Environmental and behavioural interventions for reducing physical activity limitation and preventing falls in older people with visual

Relevance of this review

Visual impairment is common in older people, reaching one in eight over the age of 75 in the UK. This condition is associated with a high risk of falls (up to 1.7 times higher than in age-matched visually normal population) and depression with a heavy impact on independence in activities of daily living (ADL) and quality of life (QoL). Visual impairment is defined as best-corrected visual acuity of the better eye less than 0.3 logMAR (Log of the Minimum Angle of Resolution) units or visual field defects within 20 degrees of fixation or low vision that cannot be corrected by standard glasses or by medical or surgical intervention. An older person with visual impairments is less physically active and more anxious than a healthy age-matched person.

The aim of this review is to assess the effectiveness and safety of environmental and behavioral interventions in reducing physical activity limitation, preventing falls, and improving QoL among visually impaired older people.

This review is important for:

Patients with visual impairment, parents/caregivers, health professionals dealing with people with low vision, researchers, general practitioners, and policymakers.

Key outcomes of the review

The review included 6 randomized studies (published up to February 2020), comprising 686 older participants with visual impairments, with mean age of 80 and mostly female. Environmental changes including home safety modification by occupational therapist and behavioural intervention (exercise) showed no evidence of difference on physical activity, fear of falling, and quality of life compared to usual activity or social/home visits. Moreover, home safety modification presented no difference on the proportion of participants who fell at six months and may slightly reduce people’s risk of falling at 12 months compared to social/home visits.

Authors’ conclusions

No evidence of effect for the environmental or behavioral interventions included in the review was found, with a low quality of evidence for all outcomes due to poor methodological quality and heterogeneous outcome measurements. A consensus of researchers and health care professionals is suggested to define standard and objective measures of physical activity and falls reliably in this population. Furthermore, it is important to customize interventions to suit particular individuals and their needs.

Future recommendations

Future research should investigate acceptable strategies and the use of validated questionnaires and measures to assess the compliance to rehabilitative approaches and performance during activities of daily living in this population.

Comment by Sara Liguori