Thomas Jonathan, Almidani Louay, Ramulu Pradeep, Varadaraj Varshini
From the Texas A&M School of Medicine (J.T.), Bryan, Texas, USA; Wilmer Eye Institute (L.A. and P.R.), Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Wilmer Eye Institute (L.A. and P.R.), Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Am J Ophthalmol. 2025 Mar;271:166-174. doi: 10.1016/j.ajo.2024.11.012. Epub 2024 Nov 25.
To examine the cross-sectional and longitudinal associations between visual impairment (VI) and falls in United States older adults.
Retrospective cross-sectional and cohort study.
This study utilized data from the National Health and Aging Trends Study 2021 and 2022. Participants were Medicare beneficiaries ≥71 years. Exposures were any VI - defined as distance or near VI (>0.3 logMAR), or contrast sensitivity (CS) impairment (<1.55 logCS) -and changes in distance visual acuity ([DVA], logMAR/y), near visual acuity ([NVA], logMAR/y), or CS (logCS/y). Outcomes were self-reported falls in the past 12 months.
2822 participants were included in the analysis. At baseline, adults with any VI had greater rates of falls (rate ratio = 1.16, 95% CI = 1.04-1.30) and multiple falls (rate ratio = 1.23, 95% CI = 1.01-1.49) than peers without VI. In longitudinal analysis, adults with any VI at baseline did not have a greater risk of falls or multiple falls in the following year compared to peers without VI; only worse CS (hazard ratio [HR] = 1.03, 95% CI = 1.01-1.06, per 0.1 logCS worse) and DVA (HR = 1.11, 95% CI = 1.04-1.18, per 0.1 logMAR worse) were associated with a greater risk of falls and multiple falls, respectively. However, in other models, change in NVA (HR = 1.04, 95% CI = 1.01-1.08, per 0.1 logMAR worse/y) was associated with greater fall risk over the follow-up period. Further, change in CS (HR = 1.11, 95% CI = 1.05-1.18, per 0.1 logCS worse/y) was associated with a greater risk of multiple falls, while changes in DVA and NVA were not.
Older United States adults with VI are more likely to experience a fall, with various components of their vision influencing the fall risk.
研究美国老年人视力障碍（VI）与跌倒之间的横断面和纵向关联。
回顾性横断面和队列研究。
本研究利用了2021年和2022年美国国家健康与老龄化趋势研究的数据。参与者为年龄≥71岁的医疗保险受益人。暴露因素为任何视力障碍，定义为远距离或近距离视力障碍（>0.3 logMAR），或对比敏感度（CS）受损（<1.55 logCS），以及远距离视力（[DVA]，logMAR/年）、近距离视力（[NVA]，logMAR/年）或CS（logCS/年）的变化。结局指标为过去12个月内自我报告的跌倒情况。
2822名参与者纳入分析。在基线时，患有任何视力障碍的成年人跌倒发生率（率比=1.16，95%置信区间=1.04-1.30）和多次跌倒发生率（率比=1.23，95%置信区间=1.01-1.49）均高于无视力障碍的同龄人。在纵向分析中，与无视力障碍的同龄人相比，基线时有任何视力障碍的成年人在次年发生跌倒或多次跌倒的风险并未增加；只有较差的CS（风险比[HR]=1.03，95%置信区间=1.01-1.06，每降低0.1 logCS）和DVA（HR=1.11，95%置信区间=1.04-1.18，每升高0.1 logMAR）分别与跌倒和多次跌倒的风险增加相关。然而，在其他模型中，NVA的变化（HR=1.04，9�%置信区间=1.01-1.08，每降低0.1 logMAR/年）与随访期间更高的跌倒风险相关。此外，CS的变化（HR=1.11，95%置信区间=1.05-1.18，每降低0.1 logCS/年）与多次跌倒的风险增加相关，而DVA和NVA的变化则不然。
患有视力障碍的美国老年人更有可能跌倒，其视力的各个组成部分都会影响跌倒风险。
