Award Date

5-1-2017

Degree Type

Professional Paper

Degree Name

Doctor of Physical Therapy (DPT)

Department

Physical Therapy

Abstract

Background and Purpose: Falls are a major concern for elderly adults and can have a significant impact on overall health and well-being. Declines in vision with aging may be related to the development of fear of falling (FOF) and impaired mobility. It is possible that impaired vision due to common eye diseases can increase the FOF avoidance behavior and affect mobility function in this population. The purpose of this study was to investigate the relation among visual impairment, mobility performance, and FOF avoidance behavior in older adults. Methods: Inclusion criteria for eligible participants were: 50 years of age and older, able to walk 50 m without assistance, and able to understand simple instructions related to the assessments. A total of 455 participants from local community adult activity centers (males=152, females=303; age=73.1±7.7 years, range=51-97 years) participated. Physical mobility was assessed using an instrumented Timed Up-and-Go test. Visual acuity (VA) was tested using a standard Snellen chart. Avoidance behavior was assessed using the Fear of Falling Avoidance Behavior Questionnaire (FFABQ). Participants’ general health and presence of eye diseases (age-related macular degeneration, cataracts, and glaucoma) was assessed using a survey of medical history. A two-way ANOVA was used to investigate effect of VA and avoidance behavior on TUG performance. An additional two-way ANOVA test was used to investigate the effect of self-reported eye disease and avoidance behavior on TUG performance. Results and Discussion: There was a statistically significant difference between avoiders and non avoiders’ TUG score (avoiders=12.45±5.85 sec, non-avoiders 8.29±3.48, p<0.001). The VA has no significant effect on TUG time (no impairment= 8.69 ± 3.49 sec, mild impairment= 9.42 ± 5.05 sec, moderate impairment= 8.11 ± 2.08 sec, severe impairment= 9.45 ± 2.68 sec, p=0.791). There is no significant VA group by avoider group interaction (p=0.66). There was also a statistically significant difference in TUG scores between participants with and without eye disease (eye disease=9.37±5.08, no eye disease=8.29±2.80, p=0.004). There is no significant eye disease by avoider group interaction (p=0.144). iv Conclusion: The results of this study indicated that the presence of one or more self-reported eye diseases and higher FOF avoidance behavior were both associated with decreased mobility. Contrary to the initial hypothesis of the present study, there was no relation between VA and mobility, nor VA and FOF avoidance behavior. It is important for clinicians to inquire about the presence of eye diseases and administer the FFABQ to older adults in order to identify risk factors related to decline in physical mobility. Presently, the continued use of the Snellen chart to assess for VA as a part of fall risk assessment may be inadequate. Future studies should focus on developing a more comprehensive clinical assessment of vision that expands beyond visual acuity for the geriatric population.

Language

English


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