Lord S R, Dayhew J
Prince of Wales Medical Research Institute, Sydney, Australia.
J Am Geriatr Soc. 2001 May;49(5):508-15. doi: 10.1046/j.1532-5415.2001.49107.x.
To determine the tests most predictive of falls in community-dwelling older people from a range of visual screening tests (high and low contrast visual acuity, edge contrast sensitivity, depth perception, and visual field size). To determine whether one or more of these visual measures, in association with measures of sensation, strength, reaction time, and balance, can accurately predict falls in this group.
Prospective cohort study of 12 months duration.
Falls and Balance Laboratory, Prince of Wales Medical Research Institute.
156 community-dwelling men and women age 63 to 90 (mean age 76.5, standard deviation = 5.1).
Screening tests of vision, sensation, strength, reaction time and balance, falls.
Of the 148 subjects available at follow-up, 64 (43.2%) reported falling, with 32 (21.7%) reporting multiple falls. Multiple fallers had decreased vision, as indicated by all visual tests, with impaired depth perception, contrast sensitivity, and low-contrast visual acuity being the strongest risk factors. Subjects with good vision in both eyes had the lowest rate of falls, whereas those with good vision in one eye and only moderate or poor vision in the other eye had elevated falling rates-equivalent to those with moderate or poor vision in both eyes. Discriminant analysis revealed that impaired depth perception, slow reaction time, and increased body sway on a compliant surface were significantly and independently associated with falls. These variables correctly classified 76% of the cases, with similar sensitivity and specificity.
The study findings indicate that impaired vision is an important and independent risk factor for falls. Adequate depth perception and distant-edge-contrast sensitivity, in particular, appear to be important for maintaining balance and detecting and avoiding hazards in the environment.
从一系列视觉筛查测试（高对比度和低对比度视力、边缘对比度敏感度、深度感知和视野大小）中确定最能预测社区居住老年人跌倒的测试。确定这些视觉测量指标中的一项或多项与感觉、力量、反应时间和平衡测量指标相结合，是否能准确预测该群体的跌倒情况。
为期12个月的前瞻性队列研究。
威尔士王子医学研究所跌倒与平衡实验室。
156名年龄在63至90岁之间（平均年龄76.5岁，标准差=5.1）的社区居住男性和女性。
视力、感觉、力量、反应时间和平衡的筛查测试，跌倒情况。
在随访时可获得的148名受试者中，64名（43.2%）报告有跌倒情况，其中32名（21.7%）报告有多次跌倒。如所有视觉测试所示，多次跌倒者的视力下降，深度感知受损、对比度敏感度降低和低对比度视力是最强的危险因素。双眼视力良好的受试者跌倒率最低，而一只眼视力良好而另一只眼仅为中度或差视力的受试者跌倒率升高——与双眼视力中度或差的受试者相当。判别分析显示，深度感知受损、反应时间缓慢以及在顺应性表面上身体摇摆增加与跌倒显著且独立相关。这些变量正确分类了76%的病例，敏感性和特异性相似。
研究结果表明，视力受损是跌倒的一个重要且独立的危险因素。特别是，足够的深度感知和远边缘对比度敏感度对于维持平衡以及检测和避免环境中的危险似乎很重要。
