Hip fractures in the elderly should not be dismissed as bad luck – a sign of proactive visual consultation: an artificial intelligence-based systematic review
DOI:
https://doi.org/10.18203/issn.2455-4510.IntJResOrthop20262923Keywords:
Eye disorders and hip fractures, Elderly fall Visual impairment and injuriesAbstract
Elderly persons with neglected visual problems face a heightened risk of fall and added mortality. Vision is essential for maintaining postural balance and spatial awareness. In order to prevent these falls, we need to know about the causative impaired vision patterns seen in these age groups. we decided to perform a systemic review using artificial intelligence (AI) based multiple tools, about the relationship between various causes of impaired vision in elderly and the risk of elderly hip fractures due to fall. We have conducted a comprehensive AI based research across multiple academic databases to identify research publications exploring the links between visual impairments, falls, and hip fractures among older adults. Studies were analysed based on the measure of vision or commonly reported eye diseases in elderly: refractive errors, cataract, glaucoma and macular degeneration, which were used as potential risk factors. This systematic review pooled data from 26 studies to evaluate the need for proactive ophthalmic consultation in elderly patients admitted with hip fractures. Visual assessment in older adults is essential to minimize fall-related complications and associated morbidity. Elderly’s sustaining a fragility hip fracture have impaired vision, much of which is easily treatable and can be detected effectively with pro-active eye consultation.
References
Lord SR, Ward JA, Williams P, Anstey KJ. Physiological factors associated with falls in older community dwelling women. J Am Geriatrics Society. 1994;42(10):1110-7.
Luukinen H, Koski K, Hiltunen L, Kivel¨a SL. Incidence rate of falls in an aged population in northern Finland. J Clin Epidemiol. 1994;47(8):843-50.
Costs of Falls Among Older Adults. Centers for Disease Control and Prevention, Home and Recreational Safety, U.S. Department of Health and Human Services, Bethesda. 2016.
Agency for Healthcare Research and Quality. Preventing Falls in Hospitals: A Toolkit for Improving Quality of Care. Rockville, MD: AHRQ. 2013. AHRQ publication no 13-0015EF. Available at: http://www.ahrq.gov/professionals/systems/hospital/fallpxtoolkit/index.html. Accessed on 10 June 2026.
Meuleners LB, Fraser ML, Ng J, Morlet N. The impact of first and second-eye cataract surgery on injurious falls that require hospitalisation: a whole-population study. Age Ageing. 2014;43:341-6.
Palagyi A, Mc Cluskey P, White A, Kris R, Lynn M, Jonathon QN, et al. While we waited: incidence and predictors of falls in older adults with cataract. Invest Ophthalmol Vis Sci. 2016;57(14):6003-10.
DeBoer MR, Pluijm SMF, Lips P, Annette CM, Hennie JVD, Dorly JHD, et al. Different aspects of visual impairment as risk factors for falls and fractures in older men and women. J Bone Mineral Res. 2004;19(9):1539-47.
Ivers RQ, Cumming RG, Mitchell P, Attebo K. Visual impairment and falls in older adults: the blue mountains eye study. J Am Geriatrics Society. 1998;46(1):58-64.
Rossat A, Fantino B, Nitenberg C, Annweiler C, Poujol L, Herrmann FR, et al. Risk factors for falling in community-dwelling older adults: which of them are associated with the recurrence of falls? J Nutrit Health Aging. 2010;14(9):787-91.
Van Nieuwenhuizen RC, Van Dijk N, Van Bredaetal FG. Assessing the prevalence of modifiable risk factors in older patients visiting an ED due to a fall using the CAREFALL Triage Instrument. Am J Emergency Med. 2010;28(9):994-1001.
Cummings SR, Nevitt MC, Kidd S. Forgetting falls. The limited accuracy of recall of falls in the elderly. J Am Geriat Society. 19988;36(7):613-6.
Tsang JY. Risk of Falls and Fractures in Individuals with Cataract, Age-Related Macular Degeneration, or Glaucoma. JAMA Ophthalmol. 2024;142(2):96-106.
Baig A, Foss A, Sahota O, Sehat K, Ash I. Vision Screening in Older Adults Admitted with a Fragility Hip Fracture: A Healthcare Quality Improvement Report. Brit Irish Orthoptic J. 2023;19(1):96-107.
Gabriele GA. Cataract and Risk of Fracture: A Systematic Review, Meta-Analysis, and Bayesian Network Meta-Analysis. Ophthalmology. 2025;132:921-34.
Cox A, Blaikie A, MacEwen CJ, Jones D, Thompson K, Holding D, et al. Visual impairment in elderly patients with hip fracture causes and associations. Eye. 2005;19:652-6.
Kulmala J, Pertti E, Olavi P, Ritva S, Sarianna S, Taina R, et al. Lowered vision as a risk factor for injurious accidents in older people. Aging Clin Exp Res. 2008;20(1):25-30.
Desapriya E, Subzwari S, Scime-Beltrano G. Vision improvement and reduction in falls after expedited cataract surgery Systematic review and metaanalysis. J Cataract Refract Surg. 2010;36:13-9.
Gutierrez-Robledo LM, Villasis-Keever MA, Avila-Avila A, Medina-Campos RH, Castrejón-Pérez RC, García-Peña C. Effect of cataract surgery on frequency of falls among older persons: a systematic review and meta-analysis. J Ophthalmol. 2021;2021:2169571.
Yeo BSY, Ong RYX, Ganasekar P. Cataract surgery and cognitive benefits in the older person: a systematic review and meta-analysis. Ophthalmology. 2024;131:975-84.
Boyd M, Kvizhinadze G, Kho A, Wilson G, Wilson N. Cataract surgery for falls prevention and improving vision: modelling the health gain, health system costs and cost-effectiveness in a high-income country. Inj Prev. 2020;26(4):302-9.
Wood JM, Lacherez P, Black AA, Cole MH, Boon MY, Kerr GK. Risk of falls, injurious falls, and other injuries resulting from visual impairment among older adults with age-related macular degeneration. Invest Ophthalmol Vis Sci. 2011;52(8):5088-92.
Bhorade AM, Perlmutter MS, Sabapathypillai SL, Goel M, Wilson B, Gordon MO. Rate of falls, fear of falling, and avoidance of activities at-risk for falls in older adults with glaucoma. Am J Ophthalmol. 2021;227:275-83.
Baig S, Diniz-Filho A, Wu A. Association of fast visual field loss with risk of falling in patients with glaucoma. JAMA Ophthalmol. 2016;134(8):880-6.
Bradley SM. Falls in older adults. Mount Sinai J Med. 2011;78(4):590-5.
Pidani AS, Sabzwari S, Ahmad K, Mohammed A, Noordin S. Effectiveness of home-based rehabilitation program in minimizing disability and secondary falls after a hip fracture: Protocol for a randomized controlled trial. Int J Surg Protoc. 2020;22:24-8.
Squirrell DM, Kenny J, Mawer N, Gupta M, West J, Currie ZI, et al. Screening for visual impairment in elderly patients with hip fracture: validating a simple bedside test. Eye (Lond). 2005;19(1):55-9.
Mehta J, Knowles K, Wilson E. Prevalence of falls in patients presenting to an ophthalmic outpatients department- a surveillance study. Br Ir Orthopt J. 2021;17(1):134-41.
Downloads
Published
How to Cite
Issue
Section
