VISIBLE – Vision Screening to Improve Balance & Prevent Falls

In 2017, the College of Optometrists reported that the rate of falls in older adults with visual impairment is almost twice as high than other older adults of the same age.

VISIBLE: Vision Screening to improve balance and prevent falls is a simple stepped approach to implement vision screening in community settings. It combines resources for opticians and wider community organisations with the aim of increasing knowledge of the link between vision, balance and falls prevention.

Join us and other influential leaders and organisations to implement vision screening to improve the quality of life for our older adult population.

VISIBLE is relevant to all organisations who are in contact with older adults including:
• Falls services;
• Physiotherapists, OTs, Social Workers, Podiatrists, Audiologists;
• Optometrists, Ophthalmologists;
• Ambulance and Fire Services;
• Social Services and Community Health;
• Acute Hospitals and Mental Health Services;
• Memory Clinics;
• Housing;
• Voluntary organisations, befrienders, handypersons, help at home services, social prescribers;
• Care Homes.

Front Title

Why focus on vision?

Falls are the most common cause of hospital admission for people aged over 65. One in three people aged over 65 will fall each year, and one in two people over the age of 80 will fall each year. NICE Clinical Guideline 161 (updated 2017), “Falls in older people: assessing risk and prevention” recommends a multifactorial risk factor assessment, including a recommendation to check for visual impairment. However, a 2014 College of Optometrists ‘Focus on Falls’ report found that only half of falls services checked vision as a core part of the service.

'Falls are estimated to cost the NHS more than £2.3 billion per year'
-NICE, 2017

Visual impairment is a key reason for falls.
Factors that contribute to the risk of falls caused by poor vision include:
• Poor balance from reduced central and/or peripheral vision;
• Trips over obstacles or on stairs due to poor central and/or peripheral vision and reduced depth perception;
• Reluctance to undertake physical activity because of uncorrected vision loss, which can reduce muscle strength and increase likelihood of a fall;

'The rate of falls in older adults with visual impairment is 1.7 times higher than other older adults of the same age'
-The College of Optometrists, 2017

In 2000, Van der Pols JC, et al, found that prevalence of ocular disease, visual deficit and blindness is higher in care homes. This correlates with the rates of falls occurring within this setting. People with dementia also have a high risk of falls. Sight loss may make the person more confused about what is happening around them and may cause problems with communication. NICE acknowledge that falls greatly impact on the individual’s quality of life, causing pain, loss of confidence and independence.

Measuring the scale of the problem
In 2016, Merton Community Falls Prevention Service worked in partnership with Merton Vision to develop a simple vision screening tool for health professionals to use. The tool formed part of a multifactorial falls assessment, which ensured that therapists checked for poor vison and provided patients with advice to encourage ophthalmic intervention.

During the Merton vision pilot, 48% patients attending the falls prevention service did not pass the vision screening assessment and were advised to visit their opticians

As a result, the Merton Falls Prevention Service have now embedded vision screening into their multifactorial falls assessment.

In their 2014 survey of falls services, The College of Optometrists found that the most common reason that falls services teams did not check vision was a lack of confidence and a lack of an ‘easy-to-use’ vision screening tool.

Resources

These resources are provided to assist with conducting a vision screening assessment.

Thomas Pocklington Trust ‘Eyes Right Toolkit’
‘Eyes Right Toolkit’ (ERT) is a simple tool designed to screen near and distant vision and can be used by anybody, but it is particularly useful in community settings. The ERT takes just 10 minutes to complete and provides clear guidance on whether a person requires an eye examination with an optometrist.

Thomas Pocklington Trust provides up to 25 Eyes Right Toolkits free of charge. To find out more or to obtain a copy of the Eyes Right Toolkit, please email Research@pocklington-trust.org.uk

For more information, please click here

Royal College of Physicians ‘Look Out! Bedside vision check for falls prevention’
‘Look out! Bedside vision check for falls prevention’ is an innovatively designed guide which aims to support busy clinical staff in assessing visual impairment in older people. It uses a mixture of questions and visual aids to help doctors, nurses and therapists check eyesight at the patient’s bedside. Results give an indication of the extent of any visual problems, known or unknown, that the patient may have.
For more information click here and to order a free copy, please email falls@rcplondon.ac.uk

The Healthy Ageing team would like to thank the following organisations for their participation and involvement in the guide:

• Merton Falls Prevention Service, Central London Community Healthcare (CLCH)
• Merton Vision
• Thomas Pocklington Trust
• London Eye Health Network
• Age UK
• Royal College of Physicians.

For more information please contact Becky Newman, Project Manager on rebecca.newman2@nhs.net