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Background: Older adults with visual impairments experience a higher risk of falling, and are more vulnerable to adverse health consequences associated with falls than those with normal vision. This study characterizes longitudinal changes in objectively measured physical activity and fear of falling (FoF) occurring after various types of falls in visually impaired older adults. Design: Prospective cohort study. Setting: Hospital‐based enrollment. Participants: People with glaucoma or suspected glaucoma. Measurements: Falls were defined as unintentionally coming to rest on the ground or a lower level, and injurious falls were determined though follow‐up calls. Study participants were categorized into three groups–fallers with injurious consequences, fallers without injurious consequences, and non‐fallers based on fall status in the first year. Physical activity was assessed by waist‐bound accelerometer. FoF was evaluated by questionnaire, with Rasch modeling generating FoF scores where higher scores reflected worse FoF. The 3‐year longitudinal changes of physical activity and FoF were modeled using mixed‐effects models. Results: In linear models fully adjusted for visual field damage and other covariates, physical activity among injurious fallers showed greater annual (per year) declines in daily steps (−425 steps/d, 95% confidence interval (CI) = −793, −57), daily active minutes (−13 min/d, 95% CI = −21, −6), and daily moderate and vigorous physical activity (MVPA) minutes (−3 MVPA minutes/d, 95% CI = −5, 0) over the 3‐year period as compared to non‐fallers; however, physical activity did not significantly decline among non‐injurious fallers. No longitudinal increases in FoF scores were observed in injurious or non‐injurious fallers when compared to non‐fallers. Conclusion: Among visually impaired older adults, injurious falls identified prospectively over 12 months contributed to a significant decline in physical activity over a 3‐year period, while minimal changes were observed in FoF. [ABSTRACT FROM AUTHOR]

OBJECTIVE Fear of falling (FoF) may alter mobility in older adults, especially among those with visual impairment. Using a longitudinal prospective cohort of older glaucoma patients, we investigated whether and how FoF is associated with future falls and physical activity. DESIGN Prospective observational cohort study. SETTING Hospital‐based single‐center recruitment. PARTICIPANTS Individuals with glaucoma or suspected glaucoma. MEASUREMENTS FoF was measured annually over a 3‐year period using the University of Illinois at Chicago FoF Questionnaire, with lower Rasch‐analyzed FoF scores (in logit units) indicating less fear. Participants recorded falls prospectively over the 3‐year period using monthly mail‐in calendars. Daily steps were collected annually over 7 days using an accelerometer. Visual field (VF) sensitivity was derived by combining sensitivities from monocular VF results. Participants completed questionnaires to determine other demographic/health characteristics. Multivariate random effects models evaluated within‐participant changes in fall rates and physical activity across study years. RESULTS: At lower FoF levels (FoF≤0), each one‐unit worsening in FoF score across study years was associated with 2.73 times higher odds of reporting at least one fall in the next year (95% confidence interval [CI] = 1.55‐4.81) but was not associated with average daily steps (P =.44). Similar results were seen when fall rates were normalized by number of steps taken (P =.97). At higher FoF levels (FoF > 0), inter‐year changes in FoF scores were not significantly associated with reporting a fall in the following year (P =.78) but were associated with 407 fewer average daily steps per one‐unit change in FoF (95% CI = −743 to −71). CONCLUSION: FoF is an important psychological factor associated with mobility in glaucoma patients, although specific aspects of mobility (fall rates vs activity levels) affected vary by the degree of FoF. Our findings suggest that customizing behavioral interventions for older adults based on their levels of FoF may be an important strategy for fall prevention and activity promotion. J Am Geriatr Soc 68:1847‐1851, 2020. [ABSTRACT FROM AUTHOR]

Objectives: To determine whether visual field (VF) damage or other factors confer a similar risk of falling when falls are ascertained as a rate over time (falls/year) as when ascertained over activity (falls/step). Design: Prospective, observational cohort study. Setting: Clinic‐based recruitment with real‐world monitoring of falls and physical activity. Particpants: Individuals with glaucoma or suspected glaucoma (N=230). Measurements: Participants recorded falls using daily calendars, with injuries identified in a follow‐up questionnaire. Annual 1‐week accelerometer trials were used to estimate steps. VF results from both eyes were merged to determine integrated VF sensitivity, with lower sensitivity indicating greater VF damage. Other potential risk factors for falls (age, sex, race, comorbid illness, polypharmacy) were determined using questionnaires. Results: The cumulative probability of falls was 45.2% at 12 months and 61.6% at 24 months; cumulative probability of injurious falls was 23.3% at 12 months and 40.0% at 24 months. Greater VF damage was associated with higher rates of falls/steps (incident rate ratio = 1.40/5 dB decrement in sensitivity; p =.004) but not with more falls/year (incident rate ratio = 1.25/5 dB decrement in sensitivity; p =.07). Several additional variables (older age, female sex, more comorbid disease) were also associated with a higher rate of falls/step (p <.02 for all) but not with falls/year (p > 0.10). Black participants had fewer falls/year than whites (p =.002) but did not differ in falls/step (p =.07). Similar results were obtained when injurious falls were analyzed. Conclusions: Risk factors associated with frequent falls when walking (falls/step) are not properly identified when analyzing falls as a rate over time (falls/year). Given the clinical importance of preventing falls while preserving physical activity, falls assessment integrated with activity measurement is recommended when determining whether a risk factor is associated with falls. J Am Geriatr Soc 67:87–92, 2019. [ABSTRACT FROM AUTHOR]

Understanding periods of the year associated with higher risk for falling and less physical activity may guide fall prevention and activity promotion for older adults. We examined the relationship between weather and seasons on falls and physical activity in a three-year cohort of older adults with glaucoma. Participants recorded falls information via monthly calendars and participated in four one-week accelerometer trials (baseline and per study year). Across 240 participants, there were 406 falls recorded over 7569 person-months, of which 163 were injurious (40%). In separate multivariable regression models incorporating generalized estimating equations, temperature, precipitation, and seasons were not significantly associated with the odds of falling, average daily steps, or average daily active minutes. However, every 10 °C increase in average daily temperature was associated with 24% higher odds of a fall being injurious, as opposed to non-injurious (p = 0.04). The odds of an injurious fall occurring outdoors, as opposed to indoors, were greater with higher average temperatures (OR per 10 °C = 1.46, p = 0.03) and with the summer season (OR = 2.69 vs. winter, p = 0.03). Falls and physical activity should be understood as year-round issues for older adults, although the likelihood of injury and the location of fall-related injuries may change with warmer season and temperatures. [ABSTRACT FROM AUTHOR]

To define and quantify patterns of objectively measured daily physical activity by level of visual field (VF) damage in glaucoma patients including: (1) activity fragmentation, a metric of health and physiologic decline, and (2) diurnal patterns of activity, a measure of rest and activity rhythms. Prospective cohort study. Older adults diagnosed with glaucoma or suspected glaucoma. Degree of VF damage was defined by the average VF sensitivity within the integrated VF (IVF). Each participant wore a hip accelerometer for 1 week to measure daily minute-by-minute activity for 7 consecutive days. Activity fragmentation was calculated as the reciprocal of the average activity bout duration in minutes, with higher fragmentation indicating more transient, rather than sustained, activity. Multivariate linear regression was used to test for cross-sectional associations between VF damage and activity fragmentation. Multivariate linear mixed-effects models were used to assess the associations between VF damage and accumulation of activity across 6 3-hour intervals from 5 am to 11 pm. Activity fragmentation and amount of activity (steps) over the course of the day. Each 5-dB decrement in IVF sensitivity was associated with 16.3 fewer active minutes/day (P < 0.05) and 2% higher activity fragmentation (P < 0.05), but not with the number of active bouts per day (P = 0.30). In time-of-day analyses, lower IVF sensitivity was associated with fewer steps over the 11 am to 2 pm , 2 pm to 5 pm , and 5 pm to 8 pm periods (106.6, 93.1, and 89.2 fewer steps, respectively; P < 0.05 for all), but not over other periods. The activity midpoint (the time at which half of the daily activity is completed) did not vary across level of VF damage. At worse levels of VF damage, glaucoma patients demonstrate shorter, more fragmented bouts of physical activity throughout the day and lower activity levels during typical waking hours, reflecting low physiologic functioning. Further work is needed to establish the temporality of this association and whether glaucoma patients with such activity patterns are at a greater risk of adverse health outcomes associated with activity fragmentation. [ABSTRACT FROM AUTHOR]