Higher risk of multiple falls among elderly women who lose visual acuity

Anne L. Coleman, Katie Stone, Susan K. Ewing, Michael Nevitt, Steven Cummings, Jane A. Cauley, Kristine E. Ensrud, Emily L. Harris, Marc C. Hochberg, Carol M. Mangione

Research output: Contribution to journalArticlepeer-review

143 Scopus citations


Objective To determine the association between changes in visual acuity (VA) and frequent falls in older women. Design Prospective cohort study. Participants Two thousand two elderly community-residing women participating in the Study of Osteoporotic Fractures with measurements of VA at baseline and a follow-up examination 4 to 6 years later (mean of 5.6 years). Methods Binocular VA with habitual correction was measured under standard illumination using Bailey-Lovie charts at baseline and fourth examinations. Change in VA was stratified into 5 categories: no change or VA gain, loss of 1 to 5 letters, loss of 6 to 10 letters, loss of 11 to 15 letters, and loss of >15 letters. A separate analysis considered decline in VA as the loss of ≥10 letters (≥2 lines) on the Bailey-Lovie acuity measure between baseline and follow-up examinations. Main outcome measures Data on falls were obtained from postcards sent every 4 months after the follow-up examination. Frequent falling was defined as ≥2 falls during a 1-year period after the follow-up examination. Results Compared with women with stable or improved VA, women with declining acuity had significantly greater odds of experiencing frequent falling during the subsequent year. Odds ratios after adjustment for baseline acuity and other confounders were 2.08 (95% confidence interval [CI]: 1.39-3.12) for loss of 1 to 5 letters, 1.85 (95% CI: 1.16-2.95) for loss of 6 to 10 letters, 2.51 (95% CI: 1.39-4.52) for loss of 11 to 15 letters, and 2.08 (95% CI: 1.01-4.30) for loss of >15 letters. In the analysis of visual decline defined as a loss of ≥10 letters, heightened risk of frequent falling was evident in each of 2 subgroups defined by splitting the sample on baseline VA, with borderline significant evidence of a more pronounced effect in those women with baseline VA of 20/40 or worse (P value for interaction, 0.083). Conclusions Loss of vision among elderly women increases the risk of frequent falls. Prevention or correction of visual loss may help reduce the number of future falls.

Original languageEnglish (US)
Pages (from-to)857-862
Number of pages6
Issue number5
StatePublished - May 2004

Bibliographical note

Funding Information:
From the Department of Health Research and Policy and Department of Medicine. Stanford Universitv School of Medicine, Stanford, California (M.A.H., K.G.); Department of Health Economics, School of Public Health, and Department of Surgery, School of Medicine, University of Alabama, Birmingham, Alabama (E.D.C., G.Z.); Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania (K.G., I.J.); Department of Medicine, Boston University School of Medicine, Boston, Massachusetts (T.R.); Department of Medicine, Saint Louis University School of Medicine, Saint Louis, Missouri (R.W.); Department of Medicine, University of Michigan School of Medicine, Ann Arbor, Michigan (B.P.); Department of Medicine, Mayo Medical School, Rochester, Minnesota (G.R., F.N.); Department of Cardiology, Cleveland Clinic Foundation. Cleveland. Ohio (P.W.); Department of Medicine, Duke University School of Medicine, Durham, North Carolina (D.B.M., D.F.). A complete list of the BARI Investigators has been published in Circulation 1991;84(suppl V):V-23-V-27. This study was supported by a grant from the Robert Wood Johnson Foundation, Princeton, New Jersey. Additional support from the National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland.


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