Assessing Clinicians’ Documentation of Vision in Older Adults Who Presented With a Fall at the Accident and Emergency Department of Northampton General Hospital

Background Falls among elderly adults are one of the most common reasons that could lead to injury and modality, as vision is one of the modifiable risk factors for falls. By assessing it, we can detect those needing further follow-up with opticians or ophthalmologists, lowering the risk of falls secondary to poor vision. Methods Data were collected and reviewed retrospectively from a consecutive list of patients who presented with a fall or head injury to the Accident and Emergency Department at Northampton General Hospital. A total of 180 patients aged 75 years or older were randomly selected between November 2022 and January 2023. This audit measured the vision documentation in the vision assessment tool used in the Emergency Department at Northampton General Hospital and was based on the National Institute for Health and Clinical Excellence (NICE) and the Royal College of Physicians guidelines. Results Out of 180 patients in the sample, 34 (19%) had their visual assessments documented. Among them, around six (17.6%) out of 34 patients had a full vision assessment documenting all the sections in the vision assessment tool. Five (14.7%) out of 34 patients and 11 (32.3%) out of 34 patients did not have documentation about their distance and near vision, respectively. The visual fields were not documented in 22 (64.7%) out of 34 patients, and no assessment of the eye movements was reported in 16 (47%) out of 34 patients. Discussion Most of the patients in the Emergency Department lacked visual documentation, resulting in low compliance with the standards. One of the factors that contribute to elderly people's falling is low vision. Uncorrected refractive errors are one of the main causes of poor vision, but their correction is also associated with an increased risk of falls among elderly patients, as they require more time to adapt to changes in prescription (e.g., new glasses). In addition, patients who suffer from some eye conditions, such as glaucoma or macular degeneration, also have a high incidence of falls caused by an impairment of the visual fields. Conclusions All patients over 75 years old who presented with a fall to the Emergency Department should have a vision assessment. Vision documentation is essential to identify patients with vision impairment needing to receive an eye assessment after their discharge to reduce the risk of falls derived from poor vision. Strategies to improve this include training and the dissemination of information (for example, posters), which could help increase documentation rates.