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Response to Outdoor Falls among Older adults
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Satya B. Verma, Optometrist, Faculty Pennsylvania College of optometry
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satya{at}pco.edu Satya B. Verma
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Dear Editor; I read with great interest the article, "Outdoor Falls Among Middle-Aged and Older adults: A Neglected Public Health Problem" by Li, Keegan, et al. in the July issue of the Journal. I think it is a great article and truly a neglected public health problem. I agree with the authors' conclusions about the environmental hazards responsible for the outdoors falls. However, they did not include another important factor--that of "environmental vision" as the cause for the falls among older adults. In their survey, the authors did ask the participants if they wore glasses or hearing aids. Just wearing of glasses even with the best and most recent visual correction may not correct the environmental vision concerns. It is well documented that older adults are more prone to visually disabling conditions like cataracts, glaucoma, macular degeneration, and diabetic retinopathy, which in addition to quantitative vision loss also affect qualitative vision. Even in the absence of these conditions, perception for contrast sensitivity, depth perception, and color vision are significantly reduced as a result of age and have a great impact on both outdoor and indoor activities. Depth perception and contrast sensitivity in the same individual could be different during a sunny bright day and cloudy day, at dawn, bright day, dusk or at night time with poorly lighted sidewalks and steps. With poor contrast and a poorly lit area a step may not even be visible to some one who may otherwise be visual acuity healthy. If we don't include these and other "visual environmental factors" in our study protocols, we may be missing and ignoring an important culprit for falls among older adults. I applaude the authors for their valuable contribution to this neglected public health concern and hope that future studies will include this overly neglected public health issue of environmental vision. This can be enhanced by not only keeping the areas well lit, but also by painting side walks and ends of the steps with colors that are easily discernable by older eyes. Thank you for the opportuntiy to allow me to raise what I believe to be an important issue in the falls among older adults. Satya B. Verma, OD, FAAO Pennsylvania College of Optometry 8360 Old York Road Elkins Park, PA 19027 satya@pco.edu |
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