heart disease, stroke, and stress/depression

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Falls among people with no, little, and moderate difficulty seeing with & w/o diabetes

Falls among people with no, little, and moderate difficulty seeing with & w/o diabetes

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Falls among people with no, little, and moderate difficulty seeing with & w/o heart disease

Falls among people with no, little, and moderate difficulty seeing with & w/o heart disease

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Falls among people with no, little, and moderate difficulty seeing with & w/o stroke

Falls among people with no, little, and moderate difficulty seeing with & w/o stroke

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Falls among people with no, little, and moderate difficulty seeing with & w/o stress,

depression & emotional problems

Falls among people with no, little, and moderate difficulty seeing with & w/o stress,

depression & emotional problems

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ConclusionsConclusions

Increased falls associated with poorer vision and advanced age

Increased falls among people reporting moderate/ extreme difficulty seeing associated with having poorer health status and having lower socioeconomic status.

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ConclusionsConclusions

Increased falls associated with severity of vision loss and presence of comorbid conditions—diabetes, stroke, heart disease & stress/depression

Comorbid conditions in conjunction with severe vision loss have propelling effect to increase risk of falls.

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RecommendationsRecommendations

Falls prevention activities should address vision impairment as part of comprehensive strategies.

Exercise/conditioning, removal of trip hazards, increased illumination may decrease likelihood of falls

Attention should be given to under medication or over medication as falls risk.

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RecommendationsRecommendations

Attention to health promotion among people reporting vision impairment may decrease risk of falls– Better weight management– Better nutrition– Increased exercise and conditioning

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DisclaimerDisclaimer

The findings and conclusions in this presentation are those of the authors and do not necessarily represent the official position of the Center for Disease Control and Prevention.

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Contact InformationContact Information

For more information, please contactJohn E. Crews, DPA at Jcrews@cdc.gov770 488 1116