Low Vision and Fall Prevention

Older man lying on steps with cane, glasses and slipper beside him where he fell

September is Fall Prevention Month, the perfect time to talk about preventing falls if you are blind or low vision.

Between 2015 to 2050, the number of people 40 years and older who are blind or low vision will double (Varma, 2016). This statistic means the number of older people with vision loss will rise dramatically along with their need for safety and services. One major concern is the risk of falls. Older people with vision loss are at high risk of falls for a variety of reasons: balance issues, medications, fear, lack of good mobility skills, and co-morbidities, to name a few. Further, they are twice as likely to report falls than older people without vision loss (Crews, et al, 2014).

The medical cost of falls is high in the United States. According to AARP (2017), “A substantial share of healthcare expenditures for adults aged 65 and older was attributable to falls, accounting for 6% of Medicare expenditures and 8% of Medicaid costs. Of the $50 billion, almost 99% was spent in the aftermath of nonfatal falls.”

Risk Factors Related to Vision

The following visual issues can greatly affect your fall risk as well as other daily activities: visual acuity, visual field, contrast sensitivity (the ability to detect differences between light and dark areas), glare, light and dark adaptation, color vision, and binocular vision. It is critical to see your eye care provider to ensure that these risk factors are addressed. For example, there are special tests that can check for contrast sensitivity.  In addition to a comprehensive eye exam, you should seek a referral for low vision care.

Risk Factors

In addition to vision problems, there are many risk factors that can lead to falls such as:

  • Difficulty with walking or balance 
  • Heart rate or heart rhythm issues
  • Muscle weakness and/or foot problems
  • A history of falls and/or a fear of falling 
  • Taking multiple medications (4 or more) 
  • Dizziness 
  • Health conditions such as arthritis, stroke, and diabetes 
  • Rushing and not paying attention 

Older people who have low vision may not be aware of simple adaptations they can make in their homes to prevent falls. Further, they may not be aware of fall prevention and related programs which mitigate the risk factors such as addressing muscle weakness and balance issues. Some popular evidence-based programs that have been adapted for people with low vision are Matter of Balance and Walk With Ease. These programs are often available in local senior centers or hospitals. Contact your Fall Prevention State Coalition to find out more. Also consider using the new CDC Falls Free CheckUp checklist.

Develop a Fall Prevention Plan

Audrey Demmitt, RN and VisionAware peer advisor wrote about developing a fall prevention plan, suggesting, among other things:

  1. Make modifications in your home environment to reduce fall hazards. Do a room-to-room assessment of your living space. Learn ways to reduce clutter, maximize lighting and contrast, make repairs, and reorganize. Check out VisionAware’s home modification section for suggestions and try our home survey checklist. For significant needs, consider getting a home assessment by an occupational therapist or vision rehabilitation therapist.
  2. Light up your home. Aging and low vision call for increased lighting. Add additional lighting in hallways, stairways, and outdoor walkways. Use the highest safe wattage in fixtures. Place nightlights in the bedroom, hallways, and bathrooms. Learn more about lighting in the home.
  3. Use a mobility cane. If you are blind or have low vision and do not use a cane, consider orientation and mobility instruction. For more information on the importance of the cane in preventing falls, be sure to read Low Vision and the White Cane, a Tool for Fall Prevention

Fall Prevention Webinar

Listen to our webinar on low vision and falls. presented by occupational therapist Cheri Harbour (formerly Nipp), MS, OTR/L, SCLV. She discussed visual challenges that can increase fall risk including visual acuity, visual field, contrast sensitivity, glare, light and dark adaptation, color vision, and binocular vision as well as adaptations and strategies to address these challenges. Find out more about what you can do to prevent falls.

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