Visual Scanning and Falls in Older Adults: The Mexico Health and Aging Study

Abstract

Background: For selected patients at increased fall risk, physical therapy may include instruction to look around and observe the environment to identify obstacles, known as visual scanning or tracking, and avoid them. Whether visual scanning reduces fall risk more broadly in the general population is unknown. Methods: Using data from the Mexico Health and Aging Study (MHAS), a longitudinal, nationally representative study of adults 50 years of age and older in Mexico (n = 13,850), we measured the association between visual scanning test performance and three fall-related outcomes: any fall in the previous 2 years, recurrent falls, and falls with injury. We conducted both cross-sectional and longitudinal analyses over 3 years of follow-up; logistic regression models were adjusted for demographic variables, self-reported comorbidities, daily activity limitations, and a standardized, composite measure of attention (Z-score of summed backwards counting and serial 7's tests) using inverse probability weighting. Inverse probability weights were multiplied by MHAS survey weight to account for complex survey design. Results: Visual scanning ability within the lowest quartile was associated with an increased risk of recurrent falls over 3 years of follow-up (adjusted OR 1.36, 95% CI: 1.02–1.80). Associations with incident falls and falls with injury attenuated after covariate adjustment. Conclusions: People with lower levels of visual scanning behavior were more likely to suffer recurrent falls over time. This highlights the importance of visual function and behavior in mitigating fall risk and suggests that efforts to improve visual scanning may help to prevent recurrent falls in older adults.