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18 Jun 2013 - Falls Prevention Programmes 'Unlikely To Be Effective For People With Sight Loss' says new review

In Falls Awareness Week, a new review published by the sight loss charity, Thomas Pocklington Trust, reveals a major failing in efforts to reduce falls and injury amongst older people. People with sight loss are almost twice as likely to fall and be injured than sighted people yet the review exposes a lack of attention to vision impairment in falls prevention programmes and finds they are "unlikely to be effective for people with sight loss."

"Falls prevention programmes work well for people who have no sight loss but the assumption that current programmes work for everyone is simply wrong," says Sarah Buchanan, Research Director, Thomas Pocklington Trust. "This review shows that sight loss is not properly recognised as a major factor in falls and that falls prevention programmes are failing to give people with sight loss the help they need."

Falls are the most common cause of hospitalisation for people aged over 65 and the leading cause of death from injury among people aged over 75 (NICE 2004). At the same time, almost two million people - most of them older - are living with sight loss in the UK: 1 in 5 people aged 75 years and 1 in 2 aged 90 years or over.

But the links between sight loss and falls have not been adequately researched, says the new review - 'Falls in older people with sight loss: a review of emerging research and key action points'.

One of the most common causes of sight loss is macular degeneration (MD), related to age. Yet there has been little research linked to eye conditions such as MD and their impact on falls.

In general, the cause of falls is often poorly recorded in the NHS. A survey in 2007 found that only half of falls clinics even assessed vision, though it is to be hoped that this might now have improved.

Such a lack of awareness of the role of sight loss hampers research into links between vision impairment and falls and the development of preventative action.

It is assumed that falls prevention programmes which are successful in the general older population should work with older people with sight loss. But the review shows that sight loss can result in unique risks and life circumstances that are not being accounted for.

• People with sight loss often adapt their movement in ways that are inherently unsafe; for example, stepping too high over a possible hazard.
• Older adults with poor vision no longer feel safe. Between 40-50% of them limit their activities due to fear of falling. Non-activity affects muscle strength, creating a vicious circle.
• Limited activity can also increase social isolation, anxiety and depression - already almost twice as common among people with sight loss as their sighted peers.
• For those who have both visual and hearing impairments the risk of falls is even higher. 22% of people over 60 in the UK have both.
With a lack of evidence for what works for people with sight loss, and diminishing NHS resources, the review suggests that commissioners find it easier to rely on general programmes than to tailor initiatives to the needs of people with sight loss. But this may be counter-productive.

Health professionals trying to reduce falls commonly suggest changes in people's homes - moving furniture or removing rugs, for example. However, people with sight loss use furniture to mark a pathway through the home or as aids to help them balance. For people with sight loss, interfering with their home environment can increase the risk of falls rather than prevent it.

Similarly, exercise programmes designed to improve older people's balance are usually designed for sighted people. Instructors may give visual “cues” or simply demonstrate the movements meaning people with sight loss miss out.

The Pocklington review calls for falls prevention programmes to better respond to the needs of people with sight loss. It calls for more focussed research into sight loss and falls and urges health professionals to gather case studies to add to knowledge of sight loss as a factor in falls.

Says Sarah Buchanan: "Unless new ways of working with people with sight loss are found and the role of sight loss in falls properly recorded and researched, then gaps in our knowledge will remain and falls prevention programmes will continue to fail people with sight loss."

Pocklington is delighted that, as part of Falls Awareness Week, Age UK is circulating a guide - Caring for Your Eyes - along with other falls prevention materials.

For more information please contact: Thomas Pocklington Trust
Tel: 020 8995 0880; Email: info@pocklington-trust.org.uk

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