School of Optometry, Faculty of Medicine, University of Montreal, Montreal, Quebec, Canada.
J Am Med Dir Assoc. 2012 Feb;13(2):187.e15-9. doi: 10.1016/j.jamda.2011.04.003. Epub 2011 May 31.
The objective of this study was to verify if vision is appropriately evaluated in older individuals admitted to a Geriatric Assessment Unit following a fall.
A retrospective clinical chart review of 158 patients from 3 university-based Geriatric Assessment Units is presented. The clinical charts of patients admitted following a fall in the Geriatric Assessment Units of 3 Montreal hospitals, between April 2006 and 2008, were reviewed. Clinical charts from age- and sex-matched controls hospitalized in the Geriatric Assessment Units during the same period but without a history of fall or fracture, were also reviewed. Pertinent sociodemographic, medical, and visual characteristics were extracted from the charts and entered into a database for analysis.
The mean age ± standard deviation for the cases (n = 79) and controls (n = 79) were 82.3 ± 6.2 years and 81.7 ± 6.4 years, respectively. Most falls were not a result of accidents, but rather were more often related to underlying medical problems that were multifactorial in origin. More cases than controls were taking antiarrhythmic and antidepressant medications, whereas more controls were taking calcium channel blockers. Cases were more likely to have cataracts, age-related macular degeneration, and decreased visual acuity. Although cases were referred more often than controls for an eye examination, they were not referred in a systematic fashion.
Our results indicate that more visual problems are identified in persons who fall and, even if they are referred more often than controls for an eye examination, their vision is not evaluated systematically by an eye care specialist despite current clinical recommendations.
These data indicate that eye care professionals should work more closely with the medical team to improve the overall clinical care of older individuals with a history of falls.
本研究旨在验证在因跌倒而入住老年评估单元的老年人中，是否对视力进行了适当评估。
回顾性分析了来自 3 所大学老年评估单元的 158 例患者的临床病历。本研究分析了 2006 年 4 月至 2008 年间，3 家蒙特利尔医院老年评估单元收治的跌倒患者的临床病历，同时也分析了同期在老年评估单元住院且无跌倒或骨折史的年龄和性别匹配的对照组的临床病历。从病历中提取了相关的社会人口学、医学和视觉特征，并将其录入数据库进行分析。
病例组（n = 79）和对照组（n = 79）的平均年龄（±标准差）分别为 82.3 ± 6.2 岁和 81.7 ± 6.4 岁。大多数跌倒并非意外，而是更多地与潜在的、多因素导致的医学问题有关。与对照组相比，病例组服用抗心律失常药和抗抑郁药的患者更多，而对照组服用钙通道阻滞剂的患者更多。病例组更可能患有白内障、年龄相关性黄斑变性和视力下降。尽管病例组比对照组更常被转诊进行眼部检查，但他们并没有被系统地转诊。
我们的研究结果表明，跌倒的人更容易出现视力问题，尽管他们比对照组更常被转诊进行眼部检查，但他们的视力并没有得到眼科专家的系统评估，尽管目前有临床建议。
这些数据表明，眼科专业人员应与医疗团队更密切地合作，以改善有跌倒史的老年人的整体临床护理。
