1. Environmental/behavioural interventions aimed at preventing falls in older people with visual impairment: Effectiveness and experiences Fiona Neil Claire Ballinger Dawn Skelton Tracey Howe Funded by the Thomas Pocklington Trust and Help the Aged

2. Experience of visual impairment

3. Possible interventions

4. Background  Falls are the leading cause of injury in people aged 75 years and over  Visual impairment is common amongst the oldest old people  Rate of falls in older people with visual impairment is 1.7 times higher  Hip fractures are 1.3-1.9 times higher  Need for a greater understanding of older peoples’ views of falls prevention

5. Background  RCT in New Zealand (2005) tested a home safety programme which involved environmental and behavioural changes to prevent falls in older people with severe visual impairment (VIP) This demonstrated a reduction in falls  Otherwise most interventions on vision and falls have concentrated around surgical procedures (e.g. Cataract removal)  Recommendations to promote engagement of older people in fall prevention activities (Yardley, 2007) Are these the same for VIP?  Glasgow based “Visibility” report (2008) used focus groups with VIPs: Services are poor and little help with interventions to maintain independence

6. Registration of two reviews  Quantitative with Cochrane RCTs only Meta analysis Effectiveness Statistical evidence  Qualitative with JBI Qualitative studies Will consider other interventions also Meta synthesis Narrative about experiences

7. Criteria for both Reviews  Participants  Aged 65 and over  Irreversible visual impairment  Community dwelling  Independently mobility around own home  Excluded if trial selected for a specific condition e.g. stroke  For JBI qualitative only – experiences of carers, family, health and social care providers also considered

8. Interventions  For both reviews visual rehabilitation, removal of home hazards, home safety modifications, provision of adaptive or assistive equipment, advice on behavioural changes to improve safety in activities of daily living  For JBI/Qual only Exercise, pharmacy, medical assessment, footwear

9. Outcomes Cochrane/Quantitative  Mobility  Falls - rates  Falls - number of people falling JBI/Qualitative  Feasibility  Appropriateness  Meaningfulness

10. Search Strategy  Keywords common to both reviews: aged; vision; accidental fall; community dwelling; interventions  English language only  1990 onwards  Electronic databases  National and regional professional associations  Voluntary organisations

11. Methods of the Reviews Critical Appraisal  Selection of studies by paired reviewers  Disparate results will be settled by 3 rd reviewer  Included studies appraised  JBI Qari software  Cochrane Revman “risk of bias” and “quality of study” tools Data Extraction Data Synthesis

12. Anticipated Outcomes Inform clinicians, policy makers, commissioners of services and older people about: Effectiveness of environmental and/or behavioural interventions in improving mobility and reducing falls of older people with VIP (Cochrane Review) Feasibility, appropriateness and meaningfulness of interventions designed to reduce or prevent falls in older people with VIP (JBI Review)