Improving vision to prevent falls in frail older people: a randomized trial.

Autor: Cumming RG; School of Public Health, University of Sydney, Sydney, Australia. bobc@health.usyd.edu.au, Ivers R, Clemson L, Cullen J, Hayes MF, Tanzer M, Mitchell P
Jazyk: angličtina
Zdroj: Journal of the American Geriatrics Society [J Am Geriatr Soc] 2007 Feb; Vol. 55 (2), pp. 175-81.
DOI: 10.1111/j.1532-5415.2007.01046.x
Abstrakt: Objectives: To determine the efficacy of vision and eye examinations, with subsequent treatment of vision problems, for preventing falls and fractures in frail older people.
Design: Randomized, controlled trial.
Setting: Community in Sydney, Australia.
Participants: Six hundred sixteen men and women aged 70 and older (mean age 81) recruited mainly from people attending outpatient aged care services.
Interventions: The intervention group received comprehensive vision and eye examinations conducted by a study optometrist. The optometrist arranged for new eyeglasses for 92 subjects and referred 24 for a home visit with an occupational therapist, 17 for glaucoma management, and 15 for cataract surgery. The control group received usual care.
Measurements: Falls and fractures during 12 months of follow-up were ascertained according to self-report using a monthly postcard system.
Results: Fifty-seven percent of subjects fell at least once during follow-up. Falls occurred more frequently in the group randomized to receive the vision intervention (65% fell at least once; 758 falls in total) than in the control group (50% fell at least once; 516 falls in total). The falls rate ratio using the negative binomial model was 1.57 (95% confidence interval (CI)=1.20-2.05, P=.001). Fractures were also more frequent in the intervention group (31 fractures) than the control group (18 fractures; relative risk from proportional hazards model 1.74, 95% CI=0.97-3.11, P=.06).
Conclusion: In frail older people, comprehensive vision and eye assessment, with appropriate treatment, does not reduce, and may even increase, the risk of falls and fractures.
Databáze: MEDLINE
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