Dynamic trajectories in visual function and fall risk in older adults.

Purpose: Visual impairment is associated with falls in older adults, but whether changes in vision alter this risk is unclear. Methods: We performed a retrospective cohort study using data from the National Health and Aging Trends Study (NHATS), a nationally representative survey of Medicare beneficiaries aged ≥65 years. Distance acuity, near acuity, and contrast sensitivity were measured in 2022 and 2023. Change from 2022-2023 was calculated and categorized as stable (to ±0.1 logMAR), improving, or worsening. Using multivariable survey-weighted logistic regression, we compared the following fall-related outcomes in 2024: any fall in the last month, any fall in the last year, or multiple falls in the last year. Results: Among 6,327 eligible participants, distance acuity trends from 2022-2023 were stable in 50.3%, improved in 19.5%, and worsened in 30.2%. Similar patterns were observed for near acuity and contrast sensitivity. Worsening distance acuity was associated with higher odds of a fall in the past year (aOR 1.44, 95% CI 1.03-2.02), and worsening near acuity was associated with higher odds of a fall in the last month (aOR 1.44, 95% CI 1.3-2.02). Improvements in distance acuity, near acuity, and contrast sensitivity from 2022-23 were not associated with lower odds of falls in 2024. Conclusions: Worsening vision is associated with an increased risk of falls, but improving vision does not appear to reduce this risk. These findings suggest that while efforts to improve vision may not prevent falls, preventing a decline in visual function may help to reduce fall risk.