Aims

This study aims to improve the way vision is checked and sight loss treated in older adults (65 years or older), who attend hospital following a fall.

Background

Falling is common in older adults. As the number of older people grows, the number of falls is expected to increase as well. Falling can affect a person's life in several ways: it can lead to pain, injuries, difficulty doing normal daily activities, weaker muscles, feeling isolated, losing independence and confidence, living in fear of falling, depression, difficulty in recovering from illnesses, developing other health problems more easily and a higher risk of death. Falls are a major health problem for the public and the United Kingdom (UK) spends more than £2 billion per year on caring for older adults who fall.

Problems with eyesight are also more common in older age and can have a similar effect on a person's independence, happiness and almost doubles their chances of falling. Sight loss in older age that is linked to falling is often treatable.

UK guidelines have been made to help prevent falls. These guidelines recommend checking for and treating sight loss in all older adults who attend hospital following a fall. However, this is only being done in a small number of hospitals. The reasons for this need to be investigated, in order to encourage and make it easier for health professionals to follow these guidelines.

Research has also shown that older adults, may be less likely to get their eyes tested regularly and attend hospital eye appointments. There are many reasons for this and vision screening whilst the patient is already receiving care in hospital, may be a good opportunity to address these issues. The views of the public are important for developing screening services that they understand and meets their needs. This study will gather the views of older people and their carers on hospital vision screening after a fall and the importance of looking after their eyes.

This study aims to improve the way vision is checked in older adults who attend hospital following a fall. This will help to identify and treat sight loss that may contribute to repeated falling. The study will combine the views of older adults and health professionals, to ensure that changes made meet patients' needs and are sustainable.

Design and methods

This study will have three parts:

1. Focus groups asking health professionals about checking vision in patients who have fallen.
2. Focus groups asking patients who have fallen and their carers about looking after their eyes.
3. Development of a way of checking vision and treating sight loss in older adults who attend hospital following a fall.

Inclusion Criteria:

Part one- Focus group study (with healthcare professionals):

• Aged 18 years or above
• Health professionals at NUHT
• Must be involved in falls assessments/ management/ care of older falls patients as part of current/ previous role at NUHT.

Part two- Focus group study (with service users/ carers):

• Adults ≥65 years
• Had at least 1 fall requiring attendance at an emergency department
• Carers of adults ≥65 who have had at least 1 fall requiring attendance at an emergency department

Part three- Intervention development using Delphi study:

• Aged 18 years or above
• Knowledge and experience of falls assessments and management in hospitals for older people
• Experience of the assessment and management of impaired vision in older people

Exclusion Criteria:

• Those who are unable to give voluntary informed consent.
• Those who have not sought secondary care following a fall.

Part one- Focus group study (with healthcare professionals):

Members of the acute multidisciplinary team who care for falls patients at Nottingham University Hospitals NHS Trust (NUHT) will be recruited.

Part two- Focus group study (with service users/ carers):

Current patients of NUHT or others recruited from the public, aged 65 or over who have had a fall. Carers of people aged 65 or over who have had a fall.

Part three- Intervention development using Delphi study:

Professionals with relevant knowledge and experience of falls assessments and management in hospitals for older people or the assessment and management of impaired vision in older people.