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How Vision Loss Contributes to Falls and Depression

By : Karen Blum / Senior Contributing Editor – Opthalmology Management

Falls and depression are common among older adults with vision loss, but both can be more complex than they appear, experts reported at the Focus on Eye Health meeting Prevent Blindness America hosted in Washington, DC.

About one in three adults age 65 or older fall annually, and the risk for those with vision impairments is much greater, said Bernard A. Steinman, PhD, of the University of Massachusetts, Boston. Falls are the leading cause of injury and injury-related deaths among older people and accounted for $30 billion in health-care costs in 2010, he said. Previously falls may make individuals fearful of participating in daily activities and reduce their physical activity, placing them at even greater risk of additional falls.

Vision loss is only one of several factors that contribute to falls, Dr. Steinman said. Other include behavioral risks like not paying attention; environmental risks such as inadequate lighting or clutter; and intrinsic factors associated with vision impairment, including diabetes, arthritis, cognitive impairment and drug side effects.

Ophthalmologists can help reduce patient falls by continually assessing their eyewear prescriptions, identifying other health risk factors for falls and making appropriate referrals to occupational therapists, orientation and mobility specialists and others whom can facilitate home safety. The website www.stopfalls.org has resources fro clinicians, patients and families.

Depression and vision loss

When it comes to depression in this population, clinicians often assume it’s due to vision loss, but that’s not always the case, said Alan R. Morse, JD, PhD, president and CEO of the Lighthouse Guild in New York. Vision loss generally does not impact depression, but it can affect the functional vision a person needs for daily activities. Individuals have their own thresholds for when vision loss affects functioning, he said, though depression occurs in about 11% of people with self-reported vision loss.

Clinicians can keep patients motivated by discussing treatment and rehabilitation options as early as possible, and encouraging them to stay physically and socially active, Dr. Morse said. “If depression isn’t improved after rehabilitation, referral for mental health treatment is essential,” he said.

Drugs used to treat depression, including selective serotonin re-uptake inhibitors and tricyclic antidepressants, have the potential to cause vision loss, he said, so clinicians need to monitor patients carefully.

If you’re unsure whether a patient has depression, refer the person to a mental health professional, but remember that rehabilitation often can be of significant help, Dr. Morse advised. “It’s far better that the patient gets a consult and finds out what they have will resolve with effective rehabilitation and they will feel better in a few months than not to make the referral and cause them unnecessary suffering or have something tragic happen,” he said.

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