Falling is a major cause of injury among older adults, contributing to fear, loss of independence and billions of dollars in healthcare costs, according to several studies. For glaucoma patients specifically, contrast sensitivity and visual field loss can decrease hazard perception. Falls are most likely to occur at home, but on the bright side, the home is a modifiable environment.

Researchers recently evaluated home hazards and lighting levels in association with fall rates among older adults with glaucoma and found that with better lighting, fewer falls occurred.

The study included 170 individuals diagnosed with glaucoma or suspected glaucoma. The participants provided three years of prospective fall data in monthly diaries and filled out information about specific fall locations in post-fall phone questionnaires. The researchers evaluated seven home areas for hazards and lighting during in-home assessments and analyzed the influences of such hazards on fall rates. Data were adjusted for age, gender, comorbidity and severity of visual field damage.

Among the participants, 59 had a total of 83 home falls, most occurring on indoor stairs (n=24, 29%) and in the bedroom (n=17, 20%). The fewest falls occurred in the bathroom.

The researchers found that “neither the number nor the percentage of hazardous items graded as hazardous was associated with the rate of falls.” They noted, however, that with each 10-fold increase in room lighting, there were 35% fewer falls in that specific home region; this rose to 48% in those with mild or no visual field loss. Poor lighting and fall rate didn’t differ significantly by degree of visual field damage in those with moderate or severe visual field damage from glaucoma.

“The recommended minimum lighting levels set by the Illuminating Engineering Society of North America is generally around 30 footcandles (323 lux),” the researchers wrote in their paper. “Home regions least likely to be at this level of lighting included the hallway, bedroom and stairs.”

“Our data suggest that better lighting in the home is associated with fewer falls, although our study wasn’t designed to determine the optimal amount of lighting needed to minimize falls,” they concluded. “Presumably, beyond some level, additional lighting would have limited benefits, or might even be harmful, though the typical lighting levels we observed were below those recommended as part of design standards and guidelines. Moreover, better lighting levels will likely be accompanied by higher energy expenditures. While lighting-efficient bulbs which produce similar lighting levels and/or last longer have been generated, such bulbs come at higher up-front costs which may not be affordable for all.”

Ramulu PY, Mihailovic A, Jian-Yu E, et al. Environmental features contributing to falls in persons with vision impairment: the role of home lighting and home hazards. Am J Ophthalmol. May 2, 2021. [Epub ahead of print].