Cataract blindness related falls among older adults: A prospective cohort study in Ghana

Abstract

Background: Cataract, the leading cause of blindness worldwide, can significantly impair visual function.

Purpose: This study investigated the association between cataract-related falls among the elderly population in the Central region of Ghana.

Methods: The prospective cohort study among cataract patients aged 65 years and older, using purposive sampling to select facilities and consecutive sampling to recruit participants.

Results: The study achieved a 40% successful follow-up rate at 3 months post-surgery. Among the 500 older adult patients, 131 (26.2%) reported falls before undergoing cataract surgery. Of the 200 patients who had 24.0% falls pre-operatively, the prevalence of falls 3 months after surgical intervention was 16%. Demographics were not significantly associated with the risk of falling before cataract surgery (p > 0.05). However, participants with chronic conditions were 2.18 times more likely to fall than those without chronic conditions. Patients with hypertension (2.23 times) and diabetes (2.49 times) had higher risk of fall compared to those without these conditions. Additionally, patients with retinal conditions (2.86 times), and those with balance problems (1.86 times) were more prone to falling before surgical intervention than their counterparts without.

Conclusion: The study highlights the significant impact of cataract surgery in reducing fall prevalence among older adults.

Keywords

cataract / diabetes / falls / Ghana / hypertension

References

[1] Jaul E , Barron J . Age-related diseases and clinical and public health implications for the 85 Years old and over population. Front Public Health. 2017; 5.

[2] Mencucci R , Stefanini S , Favuzza E , Cennamo M , De Vitto C , Mossello E . Beyond vision:Cataract and health status in old age, a narrative review. Front Med. 2023; 10.

[3] Palagyi A , McCluskey P , White A , et al. While we waited: incidence and predictors of falls in older adults with cataract. Invest Ophthalmol Vis Sci. 2016; 57 (14): 6003.

[4] Gutiérrez-Robledo LM , Villasís-Keever MA , Avila-Avila A , Medina-Campos RH , Castrejón-Pérez RC , García-Peña C . Effect of cataract surgery on frequency of falls among older persons: a systematic review and meta-analysis. J Ophthalmol. 2021; 2021: 1- 7.

[5] Bastawrous A , Dean WH , Sherwin JC . Blindness and visual impairment due to age-related cataract in sub-Saharan Africa: a systematic review of recent population-based studies. Br J Ophthalmol. 2013; 97 (10): 1237- 1243.

[6] Flaxman SR , Bourne RRA , Resnikoff S , et al. Global causes of blindness and distance vision impairment 1990-2020: a systematic review and meta-analysis. Lancet Global Health. 2017; 5 (12): e1221- e1234.

[7] Han X , Zou M , Liu Z , et al. Time trends and heterogeneity in the disease burden of visual impairment due to cataract, 1990-2019: a global analysis. Front Public Health. 2023; 11.

[8] Naidoo K , Gichuhi S , Basáñez MG , et al. Prevalence and causes of vision loss in sub-Saharan Africa: 1990-2010. Br J Ophthalmol. 2014; 98 (5): 612- 618.

[9] Mehta U , Diep A , Nguyen K , et al. Quantifying color vision changes associated with cataracts using cone contrast thresholds. Transl Vis Sci Technol. 2020; 9 (12): 11.

[10] Shandiz JH , Derakhshan A , Daneshyar A , et al. Effect of cataract type and severity on visual acuity and contrast sensitivity. J Ophthalmic Vis Res. 2011; 6 (1): 26- 31.

[11] Jeon BJ , Cha TH . The effects of balance of low vision patients on activities of daily living. J Phys Ther Sci. 2013; 25 (6): 693- 696.

[12] Ramulu PY , Mihailovic A , E JY , et al. Environmental features contributing to falls in persons with vision impairment: the role of home lighting and home hazards. Am J Ophthalmol. 2021; 230: 207- 215.

[13] Gabriel GA , Harris LR , Gnanasegaram JJ , et al. Age-related changes to vestibular heave and pitch perception and associations with postural control. Sci Rep. 2022; 12 (1): 6426.

[14] Henry M , Baudry S . Age-related changes in leg proprioception: implications for postural control. J Neurophysiol. 2019; 122 (2): 525- 538.

[15] Wiesmeier IK , Dalin D , Wehrle A , et al. Balance training enhances vestibular function and reduces overactive proprioceptive feedback in elderly. Front Aging Neurosci. 2017; 9.

[16] Timsina LR , Willetts JL , Brennan MJ , et al. Circumstances of fall-related injuries by age and gender among community-dwelling adults in the United States. PLoS One. 2017; 12 (5): e0176561.

[17] Abreu HCdeA , Reiners AAO , Azevedo RCdeS , Silva AMCda , Abreu DRdeOM , Oliveira ADde . Incidence and predicting factors of falls of older inpatients. Rev Saude Publica. 2015; 49 (0).

[18] Zhao Y(L) , Bott M , He J , Kim H , Park SH , Dunton N . Multilevel factors associated with injurious falls in acute care hospitals. J Nurs Care Qual. 2018; 33 (1): 20- 28.

[19] Wilkinson A , Meikle N , Law P , et al. How older adults and their informal carers prevent falls: an integrative review of the literature. Int J Nurs Stud. 2018; 82: 13- 19.

[20] Oliver D , Healey F , Haines TP . Preventing falls and fall-related injuries in hospitals. Clin Geriatr Med. 2010; 26 (4): 645- 692.

[21] Ghosh M , O'Connell B , Afrifa-Yamoah E , Kitchen S , Coventry L . A retrospective cohort study of factors associated with severity of falls in hospital patients. Sci Rep. 2022; 12 (1): 12266.

[22] Yawson AE , Ackuaku-Dogbe EM , Seneadza NAH , et al. Self-reported cataracts in older adults in Ghana: sociodemographic and health related factors. BMC Publ Health. 2014; 14 (1): 949.

[23] Adanusa M , Pobee SK , Zaabaar E , et al. Prevalence and risk factors for Falls among older adults in a primary care facility in Ghana. Malawi Med J. 2022; 34 (4): 225- 230.

[24] Udofia EA , Aheto JM , Mensah G , Biritwum R , Yawson AE . Prevalence and risk factors associated with non-traffic related injury in the older population in Ghana: wave 2 of the WHO Study on Global AGEing and adult health (SAGE). Prev Med Rep. 2019; 15: 100934.

[25] Mock CN , Gloyd S , Adjei S , Acheampong F , Gish O . Economic consequences of injury and resulting family coping strategies in Ghana. Accid Anal Prev. 2003; 35 (1): 81- 90.

[26] Yardley L , Beyer N , Hauer K , Kempen G , Piot-Ziegler C , Todd C . Development and initial validation of the falls efficacy scale-international (FES-I). Age Ageing. 2005; 34 (6): 614- 619.

[27] Vaishya R , Vaish A . Falls in older adults are serious. Indian J Orthop. 2020; 54 (1): 69- 74.

[28] Brannan S , Dewar C , Sen J , Clarke D , Marshall T , Murray PI . A prospective study of the rate of falls before and after cataract surgery. Br J Ophthalmol. 2003; 87 (5): 560- 562.

[29] Keay L , Palagyi A . Preventing falls in older people with cataract - it is not just about surgery. Ophthalmic Physiol Opt. 2018; 38 (2): 117- 118.

[30] Keay L , Palagyi A , McCluskey P , et al. Falls in Older people with Cataract, a longitudinal evalUation of impact and riSk: the FOCUS study protocol: Table 1. Inj Prev. 2014; 20 (4): e7- e7.

[31] Amedo AO , Koomson NY , Pascal TM , et al. Quality of Life of Cataract Patients before and after Surgery-Evidence from Four Rural Communities in Ghana. 2016. www.mathewsopenaccess.com.

[32] Kalula SZ , Ferreira M , Swingler GH , Badri M . Risk factors for falls in older adults in a South African Urban Community. BMC Geriatr. 2016; 16 (1): 51.

[33] Palagyi A , Morlet N , McCluskey P , et al. Visual and refractive associations with falls after first-eye cataract surgery. J Cataract Refract Surg. 2017; 43 (10): 1313- 1321.

[34] To Q , Huynh VA , Do D , et al. Falls and physical activity among cataract patients in Vietnam. Ophthalmic Epidemiol. 2022; 29 (1): 70- 77.

[35] Foss AJE , Harwood RH , Osborn F , Gregson RM , Zaman A , Masud T . Falls and health status in elderly women following second eye cataract surgery: a randomised controlled trial. Age Ageing. 2006; 35 (1): 66- 71.

[36] Harwood RH , Foss AJE , Osborn F , Gregson RM , Zaman A , Masud T . Falls and health status in elderly women following first eye cataract surgery: a randomised controlled trial. Br J Ophthalmol. 2005; 89 (1): 53- 59.

[37] Allain TJ , Mwambelo M , Mdolo T , Mfune P . Falls and other geriatric syndromes in Blantyre, Malawi: a community survey of older adults. Malawi Med J. 2014; 26 (4): 105- 108.

[38] Fabrício SCC , Rodrigues RAP , Costa Junior MLda . Causas e conseqüências de quedas de idosos atendidos em hospital público. Rev Saude Publica. 2004; 38 (1): 93- 99.

[39] Mane A , Sanjana T , Patil P , Sriniwas T . Prevalence and correlates of fear of falling among elderly population in urban area of Karnataka, India. J Midlife Health. 2014; 5 (3): 150.

[40] Haagsma JA , Olij BF , Majdan M , et al. Falls in older aged adults in 22 European countries: incidence, mortality and burden of disease from 1990 to 2017. Inj Prev. 2020; 26 (suppll): i67- i74.

[41] Bergen G , Stevens MR , Burns ER . Falls and fall injuries among adults aged ≥65 Years — United States, 2014. MMWR Morb Mortal Wkly Rep. 2016; 65 (37): 993- 998.

[42] Australia and New Zealand Falls Prevention Society. Action on Falls Prevention. 2024. Accessed March 1, 2024. https://www.anzfallsprevention.org/info/

[43] Lewis SR , McGarrigle L , Pritchard MW , et al. Population-based interventions for preventing falls and fall-related injuries in older people. Cochrane Database Syst Rev. 2024; 2024 (1).

[44] Juarez GA , Tripken J , Perera S , Cameron K , Vincenzo JL , Brach JS . Adoption, implementation, and maintenance of evidence-based falls prevention programs. J Appl Gerontol. 2024. Published online. 25 September 2024.

[45] To KG , Meuleners LB , Fraser ML , et al. Prevalence and visual risk factors for falls in bilateral cataract patients in Ho Chi Minh City, Vietnam. Ophthalmic Epidemiol. 2014; 21 (2): 79- 85.

[46] Skalska A , Wizner B , Piotrowicz K , et al. The prevalence of falls and their relation to visual and hearing impairments among a nationwide cohort of older Poles. Exp Gerontol. 2013; 48 (2): 140- 146.

[47] Cuevas-Trisan R . Balance problems and fall risks in the elderly. Phys Med Rehabil Clin. 2017; 28 (4): 727- 737.

[48] Chung S , Hu C , Lin H , Kao L , Huang C . Increased fall risk in patients with neovascular age-related macular degeneration: a three-year follow-up study. Acta Ophthalmol. 2017; 95 (8).

[49] Montana CL , Bhorade AM . Glaucoma and quality of life. Curr Opin Ophthalmol. 2018; 29 (2): 135- 140.

[50] Ouyang S , Zheng C , Lin Z , et al. Risk factors of falls in elderly patients with visual impairment. Front Public Health. 2022; 10.

[51] Popescu ML , Boisjoly H , Schmaltz H , et al. Age-related eye disease and mobility limitations in older adults. Invest Ophthalmol Vis Sci. 2011; 52 (10): 7168.

[52] Teng L , Wang D , Zhou Z , Sun J , Zhu M , Wang R . Associations among frailty status, hypertension, and fall risk in community-dwelling older adults. Int J Nurs Sci. 2024; 11 (1): 11- 17.

[53] Swiatoniowska-Lonc N , Jaciow E , Polanski J , Jankowska-Polanska B . Falls among patients with hypertension - preliminary study. Eur J Prev Cardiol. 2021; 28 (suppl _1).

[54] Abu BAAZ , Abdul Kadir A , Idris NS , Mohd Nawi SN . Older adults with hypertension: prevalence of falls and their associated factors. Int J Environ Res Publ Health. 2021; 18 (16): 8257.

[55] Cheng LY , Leung SY , Leung MKW . The association of glycemic control and fall risk in diabetic elderly: a cross-sectional study in Hong Kong. BMC Primary Care. 2022; 23 (1): 192.

[56] Alasmari RS , Hassani HA , Almalky NA , Bokhari AF , Al Zahrani A , Hafez AA . Risk factors for fall among the elderly with diabetes mellitus type 2 in Jeddah, Saudi Arabia, 2022: a cross-sectional study. Annals Medicine Surg. 2023; 85 (3): 427- 432.

[57] Crews RT , Yalla SV , Fleischer AE , Wu SC . A growing troubling triad: diabetes, aging, and falls. J Aging Res. 2013; 2013: 1- 6.

[58] Mihailovic A , De Luna RM , West SK , Friedman DS , Gitlin LN , Ramulu PY . Gait and balance as predictors and/or mediators of falls in glaucoma. Invest Ophthalmol Vis Sci. 2020; 61 (3): 30.

[59] Tsang JY , Wright A , Carr MJ , et al. Risk of falls and fractures in individuals with cataract, age-related macular degeneration, or glaucoma. JAMA Ophthalmol. 2024; 142 (2): 96- 106.

[60] Xing L , Bao Y , Wang B , et al. Falls caused by balance disorders in the elderly with multiple systems involved: pathogenic mechanisms and treatment strategies. Front Neurol. 2023; 14

[61] Jia H , Lubetkin EI , DeMichele K , Stark DS , Zack MM , Thompson WW . Prevalence, risk factors, and burden of disease for falls and balance or walking problems among older adults in the U.S. Prev Med (Baltim). 2019; 126: 105737.

RIGHTS & PERMISSIONS

2024 The Author(s). Eye & ENT Research published by John Wiley & Sons Australia, Ltd on behalf of Higher Education Press.