The Impact of Vision Impairment on Self-Reported Falls Among Older US Adults: Cross-Sectional and Longitudinal Study

Abstract Background Falls are the leading cause of injury among older adults, with vision impairment recognized as a significant risk factor. However, many existing studies have been limited by small sample sizes, retrospective designs, or insufficient adjustment for confounding factors. To overcome these limitations, we used data from the University of Michigan’s Health and Retirement Study (HRS) to analyze the association between self-reported vision and fall risk among older adults in a large, nationally representative sample. Objective The objective of this study was to investigate the association between vision impairment and falls and assess whether subjective vision impairment predicts future falls in older adults. Methods This cross-sectional and longitudinal analysis used data from the HRS (1996‐2020) to assess the relationship between self-reported vision, glaucoma history, and falls among US adults aged 65 years and older. HRS uses a biennial, multistage area probability sample survey design, collecting data with community-dwelling individuals followed up every 2 years until death, tracking health, economic, and social outcomes. Multivariate logistic regression was used to analyze associations between self-reported vision and self-reported falls in the past 2 years. Results A total of 38,835 respondents contributed 117,834 observations. The weighted proportion of participants reporting falls was 37.9% (95% CI 37.7%‐40.1%). Significant risk factors for falls included overall eyesight impairment (adjusted odds ratio [aOR] 1.36, 95% CI 1.20‐1.56), distance vision impairment (aOR 1.37, 95% CI 1.32‐1.42), near vision impairment (aOR 1.33, 95% CI 1.27‐1.37), and glaucoma (aOR 1.15, 95% CI 1.07‐1.24). A similar association was observed for serious falls, where overall eyesight impairment (aOR 1.20, 95% CI 1.03‐1.44), distance vision impairment (aOR 1.14, 95% CI 1.07‐1.22), near vision impairment (aOR 1.12, 95% CI 1.05‐1.18), and glaucoma (aOR 1.15, 95% CI 1.05‐1.26) were significant. In longitudinal analyses, overall vision impairment (aOR 1.23, 95% CI 1.16‐1.29), distance vision impairment (aOR 1.27, 95% CI 1.20‐1.38), near vision impairment (aOR 1.23, 95% CI 1.19‐1.32), and glaucoma (aOR 1.25, 95% CI 1.13‐1.37) increased the risk of future falls. Reported overall vision was significantly associated with the number of falls in both the same ( P <.001) and subsequent ( P <.001) survey cycles. Conclusions Both distance and near vision impairment, as well as glaucoma, are associated with a higher risk of falls in older adults and present possible areas for intervention and prevention.