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Ophthalmic Conditions Associated with Inpatient Falls among Veterans

Campagna, Giovanni, BS1; Chamberlain, Paul, MD1,2; Orengo-Nania, Silvia, MD2,3; Biggerstaff, Kristin, MD, MS2,3; Khandelwal, Sumitra, MD2,3*

doi: 10.1097/OPX.0000000000001312
ORIGINAL INVESTIGATIONS

SIGNIFICANCE Efforts to describe the relationship between pathological visual impairment and fall risk are typically confined to community dwellers. Among admitted patients, however, the associations are less understood. Fall risk assessment tools are used in some clinical settings, but most do not capture the suspected importance of ophthalmic pathologies in predicting the likelihood of an inpatient fall.

PURPOSE The purpose of this study was to determine the association between ophthalmic conditions and inpatient falls at the Michael E. DeBakey Veterans Affairs Medical Center (MEDVAMC), where vision and ophthalmic conditions are not considered when assessing fall risk.

METHODS This is a population-based, retrospective case-control study of 805 patients admitted to the MEDVAMC in January 2014 who had also visited the MEDVAMC Eye Clinic within 1 year of admission. The patients' eye examinations, ophthalmic diagnoses, and other indicators of constitutive health were compared between 60 patients who experienced an inpatient fall (“cases”) and 749 patients who did not (“controls”). Significant differences between the cases and the controls were determined using logistic regression models.

RESULTS Baseline demographics were similar among the two groups. Ophthalmic conditions associated with an increased incidence of inpatient falls included age-related macular degeneration (odds ratio, 3.9; 95% confidence interval, 1.5 to 9.9; P = .008) and a presenting visual acuity of worse than 20/40 in the better-seeing eye (odds ratio, 2.0; 95% confidence interval, 1.0 to 4.1; P = .04). Those without falls demonstrated a better mean presenting visual acuity in the better-seeing eye compared with those who fell (logMAR, 0.12 ± 0.23 vs. 0.28 ± 0.49, P < .001).

CONCLUSIONS In this population, age-related macular degeneration and poor presenting visual acuity in the better-seeing eye are associated with increased incidence of inpatient falls. An assessment of visual function and ophthalmic diagnoses may be warranted upon admission to the hospital for increased prevention of inpatient falls.

1School of Medicine, Baylor College of Medicine, Houston, Texas

2Department of Ophthalmology, Cullen Eye Institute, Baylor College of Medicine, Houston, Texas

3Eye Care Line, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas *Sumitra.Khandelwal@bcm.edu

Submitted: April 2, 2018

Accepted: August 29, 2018

Funding/Support: None of the authors have reported funding/support.

Conflict of Interest Disclosure: None of the authors have reported a financial conflict of interest.

Study Registration Information: H-36085.

Author Contributions: Conceptualization: SO-N, KB, SK; Data Curation: GC, PC; Formal Analysis: GC, PC; Investigation: SO-N, KB, SK; Methodology: SO-N, KB, SK; Project Administration: SO-N, KB, SK; Supervision: SO-N, KB, SK; Writing – Original Draft: GC, PC; Writing – Review & Editing: GC, PC, SO-N, KB, SK.

© 2018 American Academy of Optometry