"The ground was just gone": a qualitative study of experiences of Charles Bonnet Syndrome and its impact on falls

"The ground was just gone": a qualitative study of experiences of Charles Bonnet Syndrome and its impact on falls

Background

Charles Bonnet Syndrome (CBS) refers to visual hallucinations that can occur following any degree of vision loss.  Vision impairment is an established risk factor for falls but the contribution of CBS to fall risk and susceptibility to falls-related variables such as concern about falling, is unclear.  The present study explored experiences of CBS from different perspectives to understand its impact on falls.

Methods

Seventeen older adults living with CBS (mean age=76 years), and 12 community falls and sight loss professionals took part in a semi-structured interview.  Reflexive thematic analysis was used to inform generation of the themes.

Results

Themes represented the ‘CBS journey’ and highlighted the psychological, physical and cognitive challenges encountered from symptom onset through to everyday life coping with CBS.  While moving about, recognisable images could elicit a behavioural response, and contextually plausible images delayed insight.  Falls occurred when CBS distracted attention and interfered with ability to monitor surroundings; after a loss of balance when automatically reacting to a hallucination; and during whole scene hallucinations that caused disorientation and ‘obscured’ actual hazards.  CBS also contributed to concern about falling, even when symptoms were not considered intrusive, and could limit activity levels.  While walking, triggers for CBS included fluctuations in light level and situational stress.  Common self-management techniques were least effective for people with persistent symptoms. Instead, engaging in enjoyable multi-sensory activities or low to moderate intensity physical activity for health provided relief. 

Conclusion

Health and social care practitioners working with people living with non-correctable sight loss need to be aware that CBS can contribute to sight loss and falls aetiology.  More research is needed to investigate holistic strategies to increase resilience to CBS-related falls.