Poor vision has considerable resource implications for health services dealing with an ageing society. In particular, it is a major risk factor for falls, particularly affecting those over 65 years of age. For the individual affected, falls can be injurious and upsetting, and reduce the ability to live independently. Every year these falls cause over 250,000 emergency hospital admissions, with associated hip fractures alone costing the NHS over two billion pounds. Three leading causes of age-related vision loss include cataract, age related macular degeneration (AMD) and glaucoma. Though each condition has a different pattern of visual loss, all are associated with an increased falls risk. Small studies show that over a third of those with cataracts will experience falls, and that people with glaucoma or AMD fall over three times more often compared to people without eye disease. We need larger studies to help us understand whom and why people fall, so that better strategies can be developed for managing this population. Using the Clinical Practice Research Datalink (CPRD), we will investigate whether patients with these eye diseases are at higher risk of injury (e.g. fractures) from falls compared to people without these diseases. Not every person with poor vision will experience a fall, so we will explore what other factors might increase or decrease this risk including co-existing conditions and certain medications. We will also determine the costs to the NHS of treating these injuries, by calculating the cost of all the health care services used following a fall.
Visual impairment (VI) has considerable resource implications for health services dealing with an ageing society. In particular, it is a major risk factor for falls, particularly affecting those over 65 years of age. Individuals with VI are 70% more likely to have a fall, with multiple falls occurring almost twice as often. Falls cause over 250,000 emergency hospital admissions per year and associated hip fractures alone costing the NHS over two billion pounds annually. For patients, this can result in life-limiting fractures, pain and distress, and the loss of independence. Three leading causes of age-related vision loss include cataract, age related macular degeneration (AMD) and glaucoma. Small studies show that over a third of those with cataracts will experience falls, and that people with glaucoma or AMD are three times more likely to fall compared to people without eye disease. Larger studies are required to understand this population, so that better targeted strategies can be developed for managing this vulnerable population and preventing falls. Using a large database of electronic health records Clinical Practice Research Datalink (CPRD GOLD and Aurum) with linked hospitalisation and mortality records, cohort studies will be performed between 2007-2019. First, a descriptive analysis of annual incidence rates of falls and fractures in patients will be outlined. Then retrospective cohort studies will be performed, comparing patients with these eye diseases to those without (matched by age, sex and general practice), using a Cox proportional hazards model to determine the risk of complications including falls, fractures, hospitalisation and death. Other factors that may moderate this risk will be explored as an interaction within these models, including medical comorbidity, medications that increase fall risk and polypharmacy. The costs to the NHS of treating these patients will also be calculated through monetarising all health care services used following a fall.
Primary outcome will be fractures (frequency and anatomical location).
Secondary outcomes include falls; fracture or fall related-hospitalisations; cause-specific mortality; costs of healthcare utilisation resulting from a fall in people with cataract, age related macular degeneration, and glaucoma.
Darren Ashcroft - Chief Investigator - University of Manchester
Jung Yin Tsang - Corresponding Applicant - University of Manchester
Alison Wright - Collaborator - University of Manchester
Christine Dickinson - Collaborator - University of Manchester
Evangelos Kontopantelis - Collaborator - University of Manchester
Luke Munford - Collaborator - University of Manchester
Robert Harper - Collaborator - Manchester University NHS Foundation Trust (MFT)
Tjeerd van Staa - Collaborator - University of Manchester
Tom Blakeman - Collaborator - University of Manchester
HES Accident and Emergency;HES Admitted Patient Care;HES Outpatient;ONS Death Registration Data;Patient Level Index of Multiple Deprivation;Practice Level Index of Multiple Deprivation