Abstract
Introduction:
Approximately half of individuals aged 80 years and older experience at least one fall per year, costing the NHS an estimated £2 billion annually. Visual impairment is a recognised potentially modifiable risk factor for falls and their resulting consequences including injuries and hospitalisation. Despite this, visual assessment is often overlooked by clinicians when managing these patients, potentially due to the absence of standardised guidelines.
Method:
A first-cycle clinical audit was undertaken in an acute Geriatric Medicine ward between January 2025 and March 2025. Inclusion criteria comprised patients admitted following a fall (without delirium). A proforma was developed to collect data on four parameters: whether a visual history was obtained, whether visual acuity was assessed, whether visual factors were considered contributory to the fall, and whether visual impairment was present. Data were anonymised and analysed qualitatively using Microsoft Excel. Findings were used to inform recommendations for improving visual assessment in falls-related admissions.
Results:
Twenty patients met the inclusion criteria. Although 85% had previously documented visual impairment – of whom 25% were classified as partially sighted - only 10% underwent any form of visual assessment during admission. Furthermore, 80% had a known history of visual impairment, most commonly cataracts. Despite this, visual impairment was infrequently considered (5%) as a contributory cause in the fall and was not routinely addressed (100%) in the management plan.
Conclusion:
This audit revealed significant gaps in the assessment of vision among older patients presenting with falls. Given the high prevalence of visual impairment, particularly due to cataracts - in this population, and evidence linking cataract treatment to reduced fall recurrence and fracture risk, incorporating routine visual assessments and facilitating referrals to ophthalmology and optometry services should reduce falls recurrence and associated long-term healthcare costs.
Comments
Management Plan Suggestions
A very sound project- and something which I think lots of people forget about when clerking in falls patients - well done!
What would you suggest the management plan would be if we did identify visual impairment as an issue? Referral to OP opticians seems like it might be difficult to access or most patients.
Answer to question
Thank you for viewing this project and for asking a great question.
I think this depends on the type of visual impairment identified and the services available within each local region. I know in our region there are services to refer to like the Nottingham Cataract pathway. With regards to opticians, you are correct, there is no specific pathway for referral. I think advising the patient as part of the holistic management plan to visit their local optician can be more effective than we realise. Many of the patients in this sample had not seen an optician for years possibly because they were unaware of any visual impairment or did not feel it necessary. Having a healthcare professional explain the link between visual impairment and falls - an association the patient may not have previously recognised or considered - and encouraging them to visit their optician can be more persuasive than a letter received by their optician.
Hi, How do you think we…
Hi,
How do you think we could better incorporate visual assessment into day to day ward round plans/assessment?
Answer to the question
Hello, thank you for taking your time to read this project and asking this great question.
I think incorporating visual assessments can be done initially during clerking of the patients presenting with falls, although can also be done at any point during a ward round. We are already taking a thorough history of presenting complaint, past medical history etc. This should also incorporate questions regarding vision and past ocular history e.g. do they have blurred vision, when did they last visit their optician, are they known to have visual impairment. We also examine the patients thoroughly when clerking, this should also include visual fields assessments and visual acuity testing. Visual acuity testing can be done at any point during the admission prior to their discharge and takes no more than 1 minute to complete.
I also want to highlight the importance of documenting these findings and discussions. Many of the patients in this population are likely to have known visual impairments which can be found in their GP records, but can often be overlooked when documenting in their hospital notes. Some of which may have never sought treatment for these impairments. By clearly identifying and highlighting visual impairments in our ward round plans, we can prompt appropriate referrals and support patients in accessing the necessary management for their visual impairments.