Environmental Features Contributing to Falls in Persons With Vision Impairment: The Role of Home Lighting and Home Hazards

PURPOSE

To evaluate whether home hazards and lighting levels are associated with higher fall rates in adults with varying degrees of visual field (VF) damage from glaucoma.

METHODS

Participants with diagnosed or suspected glaucoma provided three years of prospective falls data via monthly falls diaries. A post-fall telephone questionnaire determined fall locations. Seven home areas were evaluated for hazards and lighting via an in-home assessment. Multivariate models adjusting for relevant confounders, including age, sex, comorbidity, and severity of VF damage, evaluated the influence of hazards and lighting on fall rates in each home region.

RESULTS

Mean baseline age for the 170 participants was 71.0 (7.6) years and 78 (46%) of participants were female. Fifty-nine participants experienced a total of 83 home falls, with the greatest number of falls occurring on the indoor stairs (n = 24, 29%) and bedroom (n = 17, 21%). Neither the number nor the percentage of hazardous items graded as hazardous was associated with the rate of falls (P > .26). Each 10-fold increase in room lighting was associated with 35% fewer falls in that home region (P = .02). The relation between lighting and the rate of falls did not differ with the degree of visual field damage (P > .3), and a lower fall rate was noted with better lighting even in participants with mild or no VF damage (rate ratio = 0.52/10-fold better lighting; P = 0.01).

CONCLUSIONS

Fewer home falls were found with better lighting, but not with fewer home hazards. Lighting improvements at home may reduce fall rates in older adults. NOTE: Publication of this article is sponsored by the American Ophthalmological Society.

Validity and reliability of the DiCI for the measurement of shoulder flexion and abduction strength in asymptomatic and symptomatic subjects

Background

A higher risk of shoulder injury in the athletic and non-athletic population is frequently associated with strength deficits. Therefore, shoulder strength assessment can be clinically useful to identify and to quantify the magnitude of strength deficit. Thus, the aim of this study was to evaluate the validity and reliability of a DiCI (a new hand-held dynamometer) for the measurement of shoulder flexion and abduction strength in asymptomatic and symptomatic subjects.

Methods

Forty-three recreational athletes (29 males and 14 females; age: 22.1 ± 0.47 years; body mass: 68.7 ± 13.1 kg; height = 173.3 ± 9.7 cm) and 40 symptomatic subjects (28 males and 12 females; age: 49.9 ± 8.1 years; body mass: 70.6 ± 14.3 kg; height = 171.7 ± 9.0 cm) completed shoulder flexion and abduction strength tests in two identical sessions one-week apart. Both types of movement were evaluated at 45º and 90º.

Results

Relative reliability analysis showed excellent intra-class correlation coefficients (ICC) for all evaluated movements (ICC range = 0.90 to 0.99). Absolute reliability analysis showed a standard error of measurement (SEM) ranging from 1.36% to 2.25%, and minimal detectable change (MDC) ranging from 3.93% to 6.25%. In conclusion, the DiCI is a valid and reliable device for assessing shoulder strength both in recreational athletes and in subjects with restricted mobility and loss of strength.