Falls in the elderly

According to the Federal Statistical Office, the percentage of people aged 65 and over in Germany increased by 50 percent between 1990 and 2018, from 11.9 million to 17.9 million. A further increase to at least 22.7 million is expected over the next 20 years.¹ Ten million elderly people fall every year in Germany. 500,000 of these falls require inpatient treatment in Germany every year.² Worldwide, 30 percent of adults over the age of 65 years fall each year.³

The causes of falls in elderly adults are multifactorial. This includes in addition to balance problems, muscle weakness in the legs, peripheral neuropathies, vestibular dysfunctions, orthostasis, cognitive impairments, loss of function, Parkinson's disease and cardiovascular diseases and also reduced vision.^4,5 In his 2014 publication David Elliott discusses the topic of “Blurred vision, spectacle correction and falls in older adults”.⁶ Among other recommendations, Elliott advises optometrists to take a conservative approach when prescribing spectacles for older people. Depending on the patient's visual acuity, this includes maximum power changes of around 0.75 diopters and only minimal axis changes for astigmatism corrections with oblique axes. When selecting the lens design, it may also be appropriate to keep the existing lens type as long as there are no technical or other reasons against it.

The influence of spectacle lens design on possible falls was also investigated in a recent study by Lord et al.⁷ The study included 268 regular wearers of multifocal spectacles (average age 80.3 years) which were examined for falls for at least 6 months over a period of 13 months. Within the first month of the study, participants underwent a comprehensive eye examination by their optometrist. If necessary, the participants received new glasses but no advice on how to use these. The lens design (bifocal, trifocal or multifocal glasses) was not changed. The cognitive and sensorimotor function, as well as the balance and activity of the participants were also checked. The result showed that multifocal lenses may increase the risk of falling more than bifocal lenses. Taking into account the established fall risk factors, the risk of multiple falls was more than twice as high for wearers of multifocal spectacles than for wearers of bifocals.

Another interesting study “The importance of assessing vision in falls management: A narrative review” was published by Metha and Baig in 2025.8 The publication was based on literature research for the period from 1887 to present. The results showed a strong correlation between falls and age-related decrease in visual functions including visual acuity, binocular single vision and visual field, but also contrast vision and stereopsis.

The studies described above once highlight again the responsibility of both eye care professions in the context of fall prevention in older patients. A comprehensive eye examination as well as the prescription of visual aids and the appropriate lens selection are equally important to reduce the risk of falling.