PURPOSE: To examine the cross-sectional and longitudinal associations between visual impairment (VI) and falls in United States older adults. DESIGN: Retrospective cross-sectional and cohort study. METHODS: This study utilized data from the National Health and Aging Trends Study 2021 and 2022. Participants were Medicare beneficiaries ≥71 years. Exposures were any VI - defined as distance or near VI (>
0.3 logMAR), or contrast sensitivity (CS) impairment (<
1.55 logCS) -and changes in distance visual acuity ([DVA], logMAR/y), near visual acuity ([NVA], logMAR/y), or CS (logCS/y). Outcomes were self-reported falls in the past 12 months. RESULTS: 2822 participants were included in the analysis. At baseline, adults with any VI had greater rates of falls (rate ratio = 1.16, 95% CI = 1.04-1.30) and multiple falls (rate ratio = 1.23, 95% CI = 1.01-1.49) than peers without VI. In longitudinal analysis, adults with any VI at baseline did not have a greater risk of falls or multiple falls in the following year compared to peers without VI
only worse CS (hazard ratio [HR] = 1.03, 95% CI = 1.01-1.06, per 0.1 logCS worse) and DVA (HR = 1.11, 95% CI = 1.04-1.18, per 0.1 logMAR worse) were associated with a greater risk of falls and multiple falls, respectively. However, in other models, change in NVA (HR = 1.04, 95% CI = 1.01-1.08, per 0.1 logMAR worse/y) was associated with greater fall risk over the follow-up period. Further, change in CS (HR = 1.11, 95% CI = 1.05-1.18, per 0.1 logCS worse/y) was associated with a greater risk of multiple falls, while changes in DVA and NVA were not. CONCLUSIONS: Older United States adults with VI are more likely to experience a fall, with various components of their vision influencing the fall risk.