A recent national University of Michigan study confirms that aging adults who have trouble with their vision are at a higher risk of mortality, and suggests a key factor is their high risk of falling.

The study, published in Innovation in Aging, uses longitudinal data from the National Health and Aging Trends Study (NHATS) to investigate the association between self-reported visual difficulty and mortality risk among older adults, as well as the role of falls in this relationship, over a 6-year period.

“Vision loss is one of the most prevalent physical impairments affecting older adults. Vision loss has increasingly been found to be related to mortality risk, but we need to better understand why this is the case” said lead author Shu Xu, a postdoctoral fellow affiliated with the Survey Research Center and the Population Studies Center at the Institute for Social Research. “Our findings show that older adults with visual difficulty are more likely to experience recurrent falls, and this, in turn, increases their risk of mortality.”

Decreased vision can make navigating hazards in the environment more difficult, increasing the risk of falls. Past research has shown that falls are the cause of approximately two-thirds of unintentional injuries and one of the leading causes of death among older adults. 

These new findings contradict what may be an under-supported theory that vision impairment is a major risk factor for falls among older adults with dementia but not for those without the condition. A recent Population Reference Bureau report included this claim based on findings from an NHATS study by Safiyyah Okoye et al. that looked at falls over a 12-month period, stratifying the vision-fall relationship by dementia status.

“We agree that cognitive decline may exacerbate the challenges of poor vision, but our data show that visual impairment is an important risk factor for recurrent falls for all older adults,” said Xu. “Our study design– six years of longitudinal data with mediation analysis– allows us to test not only whether there is an effect but also how it operates, and to provide stronger support for the link between vision loss and adverse health outcomes among older adults.”

Visual impairment impacts mental and physical health

Older Americans with visual impairment may also experience impaired daily activities, a reduction of independence, and more falls leading to injury, limited mobility, and fear of future falls, as compounding stressors, Xu said. These proliferating stressors can overwhelm an individual’s capacity to cope which has consequences for mental and physical health and can impact longevity.

Older adults with visual difficulty and their caretakers should be aware of the risks of recurrent falls. 

“A thorough assessment of their living environment and personal needs can be crucial for identifying hazards, gaps in support, and ways to improve safety in this population,” said Joshua Ehrlich of the University of Michigan Survey Research Center, an associate professor of ophthalmology and visual sciences, and a senior author on the study. “Preventive measures like exercises to improve strength and balance may be especially helpful for enhancing the safety of older Americans with visual difficulty.”

The study also suggests that healthcare policies aimed at improving access to eye care and fall prevention programs for older adults could potentially lower mortality risks associated with vision loss. Understanding fall risks is an urgent need for caregivers and policymakers helping America’s aging population.

This post was written by communications staff Tevah Platt of the Population Studies Center and Lee Ridley of the Survey Research Center, with contributions from Josh Ehrlich and Shu Xu.