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Being on the trail of ageing: Functional visual ability and risk of falling in an increasingly ageing population
Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI). Örebro University, Örebro, Sweden. (Hälsa och omvårdnad)ORCID iD: 0000-0002-2333-4316
2014 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The elderly population is estimated to increase worldwide. One of the major health determinants identified in this population are injuries where one of the most prevalent causes are falls. The overall aim of this thesis was to describe and explore visual impairment and falls of inpatients and independently living elderly in the community and how daily life activities were influenced by visual ability and risk of falling. Methods in the studies were a quantitative retrospective descriptive design for study I followed by two quantitative retrospective and explorative studies where in study II perceived vision related quality of life and in study III performance-based visual ability were investigated. Study IV was a qualitative explorative study using classic grounded theory. In study I all falls of inpatients at a medical clinic 65 years and older (n=68) were registered during one year. In study II and III a random sample (n=212) of independently living elderly between 70 and 85 years of age participated in both studies. In study IV seven women and six men between 73 and 85 years of age from the two previous studies and six visual instructors (n=19) participated. The data in study I was collected during 2004, study II and III between February 2009 to March 2010 and study IV December 2009 to January 2013. The results in study I showed that most falls in five hospital wards occurred at night and those most affected had an established visual impairment. Almost half the population in study II and III fell at least once. Perceived vision when performing daily life activities showed a positive association between visual impairment and falls in men but not in women (II). No associations were found between performance-based measured visual ability and falls (III). Visually impaired elderly did not consider risk of falling as a problem (IV). Their main concern is to remain themselves as who they used to be which is managed by self- preservation while maintaining their residual selves and resisting self decay. Maintaining residual self is done by living in the past mostly driven by inertia while resisting self decay is a proactive and purposeful driven strategy.

It is a complex issue to do fall risk assessments and planning fall preventive action where the individual’s entire life situation has to be taken into consideration.

Place, publisher, year, edition, pages
Örebro: Örebro University , 2014. , 85 p.
Series
Örebro Studies in Care Sciences, ISSN 1652-1153 ; 56
Keyword [en]
elderly, experience, falls, independently living, perceived vision, performance-based vision, visual impairment
National Category
Nursing
Identifiers
URN: urn:nbn:se:hh:diva-32749Libris ID: 15407981ISBN: 978-91-7529-018-8 (print)OAI: oai:DiVA.org:hh-32749DiVA: diva2:1057665
Public defence
2014-05-30, Haldasalen, Högskolan Halmstad, Halmstad, 11:25 (English)
Opponent
Supervisors
Note

Medicine doktorsexamen

Available from: 2017-01-10 Created: 2016-12-19 Last updated: 2017-01-10Bibliographically approved
List of papers
1. Visual impairment and falls: a register study
Open this publication in new window or tab >>Visual impairment and falls: a register study
2009 (English)In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 18, no 3, 366-372 p.Article in journal (Refereed) Published
Abstract [en]

Aim: The aim of this register study was to investigate falls and fall injuries of inpatients 65 years and over to determine whether a causal factor of visual impairment was documented.

Background: All Organisation for Economic Cooperation and Development (OECD) countries have an increasing older population with falls and fall injuries becoming a major problem. A visual impairment can be an independent risk factor for falls but can also occur in combination with other intrinsic and extrinsic risk factors.

Design: A retrospective non-randomised register study.

Methods: In 2004, all documented falls of inpatients aged 65 years and over were examined. Medical records and eye clinic records were scrutinised to identify whether any visual impairment have been documented.

Conclusion: The majority of falls occurred between the hours of 24:00-06:00 and the inpatients most often affected were those with a visual impairment. The falls occurred in connection with movement when the inpatient was unaccompanied. Documentation in records at the medical clinic was defective and subjectively perceived visual impairment was not documented at all. Both subjective and objective visual impairment occurred in all eye clinic records. Relevance to clinical practice.

Visual impairment along with the ageing process are features affecting falls and the hospital environment needs to be adapted by improving the use of strong, contrasting colours and providing good lighting for older inpatients with visual impairment during the night time period. Hospital safety for older people with visual impairment is a concern if falls are to be reduced. Healthcare professionals need to undertake individual risk assessments to establish the degree of visual impairment of the older person so that appropriate interventions can be implemented to reduce the incidence of falls and fall injuries.

Place, publisher, year, edition, pages
Oxford: Blackwell Publishing, 2009
Keyword
documentation, falls, nursing intervention, older, opthalmology, quality of life, accidental falls, aged, hospitals, statistics & numerical data, humans, nursing, quality of life, retrospective studies, vision disorders
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:hh:diva-2796 (URN)10.1111/j.1365-2702.2008.02516.x (DOI)000262476100006 ()19191983 (PubMedID)2-s2.0-58349121732 (Scopus ID)2082/3198 (Local ID)2082/3198 (Archive number)2082/3198 (OAI)
Available from: 2009-08-14 Created: 2009-08-14 Last updated: 2016-12-19Bibliographically approved
2. Perceived vision-related quality of life and risk of falling among community living elderly people
Open this publication in new window or tab >>Perceived vision-related quality of life and risk of falling among community living elderly people
2013 (English)In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 27, no 2, 433-439 p.Article in journal (Refereed) Published
Abstract [en]

Falls and fall injuries among the elderly population are common, since ageing is a risk factor of falling. Today, this is a major problem because the ageing population is increasing. There are predictive factors of falling and visual impairment is one of them. Usually, only visual acuity is considered when measuring visual impairment, and nothing regarding a person's functional visual ability is taken into account. Therefore, the aim of this study was to assess the perceived vision-related quality of life among the community living elderly using the 25-item National Eye Institute Visual Function Questionnaire (NEI VFQ-25) and to investigate whether there was any association among vision-related quality of life and falls. There were 212 randomly selected elderly people participating in the study. Our study indicated that the participants had an impaired perceived vision-related health status. General health was the only NEI VFQ-25 variable significantly associated with falls in both men and women. However, among men, near and distance activities, vision-specific social functioning, role difficulties and dependency, color and peripheral vision were related to falls.

Place, publisher, year, edition, pages
Chichester: Wiley-Blackwell, 2013
Keyword
falls, elderly, community living, vision-related quality of life
National Category
Health Sciences
Identifiers
urn:nbn:se:hh:diva-20179 (URN)10.1111/j.1471-6712.2012.01053.x (DOI)000318815700028 ()23663000 (PubMedID)2-s2.0-84877812278 (Scopus ID)
Available from: 2012-12-17 Created: 2012-12-17 Last updated: 2017-04-04Bibliographically approved
3. History of falling and visual ability among independently living elderly in Sweden
Open this publication in new window or tab >>History of falling and visual ability among independently living elderly in Sweden
2016 (English)In: Clinical Ophthalmology, ISSN 1177-5467, E-ISSN 1177-5483, Vol. 10, 1265-1273 p.Article in journal (Refereed) Published
Abstract [en]

Purpose: The aim of this study was to assess the performance-based visual ability among independently living elderly subjects and to investigate whether there was any association between visual ability and falls.

Subjects and methods: A total of 298 randomly selected subjects aged 70–85 years were invited for an examination including monocular and binocular visual acuity (VA), contrast sensitivity (CS), stereoscopic vision, and monocular visual fields (VFs), which were integrated to estimate the binocular VFs. Type of lenses used in their habitual correction was noted.

Results: Out of the 212 subjects who were examined, 38% reported at least one fall and 48% of these reported at least two falls during the last 2 years. Most subjects had normal results; 90% had normal binocular VA, 85% had normal binocular CS, and ~80% had positive stereopsis. Twenty-nine subjects had VF defects in the lower quadrants of the binocular VF, and 14 of these reported at least one fall. A significant association was seen between one fall or more and VA better eye, the odds ratio (OR) was 2.26, P=0.013, and between recurrent falls and lack of stereoscopic vision, the OR was 3.23, P=0.002; no other functional test showed any significant association with recurrent falls. The ORs were 1.58 for worse binocular VA, 0.60 for worse binocular CS, and 0.71 for non-normal stereoscopic vision for at least one fall, but wide confidence intervals made it difficult to draw firm conclusions about any association. Bifocal or progressive spectacles were worn by 71% with no significant difference between fallers and nonfallers (P=0.078).

Conclusion: Even though ~40% of the total sample had experienced one or more falls, the only visual function test significantly associated with falls were VA better eye, lack of stereoscopic vision, and recurrent falls. Our results suggest that there may be more powerful predictors of falling than decreased visual ability. © 2016 Källstrand-Eriksson et al.

Place, publisher, year, edition, pages
Auckland: Dove Medical Press, 2016
Keyword
elderly, falls, independently living, visual ability
National Category
Ophthalmology
Identifiers
urn:nbn:se:hh:diva-32542 (URN)10.2147/OPTH.S101060 (DOI)000379678800001 ()27468223 (PubMedID)2-s2.0-84982696409 (Scopus ID)
Available from: 2016-11-30 Created: 2016-11-30 Last updated: 2016-12-19Bibliographically approved
4. Seniors' self-preservation by maintaining established self and defying deterioration: A grounded theory
Open this publication in new window or tab >>Seniors' self-preservation by maintaining established self and defying deterioration: A grounded theory
2016 (English)In: International Journal of Qualitative Studies on Health and Well-being, ISSN 1748-2623, E-ISSN 1748-2631, Vol. 10, no 11, 30265Article in journal (Refereed) Published
Abstract [en]

The purpose of this classic grounded theory study was to understand how seniors who are living independently resolve issues influenced by visual impairment and high fall risk. We interviewed and observed 13 seniors with visual impairment in their homes. We also interviewed six visual instructors with experience from many hundreds of relevant incidents from the same group of seniors. We found that the seniors are resolving their main concern of “remaining themselves as who they used to be” by self-preservation. Within this category, the strategies maintaining the established self and defying deterioration emerged as the most prominent in our data. The theme maintaining the established self is mostly guided by change inertia and includes living the past (retaining past activities, reminiscing, and keeping the home intact) and facading (hiding impairment, leading to avoidance of becoming a burden and to risk juggling). Defying deterioration is a proactive scheme and involves moving (by exercising, adapting activities, using walking aids, driving), adapting (by finding new ways), and networking by sustaining old support networks or finding new networks. Self-preservation is generic human behavior and modifying this theory to other fields may therefore be worthwhile. In addition, health care providers may have use for the theory in fall preventive planning. © 2016 J. K. Eriksson et al.

Place, publisher, year, edition, pages
Järfälla: Co-Action Publishing, 2016
Keyword
Elderly, fall risk, seniors, grounded theory, living independently, self-preservation, visual impairment
National Category
Nursing
Identifiers
urn:nbn:se:hh:diva-32231 (URN)10.3402/qhw.v11.30265 (DOI)27172511 (PubMedID)2-s2.0-84982706172 (Scopus ID)
Note

Funding: Halland County Research Council, Sweden

Available from: 2016-10-20 Created: 2016-10-20 Last updated: 2016-12-19Bibliographically approved

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