Centre for Vision and Eye Research, School of Optometry and Vision Science, Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia.
Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Randwick, Australia.
Ophthalmic Physiol Opt. 2021 Mar;41(2):245-254. doi: 10.1111/opo.12777. Epub 2020 Dec 25.
To investigate the prevalence and level of concern about falling (CF) among older people with vision impairment due to age-related macular degeneration (AMD) compared to a visually normal control group, and to identify determinants of CF for the AMD group.
Participants included 133 older people: 77 with AMD (mean age = 80.5 ± 6.2 years), and 56 controls (mean age = 75.4 ± 5.3 years). Binocular visual acuity, contrast sensitivity and visual fields were measured, and CF was assessed using the Falls Efficacy Scale - International (FES-I). Data were also collected for sensorimotor function (postural sway, sit-to-stand, knee extensions, walking speed, proprioception), and neuropsychological function (reaction time, symptoms of anxiety and depression) using validated tests and scales.
Concern about falling scores were higher for AMD participants compared to control participants (mean ± S.D. 24.6 ± 8.0 vs 21.6 ± 5.7, p = 0.02, respectively), although these findings failed to reach significance when adjusted for age (p = 0.16). Among AMD participants, multivariable models showed that greater CF was associated with reduced contrast sensitivity (p = 0.02), slower sit-to-stand times (p < 0.001) and higher anxiety scores (p < 0.001); these factors explained 40% of the variance in CF (p < 0.01).
Levels of CF in older people with AMD were not found to be elevated by their disease status alone, but rather by the extent of vision loss. Levels of CF in those with AMD were associated with various visual, sensorimotor and neuropsychological factors. These findings will assist clinicians in identifying those at greatest risk of developing high CF and inform the design of future intervention programmes for this population.
与视力正常的对照组相比，调查因年龄相关性黄斑变性（AMD）而导致视力受损的老年人中对跌倒（CF）的流行率和关注程度，并确定 AMD 组 CF 的决定因素。
参与者包括 133 名老年人：77 名 AMD 患者（平均年龄 80.5 ± 6.2 岁）和 56 名对照组（平均年龄 75.4 ± 5.3 岁）。测量双眼视力、对比敏感度和视野，并使用跌倒效能量表-国际版（FES-I）评估 CF。还使用经过验证的测试和量表收集了感觉运动功能（姿势摆动、从座位到站起、膝关节伸展、行走速度、本体感觉）和神经心理学功能（反应时间、焦虑和抑郁症状）的数据。
与对照组相比，AMD 参与者的跌倒担忧评分更高（平均值 ± 标准差 24.6 ± 8.0 与 21.6 ± 5.7，p = 0.02，分别），尽管这些发现在校正年龄后没有达到显著水平（p = 0.16）。在 AMD 参与者中，多变量模型表明，较高的 CF 与较低的对比敏感度相关（p = 0.02）、较慢的从座位到站起时间（p < 0.001）和较高的焦虑评分相关（p < 0.001）；这些因素解释了 CF 变异的 40%（p < 0.01）。
AMD 老年人的 CF 水平并未因疾病状态本身而升高，而是因视力丧失程度而升高。AMD 患者的 CF 水平与各种视觉、感觉运动和神经心理学因素相关。这些发现将有助于临床医生识别那些最有可能出现高 CF 的患者，并为该人群设计未来的干预计划。
