John E. Crews, DPA Chiu-Fang Chou, DrPH Judy A. Stevens, PhD Xinzhi Zhang, MD, PhD

1. The Association between Severity of Vision Impairment and Falls among People Aged 65 Years and Older Living in the Community: Findings from the BRFSS John E. Crews, DPA Chiu-Fang Chou, DrPH Judy A. Stevens, PhD Xinzhi Zhang, MD, PhD Jinan Saaddine, MD, MPH American Public Health Association San Francisco, California October 31, 2012

2. Presenter Disclosure John E. Crews, DPA The following personal financial relationships with commercial interests relevant to this presentation existed during the past 12 months: None.

3. Background Falls in US • One out of three adults age 65 and older falls each year. • Among older adults (those 65 or older), falls are the leading cause of injury death. • Falls are the most common cause of traumatic brain injuries (TBI). In 2000, TBI accounted for 46% of fatal falls among older adults. • Falls in association with vision impairment well established (Lord, 2001).

4. Objective • To assess the prevalence of self-reported falls in the past three months among community dwelling older adults (aged 65 years and older) by vision impairment status

5. Methods Data Set: BRFSS • Established 1984 • Sampled 350,000 people World’s largest random-digit dialed telephone survey • Core question in all fifty states

6. BRFSS: Vision Module • Administered in 23 states • 10 questions—function, access, condition • Provides state level data • Began 2005; Discontinued for 2012.

7. Methods (Cont.) • Data source and Sample Size: • 2006, 2008, & 2010 BRFSS from 19 states • N=48,585 adults aged 65 and older • Outcome Variable: Self reported fall in the past 3 months • Exposure Variable: Vision impairment status • no difficulty to both question, • little difficulty to either question, and • moderate or extreme difficulty or unable to do to either question.

8. Methods (Cont.) • Covariates: • Race/ethnicity (Non-Hispanic white, Non-Hispanic black, Hispanic, and other) • Educational attainment (<HS, HS, and >HS) • Income (< $ 35,000, ≥ $ 35,000) • Age and sex • Statistical methods: Cross-tabulation; multivariate logistic regression • SAS version 9.2 with SUDAAN and Stata version 10.1. to take account of the complex survey design

9. Methods (Cont.) Vision Questions • How much difficulty, if any, do you have reading print in newspaper, magazine, recipe, menu, or numbers on the telephone? • How much difficulty, if any, do you have in recognizing a friend across the street? • Response categories: No difficulty, little difficulty, moderate difficulty, extreme difficulty, unable to do because of eyesight

10. Methods (Cont.) Falls Question • Administered in core in even years • In the past 3 months, how many times have you fallen? • Response: Number of falls • Case definition: any self reported fall

11. Self reported no, little, & moderate/extreme difficulty seeing by age

12. Falls among all older people by age group

13. Percent of Falls by Age Group & Severity of VI

14. Prevalence of falls among people reporting no, little, moderate/extreme difficulty seeing by education & income

15. Self- reported fair poor health among people age 65+ who have fallen with No, Little, & Moderate/Severe Vision Impairment

16. Falls among people with no, little, and moderate/extreme difficulty seeing reporting comorbid conditions—diabetes, heart disease, stroke, and stress/depression

17. Falls among people with no, little, and moderate difficulty seeing with & w/o diabetes

18. Falls among people with no, little, and moderate difficulty seeing with & w/o heart disease

19. Falls among people with no, little, and moderate difficulty seeing with & w/o stroke

20. Falls among people with no, little, and moderate difficulty seeing with & w/o stress, depression & emotional problems

21. Conclusions • Increased falls associated with poorer vision and advanced age • Increased falls among people reporting moderate/ extreme difficulty seeing associated with having poorer health status and having lower socioeconomic status.

22. Conclusions • Increased falls associated with severity of vision loss and presence of comorbid conditions—diabetes, stroke, heart disease & stress/depression • Comorbid conditions in conjunction with severe vision loss have propelling effect to increase risk of falls.

23. Recommendations • Falls prevention activities should address vision impairment as part of comprehensive strategies. • Exercise/conditioning, removal of trip hazards, increased illumination may decrease likelihood of falls • Attention should be given to under medication or over medication as falls risk.

24. Recommendations • Attention to health promotion among people reporting vision impairment may decrease risk of falls • Better weight management • Better nutrition • Increased exercise and conditioning

25. Disclaimer • The findings and conclusions in this presentation are those of the authors and do not necessarily represent the official position of the Center for Disease Control and Prevention.

26. Contact Information For more information, please contact John E. Crews, DPA at Jcrews@cdc.gov 770 488 1116