The Role of Home Hazards in the Association Between Visual Function and Falls in Older Adults.

Abstract

Older adults with poor vision are more likely to fall. However, there has been little research to understand whether this association is concentrated among individuals with specific exposures, such as home environmental hazards. To assess the association between differences in visual function, home environmental hazards, and falls. This population-based cross-sectional study used data from the National Health and Aging Trends Study, which gathers nationally representative data on Medicare beneficiaries aged 65 years and older in the US. A total of 4648 community-dwelling older adults who completed visual function tests and the home environment instrument in 2022 were included. Data were analyzed from September 2024 to March 2025. Objective measured visual function was assessed using binocular presenting distance visual acuity (DVA; logMAR) and contrast sensitivity (CS: logCS). Home hazards included absence of grab bars in the bathroom, tripping hazards, and broken flooring, as well as an ordinal variable representing cumulative hazards (0, 1, ≥2). Falls were defined as any self-reported fall in the past month. Survey-weighted multivariable logistic regression assessed the associations of visual function, home hazards, and falls. The survey-weighted prevalence of home hazards among 4648 participants (53.6% female) was 47.0% (no grab bars), 9.5% (tripping hazards), 4.5% (broken flooring), and 7.3% (≥2 hazards). Mean (SD) DVA was 0.10 (0.18) logMAR and mean (SD) CS was 1.72 (0.23) logCS. Worse DVA and CS were associated with falling in homes with hazards, including no grab bars (DVA: OR, 1.14; 95% CI, 1.02-1.27; CS: OR, 0.91; 95% CI, 0.84-1.00), tripping hazards (DVA: OR, 1.29; 95% CI, 1.11-1.49; CS: OR, 0.87; 95% CI, 0.78-0.98), and broken flooring (DVA: OR, 1.47; 95% CI, 1.26-1.70; CS: OR, 0.79; 95% CI, 0.68-0.93). The presence of multiple hazards further strengthened this association (DVA: OR, 1.31; 95% CI, 1.12-1.53; CS: OR, 0.93; 95% CI, 0.86-1.00). The association between differences in visual function and falls among older adults in this study was shaped by the home environment. These findings underscore the potential importance of considering both intrinsic and extrinsic risk factors in fall prevention and highlight the potential for targeted strategies that include home safety interventions for individuals with poor visual function.