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Insufficient lighting most common home hazard for glaucoma patients
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Individuals with more advanced glaucoma do not adapt their homes for safety, according to a cross-sectional study using data from the ongoing Falls in Glaucoma Study.
A total of 174 of 245 study participants agreed to a home assessment using the Home Environment Assessment for the Visually Impaired. An evaluator assessed up to 127 potential fall-related hazards in eight home regions.
Researchers found no significant visual or demographic differences between participants who did and did not complete the home assessment.
Among the home assessment participants, mean age was 71.1 years, and integrated visual field (IVF) sensitivity ranged from 5.6 dB to 33.4 dB.
The mean number of items graded per home was 85.2, and an average of 32.7 were identified as hazards. Total home hazards or the number of hazards in any given room were not related to IVF sensitivity, contrast sensitivity or visual acuity, according to researchers.
The most common hazards identified in one or more rooms were ambient lighting less than 300 lux, exposed light bulbs, lack of grab bars by the toilet, door threshold height greater than 0.5 inches and seats without arm rests.
Patients with diagnosed glaucoma had more hazards in the bathroom than those with suspected glaucoma.
Only 27.9% of evaluated rooms demonstrated adequate lighting, according to the study.
Researchers reported that individuals with more severe VF damage had the same high number of home hazards as those with lesser levels of VF damage.
“Those most in need of a safer home environment are not making adaptations that could potentially reduce their likelihood of falling,” researchers wrote.
They suggest that, “those with more severe glaucoma are unaware of their predisposition to falls, unaware of how their needs change as they develop VF damage or unable/unmotivated to address these hazards.” – by Abigail Sutton
Disclosure: The researchers reported no relevant financial disclosures.
Perspective
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Carl H. Jacobsen, OD, FAAO
Mrs. Lee, your elderly yet vital patient, falls at home and breaks her hip. After an extended hospital stay, she is wheeled into your office for an appointment.
Mrs. Lee is depressed and has aged tremendously; she is a shadow of her former self. We’ve all seen the impact a fall can have on our elderly patients.
It is clear that falling is a major public health problem and that falls occur more often in elderly patients with compromised health. More specifically, glaucoma is associated with an increased risk of falling due largely to visual field and contrast sensitivity losses (Black et al.).
Yonge and colleagues examined a glaucoma population and found that advanced glaucoma patients are not more likely to modify their homes to decrease fall risk than patients with less advanced glaucoma.
As practitioners, we work hard to control glaucoma progression. We owe it to our patients to take the additional step of raising awareness of glaucoma’s effects on mobility and perhaps introducing our patients to resources that will help them reduce their risk of falling.
Reference:
Black AA, et.al. Inferior field loss increases rate of falls in older adults with glaucoma. Optom Vis Sci. 2011;88:1275-1282. doi: 10.1097/OPX.0b013e31822f4d6a.
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