UBC Theses and Dissertations
The risk of falls in elderly, community-dwelling women with exudative age-related macular degeneration Szabo, Shelagh Maria
Purpose: To prospectively determine physiologic risk factors for falls, and falls incidence, among elderly, community-dwelling women with exudative age-related macular degeneration (AMD). Design: 1) Cross-sectional, and 2) prospective longitudinal cohort study. Methods: In our cross-sectional study, 11 5 community-dwelling women aged 70 or over with exudative AMD were assessed for fall risk by Physiological Profile Assessment (PPA). The PPA generates a personalized risk score by comparing participants’ scores on fall risk factor measures to a healthy Australian population. A second comparison group consisted of 34 normally-sighted women aged 70 or older without exudative AMD. In our cohort study, we followed 11 5 community-dwelling women aged 70 or over with exudative AMD and 93 normally-sighted women without AMD for 6 months and compared the falls incidence per group. Falls were measured by monthly telephone follow up. Multivariate negative binomial regression was used to model the association between falls incidence, and exudative AMD. Results: In our cross-sectional study, we measured mean overall fall risk scores of 3.26 in the AMD group and 0.96 in the non-AMD group (p<0.0001). The AMD group as a whole scored significantly lower on measures of vision, postural sway, and reaction time, compared to the Australian population, but not on proprioception or quadriceps strength. In contrast, the average for the non-AMD group was within one standard deviation of the mean of the Australian cohort on all PPA measures except reaction time (Z=-I .07). The fall rate was 82 falls per 100 person years for women with AMD, and 28 falls per 100 person years for women without AMD. Although AMD, comorbidities, and self-reported 12 month fall history were significant univariate predictors of falls, on multivariate modeling only AMD remained significant. The adjusted relative risk for having a fall over 6 months, for women with AMD compared to the non-AMD cohort, was 3.15 (95% confidence interval = 1.47 - 6.74). Conclusion: Elderly women with exudative AMD are at a significantly higher risk of falls than those without AMD, by falls risk profile as well as 6-month falls incidence.
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