Use this URL to cite or link to this record in EThOS:
Title: Impact of vision on falls and fear of falling in older adults
Author: Mehta, Jignasa
ISNI:       0000 0004 9358 688X
Awarding Body: University of Liverpool
Current Institution: University of Liverpool
Date of Award: 2020
Availability of Full Text:
Access from EThOS:
Access from Institution:
Background: Falls are the second leading cause of accidental deaths worldwide mainly in older people. A fall does not only lead to physical health issues but also has psychosocial consequences such as the fear of falling and social isolation. Older people have poor vision. There is published evidence to suggest that poor vision is a risk factor for falls and fear of falling, though it is variable and studies exploring this vary in methodological quality and rigour. Despite, the National Institute of Clinical Excellence (NICE) recommendations, less than half of falls clinics assess vision as part of the multi-factorial assessment of older adults at risk of falls. Published evidence suggests that there is an association of fear of falling with specific ophthalmic conditions. However, no qualitative studies have explored the fear of falling in older adults with age-related ophthalmological conditions. Aim: To investigate the relationship between visual function and falls and to explore the fear of falling in older adults with age-related ophthalmic conditions. Method: A mixed-methods approach was used for the study in this thesis. I employed a prospective observational age-matched case-control design to compare measures of visual function between age-matched falls (n=83) and non-falls participants (n=83). Sociodemographic factors, general health, number of medications, health quality, fear of falling and physical activity data were also collected for each participant. The qualitative phase of the study was informed by a phenomenological approach. I conducted semi-structured interviews with two groups of participants with age-related ophthalmic conditions to explore the fear of falling: 1) falls participants (n=15) and 2) participants who had not experienced a fall since their ophthalmic diagnosis (n=15). Results: Falls participants had significantly poorer visual acuity, contrast sensitivity and depth perception than non-falls participants on univariate analysis (all p<0.05). Multivariable logistic regression demonstrated that the combination of social (people from areas of lower-income deprivation), behavioural (older adults reluctant to socialise out of the home) and biological (reduced contrast sensitivity and depth perception) determinants were significant predictors of a fall (p<0.05). Participants with age-related sight conditions privilege difficulties with depth perception and lighting when describing the lived experience of their sight. However, many of the participants did not consider their sight condition to be a contributing factor in their fall. The consequences of a fall were transformative from an emotional, social and physical perspective. There was a preponderance of fallers who were fearful of falling compared to the non-fallers who appeared to continue with their daily routines with caution. Although the fall appeared to be transformative for some at the time of the interview, there was a temporal sense of managing the risk or fear and 'getting on with it' to minimise the impact on their daily living. Personal, social and environmental resources influenced participants' responses to managing their risk/fear of falls. Similarly, being diagnosed with a sight condition did not appear to encumber individuals as they used similar resources to cope with their condition and maintain their routines. Conclusions: Impaired stereoacuity and contrast sensitivity were key visual risk factors for further falls in this study and should be included in the falls assessment. Individuals did not attribute fear of falling to having an age-related ophthalmic condition but were conscious of difficulties with depth perception and lighting. Personal, social and environmental resources influenced participants' responses to fear of falling and therefore their resilience.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral