Focus on Falls The importance of vision in preventing falls

Falls are the most common cause of people over 65 being taken into hospital. One in three people in this age group will fall every year. Falls are the biggest cause of accidental death in people over 75 and cost the NHS around £2.2 billion per year. You are almost twice as likely to fall if you are over 65 and have some form of visual impairment. Hip fractures are also notably more likely.

The NICE clinical guideline on falls recommends that multi-factorial assessments undertaken by falls services should include investigation of visual impairment. National Institute for Health and Care Excellence (2013) The assessment and prevention of falls in older people, Clinical guideline 161. London: NICE. Available from: [accessed 25 Feb 2013]

Vision is fundamental to coordinating movement – our balance and postural stability are directly affected by vision. Vision adapts gait to enable safe travel though our environment - avoiding obstacles, negotiating steps and stairs. Poor balance can be caused by reduced central and/or peripheral vision. Eye movement disorders can knock you off balance.

Uncorrected visual loss can have a more subtle but equally detrimental effect on falls risk. Wearing bifocal and multi-focal lenses can increase the risk of falling. Patients wearing glasses with an outdated or wrong prescription (which is more common than you might think) are much more at risk of taking a tumble. Even a small reduction in depth perception can lead to trips over obstacles or overstepping on stairs.

Many patients attending A&E clinics for falls or hip fractures have correctable visual impairment but have typically not attended for eye exams for several years. Studies have found that between 40 and 50% of older people with sight loss actually fear falling to the extent that they reduce their own levels of activity. This can reduce muscle strength and, ironically, further increases their likelihood of a fall. This completes a bit of a vicious circle. However, looking at it in a more positive light, evidence shows that early cataract removal and home assessments can really help to reduce the likelihood of falls.

Housing for people with sight loss: A practical guide to improving existing homes, Good Practice Guide 4 (3rd edition) Homes and living spaces for people with sight loss: A guide for interior designers October trust.org.uk/Resources/Thomas%20Pocklington/Documents/PDF/Research%20Publications/pocklington-for- professionals-interior-design-guide.pdf Choosing Energy Saving Light Bulbs Home Safety Assessments can drastically reduce the likelihood of a fall for people with visual impairment. Lighting and colour contrast around the home is imperative. For tips on home design for people with sight loss, the Thomas Pocklington Trust have produced a number of resources. They include a guide on levels of lighting and which bulbs to select...

There is currently no real evidence to suggest that standard rehabilitation programmes for fallers are effective for people with sight loss… Northumbria, Manchester, Newcastle and Glasgow Caledonian Universities are conducting research at the moment which is looking to adapt exercise programmes to improve falls prevention among older people with sight loss. (Funded by the National Institute for Health Research)

The cross-sector Focus on Falls project sought to: Outline and promote the pivotal role that improving vision has in preventing falls. Produce a clearer picture of vision testing within falls services Support falls professionals in testing patients’ vision and to demonstrate the role optometrists can play in this. Make connections between falls professionals and optometrists to improve continuity of care

There is variation within falls services in terms of the frequency and method of their vision checking A lack of resource and capacity is key to this variation Most falls teams would welcome support in performing eyesight checks Referral between falls teams and optometrists could help the patient pathway and help foster clinical continuity FOCUS ON FALLS - MAIN FINDINGS

A quick and easy solution for non-professionals to check patients’ vision, try using the Thomas Pocklington Trust’s “EYES RIGHT TOOL” (available from the College of Optometrists via

Optometrists can play a vital role in helping to prevent falls by detecting and appropriately correcting sight loss, providing the right advice as well as ensuring spectacles are correctly centred and of a suitable design for the patient.

Why not get in touch with a local optometric practice or Domiciliary Eye Service (sight tests at home)? Visit our falls webpage for help: