Relationship between fear of falling and mobility varies with visual function among older adults

The present study examined the association between vision, fear of falling and fear-related activity restriction, and assessed the effect of vision on the relationship between fear of falling and mobility, using data from a nationally representative sample of community-dwelling adults aged ≥ 50 years.

Participants (n=5003) completed an interview and health assessment (including Timed Up-and-Go, vision and cognitive tests). Visual acuity and contrast sensitivity were assessed using an Early Treatment Diabetic Retinopathy Study logMAR chart and Functional Vision Analyzer, respectively. Participants self-reported their vision as excellent, very good, good, fair or poor. They were assigned to no fear of falling, fear without activity restriction and fear with activity restriction groups. Logistic regression models examined the relationship between vision, fear of falling and activity restriction. Linear regression models were used to examine the main and interaction effects of fear of falling, self-reported vision, visual acuity, and contrast sensitivity on mobility after adjusting for confounders.

Poorer self-reported vision was independently associated with fear of falling and fear-related activity restriction (P<0.05), but visual acuity and contrast sensitivity were not. Participants with the lowest visual acuity and contrast sensitivity levels, combined with fear-related activity restriction, had slower Timed Up-and-Go than those in the highest visual performance quartiles (P<0.05).

Participants' perceptions of visual function were related to fear of falling and activity restriction, but this was not explained by other visual factors measured here. However, poorer visual acuity and contrast sensitivity did moderate the relationship between fear-related activity restriction and mobility, highlighting the importance of a comprehensive vision assessment especially in individuals with fear of falling.