Vision problems slow recovery from hip fracture

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Nearly one-quarter of elderly people undergoing rehabilitation following hip fracture have failing eyesight, and this impairment appears to impede their recovery, according to new research.

Based on these results, clinicians working with hip fracture patients should first test their vision and make sure they can see well, advise the researchers, led by Dr. Devora Lieberman of Soroka Medical Center in Israel.

"Practically speaking, we suggest that an optometrist test visual acuity in elderly patients toward the beginning of rehabilitation and that eyeglasses be prescribed to improve visual acuity to the optimal extent,” the team writes.

Doctors may even want to consider repairing cataracts before starting patients in rehab, they add.

Previous research has shown that poor eyesight and a restricted field of vision, as well as difficulty in seeing contrasts between objects, appears to be strongly associated with a history of two or more falls.

To investigate whether problems seeing or hearing can affect rehabilitation, Lieberman and colleagues followed 896 people 65 years of age or older who were hospitalized for rehabilitation following surgery to correct a hip fracture.

The researchers checked participants’ hearing and sight. During vision tests, patients wore their own eyeglasses and read a standard eye chart. Poor vision was defined as, in meters, equal to or less than 6/60 vision in the better of both eyes. [670 para 2]

Reporting in the Journal of Rehabilitation Research & Development, the researchers found that 23 percent of patients had failing eyesight, and nearly 26 percent had poor hearing.

Participants who had trouble either hearing or seeing tended to show poorer functioning before their hip fracture and when discharged from rehabilitation, to take longer to complete rehabilitation, and to fare worse from the rehab program.

However, once the researchers removed the influence of other factors—such as age and other impairments—only poor vision appeared to influence how well people recovered during rehabilitation.

It is often easier to get around hearing problems, which may explain why bad eyesight may affect rehabilitation more than impaired hearing, the authors note.

“While impaired hearing can be compensated for by speaking with a raised voice close to the elderly patient’s ear and the aid of other senses, including hand movements, compensation for impaired vision is much more limited,” they write.

SOURCE: Journal of Rehabilitation Research & Development, September/October 2004.

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