Poor Vision can Increase the Risk of Falls and Fractures
Poor vision increases the risk of falls and fractures.
The Book
Bhavin Jankharia
The Detailed 15-Point Guide to Live Long, Healthy
Bhavin Jankharia
Text
Since the first piece titled, “Falls” in Jun 2021, in which I quoted Indian data on falls and fractures, a couple of new papers have added to our knowledge of what happens in India. One recent paper by Isha Biswas and colleagues has found the prevalence of injuries to be almost 65% in those who fall [1], which means that 2/3rds of those who fall sustain injuries of some significance. On the other hand, analysis of the Longitudinal Aging Study in India (LASI) cohort by Shriya Thakkar and colleagues [2] has found a 30% prevalence of frailty in those over the age of 60 years, with a 15.4% prevalence of falls in frail individuals as against a prevalence of 11.8% in non-frail older adults, a much lower prevalence compared to Ravneet Kaur’s meta-analysis [3] that mentions a 31% prevalence of falls in Indian adults. Irrespective of whether it is 15% or 30%, from a sheer numbers perspective, the prevalence of falls in those over 60 years of age, still falls between 22 (15%) and 45 million (30%), 2/3rds of them sustaining injuries that need management. These are huge numbers.
We need to do whatever is possible to reduce our risk of falling and the risk of fracture, if we fall.
I wrote this recently in Nov, 2023 in my article titled “Falls-Proofing the House”.
“Not falling is an integral part of our atmasvasth quest to live long, healthy. The three pillars of falls prevention include physical activity and exercise to improve muscle strength and balance, personal measures such as taking care of poor vision, reduced hearing and polypharmacy and measures at home that reduce the risk of falls, including better lighting, provision of hand-rails, etc.”
That article focused on the third pillar, i.e. the measures we can take at home to reduce the risk of falls. What many people forget are the constituents of the 2nd pillar, which involves taking care of vision and hearing issues and polypharmacy.
Audio
Text (Contd)
A recent paper by Jung Yin Tsang and colleagues in JAMA Opthal has reiterated the intuitive connection between poor vision and the risk of falls [4]. They matched 576,000 odd people in a cohort in England with cataracts, advanced macular degeneration (AMD) and glaucoma, the three commonest causes of poor vision in the elderly in the West, with 2.88 million people without these problems and found a significant increase in the prevalence of falls and fractures in those with vision problems, compared to those without.
Is it possible that those with poor vision also had other co-morbidities and were sicker and/or taking more medicines than those with normal vision, thus predisposing them to an increased risk of falls and fractures due to other reasons apart from just poor vision? Perhaps, though the authors have tried to control for this. Even then, poor vision can often be corrected and there is no reason not to test and treat the causes of visual impairment.
Poor or low vision is a problem worldwide and in India. In my piece, “The Importance of Being Able to See Well” published in Jan 2022, I listed out the various conditions (cataracts, glaucoma, macular degeneration, diabetic retinopathy and dry eyes) that cause poor vision in India. I missed mentioning refractive errors such as presbyopia, which, if uncorrected, can also cause vision impairment. Unlike with most cancers and cardiovascular issues, many of the conditions that cause poor vision can be easily controlled or managed or treated, if detected in time.
A recent analysis of the LASI cohort by Shobhit Srivastava and colleagues [5] has pegged the prevalence of visual impairment in those over the age of 45 to be 33.8% in Indian men and 40% in Indian women. This is a ridiculously high number. Poor vision leads to a host of problems that we can easily see in those around us with visual impairment. Added to this, is the increased risk of falling and fracturing.
What does this mean for you and I? Not falling and not fracturing are an important part of our atmasvasth quest to live long, healthy and in the din created by cancer and cardiovascular diseases, we tend to lose sight of other health issues that are equally important for a long healthspan and lifespan. The 8th point in the 15-point atmasvasth guide to live long, healthy is “Manage Your Senses (oral, vision, hearing)”. If at any time, you experience vision problems, do not wait or hesitate to see your family physician or ophthalmologist. It is also a good idea to visit an ophthalmologist at least once in two years, if not once a year, to make sure there is no lurking eye-related issue that has the potential to become a problem in the future.
Footnotes:
1. Biswas I, Adebusoye B, Chattopadhyay K. Health Consequences of Falls among Older Adults in India: A Systematic Review and Meta-Analysis. Geriatrics (Basel). 2023 Apr 18;8(2):43.
2. Thakkar S, T M, Srivastava S. Cross-sectional associations of physical frailty with fall, multiple falls and fall-injury among older Indian adults: Findings from LASI, 2018. PLoS One. 2022 Aug 12;17(8):e0272669.
3. Kaur R, Kalaivani M, Goel AD, Goswami AK, Nongkynrih B, Gupta SK. Burden of falls among elderly persons in India: A systematic review and meta-analysis. Natl Med J India. 2020 Jul-Aug;33(4):195-200.
4. Tsang JY et al. Risk of Falls and Fractures in Individuals With Cataract, Age-Related Macular Degeneration, or Glaucoma. JAMA Ophthalmol. 2023 Dec 28.
5. Srivastava S et al. Prevalence and predictors of vision impairment among older adults in India: evidence from LASI, 2017-18. BMC Ophthalmol. 2023 Jun 5;23(1):251.
Atmasvasth Newsletter
Join the newsletter to receive the latest updates in your inbox.
