Effectiveness of service provision in reducing falls in people with visual impairment

Introduction- Older people with visual impairment (VI) are much more likely to fall than their fully-sighted counterparts (Dhital et al 2010). Age-related macular degeneration (ARMD) is the most common cause of VI in older adults and has been attributed to an increase in falls risk (Szabo et al 2010). This collaborative study, between the Royal National Institute for the Blind (RNIB) and Occupational Therapy (OT) researchers, aimed to establish the effectiveness of an existing service, Eye Care Liaison Officers (ECLOs), in reducing incidence of falls amongst older adults with ARMD.Methods - A randomised control trial study design was used. Ethical approval was obtained through the Office for Research Ethics NI and the Belfast HSC Trust. Consenting participants were 65 years or older, diagnosed with ARMD, cognitively able and attending the out-patient macular clinic. The intervention group (n= 33) received condition-specific falls advice and literature alongside usual ECLO intervention. The control group (n=29) received usual care only. Standardised assessments were used to establish falls risk, confidence and perceived health status. For six months following intervention, all participants completed falls calendars and received monthly telephone calls to establish falls incidence. Data was analysed descriptively. Further statistical analysis is ongoing to determine any differences between control and intervention groups. These results will be fully presented at conference.Impact - Falls are a significant health problem for older people, with 30% of people over 65 years old experiencing a fall (National Institute for Clinical Excellence 2013). In this study, falls were reported by over 60% of all participants, with 75% of these fallers citing two or more falls. A substantial number of reported falls occurred around the home, with falls on steps due to misjudging step distance frequently cited as the cause. Conversations with participants highlighted that they tended not to associate falling with their VI.Conclusions - Preliminary results evidence the high incidence of falls in individuals with ARMD. Full results will be presented showing the falls incidence for each group and the difference, if any, of the enhanced ECLO intervention. Discussion- The implications from this study for future service development are as follows:1. ECLOs are an existing resource within eye clinics working with a high risk falls group. With appropriate falls-specific training, the ECLO is well placed, to give timely, relevant information regarding falls prevention.2. The unexpected high incidence of falls stresses the importance of being visually aware and understanding the link between VI and falls. A need exists for closer working between established falls services and eye care services. This should include clear referral pathways.