退伍军人住院期间跌倒相关的眼科疾病

Campagna Giovanni, Chamberlain Paul, Orengo-Nania Silvia, Biggerstaff Kristin, Khandelwal Sumitra

School of Medicine, Baylor College of Medicine, Houston, Texas.

Department of Ophthalmology, Cullen Eye Institute, Baylor College of Medicine, Houston, Texas.

Optom Vis Sci. 2018 Dec;95(12):1114-1119. doi: 10.1097/OPX.0000000000001312.

SIGNIFICANCE

Efforts to describe the relationship between pathological visual impairment and fall risk are typically confined to community dwellers. Among admitted patients, however, the associations are less understood. Fall risk assessment tools are used in some clinical settings, but most do not capture the suspected importance of ophthalmic pathologies in predicting the likelihood of an inpatient fall.

PURPOSE

The purpose of this study was to determine the association between ophthalmic conditions and inpatient falls at the Michael E. DeBakey Veterans Affairs Medical Center (MEDVAMC), where vision and ophthalmic conditions are not considered when assessing fall risk.

METHODS

This is a population-based, retrospective case-control study of 805 patients admitted to the MEDVAMC in January 2014 who had also visited the MEDVAMC Eye Clinic within 1 year of admission. The patients' eye examinations, ophthalmic diagnoses, and other indicators of constitutive health were compared between 60 patients who experienced an inpatient fall ("cases") and 749 patients who did not ("controls"). Significant differences between the cases and the controls were determined using logistic regression models.

RESULTS

Baseline demographics were similar among the two groups. Ophthalmic conditions associated with an increased incidence of inpatient falls included age-related macular degeneration (odds ratio, 3.9; 95% confidence interval, 1.5 to 9.9; P = .008) and a presenting visual acuity of worse than 20/40 in the better-seeing eye (odds ratio, 2.0; 95% confidence interval, 1.0 to 4.1; P = .04). Those without falls demonstrated a better mean presenting visual acuity in the better-seeing eye compared with those who fell (logMAR, 0.12 ± 0.23 vs. 0.28 ± 0.49, P < .001).

CONCLUSIONS

In this population, age-related macular degeneration and poor presenting visual acuity in the better-seeing eye are associated with increased incidence of inpatient falls. An assessment of visual function and ophthalmic diagnoses may be warranted upon admission to the hospital for increased prevention of inpatient falls.

意义

描述病理性视力损害与跌倒风险之间关系的研究通常局限于社区居民。然而，在住院患者中，这种关联尚鲜为人知。一些临床环境中使用了跌倒风险评估工具，但大多数工具并未考虑到眼科疾病在预测住院患者跌倒可能性方面的潜在重要性。

目的

本研究旨在确定在迈克尔·E·德贝基退伍军人事务医疗中心（MEDVAMC）眼科疾病与住院患者跌倒之间的关联，该中心在评估跌倒风险时未考虑视力和眼科疾病因素。

方法

这是一项基于人群的回顾性病例对照研究，研究对象为2014年1月入住MEDVAMC且在入院前1年内也去过该中心眼科诊所的805例患者。比较了60例发生住院跌倒的患者（“病例组”）和749例未发生跌倒的患者（“对照组”）的眼部检查、眼科诊断以及其他健康指标。使用逻辑回归模型确定病例组和对照组之间的显著差异。

结果

两组患者的基线人口统计学特征相似。与住院跌倒发生率增加相关的眼科疾病包括年龄相关性黄斑变性（比值比，3.9；95%置信区间，1.5至9.9；P = 0.008）以及较好眼的最佳矫正视力低于20/40（比值比，2.0；95%置信区间，1.0至4.1；P = 0.04）。与跌倒患者相比，未跌倒患者较好眼的平均最佳矫正视力更好（最小分辨角对数视力，0.12±0.23 vs. 0.28±0.49，P < 0.001）。