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Visual acuity assessment in elderly patients with falls

Poster Details

First Author: A.Yusuf UK

Co Author(s):    O. Kailani   M. Bizrah   D. McIntosh   E. Osullivan           

Abstract Details


The Nice Guidelines of “Falls assessment and prevention of falls in older people”, expresses that vision should be assessed and impaired vision should be corrected (Act 4.3) . However, The College of Optometrist showed that despite the NICE guidelines a national audit that was carried out proved that only 50% of sites employed a proforma to prompt a standardized visual acuity assessment. The objective was to assess whether visual assessment is carried out on elderly patients (>65 years old) presenting with falls or had a fall in the past at a busy London teaching hospital.


London teaching hospital


Medical notes were screened on all three geriatric wards at a single London teaching hospital (King’s College Hospital, Denmark Hill), for patients presenting with falls or collapse. These patient notes were reviewed to assess for any documentation of a visual acuity assessment during admission. A subsequent ophthalmic history and formal vision assessment was completed.


Of the 69 geriatric inpatients, 26 were admitted due to falls. Two patients(7.7%) out of 26 had documentation of a visual assessment and unrecorded for the remainder. was not conducted or recorded. Visual acuity using a Snellen chart revealed that 18(69.2%) of patients presenting with falls was 6/12 or worse, suggesting a visual impairment. Twenty-one(80.7%) patients had a significant ophthalmic history (significant ammetropia, unoperated cataract, significant visual field defect, macular degeneration).


Results illustrate that the NICE guidelines (ACT 4.3) are not being adhered to. Visual assessment is severely neglected in the assessment of elderly patients with falls. The recommendations revolve around a triad of changes including: a strategy to educate medical and geriatric clinicians with vision tutorials, a proposed new falls pro-forma to include Ophthalmic assessment on admission and propagation of Snellen charts on the wards. The effects of the implemented changes will be gauged in three months, to complete the audit cycle.

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